Implementation of Interventions for the Control of Typhoid Fever in Low- and Middle-Income Countries

Abstract

Abstract.Past research has focused on typhoid fever surveillance with little attention to implementation methods or effectiveness of control interventions. This study purposefully sampled key informants working in public health in Chile, India, Pakistan, Bangladesh, Thailand, Vietnam, South Africa, and Nigeria to 1) scope typhoid-relevant interventions implemented between 1990 and 2015 and 2) explore contextual factors perceived to be associated with their implementation, based on the Consolidated Framework for Implementation Research (CFIR). We used a mixed methods design and collected quantitative data (CFIR questionnaire) and qualitative data (interviews with 34 public health experts). Interview data were analyzed using a deductive qualitative content analysis and summary descriptive statistics are provided for the CFIR data. Despite relatively few typhoid-specific interventions reportedly implemented in these countries, interventions for diarrheal disease control and regulations for food safety and food handlers were common. Most countries implemented agricultural and sewage treatment practices, yet few addressed the control of antibiotic medication. Several contextual factors were perceived to have influenced the implementation of typhoid interventions, either as enablers (e.g., economic development) or barriers (e.g., limited resources and habitual behaviors). Consolidated Framework for Implementation Research factors rated as important in the implementation of typhoid interventions were remarkably consistent across countries. The findings provide a snapshot of typhoid-relevant interventions implemented over 25 years and highlight factors associated with implementation success from the perspective of a sample of key informants. These findings can inform systematic investigations of the implementation of typhoid control interventions and contribute to a better understanding of the direct effects of implementation efforts.

Pattern of Anti-microbial Drug Resistance in Childhood Typhoid Fever in a Selected Hospital in Karachi, Pakistan

“…In 2018, three cases of XDR typhoid fever were reported in travelers. Antimicrobial resistance emerging in areas endemic for typhoid, leading to treatment failure [13].…”

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

“…Common qualitative methods utilized across the studies included focus group discussions and key informant interviews. Mixed methods studies used review of financial records [15], routine facility, or surveillance indicators [13,17,22,28,43], health worker questionnaires or other quantitative study process indicators [10,20,23,28,29], or validated surveys to calculate measures such as organizational readiness and provider burnout [24] in conjunction with qualitative research. CFIR constructs can be scored quantitatively and compared across cases according to strength and valence [44].…”

“…Quantitative scoring of constructs was employed in three studies [19,24,40]. Another study created a quantitative questionnaire to align with CFIR constructs, in which participants were asked to rate CFIR constructs on a 5-point Likert scale from "very unimportant" to "very important" for implementation success [10].…”

“…The unit of analysis for most of the articles was health providers in facilities or communities involved in implementation (n = 19), followed by organizations (e.g., health facilities, district health offices) involved in implementation (n = 12), patients benefiting from the intervention (n = 7), and policymakers and health system leaders at national or subnational levels (n = 5). Nine of the studies focused upon more than one unit of analysis [10,13,14,16,30,35,39,40,42].…”

“…Damschroder et al suggest that when the CFIR is applied post-implementation, it should be used to link determinants of implementation to targeted outcomes (e.g., intervention acceptability or effectiveness) [2]. However, only 6 (18%) studies reporting linking outcomes to specific CFIR constructs, all of which took place mid-or post-implementation [10,17,19,21,24,40]. These papers identified relationships between specific CFIR constructs and measures of high and low fidelity to the intervention [19], measures of high and low uptake of the intervention [21,24,40], successful implementation generally [10], as well as variations in implementation success, including successes in intervention management, supervision, and facilitation [17].…”