Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-16 (of 16 Records) |
Query Trace: Campbell CH[original query] |
---|
Lessons learned in conducting mass drug administration for schistosomiasis control and measuring coverage in an operational research setting
Binder S , Campbell CH , Castleman JD , Kittur N , Kinung'hi S , Olsen A , Magnussen P , Karanja DMS , Mwinzi PNM , Montgomery SP , Secor WE , Phillips AE , Dhanani N , Gazzinelli-Guimaraes PH , Clements M , N'Goran EK , Meite A , Utzinger J , Hamidou AA , Garba A , Fleming FM , Whalen CC , King CH , Colley DG . Am J Trop Med Hyg 2020 103 105-113 The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was created to conduct research that could inform programmatic decision-making related to schistosomiasis. SCORE included several large cluster randomized field studies involving mass drug administration (MDA) with praziquantel. The largest of these were studies of gaining or sustaining control of schistosomiasis, which were conducted in five African countries. To enhance relevance for routine practice, the MDA in these studies was coordinated by or closely aligned with national neglected tropical disease control programs. The study protocol set minimum targets of at least 90% for coverage among children enrolled in schools and 75% for all school-age children. Over the 4 years of intervention, an estimated 3.5 million treatments were administered to study communities. By year 4, the median village coverage was at or above targets in all studies except that in Mozambique. However, there was often a wide variation behind these summary statistics, and all studies had several villages with very low or high coverage. In studies where coverage was estimated by comparing the number of people treated with the number eligible for treatment, denominator estimation was often problematic. The SCORE experiences in conducting these studies provide lessons for future efforts that attempt to implement strong research designs in real-world contexts. They also have potential applicability to country MDA campaigns against schistosomiasis and other neglected tropical diseases, most of which are conducted with less logistical and financial support than was available for the SCORE study efforts. |
Evaluation, validation, and recognition of the point-of-care circulating cathodic antigen, urine-based assay for mapping Schistosoma mansoni infections
Colley DG , King CH , Kittur N , Ramzy RMR , Secor WE , Fredericks-James M , Ortu G , Clements MN , Ruberanziza E , Umulisa I , Wittmann U , Campbell CH . Am J Trop Med Hyg 2020 103 42-49 Efforts to control Schistosoma mansoni infection depend on the ability of programs to effectively detect and quantify infection levels and adjust programmatic approaches based on these levels and program goals. One of the three major objectives of the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has been to develop and/or evaluate tools that would assist Neglected Tropical Disease program managers in accomplishing this fundamental task. The advent of a widely available point-of-care (POC) assay to detect schistosome circulating cathodic antigen (CCA) in urine with a rapid diagnostic test (the POC-CCA) in 2008 led SCORE and others to conduct multiple evaluations of this assay, comparing it with the Kato-Katz (KK) stool microscopy assay-the standard used for more than 45 years. This article describes multiple SCORE-funded studies comparing the POC-CCA and KK assays, the pros and cons of these assays, the use of the POC-CCA assay for mapping of S. mansoni infections in areas across the spectrum of prevalence levels, and the validation and recognition that the POC-CCA, although not infallible, is a highly useful tool to detect low-intensity infections in low-to-moderate prevalence areas. Such an assay is critical, as control programs succeed in driving down prevalence and intensity and seek to either maintain control or move to elimination of transmission of S. mansoni. |
Circulating anodic antigen (CAA): A highly sensitive diagnostic biomarker to detect active Schistosoma infections-improvement and use during SCORE
Corstjens Plam , de Dood CJ , Knopp S , Clements MN , Ortu G , Umulisa I , Ruberanziza E , Wittmann U , Kariuki T , LoVerde P , Secor WE , Atkins L , Kinung'hi S , Binder S , Campbell CH , Colley DG , van Dam GJ . Am J Trop Med Hyg 2020 103 50-57 The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was funded in 2008 to conduct research that would support country schistosomiasis control programs. As schistosomiasis prevalence decreases in many places and elimination is increasingly within reach, a sensitive and specific test to detect infection with Schistosoma mansoni and Schistosoma haematobium has become a pressing need. After obtaining broad input, SCORE supported Leiden University Medical Center (LUMC) to modify the serum-based antigen assay for use with urine, simplify the assay, and improve its sensitivity. The urine assay eventually contributed to several of the larger SCORE studies. For example, in Zanzibar, we demonstrated that urine filtration, the standard parasite egg detection diagnostic test for S. haematobium, greatly underestimated prevalence in low-prevalence settings. In Burundi and Rwanda, the circulating anodic antigen (CAA) assay provided critical information about the limitations of the stool-based Kato-Katz parasite egg-detection assay for S. mansoni in low-prevalence settings. Other SCORE-supported CAA work demonstrated that frozen, banked urine specimens yielded similar results to fresh ones; pooling of specimens may be a useful, cost-effective approach for surveillance in some settings; and the assay can be performed in local laboratories equipped with adequate centrifuge capacity. These improvements in the assay continue to be of use to researchers around the world. However, additional work will be needed if widespread dissemination of the CAA assay is to occur, for example, by building capacity in places besides LUMC and commercialization of the assay. Here, we review the evolution of the CAA assay format during the SCORE period with emphasis on urine-based applications. |
SCORE studies on the impact of drug treatment on morbidity due to Schistosoma mansoni and Schistosoma haematobium infection
King CH , Binder S , Shen Y , Whalen CC , Campbell CH , Wiegand RE , Olsen A , Secor WE , Montgomery SP , Musuva R , Mwinzi PNM , Magnussen P , Kinung'hi S , Andrade GN , Ezeamama AE , Colley DG . Am J Trop Med Hyg 2020 103 30-35 The Schistosomiasis Consortium for Operational Research (SCORE) was funded in 2008 to improve the evidence base for control and elimination of schistosomiasis-better understanding of the systemic morbidities experienced by children in schistosomiasis-endemic areas and the response of these morbidities to treatment, being essential for updating WHO guidelines for mass drug administration (MDA) in endemic areas. This article summarizes the SCORE studies that aimed to gauge the impact of MDA-based treatment on schistosomiasis-related morbidities. Morbidity cohort studies were embedded in the SCORE's larger field studies of gaining control of schistosomiasis in Kenya and Tanzania. Following MDA, cohort children had less undernutrition, less portal vein dilation, and increased quality of life in Year 5 compared with baseline. We also conducted a pilot study of the Behavioral Assessment System for Children (BASC-2) in conjunction with the Kenya gaining control study, which demonstrated beneficial effects of treatment on classroom behavior. In addition, the SCORE's Rapid Answers Project performed systematic reviews of previously available data, providing two meta-analyses related to morbidity. The first documented children's infection-related deficits in school attendance and achievement and in formal tests of learning and memory. The second showed that greater reductions in egg output following drug treatment correlates significantly with reduced odds of most morbidities. Overall, these SCORE morbidity studies provided convincing evidence to support the use of MDA to improve the health of school-aged children in endemic areas. However, study findings also support the need to use enhanced metrics to fully assess and better control schistosomiasis-associated morbidity. |
Challenges in protocol development and interpretation of the Schistosomiasis Consortium for Operational Research and Evaluation Intervention Studies
King CH , Kittur N , Wiegand RE , Shen Y , Ge Y , Whalen CC , Campbell CH , Hattendorf J , Binder S . Am J Trop Med Hyg 2020 103 36-41 In 2010, the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) began the design of randomized controlled trials to compare different strategies for praziquantel mass drug administration, whether for gaining or sustaining control of schistosomiasis or for approaching local elimination of Schistosoma transmission. The goal of this operational research was to expand the evidence base for policy-making for regional and national control of schistosomiasis in sub-Saharan Africa. Over the 10-year period of its research programs, as SCORE operational research projects were implemented, their scope and scale posed important challenges in terms of research performance and the final interpretation of their results. The SCORE projects yielded valuable data on program-level effectiveness and strengths and weaknesses in performance, but in most of the trials, a greater-than-expected variation in community-level responses to assigned schedules of mass drug administration meant that identification of a dominant control strategy was not possible. This article critically reviews the impact of SCORE's cluster randomized study design on performance and interpretation of large-scale operational research such as ours. |
Impact of different mass drug administration strategies for gaining and sustaining control of Schistosoma mansoni and Schistosoma haematobium infection in Africa
King CH , Kittur N , Binder S , Campbell CH , N'Goran EK , Meite A , Utzinger J , Olsen A , Magnussen P , Kinung'hi S , Fenwick A , Phillips AE , Gazzinelli-Guimaraes PH , Dhanani N , Ferro J , Karanja DMS , Mwinzi PNM , Montgomery SP , Wiegand RE , Secor WE , Hamidou AA , Garba A , Colley DG . Am J Trop Med Hyg 2020 103 14-23 This report summarizes the design and outcomes of randomized controlled operational research trials performed by the Bill & Melinda Gates Foundation-funded Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) from 2009 to 2019. Their goal was to define the effectiveness and test the limitations of current WHO-recommended schistosomiasis control protocols by performing large-scale pragmatic trials to compare the impact of different schedules and coverage regimens of praziquantel mass drug administration (MDA). Although there were limitations to study designs and performance, analysis of their primary outcomes confirmed that all tested regimens of praziquantel MDA significantly reduced local Schistosoma infection prevalence and intensity among school-age children. Secondary analysis suggested that outcomes in locations receiving four annual rounds of MDA were better than those in communities that had treatment holiday years, in which no praziquantel MDA was given. Statistical significance of differences was obscured by a wider-than-expected variation in community-level responses to MDA, defining a persistent hot spot obstacle to MDA success. No MDA schedule led to elimination of infection, even in those communities that started at low prevalence of infection, and it is likely that programs aiming for elimination of transmission will need to add supplemental interventions (e.g., snail control, improvement in water, sanitation and hygiene, and behavior change interventions) to achieve that next stage of control. Recommendations for future implementation research, including exploration of the value of earlier program impact assessment combined with intensification of intervention in hot spot locations, are discussed. |
Discovering, defining, and summarizing persistent hotspots in SCORE studies
Kittur N , Campbell CH , Binder S , Shen Y , Wiegand R , Mwanga JR , Kinung'hi SM , Musuva RM , Odiere MR , Matendechero SH , Knopp S , Colley DG . Am J Trop Med Hyg 2020 103 24-29 The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) conducted large field studies on schistosomiasis control and elimination in Africa. All of these studies, carried out in low-, moderate-, and high-prevalence areas, resulted in a reduction in prevalence and intensity of Schistosoma infection after repeated mass drug administration (MDA). However, in all studies, there were locations that experienced minimal or no decline or even increased in prevalence and/or intensity. These areas are termed persistent hotspots (PHS). In SCORE studies in medium- to high-prevalence areas, at least 30% of study villages were PHS. There was no consistent relationship between PHS and the type or frequency of intervention, adequacy of reported MDA coverage, and prevalence or intensity of infection at baseline. In a series of small studies, factors that differed between PHS and villages that responded to repeated MDA as expected included sources of water for personal use, sanitation, and hygiene. SCORE studies comparing PHS with villages that responded to MDA suggest the potential for PHS to be identified after a few years of MDA. However, additional studies in different social-ecological settings are needed to develop generalizable approaches that program managers can use to identify and address PHS. This is essential if goals for schistosomiasis control and elimination are to be achieved. |
Survey of schistosomiasis in Saint Lucia: Evidence for interruption of transmission
Gaspard J , Usey MM , Fredericks-James M , Sanchez MJ , Atkins L , Campbell CH , Corstjens Plam , van Dam GJ , Colley DG , Secor WE . Am J Trop Med Hyg 2020 102 (4) 827-831 Saint Lucia at one time had levels of schistosomiasis prevalence and morbidity as high as many countries in Africa. However, as a result of control efforts and economic development, including more widespread access to sanitation and safe water, schistosomiasis on the island has practically disappeared. To evaluate the current status of schistosomiasis in Saint Lucia, we conducted a nationally representative school-based survey of 8-11-year-old children for prevalence of Schistosoma mansoni infections using circulating antigen and specific antibody detection methods. We also conducted a questionnaire about available water sources, sanitation, and contact with fresh water. The total population of 8-11-year-old children on Saint Lucia was 8,985; of these, 1,487 (16.5%) provided urine for antigen testing, 1,455 (16.2%) provided fingerstick blood for antibody testing, and 1,536 (17.1%) answered the questionnaire. Although a few children were initially low positives by antigen or antibody detection methods, none could be confirmed positive by follow-up testing. Most children reported access to clean water and sanitary facilities in or near their homes and 48% of the children reported contact with fresh water. Together, these data suggest that schistosomiasis transmission has been interrupted on Saint Lucia. Additional surveys of adults, snails, and a repeat survey among school-age children will be necessary to verify these findings. However, in the same way that research on Saint Lucia generated the data leading to use of mass drug administration for schistosomiasis control, the island may also provide the information needed for guidelines to verify interruption of schistosomiasis transmission (247 words). |
Five-year impact of different multi-year mass drug administration strategies on childhood schistosoma mansoni-associated morbidity: A combined analysis from the Schistosomiasis Consortium for Operational Research and Evaluation Cohort Studies in the Lake Victoria Regions of Kenya and Tanzania
Shen Y , Wiegand RE , Olsen A , King CH , Kittur N , Binder S , Zhang F , Whalen CC , Secor WE , Montgomery SP , Mwinzi PNM , Magnussen P , Kinung'hi S , Campbell CH , Colley DG . Am J Trop Med Hyg 2019 101 (6) 1336-1344 The WHO recommends mass treatment with praziquantel as the primary approach for Schistosoma mansoni-related morbidity control in endemic populations. The Schistosomiasis Consortium for Operational Research and Evaluation implemented multi-country, cluster-randomized trials to compare effectiveness of community-wide and school-based treatment (SBT) regimens on prevalence and intensity of schistosomiasis. To assess the impact of two different treatment schedules on S. mansoni-associated morbidity in children, cohort studies were nested within the randomized trials conducted in villages in Kenya and Tanzania having baseline prevalence >/= 25%. Children aged 7-8 years were enrolled at baseline and followed to ages 11-12 years. Infection intensity and odds of infection were reduced both in villages receiving four years of annual community-wide treatment (CWT) and those who received biennial SBT over 4 years. These regimens were also associated with reduced odds of undernutrition and reduced odds of portal vein dilation at follow-up. However, neither hemoglobin levels nor the prevalence of the rare abnormal pattern C liver scores on ultrasound improved. For the combined cohorts, growth stunting worsened in the areas receiving biennial SBT, and maximal oxygen uptake as estimated by fitness testing scores declined under both regimens. After adjusting for imbalance in starting prevalence between study arms, children in villages receiving annual CWT had significantly greater decreases in infection prevalence and intensity than those villages receiving biennial SBT. Although health-related quality-of-life scores improved in both study arms, children in the CWT villages gained significantly more. We conclude that programs using annual CWT are likely to achieve better overall S. mansoni morbidity control than those implementing only biennial SBT. |
Persistent hot spots in Schistosomiasis Consortium for Operational Research and Evaluation Studies for Gaining and Sustaining Control of Schistosomiasis after four years of mass drug administration of praziquantel
Kittur N , King CH , Campbell CH , Kinung'hi S , Mwinzi PNM , Karanja DMS , N'Goran EK , Phillips AE , Gazzinelli-Guimaraes PH , Olsen A , Magnussen P , Secor WE , Montgomery SP , Utzinger J , Walker JW , Binder S , Colley DG . Am J Trop Med Hyg 2019 101 (3) 617-627 Control of schistosomiasis presently relies largely on preventive chemotherapy with praziquantel through mass drug administration (MDA) programs. The Schistosomiasis Consortium for Operational Research and Evaluation has concluded five studies in four countries (Cote d'Ivoire, Kenya, Mozambique, and Tanzania) to evaluate alternative approaches to MDA. Studies involved four intervention years, with final evaluation in the fifth year. Mass drug administration given annually or twice over 4 years reduced average prevalence and intensity of schistosome infections, but not all villages that were treated in the same way responded similarly. There are multiple ways by which responsiveness to MDA, or the lack thereof, could be measured. In the analyses presented here, we defined persistent hot spots (PHSs) as villages that achieved less than 35% reduction in prevalence and/or less than 50% reduction in infection intensity after 4 years of either school-based or community-wide MDA, either annually or twice in 4 years. By this definition, at least 30% of villages in each of the five studies were PHSs. We found no consistent relationship between PHSs and the type or frequency of intervention, adequacy of reported MDA coverage, and prevalence or intensity of infection at baseline. New research is warranted to identify PHSs after just one or a few rounds of MDA, and new adaptive strategies need to be advanced and validated for turning PHSs into responder villages. |
Protocol and baseline data for a multi-year cohort study of the effects of different mass drug treatment approaches on functional morbidities from schistosomiasis in four African countries
Shen Y , King CH , Binder S , Zhang F , Whalen CC , Secor WE , Montgomery SP , Mwinzi PNM , Olsen A , Magnussen P , Kinung'hi S , Phillips AE , Nala R , Ferro J , Aurelio HO , Fleming F , Garba A , Hamidou A , Fenwick A , Campbell CH Jr , Colley DG . BMC Infect Dis 2017 17 (1) 652 BACKGROUND: The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) focus is on randomized trials of different approaches to mass drug administration (MDA) in endemic countries in Africa. Because their studies provided an opportunity to evaluate the effects of mass treatment on Schistosoma-associated morbidity, nested cohort studies were developed within SCORE's intervention trials to monitor changes in a suite of schistosomiasis disease outcomes. This paper describes the process SCORE used to select markers for prospective monitoring and the baseline prevalence of these morbidities in four parallel cohort studies. METHODS: In July 2009, SCORE hosted a discussion of the potential impact of MDA on morbidities due to Schistosoma infection that might be measured in the context of multi-year control. Candidate markers were reviewed and selected for study implementation. Baseline data were then collected from cohorts of children in four country studies: two in high endemic S. mansoni sites (Kenya and Tanzania), and two in high endemic S. haematobium sites (Niger and Mozambique), these cohorts to be followed prospectively over 5 years. RESULTS: At baseline, 62% of children in the S. mansoni sites had detectable eggs in their stool, and 10% had heavy infections (≥ 400 eggs/g feces). Heavy S. mansoni infections were found to be associated with increased baseline risk of anemia, although children with moderate or heavy intensity infections had lower risk of physical wasting. Prevalence of egg-positive infection in the combined S. haematobium cohorts was 27%, with 5% of individuals having heavy infection (≥50 eggs/10 mL urine). At baseline, light intensity S. haematobium infection was associated with anemia and with lower scores in the social domain of health-related quality-of-life (HRQoL) assessed by Pediatric Quality of Life Inventory. CONCLUSIONS: Our consensus on practical markers of Schistosoma-associated morbidity indicated that height, weight, hemoglobin, exercise tolerance, HRQoL, and ultrasound abnormalities could be used as reference points for gauging treatment impact. Data collected over five years of program implementation will provide guidance for future evaluation of morbidity control in areas endemic for schistosomiasis. TRIAL REGISTRATION: These cohort studies are registered and performed in conjunction with the International Standard Randomised Controlled Trial Registry trials ISRCTN16755535 , ISRCTN14117624 , ISRCTN95819193 , and ISRCTN32045736 . |
Risk factors for Anopheles mosquitoes in rural and urban areas of Blantyre District, southern Malawi
Mzilahowa T , Luka-Banda M , Uzalili V , Mathanga DP , Campbell CH Jr , Mukaka M , Gimnig JE . Malawi Med J 2016 28 (4) 151-158 Background Although urban malaria transmission is low and seasonal, it remains a major public health problem. This study aimed at demonstrating the presence of Anopheles mosquitoes and their potential to transmit malaria in urban settings. Methods Two cross-sectional surveys were carried out in Blantyre District, Malawi, during the dry and wet seasons of 2008 and 2010, respectively. A map of Blantyre was divided into a grid of 400 cells, of which 60 cells were randomly selected. Five households located within 100 m from the centre of each selected cell were enrolled, a standard questionnaire was administered, and indoor resting mosquitoes were sampled. Results In 2008 and 2010, a total of 960 and 1045 mosquitoes were collected, respectively. Anophelesfunestus comprised 9.9% (n = 95) and 10.3% (n = 108) during the two surveys, respectively. Anophelesgambiae sensu lato (s.l.) was rarely detected during the second survey (n = 6; 0.6%). Molecular identification was performed on samples collected during the first survey, and An. funestus sensu stricto (s.s.) was the only sibling species detected. All the Anopheles mosquitoes were collected from households located in rural areas of Blantyre and none from urban areas. In univariate analysis, the presence of open eaves was associated with increased Anopheles prevalence, both during the dry (incidence rate ratio, IRR = 4.3; 95% CI 2.4-7.6) and wet (IRR = 2.47; 95% CI 1.7-3.59) seasons. Chances of detecting Anopheles spp. decreased with increasing altitude (IRR = 0.996; 95% CI 0.995-0.997) and during the dry season, but increased during the wet season (IRR = 1.0017; 95% CI 1.0012-1.0023). These factors remained significant following a multiple Poisson regression analysis. No association was found between insecticide-treated bednet ownership and the number of Anopheles mosquitoes detected. Conclusions The presence of An. funestus s.s and An. gambiae s.l. in the periphery of Blantyre city was an indication that malaria transmission was potentially taking place in these areas. |
Gaining and sustaining schistosomiasis control: study protocol and baseline data prior to different treatment strategies in five African countries
Ezeamama AE , He CL , Shen Y , Yin XP , Binder SC , Campbell CH Jr , Rathbun S , Whalen CC , N'Goran EK , Utzinger J , Olsen A , Magnussen P , Kinung'hi S , Fenwick A , Phillips A , Ferro J , Karanja DM , Mwinzi PN , Montgomery S , Secor WE , Hamidou A , Garba A , King CH , Colley DG . BMC Infect Dis 2016 16 (1) 229 BACKGROUND: The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was established in 2008 to answer strategic questions about schistosomiasis control. For programme managers, a high-priority question is: what are the most cost-effective strategies for delivering preventive chemotherapy (PCT) with praziquantel (PZQ)? This paper describes the process SCORE used to transform this question into a harmonized research protocol, the study design for answering this question, the village eligibility assessments and data resulting from the first year of the study. METHODS: Beginning in 2009, SCORE held a series of meetings to specify empirical questions and design studies related to different schedules of PCT for schistosomiasis control in communities with high (gaining control studies) and moderate (sustaining control studies) prevalence of Schistosoma infection among school-aged children. Seven studies are currently being implemented in five African countries. During the first year, villages were screened for eligibility, and data were collected on prevalence and intensity of infection prior to randomisation and the implementation of different schemes of PZQ intervention strategies. RESULTS: These studies of different treatment schedules with PZQ will provide the most comprehensive data thus far on the optimal frequency and continuity of PCT for schistosomiasis infection and morbidity control. CONCLUSIONS: We expect that the study outcomes will provide data for decision-making for country programme managers and a rich resource of information to the schistosomiasis research community. TRIAL REGISTRATION: The trials are registered at International Standard Randomised Controlled Trial registry (identifiers: ISRCTN99401114 , ISRCTN14849830 , ISRCTN16755535 , ISRCTN14117624 , ISRCTN95819193 and ISRCTN32045736 ). |
Associations between peripheral Plasmodium falciparum malaria parasitemia, human immunodeficiency virus, and concurrent helminthic infection among pregnant women in Malawi
Thigpen MC , Filler SJ , Kazembe PN , Parise ME , Macheso A , Campbell CH , Newman RD , Steketee RW , Hamel M . Am J Trop Med Hyg 2011 84 (3) 379-85 Approximately 2 billion persons worldwide are infected with schistosomiasis and soil-transmitted helminthes (STH), many in areas where endemic malaria transmission coexists. Few data exist on associations between these infections. Nested within a larger clinical trial, primigravid and secundigravid women provided blood samples for human immunodeficiency virus (HIV) testing and peripheral malaria films and stool and urine for evaluation of STH and Schistosoma spp. during their initial antenatal clinic visit. The most common parasitic infections were malaria (37.6%), S. haematobium (32.3%), and hookworm (14.4%); 14.2% of women were HIV-infected. S. haematobium infection was associated with lower malarial parasite densities (344 versus 557 parasites/muL blood; P < 0.05). In multivariate analysis, HIV and hookworm infection were independently associated with malaria infection (adjusted odds ratio = 1.9 and 95% confidence interval = 1.2-3.0 for HIV; adjusted odds ratio = 1.9 and 95% confidence interval = 1.03-3.5 for hookworm). Concurrent helminthic infection had both positive and negative effects on malaria parasitemia among pregnant women in Malawi. |
Socio-cultural predictors of health-seeking behaviour for febrile under-five children in Mwanza-Neno district, Malawi
Chibwana AI , Mathanga DP , Chinkhumba J , Campbell CH Jr . Malar J 2009 8 219 BACKGROUND: Prompt access to effective treatment for malaria is unacceptably low in Malawi. Less than 20% of children under the age of five with fever receive appropriate anti-malarial treatment within 24 hours of fever onset. This study assessed socio-cultural factors associated with delayed treatment of children with fever in Mwanza district, Malawi. METHODOLOGY: It was a qualitative study using focus group discussions and key informant interviews. RESULTS: A total of 151 caregivers and 46 health workers participated in the focus group discussions. The majority of caregivers were able to recognize fever and link it to malaria. Despite high knowledge of malaria, prompt treatment and health-seeking behaviour were poor, with the majority of children first being managed at home with treatment regimens other than effective anti-malarials. Traditional beliefs about causes of fever, unavailability of anti-malarial drugs within the community, barriers to accessing the formal health care system, and trust in traditional medicine were all associated with delays in seeking appropriate treatment for fever. CONCLUSION: The study has demonstrated important social cultural factors that negatively influence for caregivers of children under five. To facilitate prompt and appropriate health-seeking behaviour, behavioral change messages must address the prevailing local beliefs about causes of fever and the socio-economic barriers to accessing health care. |
Integration of insecticide-treated net distribution into routine immunization services in Malawi: a pilot study
Mathanga DP , Luman ET , Campbell CH , Silwimba C , Malenga G . Trop Med Int Health 2009 14 (7) 792-801 OBJECTIVES: To determine the feasibility of distributing insecticide-treated nets (ITNs) through routine immunization services, to increase ownership and use of ITNs among high-risk groups, whereas maintaining or improving timely completion of routine vaccinations. METHODS: Free ITNs were provided with timely completion of routine vaccinations in two intervention districts in southern Malawi for 15 months. Cross-sectional baseline and follow-up household surveys were conducted in the two intervention districts and one control district. RESULTS: Insecticide-treated nets utilization among children aged 12-23 months roughly doubled in the two intervention districts and did not change in the control district. Timely vaccination coverage increased in all three districts. The percentage of children aged 12-23 months who were both fully vaccinated by 12 months and slept under an ITN the night prior to the interview increased from 10-14% at baseline to 40-44% at follow-up in the intervention districts (P < 0.001), but did not change significantly in the control district. CONCLUSIONS: This study is the first to evaluate the provision of free ITNs at completion of a child's primary vaccination series, demonstrating that such a linkage is both feasible and can result in improved coverage with the combined services. Additional studies are needed to determine whether such a model is effective in other countries, and whether integration of other health services with immunization delivery could also be synergistic. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 13, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure