Journal Article > ResearchFull Text
Glob Health Action. 2018 January 15; Volume 11 (Issue 1); DOI:10.1080/16549716.2017.1417522
Albuquerque S, Eriksson A, Alvesson HM
Glob Health Action. 2018 January 15; Volume 11 (Issue 1); DOI:10.1080/16549716.2017.1417522
Low retention of humanitarian workers poses constraints on humanitarian organisations' capacity to respond effectively to disasters. Research has focused on reasons for humanitarian workers leaving the sector, but little is known about the factors that can elucidate long-term commitment.
Journal Article > ResearchFull Text
Glob Health Action. 2018 February 1; Volume 11 (Issue 1); DOI:10.1080/16549716.2018.1445467
Sagili KD, Satyanarayana S, Chadha SS, Wilson NC, Kumar AMV, et al.
Glob Health Action. 2018 February 1; Volume 11 (Issue 1); DOI:10.1080/16549716.2018.1445467
BACKGROUND:
The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices.
OBJECTIVES:
To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice.
METHODS:
From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project's core activities and outcomes.
RESULTS:
In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice.
CONCLUSIONS:
OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.
The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices.
OBJECTIVES:
To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice.
METHODS:
From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project's core activities and outcomes.
RESULTS:
In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice.
CONCLUSIONS:
OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.
Journal Article > ResearchFull Text
Glob Health Action. 2014 July 30; Volume 7; DOI:10.3402/gha.v7.24861
Khan S, Das M, Andries A, Deshpande A, Mansoor H, et al.
Glob Health Action. 2014 July 30; Volume 7; DOI:10.3402/gha.v7.24861
There are limited data on the failure of second-line antiretroviral therapy (ART) and the use of third-line ART in people living with HIV in resource-limited settings. Since 2011, the Médecins Sans Frontières (MSF) HIV/tuberculosis programme in Mumbai, India, has been providing third-line ART to patients in care.
Journal Article > ResearchFull Text
Glob Health Action. 2014 April 8; Volume 7 (Issue 1); DOI:10.3402/gha.v7.23758
Molfino L, Kumar AMV, Isaakidis P, Van der Bergh R, Khogali MA, et al.
Glob Health Action. 2014 April 8; Volume 7 (Issue 1); DOI:10.3402/gha.v7.23758
Background : In Mozambique, antiretroviral therapy (ART) scale-up has been successfully implemented. However, attrition in care remains a major programmatic challenge. In 2009, an intermediary-level HIV referral center was created in Maputo to ensure access to specialized care for HIV-infected patients with complications (advanced clinical-immunological stage, Kaposi sarcoma, or suspected ART failure). Objective : To determine the attrition from care and to identify risk factors that lead to high attrition among patients referred to an intermediary-level HIV referral center. Design : This was a retrospective cohort study from 2009 to 2011. Results : A total of 1,657 patients were enrolled, 847 (51%) were men, the mean age was 36 years (standard deviation: 11), the mean CD4 count was 27 cells/µl (interquartile range: 11-44), and one-third were severely malnourished. The main reasons for referral were advanced clinical stages (WHO stages 3 and 4, and CD4 count <50 cells/µl) in 70% of the cases, and 19% had Kaposi sarcoma. The overall attrition rate was 28.7 per 100 person-years (PYs) - the mortality rate was 5.0 (95% confidence interval [CI]: 4.2-5.9) per 100 PYs, and the loss-to-follow-up rate was 23.7 (95% CI: 21.9-25.6) per 100 PYs. There were 793 attritions - 137 deaths and 656 lost to follow-up (LTFU); 77% of all attrition happened within the first year. The factors independently associated with attrition were male sex (adjusted hazard ratio [aHR]: 1.15, 95% CI: 1.0-1.3), low body mass index (aHR: 1.51, 95% CI: 1.2-1.8), WHO clinical stage 3 or 4 (aHR: 1.30, 95% CI: 1.0-1.6; and aHR: 1.91, 95% CI: 1.4-2.5), later year of enrollment (aHR 1.61, 95% CI 1.3-1.9), and 'being already on ART' at enrollment (aHR 13.71, 95% CI 11.4-16.4). Conclusions : Attrition rates among HIV-infected patients enrolled in an intermediary referral center were high, mainly related to advanced stage of clinical disease. Measures are required to address this, including innovative strategies for HIV-testing uptake, earlier ART initiation and nutritional supplementation, and special attention to men and those who are already on ART at enrolment. Qualitative research is required to understand the reasons for being LTFU and design informed evidence-based interventions.
Journal Article > ResearchFull Text
Glob Health Action. 2017 May 2; Volume 10 (Issue 1); 1287334.; DOI:10.1080/16549716.2017.1287334
Zhang Z, Hu Y, Zou G, Lin MF, Zeng J, et al.
Glob Health Action. 2017 May 2; Volume 10 (Issue 1); 1287334.; DOI:10.1080/16549716.2017.1287334
BACKGROUND
Overuse of antibiotics contributes to the development of antimicrobial resistance.
OBJECTIVE
This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China.
METHODS
We conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2-14 years with upper respiratory infections (URI). Twenty health facilities were randomly selected, including four county hospitals, eight township hospitals and eight village clinics. Prescriptions were extracted from the electronic records in the county hospitals and paper copies in the township hospitals and village clinics.
RESULTS
The antibiotic prescription rate was higher in township hospitals (593/877, 68%) compared to county hospitals (2736/8166, 34%) and village clinics (96/297, 32%) (p < 0.001). Among prescriptions containing antibiotics, county hospitals were found to have the highest use rate of broad-spectrum antibiotics (82 vs 57% [township], vs 54% [village], p < 0.001), injectable antibiotics (65 vs 43% [township], vs 33% [village], p < 0.001) and multiple antibiotics (47 vs 15% [township], vs 0% [village], p < 0.001). Logistic regression showed that the likelihood of prescribing an antibiotic was significantly associated with patients being 6-14 years old compared with being 2-5 years old (adjusted odds ratio [aOR] = 1.3, 95% CI 1.2-1.5), and receiving care at township hospitals compared with county hospitals (aOR = 5.0, 95% CI 4.1-6.0). Prescriptions with insurance copayment appeared to lower the risk of prescribing antibiotics compared with those without (aOR = 0.8, 95% CI 0.7-0.9).
CONCLUSIONS
Inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significant high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.
Overuse of antibiotics contributes to the development of antimicrobial resistance.
OBJECTIVE
This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China.
METHODS
We conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2-14 years with upper respiratory infections (URI). Twenty health facilities were randomly selected, including four county hospitals, eight township hospitals and eight village clinics. Prescriptions were extracted from the electronic records in the county hospitals and paper copies in the township hospitals and village clinics.
RESULTS
The antibiotic prescription rate was higher in township hospitals (593/877, 68%) compared to county hospitals (2736/8166, 34%) and village clinics (96/297, 32%) (p < 0.001). Among prescriptions containing antibiotics, county hospitals were found to have the highest use rate of broad-spectrum antibiotics (82 vs 57% [township], vs 54% [village], p < 0.001), injectable antibiotics (65 vs 43% [township], vs 33% [village], p < 0.001) and multiple antibiotics (47 vs 15% [township], vs 0% [village], p < 0.001). Logistic regression showed that the likelihood of prescribing an antibiotic was significantly associated with patients being 6-14 years old compared with being 2-5 years old (adjusted odds ratio [aOR] = 1.3, 95% CI 1.2-1.5), and receiving care at township hospitals compared with county hospitals (aOR = 5.0, 95% CI 4.1-6.0). Prescriptions with insurance copayment appeared to lower the risk of prescribing antibiotics compared with those without (aOR = 0.8, 95% CI 0.7-0.9).
CONCLUSIONS
Inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significant high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.
Journal Article > ResearchFull Text
Glob Health Action. 2013 May 16; Volume 6; DOI:10.3402/gha.v6i0.20311
Kersten R, Bosse G, Dorner F, Slavuckij A, Marx M
Glob Health Action. 2013 May 16; Volume 6; DOI:10.3402/gha.v6i0.20311
While quality of care is a major concern in the western world, not many studies investigate this topic in low-income countries. Even less is known about the quality of care in humanitarian aid settings, where additional challenges from natural or manmade disasters contribute to additional challenges. This study tried to address this gap by introducing a new approach to systematically measure quality of care in a project of Médecins Sans Frontières (MSF) in Agok area, between South Sudan and Sudan. Our objective was to obtain a valid snapshot of quality of care for a MSF project in three weeks that has the potential to serve as a baseline for quality improvement strategies. The evaluation followed a cross-sectional study design to assess structural, process and outcome quality according to Donabedian's criteria of quality of care. A bundle of well-established methods for collection of quantitative and qualitative data was used to assess the project by following a triangulated mixed-methods approach. Mean structural quality scored 73% of expected performance level and mean process quality 59%. The overall mortality rate for the hospital was 3.6%. On average, less complicated cases got a better level of care than patients who were seriously ill. Significant motivational issues were discovered in staff interviews potentially affecting quality of care. The tool appeared to be quick, feasible and effective in judging quality of care in the selected project. To tap the whole potential of the approach a re-evaluation should be carried out to assess the effectiveness of implemented improvement strategies in Agok. To confirm the usefulness of the approach, more studies are needed covering the variety of different humanitarian aid settings.
Journal Article > ResearchFull Text
Glob Health Action. 2016 November 23
Muthuvel T, Isaakidis P, Shewade HD, Kattuppara L, Singh RS, et al.
Glob Health Action. 2016 November 23
Leprosy remains an important cause of preventable disabilities. After the advent of multidrug therapy, new leprosy cases have come down dramatically. Despite this achievement, India, which contributes 60% of the global leprosy burden, faces some challenges to eliminate the disease, including active transmission in the community and delayed diagnosis of leprosy patients.
Journal Article > ResearchFull Text
Glob Health Action. 2019 October 15
Cossa L, Harrison RE, Mpunga J, Lobo S, Kisaka Kimupelenge P, et al.
Glob Health Action. 2019 October 15
Background: Determine TB-LAM is a urine-based point-of-care assay for diagnosis of tuberculosis (TB).
Objective: To assess the feasibility of using LAM to diagnose TB in adult HIV-positive patients in resource-limited settings.
Methods: We performed a multi-centric mixed-methods cross-sectional descriptive study in the Democratic Republic of Congo, Malawi, and Mozambique. We used the study and program monitoring tools to estimate user workload, turn-around time (TAT), and proportion of patients with LAM and sputum-based results. We conducted semi-structured interviews to assess the user acceptability of the LAM.
Results: The duration of the LAM testing activity per patient was 27 min (IQR 26-29); staff continued with other duties whilst waiting for the result. More patients had a LAM versus a sputum-based result: 168/213 (78.9%) vs 77/213 (36.1%), p < 0.001 in DRC; 691/695 (99.4%) vs 429/695 (61.7%), p < 0.001 in Malawi; and 646/647 (99.8%) vs 262/647 (40.5%), p < 0.001 in Mozambique. The median TAT in minutes when LAM was performed in the consultation room was 75 (IQR 45-188) in DRC, 29 (IQR 27-39) in Malawi, and 36 (IQR 35-41) in Mozambique. In comparison, the overall median TAT for sputum-based tests (smear or GeneXpert) was 2 (IQR 1-3) days. The median time to the first anti-TB drug dose for LAM-positive patients was 155 (IQR 90-504) minutes in DRC and 90 (IQR 60-117) minutes in Mozambique. The overall inter-reader agreement for the interpretation of the LAM result as positive or negative was 98.9%, kappa 0.97 (95%CI 0.96-0.99). Overall, LAM users found the test easy to perform. Major concerns were use of the reading card and the prior requirement of CD4 results before LAM testing.
Conclusion: It is feasible to implement the LAM test in low resource settings. The short TAT permitted same day initiation of TB treatment for LAM-positive patients.
Objective: To assess the feasibility of using LAM to diagnose TB in adult HIV-positive patients in resource-limited settings.
Methods: We performed a multi-centric mixed-methods cross-sectional descriptive study in the Democratic Republic of Congo, Malawi, and Mozambique. We used the study and program monitoring tools to estimate user workload, turn-around time (TAT), and proportion of patients with LAM and sputum-based results. We conducted semi-structured interviews to assess the user acceptability of the LAM.
Results: The duration of the LAM testing activity per patient was 27 min (IQR 26-29); staff continued with other duties whilst waiting for the result. More patients had a LAM versus a sputum-based result: 168/213 (78.9%) vs 77/213 (36.1%), p < 0.001 in DRC; 691/695 (99.4%) vs 429/695 (61.7%), p < 0.001 in Malawi; and 646/647 (99.8%) vs 262/647 (40.5%), p < 0.001 in Mozambique. The median TAT in minutes when LAM was performed in the consultation room was 75 (IQR 45-188) in DRC, 29 (IQR 27-39) in Malawi, and 36 (IQR 35-41) in Mozambique. In comparison, the overall median TAT for sputum-based tests (smear or GeneXpert) was 2 (IQR 1-3) days. The median time to the first anti-TB drug dose for LAM-positive patients was 155 (IQR 90-504) minutes in DRC and 90 (IQR 60-117) minutes in Mozambique. The overall inter-reader agreement for the interpretation of the LAM result as positive or negative was 98.9%, kappa 0.97 (95%CI 0.96-0.99). Overall, LAM users found the test easy to perform. Major concerns were use of the reading card and the prior requirement of CD4 results before LAM testing.
Conclusion: It is feasible to implement the LAM test in low resource settings. The short TAT permitted same day initiation of TB treatment for LAM-positive patients.
Journal Article > ResearchFull Text
Glob Health Action. 2022 October 6; Volume 15 (Issue 1); DOI:10.1080/16549716.2022.2128281
Cubides JC, Jorgensen N, Peiter PC
Glob Health Action. 2022 October 6; Volume 15 (Issue 1); DOI:10.1080/16549716.2022.2128281
In the medical humanitarian context, the challenging task of collecting health information from people on the move constitutes a key element to identifying critical health care needs and gaps. Médecins Sans Frontières (MSF), during its long history of working with migrants, refugees and mobile populations in different contexts, has acknowledged how crucial it is to generate detailed context-related data on migrant and refugee populations in order to adapt the response interventions to their needs and circumstances. In 2019, the Brazilian Medical Unit/MSF developed the Migration History Tool (MHT), an application based on the life history method which was created in close dialogue with field teams in order to respond to information needs emerging from medical operations in mobile populations. The tool was piloted in two different contexts: firstly, among mobile populations transiting and living in Beitbridge and Musina, at the Zimbabwe-South Africa border; and, secondly, among Venezuelan migrants and refugees in Colombia. This article describes the implementation of this innovative method for collecting quantitative retrospective data on mobility and health in the context of two humanitarian interventions. The results have proven the flexibility of the methodology, which generated detailed information on mobility trajectories and on the temporalities of migration in two different contexts. It also revealed how health outcomes are not only associated with the spatial dimensions of movement, but also with the temporalities of mobility trajectories.
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Glob Health Action. 2024 April 25; Volume 17 (Issue 1); 2331291.; DOI:10.1080/16549716.2024.2331291
Caleo G, Lokuge K, Kardamanidis K, Greig J, Belava J, et al.
Glob Health Action. 2024 April 25; Volume 17 (Issue 1); 2331291.; DOI:10.1080/16549716.2024.2331291
BACKGROUND
There is a lack of empirical data on design effects (DEFF) for mortality rate for highly clustered data such as with Ebola virus disease (EVD), along with a lack of documentation of methodological limitations and operational utility of mortality estimated from cluster-sampled studies when the DEFF is high.
OBJECTIVES
The objectives of this paper are to report EVD mortality rate and DEFF estimates, and discuss the methodological limitations of cluster surveys when data are highly clustered such as during an EVD outbreak.
METHODS
We analysed the outputs of two independent population-based surveys conducted at the end of the 2014-2016 EVD outbreak in Bo District, Sierra Leone, in urban and rural areas. In each area, 35 clusters of 14 households were selected with probability proportional to population size. We collected information on morbidity, mortality and changes in household composition during the recall period (May 2014 to April 2015). Rates were calculated for all-cause, all-age, under-5 and EVD-specific mortality, respectively, by areas and overall. Crude and adjusted mortality rates were estimated using Poisson regression, accounting for the surveys sample weights and the clustered design.
RESULTS
Overall 980 households and 6,522 individuals participated in both surveys. A total of 64 deaths were reported, of which 20 were attributed to EVD. The crude and EVD-specific mortality rates were 0.35/10,000 person-days (95%CI: 0.23-0.52) and 0.12/10,000 person-days (95%CI: 0.05-0.32), respectively. The DEFF for EVD mortality was 5.53, and for non-EVD mortality, it was 1.53. DEFF for EVD-specific mortality was 6.18 in the rural area and 0.58 in the urban area. DEFF for non-EVD-specific mortality was 1.87 in the rural area and 0.44 in the urban area.
CONCLUSION
Our findings demonstrate a high degree of clustering; this contributed to imprecise mortality estimates, which have limited utility when assessing the impact of disease. We provide DEFF estimates that can inform future cluster surveys and discuss design improvements to mitigate the limitations of surveys for highly clustered data.
There is a lack of empirical data on design effects (DEFF) for mortality rate for highly clustered data such as with Ebola virus disease (EVD), along with a lack of documentation of methodological limitations and operational utility of mortality estimated from cluster-sampled studies when the DEFF is high.
OBJECTIVES
The objectives of this paper are to report EVD mortality rate and DEFF estimates, and discuss the methodological limitations of cluster surveys when data are highly clustered such as during an EVD outbreak.
METHODS
We analysed the outputs of two independent population-based surveys conducted at the end of the 2014-2016 EVD outbreak in Bo District, Sierra Leone, in urban and rural areas. In each area, 35 clusters of 14 households were selected with probability proportional to population size. We collected information on morbidity, mortality and changes in household composition during the recall period (May 2014 to April 2015). Rates were calculated for all-cause, all-age, under-5 and EVD-specific mortality, respectively, by areas and overall. Crude and adjusted mortality rates were estimated using Poisson regression, accounting for the surveys sample weights and the clustered design.
RESULTS
Overall 980 households and 6,522 individuals participated in both surveys. A total of 64 deaths were reported, of which 20 were attributed to EVD. The crude and EVD-specific mortality rates were 0.35/10,000 person-days (95%CI: 0.23-0.52) and 0.12/10,000 person-days (95%CI: 0.05-0.32), respectively. The DEFF for EVD mortality was 5.53, and for non-EVD mortality, it was 1.53. DEFF for EVD-specific mortality was 6.18 in the rural area and 0.58 in the urban area. DEFF for non-EVD-specific mortality was 1.87 in the rural area and 0.44 in the urban area.
CONCLUSION
Our findings demonstrate a high degree of clustering; this contributed to imprecise mortality estimates, which have limited utility when assessing the impact of disease. We provide DEFF estimates that can inform future cluster surveys and discuss design improvements to mitigate the limitations of surveys for highly clustered data.