PO 7167 IMPROVING USE OF LONG-LASTING INSECTICIDAL NETS IN KAYANGE COMMUNITY OF NORTH-WESTERN BURUNDI: A QUALITY IMPROVEMENT STUDY

BackgroundThe use of long-lasting insecticidal nets (LLINs) for malaria prevention is a cost-effective intervention. WHO recommends universal coverage and use of LLINs. In lower- and middle-income countries, LLINs are provided free of charge but are either not used or misused. Our study sought to improve LLIN use in Kayange community of north-western Burundi by using a model for improvement (MFI).MethodsA one-group, pre/post-test study was conducted. LLIN weekly use was assessed for four weeks before intervention and for another four weeks after intervention. The study was conducted in 96 households. The intervention consisted of testing four different weekly small change actions by using the MFI.ResultsOf the 96 households, 83 households (87%) owned at least one LLIN. However, only 40 households (42%) owned at least one LLIN for every two people. After intervention, the number of LLINs used increased from 32 to 75 per cent (134% increase) and the number of persons (general population) sleeping under LLIN from 35 to 73 per cent (108% increase). The number of children under 5 years old sleeping under LLIN increased from 31 to 76 per cent (145% increase) and the number of pregnant women who slept under LLIN from 43 to 73 per cent (69% increase). Also, the averages of the number of nights in each week that the general population slept under LLIN increased from 2.13 to 5.11 (140% increase), children under 5 years old slept under LLIN from 1.68 to 4.78 (184% increase) and pregnant women slept under LLIN from 1.56 to 4.47 (186% increase).ConclusionOur intervention led to significant increase in all outcome indicators. This increase is the result of a combination of an enabling context and an effective implementation of an evidence-based quality improvement intervention. Small tests of change at the community level have the potential for achieving improved outcomes.

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Improving long-lasting insecticidal nets use in Kayange community of north-western Burundi: a pilot study exploring the use of quality improvement methodologies in low-resource community settings

BMJ Open Quality ◽

10.1136/bmjoq-2018-000540 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000540 ◽

Cited By ~ 1

Author(s):

Desire Habonimana ◽

Gideon Nimako ◽

Jabulani Ncayiyana ◽

Gabriel Ndayisaba ◽

Rohit Ramaswamy

Keyword(s):

Quality Improvement ◽

Pilot Study ◽

General Population ◽

Pregnant Women ◽

Rural Community ◽

Community Settings ◽

Low Resource ◽

Utilisation Data ◽

Long Lasting Insecticidal Nets ◽

Children Under 5

Quality improvement (QI) approaches have demonstrated a lot of promise in improving clinical care processes, both in high-resource and low-resource settings. However, most examples of QI initiatives in healthcare in low-income countries are clinic-based. The objective of this study was to demonstrate feasibility of applying QI methods in low-resource community settings by applying them to the problem of correct utilisation of long-lasting insecticidal nets (LLINs) in a rural community in Burundi. Correct utilisation of LLINs had been shown to be a cost-effective approach to malaria prevention. In Burundi, LLINs utilisation is low. The Model for Improvement, a well-known QI approach, was used to increase LLINs utilisation in a rural community in Burundi. In the baseline, LLINs ownership and weekly utilisation together with factors affecting LLINs non-use were documented for a period of 4 weeks before intervention. Improvement ideas were collaboratively developed by a quality improvement team (QIT) and tested using Plan-Do-Study-Act (PDSA) cycles. The first PDSA cycle consisted of the demonstration of how to mount LLINs, the second was an implementation of reminders done by household ‘watchdogs’, the third cycle consisted of conducting two community reminders every week and the last cycle was a combination of the last two PDSA cycles. The intervention lasted 4 weeks and data were collected weekly. LLINs utilisation was calculated each week and plotted on a run chart to demonstrate improvement trends. LLINs utilisation data were collected for another 3 weeks postintervention. Of 96 households, 83 (87%) households owned at least one LLIN. After intervention, the number of LLINs used increased from 32% to 75% (134% increase) and the number of persons (general population) sleeping under LLINs from 35% to 73% (108% increase). The number of children under 5 years sleeping under LLINs increased from 31% to 76% (145% increase) and the number of pregnant women who slept under LLINs from 43% to 73% (69% increase). Also, the averages of the number of nights in each week that the general population slept under LLINs increased from 2.13 to 5.11 (140% increase), children under 5 years from 1.68 to 4.78 (184% increase) and pregnant women from 1.56 to 4.47 (186% increase). Each of the 4 PDSA cycles led to a significant increase in outcome indicators and the trends appear to persist even after the implementation was complete. While it is impossible to draw generalisable conclusions from a small pilot study, QI approaches appear to be feasible to implement in low-resource community setting and have promise in producing results. More research at larger scale should be encouraged to validate our initial findings.

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Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

BMC Research Notes ◽

10.1186/s13104-019-4620-6 ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Jorge A. H. Arroz ◽

Baltazar Candrinho ◽

Chandana Mendis ◽

Melanie Lopez ◽

Maria do Rosário O. Martins

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Universal Coverage ◽

Cost Effectiveness Ratio ◽

Net Benefit ◽

Incremental Net Benefit ◽

The Cost ◽

And Control ◽

Delivery Models ◽

Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs. new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

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Quality improvement intervention for stroke care cost effective in China

PharmacoEconomics & Outcomes News ◽

10.1007/s40274-020-6605-z ◽

2020 ◽

Vol 847 (1) ◽

pp. 29-29

Keyword(s):

Quality Improvement ◽

Cost Effective ◽

Stroke Care ◽

Quality Improvement Intervention ◽

Improvement Intervention

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Predictors of knowledge and use of long-lasting insecticidal nets for the prevention of malaria among the pregnant women in Pakistan

Malaria Journal ◽

10.1186/s12936-021-03878-w ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Ramesh Kumar ◽

Midhat Farzeen ◽

Jamil Ahmed ◽

Manohar Lal ◽

Ratana Somrongthong

Keyword(s):

Antenatal Care ◽

Mobile Phone ◽

Pregnant Women ◽

Maternal Education ◽

Reference Group ◽

Scale Up ◽

Monitoring And Evaluation ◽

Malaria Prevention ◽

Roll Back Malaria ◽

Long Lasting Insecticidal Nets

Abstract Background Malaria is endemic to Pakistan with high prevalence among pregnant women and linked with maternal anaemia, intrauterine growth retardation, preterm birth, and low birth weight. The use of long-lasting insecticidal nets (LLINs) is a proven and cost-effective intervention preventing malaria among pregnant women. The present study aimed to explore predictors of knowledge and use of LLINs among pregnant women in Pakistan. Methods This was part of a quasi-experimental study of 200 pregnant women conducted in a rural district of Sindh province in Pakistan. Data were collected using Malaria Indicator Survey questionnaires developed by Roll Back Malaria Partnership to end Malaria Monitoring and Evaluation Reference Group. Pregnant women and mothers with newborns of six months of age were interviewed in their homes. Results The age of the women was from 18 to 45, two thirds of the respondents (72.5%) were uneducated and married (77%). Majority (92%) of the women had received antenatal care during pregnancy, and 29.5% women had received counseling on malaria during their antenatal care visits. Multiple linear regression showed that the type of latrine was the most significant (β = 0.285, p < 0.001) determinant of knowledge about malaria among pregnant women followed by the death of a newborn (β = 0.271, p < 0.001). The use of mobile phone was the most significant (β = 0.247, p < 0.001) predictor of usage of LLINs among pregnant women followed by the death of a newborn (β = 0.232, p < 0.05). Conclusions Maternal education, type of latrine, use of mobile phone, malaria during previous pregnancy and newborn death were strong predictors of knowledge and use of LLINs in pregnant women in Pakistan. There is a need to scale-up programmes that aim to create awareness regarding malaria among pregnant women. Mobile phone technology can be used to implement awareness programmes focusing on malaria prevention among women.

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Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

10.21203/rs.2.12474/v1 ◽

2019 ◽

Author(s):

Jorge Arroz ◽

Baltazar Candrinho ◽

Chandana Mendis ◽

Melanie Lopez ◽

Maria do Rosário Oliveira Martins

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Universal Coverage ◽

Cost Effectiveness Ratio ◽

Net Benefit ◽

Incremental Net Benefit ◽

The Cost ◽

And Control ◽

Delivery Models ◽

Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

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Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

10.21203/rs.2.12474/v3 ◽

2019 ◽

Author(s):

Jorge Arroz ◽

Baltazar Candrinho ◽

Chandana Mendis ◽

Melanie Lopez ◽

Maria do Rosário Oliveira Martins

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Universal Coverage ◽

Cost Effectiveness Ratio ◽

Net Benefit ◽

Incremental Net Benefit ◽

The Cost ◽

And Control ◽

Delivery Models ◽

Long Lasting Insecticidal Nets

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The effect of malaria prevention and control interventions on malaria morbidity among children under 5 years and pregnant women in Kintampo North Municipality, Ghana

Journal of Interventional Epidemiology and Public Health ◽

10.37432/jieph.2018.1.1.7 ◽

2018 ◽

Vol 1 ◽

Author(s):

Christopher Tamal ◽

Chrysantus Kubio ◽

Delia Akosua Bandoh ◽

Maurice Owiny ◽

Ernest Kenu ◽

...

Keyword(s):

Pregnant Women ◽

Prevention And Control ◽

Malaria Prevention ◽

Malaria Morbidity ◽

And Control ◽

Children Under 5

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Cost-Effectiveness of a Multifaceted Quality Improvement Intervention for Acute Ischemic Stroke in China

Stroke ◽

10.1161/strokeaha.119.027980 ◽

2020 ◽

Vol 51 (4) ◽

pp. 1265-1271 ◽

Cited By ~ 1

Author(s):

Yuesong Pan ◽

Lei Zhang ◽

Zixiao Li ◽

Xia Meng ◽

Yilong Wang ◽

...

Keyword(s):

Quality Improvement ◽

Cost Effectiveness ◽

Cost Effective ◽

Stroke Care ◽

Quality Improvement Intervention ◽

Life Years ◽

Chinese Yuan ◽

Quality Adjusted Life ◽

Improvement Intervention

Background and Purpose— Multifaceted quality improvement interventions of stroke care have been shown to improve hospital personnel adherence to evidence-based performance measures and subsequent stroke outcomes. This study aimed to evaluate the cost-effectiveness of a multifaceted quality improvement intervention for stroke care in China, the world’s largest low- and middle-income country. Methods— A short-term decision tree model and a long-term Markov model were used to analyze the cost-effectiveness of a multifaceted quality improvement intervention for patients with acute ischemic stroke. Outcomes, transition probability, and cost data were obtained from a recent clinical trial and the published literature. The benefit of the intervention was assessed by the costs per quality-adjusted life-years gained in the short- and long-term. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the findings. Results— Compared with usual care, a multifaceted quality improvement intervention for stroke care was found to be cost-effective in the first year and highly cost-effective from the second year onward. In the long-term, the intervention yielded a lifetime gain of 0.246 quality-adjusted life-years at an additional cost of Chinese Yuan Renminbi 1510 (US $230), resulting in a cost of Chinese Yuan Renminbi 6138 (US $940) per quality-adjusted life-year gained. Probabilistic sensitivity analysis indicated that the intervention was highly cost-effective in 99.9% of the simulation runs at a willingness-to-pay threshold of Chinese Yuan Renminbi 59 700 (1× gross domestic product per capita of China in 2017, US $9200) per quality-adjusted life-year. Conclusions— A multifaceted quality improvement intervention for stroke care was highly cost-effective in China. The results of this study may be used as a reference for delivering such interventions in low- and middle-income countries and in underserved areas of high-income countries.

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Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya

BMJ Global Health ◽

10.1136/bmjgh-2020-002452 ◽

2021 ◽

Vol 6 (3) ◽

pp. e002452

Author(s):

Meghan Bruce Kumar ◽

Jason J Madan ◽

Peter Auguste ◽

Miriam Taegtmeyer ◽

Lilian Otiso ◽

...

Keyword(s):

Quality Improvement ◽

Cost Effectiveness ◽

Cost Effective ◽

Quality Improvement Intervention ◽

Skilled Delivery ◽

Community Healthcare ◽

Improvement Interventions ◽

Quality Improvement Interventions ◽

The Cost ◽

Improvement Intervention

IntroductionImprovements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya.MethodsWe estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses.ResultsWe found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars).ConclusionsThis analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas.

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