Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone

Abstract Background Intermittent preventive treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a proven strategy to protect infants against malaria. Sierra Leone is the first country to implement IPTi nationwide. IPTi implementation was evaluated in Kambia, one of two initial pilot districts, to assess quality and coverage of IPTi services. Methods This mixed-methods evaluation had two phases, conducted 3 (phase 1) and 15–17 months (phase 2) after IPTi implementation. Methods included: assessments of 18 health facilities (HF), including register data abstraction (phases 1 and 2); a knowledge, attitudes and practices survey with 20 health workers (HWs) in phase 1; second-generation sequencing of SP resistance markers (pre-IPTi and phase 2); and a cluster-sample household survey among caregivers of children aged 3–15 months (phase 2). IPTi and vaccination coverage from the household survey were calculated from child health cards and maternal recall and weighted for the complex sampling design. Interrupted time series analysis using a Poisson regression model was used to assess changes in malaria cases at HF before and after IPTi implementation. Results Most HWs (19/20) interviewed had been trained on IPTi; 16/19 reported feeling well prepared to administer it. Nearly all HFs (17/18 in phase 1; 18/18 in phase 2) had SP for IPTi in stock. The proportion of parasite alleles with dhps K540E mutations increased but remained below the 50% WHO-recommended threshold for IPTi (4.1% pre-IPTi [95%CI 2–7%]; 11% post-IPTi [95%CI 8–15%], p < 0.01). From the household survey, 299/459 (67.4%) children ≥ 10 weeks old received the first dose of IPTi (versus 80.4% for second pentavalent vaccine, given simultaneously); 274/444 (62.5%) children ≥ 14 weeks old received the second IPTi dose (versus 65.4% for third pentavalent vaccine); and 83/217 (36.4%) children ≥ 9 months old received the third IPTi dose (versus 52.2% for first measles vaccine dose). HF register data indicated no change in confirmed malaria cases among infants after IPTi implementation. Conclusions Kambia district was able to scale up IPTi swiftly and provide necessary health systems support. The gaps between IPTi and childhood vaccine coverage need to be further investigated and addressed to optimize the success of the national IPTi programme.

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Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

10.21203/rs.2.12320/v2 ◽

2019 ◽

Author(s):

Ignatius Cheng Ndong ◽

Daniel Okyere ◽

Juliana Yartey Enos ◽

Benedicta Ayiedu Mensah ◽

Alexander Kwadwo Nyarko ◽

...

Keyword(s):

Malaria Control ◽

Lower Cost ◽

Health Centre ◽

Scale Up ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Asymptomatic Malaria ◽

Community Based ◽

High Coverage ◽

Asymptomatic Parasitaemia

Abstract Background: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Intermittent Preventive Treatment and Test, Treat and Track (T3) using ACTs. Intermittent preventive treatment of children (IPTc) in Ghana has demonstrated a parasite load reduction of 90%. However, unanswered questions include – whether mass treatment of population sub-groups such as IPTc could be scaled-up to whole populations as in mass testing, treatment and tracking (MTTT)? What is needed to implement MTTT at scale? Can MTTT reduce asymptomatic parasitaemia levels in children under 15? And whether MTTT of populations complemented by community-based management of malaria (CBMm) using volunteers could be an effective strategy for malaria control at a lower cost. Methods: A population of 5,000 asymptomatic individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers (CBHVs) who conducted house-to-house testing using RDTs every four months and treated positive cases with ACTs. Between interventions, CBMm was done on symptomatic cases. Results: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 1,795 (36.3%) in July 2017 to 1,303 (32.9%) in July 2018. Implementing MTTT significantly averted asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and temperature (OR=0.76, CI=0.67, 0.85 p ≤ 0.001). In comparison, treatment of symptomatic patients at the Health Centre reduced parasitaemia by 9% over the same period which was however, not statistically significant (OR=0.91, CI=0.67, 1.38 p = 0.672). A total of 223 (5.1%) cases were averted in children under 15 years (X² = 9.7, p < 0.002). An important observation was a decrease in hospital attendance, which negatively affected the internally generated funds (IGF) scheme of the participating health facilities. Conclusion: This study has demonstrated that implementing MTTT was feasible and could reduce prevalence of malaria asymptomatic parasitaemia in children under 15 years of age. Furthermore, the use of CBHVs could ensure high coverage at lower cost.

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Effectiveness of Antenatal Clinics to Deliver Intermittent Preventive Treatment and Insecticide Treated Nets for the Control of Malaria in Pregnancy in Mali: A Household Survey

PLoS ONE ◽

10.1371/journal.pone.0092102 ◽

2014 ◽

Vol 9 (3) ◽

pp. e92102 ◽

Cited By ~ 16

Author(s):

Jenny Hill ◽

Kassoum Kayentao ◽

Mahamoudou Touré ◽

Sory Diarwara ◽

Jane Bruce ◽

...

Keyword(s):

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Household Survey ◽

Malaria In Pregnancy ◽

Insecticide Treated Nets ◽

Antenatal Clinics ◽

In Pregnancy

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Global Call to Action to scale-up coverage of intermittent preventive treatment of malaria in pregnancy: seminar report

Malaria Journal ◽

10.1186/s12936-015-0730-3 ◽

2015 ◽

Vol 14 (1) ◽

Cited By ~ 10

Author(s):

Koki Agarwal ◽

Pedro Alonso ◽

R Matthew Chico ◽

Jane Coleman ◽

Stephanie Dellicour ◽

...

Keyword(s):

Scale Up ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Malaria In Pregnancy ◽

Call To Action ◽

In Pregnancy ◽

Seminar Report

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Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

10.21203/rs.2.12320/v1 ◽

2019 ◽

Author(s):

Ignatius Cheng Ndong ◽

Daniel Okyere ◽

Juliana Yartey Enos ◽

Benedicta Ayiedu Mensah ◽

Alexander Kwadwo Nyarko ◽

...

Keyword(s):

Malaria Control ◽

Lower Cost ◽

Health Centre ◽

Scale Up ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Asymptomatic Malaria ◽

Community Based ◽

High Coverage ◽

Asymptomatic Parasitaemia

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Outcomes associated with scale-up of the Stepping On falls prevention program: A case study in redesigning for dissemination

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.17 ◽

2020 ◽

Vol 4 (3) ◽

pp. 250-259 ◽

Cited By ~ 1

Author(s):

Jane E. Mahoney ◽

Ron Gangnon ◽

Lindy Clemson ◽

LaVerne Jaros ◽

Sandy Cech ◽

...

Keyword(s):

Behavior Change ◽

Phase 1 ◽

Scale Up ◽

Falls Prevention ◽

Complex Behavior ◽

Phase 2 ◽

Baseline Phase ◽

Behavior Change Interventions ◽

Two Phases

AbstractIntroduction:Translating complex behavior change interventions into practice can be accompanied by a loss of fidelity and effectiveness. We present the evaluation of two sequential phases of implementation of a complex evidence-based community workshop to reduce falls, using the Replicating Effective Programs Framework. Between the two phases, workshop training and delivery were revised to improve fidelity with key elements.Methods:Stepping On program participants completed a questionnaire at baseline (phase 1: n = 361; phase 2: n = 2219) and 6 months post-workshop (phase 1: n = 232; phase 2: n = 1281). Phase 2 participants had an additional follow-up at 12 months (n = 883). Outcomes were the number of falls in the prior 6 months and the Falls Behavioral Scale (FaB) score.Results:Workshop participation in phase 1 was associated with a 6% reduction in falls (RR = 0.94, 95% CI 0.74–1.20) and a 0.14 improvement in FaB score (95% CI, 0.11– 0.18) at 6 months. Workshop participation in phase 2 was associated with a 38% reduction in falls (RR = 0.62, 95% CI 0.57–0.68) and a 0.16 improvement in FaB score (95% CI 0.14–0.18) at 6 months, and a 28% reduction in falls (RR = 0.72, 95% CI 0.65–0.80) and a 0.19 score improvement in FaB score (95% CI 0.17–0.21) at 12-month follow-up.Conclusions:Effectiveness can be maintained with widespread dissemination of a complex behavior change intervention if attention is paid to fidelity of key elements. An essential role for implementation science is to ensure effectiveness as programs transition from research to practice.

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Prevalence and Associated Factors of Taking Intermittent Preventive Treatment in Pregnancy in Sierra Leone

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed4010032 ◽

2019 ◽

Vol 4 (1) ◽

pp. 32 ◽

Cited By ~ 6

Author(s):

Amos Buh ◽

Komlan Kota ◽

Ghose Bishwajit ◽

Sanni Yaya

Keyword(s):

Logistic Regression ◽

Antenatal Care ◽

Sierra Leone ◽

Rural Women ◽

Rural Areas ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

World Health ◽

Lower Odds ◽

In Pregnancy

Malaria infection during pregnancy is a major public health problem in sub-Saharan Africa. The World Health Organization (WHO) recommends that gestational and congenital malaria can be prevented by using intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). IPTp-SP is a full therapeutic course of antimalarial medicine administered during pregnancy as a component of antenatal care. This study’s objective was to assess the prevalence and predictors of IPTp-SP uptake in pregnancy in Sierra Leone. This study was based on the fifth round of the Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2016. Participants were 8526 women aged between 15–49 years. Outcome variables were uptake of IPTp-SP during the last pregnancy. Data were analysed using cross-tabulation and logistic regression methods. Results showed that the prevalence of taking IPTp-SP was 94.81% (92.40, 96.14), and that the prevalence of taking at least three doses was 93.24% (92.50, 94.81). In the multivariate logistic regression, education, parity, and antenatal care (ANC) use were significant predictors of IPTp-SP uptake. Women with higher education had lower odds of taking IPTp-SP (Odds Ratio = 0.647, 95%CI = 0.444, 0.943); having higher parity (>4) was associated with lower odds of taking IPTp-SP (OR = 0.663; 95%CI = 0.442, 0.994) and adequate ANC use increased the odds of taking IPTp-SP in both urban (OR = 1.450, 95%CI = 1.158, 3.128) and rural areas (OR = 1.903, 95%CI = 1.069, 1.966). In contrast, the positive association between ANC visits and adequate doses of taking IPTp-SP was true for rural women only (OR = 1.408, 95%CI = 1.174, 1.689). In conclusion, the use of IPTp-SP is close to being universal, with the prevalence being relatively higher in the rural areas. Based on our findings, promoting adequate antenatal care visits should be regarded as a key strategy to improve the use of IPTp-SP in Sierra Leone. Further studies could focus on exploring other predictors of IPTp-SP uptake that are not captured by MICS in Sierra Leone.

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Determinants of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Pregnant Women (IPTp-SP) in Mali, a household survey.

10.21203/rs.3.rs-41058/v1 ◽

2020 ◽

Author(s):

Oumar Sangho ◽

Moctar Tounkara ◽

Lillian Joyce Whiting-Collins ◽

Madeleine Beebe ◽

Peter J. Winch ◽

...

Keyword(s):

Pregnant Women ◽

Intermittent Preventive Treatment ◽

Care Facility ◽

Health Care Facility ◽

Preventive Treatment ◽

Household Survey ◽

Early Initiation ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Government

Abstract Background: In malaria endemic regions, Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine (IPTp-SP) is recommended for all pregnant women during prenatal consultation from the fourth to the ninth month of pregnancy, up to the time of delivery. The Government of Mali is aiming for universal coverage of IPTp-SP. However, coverage is still low, estimated to be 18% for completion of three doses (IPTp-SP3). The objective of this study was to identify the factors that influence IPTp-SP in the Health District of Sélingué, Mali.Methods: We performed a cross-sectional survey with 30 clusters, proportional to village size with two stages of sampling. We collected data electronically with Magpi software during face-to-face interviews/surveys. The data were analyzed with SPSS version 20. We performed a descriptive analysis, and bivariate and multivariate logistic regression. An equity analysis examined the effect of distance from health care facility on completion of three or more antenatal visits (ANC3+) and three or more doses of Intermittent Preventive Treatment (IPTp-SP3+).Results: Of the 1,021 women surveyed, 87.8% (n = 896) attended at least one ANC visit. Of these, 86.3% (n = 773) received at least 1 dose of IPTp-SP. The frequency of three or more ANC visits was 90.8%. Compliance with three or more malaria treatments was 63.7%. The determinants statistically related to ANC3+ were the early initiation of ANC (OR = 3.22 [1.22, 10.78]), the number of payments made for the malaria treatment (OR = 21.5 [2.64; 09], OR = 11.24 [2.5, 50.46]) and the presence of a Community Health Center (CHC) in the village (OR = 9.69 [1.09, 86.21]). The ability to read (OR = 1.60 [1.01, 2.55]), the early initiation of ANC (OR = 1.46 [1.06, 2.00], knowledge of the utility of the drug (OR = 2.38 [1.24, 4.57]), and knowledge of the recommended dose of the drug (OR = 6.11 [3.98, 9.39]) were related to completion of three or more treatments (IPTp-SP3+).Conclusion: The early initiation of ANC was a good determinant of the completeness of ANC3+ and IPTp-SP3+. Coverage was fair, but still far from universal. Alternative strategies are needed to further increase coverage.

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Rationalization and internalization

Swiss Journal of Psychology ◽

10.1024//1421-0185.60.4.215 ◽

2001 ◽

Vol 60 (4) ◽

pp. 215-230 ◽

Cited By ~ 6

Author(s):

Jean-Léon Beauvois

Keyword(s):

Phase 1 ◽

Facilitatory Effect ◽

Phase 2 ◽

Causal Explanations ◽

Reduction Effect ◽

Dissonance Reduction

After having been told they were free to accept or refuse, pupils aged 6–7 and 10–11 (tested individually) were led to agree to taste a soup that looked disgusting (phase 1: initial counter-motivational obligation). Before tasting the soup, they had to state what they thought about it. A week later, they were asked whether they wanted to try out some new needles that had supposedly been invented to make vaccinations less painful. Agreement or refusal to try was noted, along with the size of the needle chosen in case of agreement (phase 2: act generalization). The main findings included (1) a strong dissonance reduction effect in phase 1, especially for the younger children (rationalization), (2) a generalization effect in phase 2 (foot-in-the-door effect), and (3) a facilitatory effect on generalization of internal causal explanations about the initial agreement. The results are discussed in relation to the distinction between rationalization and internalization.

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PENERAPAN MODEL QUANTUM LEARNING UNTUK MENINGKATKAN HASIL BELAJAR AUTOCAD SISWA KELAS X TEKNIK PEMESINAN SMK NEGERI 1 STABAT

Jurnal Teknologi Pendidikan (JTP) ◽

10.24114/jtp.v5i1.509 ◽

2013 ◽

Vol 5 (1) ◽

Author(s):

Abdul Hasan Saragih

Keyword(s):

Positive Response ◽

Phase 1 ◽

First Grade ◽

Learning Model ◽

Second Phase ◽

Phase 2 ◽

Phase 3 ◽

The Third ◽

Third Phase ◽

Quantum Learning

This classroom research was conducted on the autocad instructions to the first grade of mechinary class of SMK Negeri 1 Stabat aiming at : (1) improving the student’ archievementon autocad instructional to the student of mechinary architecture class of SMK Negeri 1 Stabat, (2) applying Quantum Learning Model to the students of mechinary class of SMK Negeri 1 Stabat, arising the positive response to autocad subject by applying Quantum Learning Model of the students of mechinary class of SMK Negeri 1 Stabat. The result shows that (1) by applying quantum learning model, the students’ achievement improves significantly. The improvement ofthe achievement of the 34 students is very satisfactory; on the first phase, 27 students passed (70.59%), 10 students failed (29.41%). On the second phase 27 students (79.41%) passed and 7 students (20.59%) failed. On the third phase 30 students (88.24%) passed and 4 students (11.76%) failed. The application of quantum learning model in SMK Negeri 1 Stabat proved satisfying. This was visible from the activeness of the students from phase 1 to 3. The activeness average of the students was 74.31% on phase 1,81.35% on phase 2, and 83.63% on phase 3. (3) The application of the quantum learning model on teaching autocad was very positively welcome by the students of mechinary class of SMK Negeri 1 Stabat. On phase 1 the improvement was 81.53% . It improved to 86.15% on phase 3. Therefore, The improvement ofstudent’ response can be categorized good.

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In situ deteriorating patient simulation in general practice

British Journal of General Practice ◽

10.3399/bjgp20x711425 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711425

Author(s):

Joanna Lawrence ◽

Petronelle Eastwick-Field ◽

Anne Maloney ◽

Helen Higham

Keyword(s):

Life Support ◽

Early Recognition ◽

Phase 1 ◽

Patient Simulation ◽

Medical Emergency ◽

Phase 2 ◽

Action Plans ◽

Integrated Simulation ◽

Deteriorating Patient

BackgroundGP practices have limited access to medical emergency training and basic life support is often taught out of context as a skills-based event.AimTo develop and evaluate a whole team integrated simulation-based education, to enhance learning, change behaviours and provide safer care.MethodPhase 1: 10 practices piloted a 3-hour programme delivering 40 minutes BLS and AED skills and 2-hour deteriorating patient simulation. Three scenarios where developed: adult chest pain, child anaphylaxis and baby bronchiolitis. An adult simulation patient and relative were used and a child and baby manikin. Two facilitators trained in coaching and debriefing used the 3D debriefing model. Phase 2: 12 new practices undertook identical training derived from Phase 1, with pre- and post-course questionnaires. Teams were scored on: team working, communication, early recognition and systematic approach. The team developed action plans derived from their learning to inform future response. Ten of the 12 practices from Phase 2 received an emergency drill within 6 months of the original session. Three to four members of the whole team integrated training, attended the drill, but were unaware of the nature of the scenario before. Scoring was repeated and action plans were revisited to determine behaviour changes.ResultsEvery emergency drill demonstrated improved scoring in skills and behaviour.ConclusionA combination of: in situ GP simulation, appropriately qualified facilitators in simulation and debriefing, and action plans developed by the whole team suggests safer care for patients experiencing a medical emergency.

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