scholarly journals “Nine Dimensions”: A multidisciplinary approach for community engagement in a complex postwar border region as part of the targeted malaria elimination in Karen/Kayin State, Myanmar

2018 ◽  
Vol 3 ◽  
pp. 116
Author(s):  
Decha Tangseefa ◽  
Krishna Monthathip ◽  
Naruemol Tuenpakdee ◽  
Andrea König ◽  
Ladda Kajeechiwa ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Elimination ◽  
Participant Observation ◽  
Structured Interviews ◽  
Team Members ◽  
Cross Border ◽  
Control Programmes ◽  
Elimination Programme ◽  
Post War

Background:In light of growing antimalarial drug resistance in Southeast Asia, control programmes have become increasingly focused on malaria elimination, composed of mass drug administration coupled with prompt diagnosis and treatment of symptomatic cases. The key to a successful elimination programme centres on high participation rates in targeted communities, often enhanced by community engagement (CE) efforts. Social science research was conducted to develop a conceptual framework used for CE activities in the Targeted Malaria Elimination programme, as a cross-border operation in Karen/Kayin State, Myanmar.Methods:Data was collected from three main sources: (1) participant observation and semi-structured interviews of CE team members; (2) participant observation and semi-structured interviews with villagers; and (3) records of CE workshops with CE workers conducted as part of the TME programme.Results:Interviews were conducted with 17 CE team members, with 10 participant observations and interviews conducted with villagers and a total of 3 workshops conducted over the course of this pilot programme in 4 villages (November 2013 to October 2014). Thematic analysis was used to construct the nine dimensions for CE in this complex, post-war region: i) history of the people; ii) space; iii) work; iv) knowledge about the world; v) intriguing obstacle (rumour); vi) relationship with the health care system; vii) migration; viii) logic of capitalism influencing openness; and ix) power relations.Conclusions:Conducting CE for the Targeted Malaria Elimination programme was immensely complicated in Karen/Kayin State because of three key realities: heterogeneous terrains, a post-war atmosphere and cross-border operations. These three key realities constituted the nine dimensions, which proved integral to health worker success in conducting CE. Summary of this approach can aid in infectious disease control programmes, such as those using mass drug administration, to engender high rates of community participation.

scholarly journals “Nine Dimensions”: A multidisciplinary approach for community engagement in a complex postwar border region as part of the targeted malaria elimination in Karen/Kayin State, Myanmar

2019 ◽  
Vol 3 ◽  
pp. 116 ◽  
Author(s):  
Decha Tangseefa ◽  
Krishna Monthathip ◽  
Naruemol Tuenpakdee ◽  
Andrea König ◽  
Ladda Kajeechiwa ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Elimination ◽  
Participant Observation ◽  
Structured Interviews ◽  
Team Members ◽  
Cross Border ◽  
Control Programmes ◽  
Elimination Programme ◽  
Post War

Background: In light of growing antimalarial drug resistance in Southeast Asia, control programmes have become increasingly focused on malaria elimination, composed of mass drug administration coupled with prompt diagnosis and treatment of symptomatic cases. The key to a successful elimination programme centres on high participation rates in targeted communities, often enhanced by community engagement (CE) efforts. Social science research was conducted to develop a conceptual framework used for CE activities in the Targeted Malaria Elimination programme, as a cross-border operation in Karen/Kayin State, Myanmar. Methods: Data was collected from three main sources: (1) participant observation and semi-structured interviews of CE team members; (2) participant observation and semi-structured interviews with villagers; and (3) records of CE workshops with CE workers conducted as part of the TME programme. Results: Interviews were conducted with 17 CE team members, with 10 participant observations and interviews conducted with villagers and a total of 3 workshops conducted over the course of this pilot programme in 4 villages (November 2013 to October 2014). Thematic analysis was used to construct the nine dimensions for CE in this complex, post-war region: i) history of the people; ii) space; iii) work; iv) knowledge about the world; v) intriguing obstacle (rumour); vi) relationship with the health care system; vii) migration; viii) logic of capitalism influencing openness; and ix) power relations. Conclusions: Conducting CE for the Targeted Malaria Elimination programme was immensely complicated in Karen/Kayin State because of three key realities: heterogeneous terrains, a post-war atmosphere and cross-border operations. These three key realities constituted the nine dimensions, which proved integral to health worker success in conducting CE. Summary of this approach can aid in infectious disease control programmes, such as those using mass drug administration, to engender high rates of community participation.

scholarly journals Estimating the programmatic cost of targeted mass drug administration for malaria in Myanmar

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shwe Sin Kyaw ◽  
Gilles Delmas ◽  
Tom L. Drake ◽  
Olivier Celhay ◽  
Wirichada Pan-ngum ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Elimination ◽  
Unit Cost ◽  
Financial Data ◽  
Research Activities ◽  
High Incidence ◽  
Implementation Costs ◽  
The Cost ◽  
Greater Mekong Subregion

Abstract Background Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. Targeted MDA, sometimes referred to as focal MDA, is the practice of delivering MDA to high incidence subpopulations only, rather than the entire population. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA, targeted or otherwise, is to be included in elimination packages beyond existing malaria interventions. This study aims to estimate the programmatic cost and the unit cost of targeted MDA in Kayin State, Myanmar. Methods We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the targeted MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for targeted MDA, and conducting mass treatment in target villages) were evaluated. We then estimated the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses. Results The cost of delivering targeted MDA within an integrated malaria elimination initiative in eastern Kayin State was approximately US$ 910,000. The cost per person reached, distributed among those in targeted and non-targeted villages, for the MDA component was US$ 2.5. Conclusion This cost analysis can assist policymakers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of targeting MDA to different numbers of target villages.

scholarly journals WILL MASS DRUG ADMINISTRATION ELIMINATE LYMPHATIC FILARIASIS? EVIDENCE FROM NORTHERN COASTAL TANZANIA

2012 ◽  
Vol 45 (4) ◽  
pp. 517-545 ◽  
Author(s):  
MELISSA PARKER ◽  
TIM ALLEN
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Participant Observation ◽  
Drug Uptake ◽  
Village Level ◽  
Treatment And Prevention ◽  
Free Treatment ◽  
Adults And Children ◽  
Study Sites

SummaryThis article documents understandings and responses to mass drug administration (MDA) for the treatment and prevention of lymphatic filariasis among adults and children in northern coastal Tanzania from 2004 to 2011. Assessment of village-level distribution registers, combined with self-reported drug uptake surveys of adults, participant observation and interviews, revealed that at study sites in Pangani and Muheza districts the uptake of drugs was persistently low. The majority of people living at these highly endemic locations either did not receive or actively rejected free treatment. A combination of social, economic and political reasons explain the low uptake of drugs. These include a fear of treatment (attributable, in part, to a lack of trust in international aid and a questioning of the motives behind the distribution); divergence between biomedical and local understandings of lymphatic filariasis; and limited and ineffective communication about the rationale for mass treatment. Other contributory factors are the reliance upon volunteers for distribution within villages and, in some locations, strained relationships between different groups of people within villages as well as between local leaders and government officials. The article also highlights a disjuncture between self-reported uptake of drugs by adults at a village level and the higher uptake of drugs recorded in official reports. The latter informs claims that elimination will be a possibility by 2020. This gives voice to a broader problem: there is considerable pressure for those implementing MDA to report positive results. The very real challenges of making MDA work are pushed to one side – adding to a rhetoric of success at the expense of engaging with local realities. It is vital to address the kind of issues raised in this article if current attempts to eliminate lymphatic filariasis in mainland coastal Tanzania are to achieve their goal.

scholarly journals Electrocardiographic Safety of Repeated Monthly Dihydroartemisinin-Piperaquine as a Candidate for Mass Drug Administration

2018 ◽  
Vol 62 (12) ◽  
Author(s):  
Pere Millat-Martínez ◽  
Rhoda Ila ◽  
Moses Laman ◽  
Leanne Robinson ◽  
Harin Karunajeewa ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Elimination ◽  
Safety Data ◽  
Repeated Administration ◽  
Risk Difference ◽  
Safety Endpoint ◽  
The Difference ◽  
Repeated Dosing ◽  
Long Acting

ABSTRACT Mass drug administration (MDA) of sequential rounds of antimalarial drugs is being considered for use as a tool for malaria elimination. As an effective and long-acting antimalarial, dihydroartemisinin-piperaquine (DHA-PQP) appears to be suitable as a candidate for MDA. However, the absence of cardiac safety data following repeated administration hinders its use in the extended schedules proposed for MDA. We conducted an interventional study in Lihir Island, Papua New Guinea, using healthy individuals age 3 to 60 years who received a standard 3-day course of DHA-PQP on 3 consecutive months. Twelve-lead electrocardiography (ECG) readings were conducted predose and 4 h after the final dose of each month. The primary safety endpoint was QT interval correction (QTc using Fridericia’s correction [QTcF]) prolongation from baseline to 4 h postdosing. We compared the difference in prolongations between the third course postdose and the first course postdose. Of 84 enrolled participants, 69 (82%) participants completed all treatment courses and ECG measurements. The average increase in QTcF was 19.6 ms (standard deviation [SD], 17.8 ms) and 17.1 ms (SD, 17.1 ms) for the first-course and third-course postdosing ECGs risk difference, −2.4 (95% confidence interval [95% CI], −6.9 to 2.1; P = 0.285), respectively. We recorded a QTcF prolongation of >60 ms from baseline in 3 (4.3%) and 2 (2.9%) participants after the first course and third course (P = 1.00), respectively. No participants had QTcF intervals of >500 ms at any time point. Three consecutive monthly courses of DHA-PQP were as safe as a single course. The absence of cumulative cardiotoxicity with repeated dosing supports the use of monthly DHA-PQP as part of malaria elimination strategies.

scholarly journals Community engagement for malaria elimination in contested areas of the Karen/Kayin State, Myanmar: A case study on the Malaria Elimination Task Force

2018 ◽  
Vol 3 ◽  
pp. 22 ◽  
Author(s):  
Andrea König ◽  
Ladda Kajeechiwa ◽  
May Myo Thwin ◽  
Suphak Nosten ◽  
Saw Win Tun ◽  
...  
Keyword(s):  
Community Engagement ◽  
Malaria Elimination ◽  
Task Force ◽  
Participant Observation ◽  
Mutual Understanding ◽  
Group Discussions ◽  
Team Members ◽  
Complex Landscape ◽  
Key Dimensions ◽  
Context Specific

Background: This study evinces how the community engagement (CE) approach of the Malaria Elimination Task Force (METF) in the Karen/Kayin State of southeast Myanmar contributed to generating participation in program activities, such as early detection and treatment, malaria blood surveys and mass drug administration. Methods: We investigated the CE approach through ethnographic and key-informant unstructured interviews as well as focus group discussions and participant observation with program participants METF team members. Interview transcripts were analysed manually applying inductive content analysis. Results: In the context of the Thai-Myanmar border, CE had two main dimensions: The first was to enable the politically sensitive entry of the program into intervention areas, the second was to create mutual understanding among the METF team and people from the population and gain trust. For the first, the METF needed to acknowledge, get permission and communicate with a complex landscape of governing actors and leaders. For the second, creating mutual understanding meant to spend time learning about villagers’ lifeworlds and adapting engagement accordingly to create understanding of the program in resonance with these lifeworlds. Gaining trust meant to leverage leadership and build trust through informal “horizontal” engagement and acts of caring. Three key dimensions of villagers’ lifeworlds that appeared most crucial for staff to learn about were: villagers’ experience with the outside world; leadership and governing relationships to villagers: authority and distrust; and their perceived need for malaria care. Conclusions: Successful CE is highly context specific. CE success was based on the adaptability of the approach towards the complex political and socio-cultural contexts of the different areas of the Karen/Kayin State. Hence, CE is not a fixed approach or strategy defined before entering the setting, but constantly evolving based on the encounters with stakeholders and people of the population.

University-Industry Linkage Through Business Incubation

2019 ◽  
pp. 223-244
Author(s):  
Dinis Caetano ◽  
Miguel T. Preto ◽  
Miguel Amaral
Keyword(s):  
Positive Impact ◽  
Participant Observation ◽  
Primary Data ◽  
Structured Interviews ◽  
Team Members ◽  
Management Board ◽  
Top Managers ◽  
The University

This chapter focuses on the role played by business incubators in developing and facilitating knowledge transfer, networks, and business support to tenant firms through a sustainable ecosystem. The authors conduct an in-depth qualitative case-study of one tech-based business incubator in Portugal—IPN, created in 1991 by the University of Coimbra—to provide insight on how the incubator's direction/management board and a group of incubatees perceive incubation and its impact. Primary data was collected via participant observation/focus group involving the incubators' CEO and six team members. Semi-structured interviews were carried out among the CEOs and top managers from 11 companies supported by IPN whether as (1) incubates, (2) under acceleration, and (3) graduates. Results show a positive impact of incubation on internationalization and growth for incubatees and companies under acceleration. However, there is a need for new post-incubation follow-up mechanisms and a normative context promoting richer interactions with graduates.

Can coverage of schistosomiasis and soil transmitted helminthiasis control programmes targeting school-aged children be improved? New approaches

Parasitology ◽  
2009 ◽  
Vol 136 (13) ◽  
pp. 1781-1788 ◽  
Author(s):  
K. MASSA ◽  
A. OLSEN ◽  
A. SHESHE ◽  
R. NTAKAMULENGA ◽  
B. NDAWI ◽  
...  
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Treatment Approach ◽  
Similar Treatment ◽  
Treatment Coverage ◽  
School Aged Children ◽  
School Based ◽  
Control Programmes ◽  
Soil Transmitted Helminthiasis

SUMMARYControl programmes generally use a school-based strategy of mass drug administration to reduce morbidity of schistosomiasis and soil-transmitted helminthiasis (STH) in school-aged populations. The success of school-based programmes depends on treatment coverage. The community-directed treatment (ComDT) approach has been implemented in the control of onchocerciasis and lymphatic filariasis in Africa and improves treatment coverage. This study compared the treatment coverage between the ComDT approach and the school-based treatment approach, where non-enrolled school-aged children were invited for treatment, in the control of schistosomiasis and STH among enrolled and non-enrolled school-aged children. Coverage during the first treatment round among enrolled children was similar for the two approaches (ComDT: 80·3% versus school: 82·1%, P=0·072). However, for the non-enrolled children the ComDT approach achieved a significantly higher coverage than the school-based approach (80·0 versus 59·2%, P<0·001). Similar treatment coverage levels were attained at the second treatment round. Again, equal levels of treatment coverage were found between the two approaches for the enrolled school-aged children, while the ComDT approach achieved a significantly higher coverage in the non-enrolled children. The results of this study showed that the ComDT approach can obtain significantly higher treatment coverage among the non-enrolled school-aged children compared to the school-based treatment approach for the control of schistosomiasis and STH.

scholarly journals The promise, problems and pitfalls of mass drug administration for malaria elimination: a qualitative study with scientists and policymakers

2018 ◽  
Vol 11 (3) ◽  
pp. 166-176 ◽  
Author(s):  
Nils Kaehler ◽  
Bipin Adhikari ◽  
Phaik Yeong Cheah ◽  
Nicholas P J Day ◽  
Daniel H Paris ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Elimination ◽  
Artemisinin Resistance ◽  
Malaria Prevention ◽  
Evidence Base ◽  
World Health ◽  
Pilot Studies ◽  
Target Populations ◽  
Health Organization

Abstract Background The emergence of artemisinin resistance in the Greater Mekong Subregion (GMS) has prompted urgent containment measures. One possible approach is mass drug administration (MDA). This article explores attitudes towards and perceptions of MDA for malaria elimination among policymakers and leading malariologists. Methods Thirty-two semistructured interviews (SSI) were conducted with policymakers (n=17) and principal investigators (n=15) selected based on their involvement in malaria prevention, control and elimination in the GMS. Interviews were audio recorded and transcribed for qualitative content (thematic) analysis using NVivo (QSR International, Doncaster, Victoria, Australia). Results Researchers and policymakers described reluctance and consequently delays to pilot MDA for malaria elimination. Most policymakers and some researchers reported concerns around the evidence base, citing a lack of data on its effectiveness and appropriate target populations. There were also worries about promoting resistance. Other issues included a previous lack of support from the World Health Organization, past MDAs, the remoteness of target populations and challenges explaining the rationale for MDA. Conclusions The complex rationale for MDA for malaria elimination, mistaking pilot studies for implementation, past experiences with MDA, difficulties in selecting appropriate sites and the WHO’s lack of clear backing undermined the support for MDA for malaria elimination.

Sign in / Sign up

Export Citation Format

Share Document