morbidity control
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2022 ◽  
pp. 1-20
Author(s):  
Soledad Natalia M. Dalisay ◽  
Vicente Y. Belizario ◽  
Joseph Aaron S. Joe ◽  
Carlo R. Lumangaya ◽  
Reginaldo D. Cruz

Abstract Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Periodic Mass Drug Administration (MDA) to at-risk populations is the main strategy for morbidity control of schistosomiasis. Attaining MDA coverage targets is important for the reduction of morbidity and prevention of complications due to the disease, and towards achieving Universal Health Care. The study employed a qualitative case study design. Key informant interviews and focus group discussions were conducted to provide in-depth and situated descriptions of the contexts surrounding the implementation of MDA in two selected villages in known schistosomiasis-endemic provinces in Mindanao in the Philippines. Data analysis was done using the Critical Ecology for Medical Anthropology (CEMA) model coupled with the intersectionality approach. It was found that within various areas in the CEMA model, enabling as well as constraining factors have been encountered in MDA in the study settings. The interplay of income class, geographical location, gender norms and faith-based beliefs may have led to key populations being missed during the conduct of MDA in the study sites. The constraints faced by the target beneficiaries of MDA, as well as programme implementers, must be addressed to enhance service delivery and to control morbidity due to schistosomiasis. Improving compliance with MDA also requires a holistic, integrated approach to addressing barriers to participation, which are shaped by wider socio-political and power structures.


2021 ◽  
Vol 15 (10) ◽  
pp. e0009403
Author(s):  
Andualem Deneke Beyene ◽  
Fikreab Kebede ◽  
Belete Mengistu Mammo ◽  
Biruck Kebede Negash ◽  
Addisalem Mihret ◽  
...  

Background Ethiopia aims to eliminate lymphatic filariasis by 2020, through a dual approach of mass drug administration to interrupt transmission and morbidity control which includes making hydrocele surgery available in all endemic areas. Locating patients requiring surgery, providing high quality surgeries, and following up patients are all formidable challenges for many resource-challenged or difficult-to-reach communities. To date, hydrocele surgery in Ethiopia has only occurred when a patient has the knowledge, time and resources to travel to regional hospitals. Ethiopia tested the novel approach of using a surgical camp, defined as mobilizing, transporting, providing surgery at a static site, and following up of a large cohort of hydrocele patients within a hospital’s catchment area, to address delays in seeking and receiving care. Methodology and results Health extension workers mobilized 252 patients with scrotal swelling from a list of 385 suspected hydrocele cases from seven endemic districts in the region of Beneshangul-Gumuz. Clinical health workers and surgeons confirmed 119 as eligible for surgery. Of 70 additional patients who self-referred, 56 were eligible for surgery. Over a two-week period at a regional hospital, 175 hydrocele excision surgeries were conducted. After discharge three days after surgery, trained clinical health workers followed up with the patients on Day 5, Day 8, Day 14 and 1st-month benchmarks with a randomized follow-up of a selection of patients conducted at 9–12 months. There were no post-operative complications upon discharge at Day 3 and 22, while minor complications occurred (12.6%) between Day 3 and one month. The 9–12 month follow-up found patients self-reported an improvement in quality of life, health and economic status. Conclusion A hydrocele surgery camp was effective at providing a large number of quality surgeries in a short time. Using peripheral health workers to mobilize and follow up patients helped address delays in seeking and receiving quality care. Mainstreaming patient mobilization and follow-up into a community health system could be effective in other countries. The camp’s results also influenced two regions in Ethiopia to change their policies in order to offer free hydrocele surgery (including patient transport, consultation, surgery, diagnostic tests and necessary medications).


2021 ◽  
Vol 15 (6) ◽  
pp. e0009451
Author(s):  
Ryan E. Wiegand ◽  
Fiona M. Fleming ◽  
Anne Straily ◽  
Susan P. Montgomery ◽  
Sake J. de Vlas ◽  
...  

Background Recent research suggests that schistosomiasis targets for morbidity control and elimination as a public health problem could benefit from a reanalysis. These analyses would define evidence-based targets that control programs could use to confidently assert that they had controlled or eliminated schistosomiasis as a public health problem. We estimated how low Schistosoma haematobium infection levels diagnosed by urine filtration in school-age children should be decreased so that microhematuria prevalence was at, or below, a “background” level of morbidity. Methodology Data obtained from school-age children in Burkina Faso, Mali, Niger, Tanzania, and Zambia who participated in schistosomiasis monitoring and evaluation cohorts were reanalyzed before and after initiation of preventive chemotherapy. Bayesian models estimated the infection level prevalence probabilities associated with microhematuria thresholds ≤10%, 13%, or 15%. Principal findings An infection prevalence of 5% could be a sensible target for urogenital schistosomiasis morbidity control in children as microhematuria prevalence was highly likely to be below 10% in all surveys. Targets of 8% and 11% infection prevalence were highly likely to result in microhematuria levels less than 13% and 15%, respectively. By contrast, measuring heavy-intensity infections only achieves these thresholds at impractically low prevalence levels. Conclusions/Significance A target of 5%, 8%, or 11% urogenital schistosomiasis infection prevalence in school-age children could be used to determine whether a geographic area has controlled or eliminated schistosomiasis as a public health problem depending on the local background threshold of microhematuria.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Chuchu Churko ◽  
Mekuria Asnakew Asfaw ◽  
Abayneh Tunje ◽  
Eyayou Girma ◽  
Zerihun Zerdo

Abstract Background Podoconiosis is entirely preventable, non-communicable disease with high potential of elimination. The prevalence of podoconiosis in Ethiopia was 7.45%. One of the pillars for elimination of podoconiosis is morbidity control and management. Therefore, the present study aimed to assess the knowledge, attitude, practices and associated factors of health professionals towards podoconiosis cause, prevention and treatments. Methods Facility based cross-sectional study was conducted. The source population was all health professionals currently working in public health facilities. The final estimated sample size was 349. A pretested self-administrated structured questionnaire was used to collect the data. The data were coded, entered, and cleaned by using Epi.info version7, and analyzed by using SPSS version 20. Result A total of 320 health professionals participated in the study. Sixty eight (23.1%) health professionals had poor knowledge towards podoconiosis. Seventy (21.9%) identified podoconiosis as infectious disease. Profession, address of health facility, service year and attitude of participants were significantly associated with knowledge towards podoconiosis. More than half (56%) had favorable attitude towards podoconiosis patients. Knowledge score (95%CI: 1.389, 4.059, p-value = 0.002) was the independent predictor for attitude status. Very few (11.6%) respondents treated podoconiosis patients. Age group 45 years old and above and training on lymphedema morbidity management and disability prevention were significantly associated with clinical experience in treating affected patients, (AOR = 17.345; 95%CI: 4.62, 65.119) and (AOR = 7.385; 95%CI: 2.5, 21.797), respectively. Conclusion Despite, high percent of good knowledge of health professionals towards podoconiosis, clinical experience of health professionals in treating podoconiosis patients was very low. In-service trainings will be given for health professionals to improve treatment. In podoconiosis endemic districts hygiene supplies and other referencing materials should be made available for podoconiosis case management.


2021 ◽  
Author(s):  
Ling-Ling Wu ◽  
He-Hua Hu ◽  
Xia Zhang ◽  
Xiao-Nong Zhou ◽  
Tie-Wu Jia ◽  
...  

Abstract Background: Under the condition of low epidemic level and limited funding, it is urgent to carry out health economic evaluation on the integrated schistosomiasis control strategy currently implemented in lake region in order to rationally allocate and utilize health resources and maximize benefits. The objective of this study is to provide reference for understanding the effectiveness of the integrated control strategy and adjusting prevention and control strategies or measures. Methods: The investment in schistosomiasis control and disability adjusted life years (DALYs)caused by schistosomiasis were calculated. Incremental cost-effectiveness ratio (ICER) was conducted through calculating the incremental cost of every additional case averted, the incremental cost of every additional DALY averted through implementation of the integrated schistosomiasis control at different control stages in Jiangling County. Results: The total expenditure for schistosomiasis control in Jiangling County from 2009 to 2019 was 607 million Chinese yuan (CNY). The average annual costs for schistosomiasis prevention and control in stages of morbidity control (2009-2012), transmission control (2013-2016), and transmission interruption (2017-2019) were 41.98 million CNY,90.19 million CNY and 26.06 million CNY respectively. The overall disease burden caused by schistosomiasis presented a downward trend. Meanwhile, the disease burden of advanced cases showed an upward trend with the DALY increased from 943.72 to1031.59 person-years. Most disease burden occurred in the age group over 45 years old (especially the elderly over 60 years old). Taking the morbidity control stage as an analysis control, incremental cost-effectiveness analysis (ICEA) showed that the cost increased by 8505.5 CNY and decreased by 2217.6 CNY respectively to avert one additional case in transmission control stage and transmission interruption stage respectively in Jiangling County. Correspondingly, to avert one additional DALY, the cost increased by 73937.6 CNY and decreased by 21508.6 CNY respectively. Conclusions: As the epidemic declines, the integrated prevention and control strategy is more cost-effective. Surveillance and management on elder population should be strengthened to avert higher diseases burden.


2021 ◽  
Author(s):  
Chuchu Churko ◽  
Mekuria Asnakew ◽  
Abayneh Tunje ◽  
Eyayou Girma ◽  
Zerihun Zerdo

Abstract Background: Podoconiosis is entirely preventable, non-communicable disease with high potential of elimination. One of the pillars for elimination of podoconiosis is morbidity control and management. Therefore, the present study was aimed to assess the knowledge, attitude, practices and associated factors of health professionals towards podoconiosis cause, prevention and treatments. Methods: facility based cross-sectional study was conducted. The source population was all health professionals currently working in public health facilities. The final estimated sample size was 349. A pretested self-administrated structured questionnaire was used to collect the data. The data were coded, entered, and cleaned by using Epi.info version7, and analyzed by using SPSS version 20. Result: a total of 320 health professionals were participated in the study. Sixty eight (23.1%) health professionals had poor knowledge towards podoconiosis. Seventy (21.9%) responded as podoconiosis is infectious disease. Profession, address of health facility, service year and attitude of participants became significantly associated with knowledge towards podoconiosis. More than half (56%) had favorable attitude towards podoconiosis patients. Knowledge score (95%CI: 1.389, 4.059, p-value= 0.002) was the independent predictor for attitude status. Very few (11.6%) respondents ever treated podoconiosis patients. Age group 45 years old and above and training on LMMDP was significantly associate with practice, (AOR=17.345; 95%CI: 4.62, 65.119) and (AOR=7.385; 95%CI: 2.5, 21.797), respectively. Conclusion: Despite, high percent of good knowledge and favorable attitude of health professionals towards podoconiosis, practice of study subjects was very low. In-service trainings will be given for health professionals to improve practice. In podoconiosis endemic districts hygiene supplies and other referencing materials should be made available for podoconiosis case management.


2020 ◽  
Vol 14 (11) ◽  
pp. e0008829
Author(s):  
Kumudha Aruldas ◽  
Arianna Rubin Means ◽  
Angelin Titus ◽  
Yesudoss Jacob ◽  
Rajeshkumar Rajendiran ◽  
...  

Current soil-transmitted helminth (STH) programs target morbidity control with school-based deworming. Increasing interest in steering neglected tropical disease (NTD) programmes from morbidity control towards disease elimination has prompted evaluation of strategies that may interrupt transmission. The feasibility of interrupting transmission of STH with community-wide deworming is being tested in the ongoing DeWorm3 cluster randomized trial. Gender-based perspectives about susceptibility to infection and need for treatment have been shown to influence both health-seeking behaviour and health outcomes. We carried out a qualitative study among men and women in the community to understand their knowledge, beliefs, and attitudes about STH infections and community-wide mass drug administration (cMDA). Eight semi-structured focus group discussions were conducted among men and women residing in the DeWorm3 study site in India—Vellore and Tiruvannamalai districts of Tamil Nadu. Thematic coding was used to analyse the transcripts in ATLAS.ti 8.0. Both men and women in this study demonstrated a high level of STH knowledge but some men had misconceptions that intestinal worms were beneficial. Men and women shared several similar beliefs and attitudes regarding STH treatment. Both believed that adults were likely to have STH infections and both reported that stigma prevented them from seeking treatment. Influenced by gender norms, women were more likely to associate STH infections with inadequate sanitation and hygiene, while men were more likely to believe that those engaged in agricultural work were at risk. Both genders reported a positive attitude towards cMDA for STH. Barriers to cMDA implementation differed by gender; women expressed concern regarding side-effects and drug quality while men were concerned that treatment coverage may be affected due to the absence of people during the day when the drug is distributed. Both men and women perceived the treatment of adults for STH infections to be important, however, the perceived barriers to participating in cMDA differed by gender in this community. The study identified key messages to be incorporated in communication and outreach strategies for cMDA programmes.


2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Klodeta Kura ◽  
Robert J. Hardwick ◽  
James E. Truscott ◽  
Jaspreet Toor ◽  
T. Deirdre Hollingsworth ◽  
...  

Abstract Background Schistosomiasis remains an endemic parasitic disease causing much morbidity and, in some cases, mortality. The World Health Organization (WHO) has outlined strategies and goals to combat the burden of disease caused by schistosomiasis. The first goal is morbidity control, which is defined by achieving less than 5% prevalence of heavy intensity infection in school-aged children (SAC). The second goal is elimination as a public health problem (EPHP), achieved when the prevalence of heavy intensity infection in SAC is reduced to less than 1%. Mass drug administration (MDA) of praziquantel is the main strategy for control. However, there is limited availability of praziquantel, particularly in Africa where there is high prevalence of infection. It is therefore important to explore whether the WHO goals can be achieved using the current guidelines for treatment based on targeting SAC and, in some cases, adults. Previous modelling work has largely focused on Schistosoma mansoni, which in advance cases can cause liver and spleen enlargement. There has been much less modelling of the transmission of Schistosoma haematobium, which in severe cases can cause kidney damage and bladder cancer. This lack of modelling has largely been driven by limited data availability and challenges in interpreting these data. Results In this paper, using an individual-based stochastic model and age-intensity profiles of S. haematobium from two different communities, we calculate the probability of achieving the morbidity and EPHP goals within 15 years of treatment under the current WHO treatment guidelines. We find that targeting SAC only can achieve the morbidity goal for all transmission settings, regardless of the burden of infection in adults. The EPHP goal can be achieved in low transmission settings, but in some moderate to high settings community-wide treatment is needed. Conclusions We show that the key determinants of achieving the WHO goals are the precise form of the age-intensity of infection profile and the baseline SAC prevalence. Additionally, we find that the higher the burden of infection in adults, the higher the chances that adults need to be included in the treatment programme to achieve EPHP.


Author(s):  
Parthasarathi Ramanathan ◽  
Ram Prabhakar ◽  
Velmurugan Anbu Ananthan

Background: The psychological and social stigma associated with lymphatic filariasis can adversely affect productivity and quality of life. This study was carried out to assess the perception of social stigma among patients with lymphatic filariasis.Methods: A hospital based cross sectional study was done on 30 subjects with lymphatic filariasis who attended a filariasis morbidity control clinic in Tamil Nadu. Data was collected using a locally adopted, pilot tested interviewer administered questionnaire derived from explanatory model interview catalogue community stigma scale (EMIC-CSS).  Patients were categorized into none, mild, moderate and severe levels of social stigma based on their responses for questions related to stigma assessment. Data was analyzed using Epi-Info. Quantitative variables were presented as mean with standard deviation. Qualitative variables were presented as frequency with proportion. Results: Majority of the study subjects were males (60%), Hindu by religion (73.3%) and belonged to nuclear family (73.3%). The mean age (±SD) was 47 (±10.9) years. 66.7% of subjects were aged between 46-50 years. Majority (60%) of subjects had mild stigma. 13% had moderate while 3% had severe stigma. 23% of subjects had no stigma. Conclusions: 87% of this study subjects had perceived the social stigma towards lymphatic filariasis. Hence, apart from prevention and treatment measures for filariasis, importance has to be given in context of reducing social stigma towards the disease.


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