Evaluation of a city-wide school-located influenza vaccination program in Oakland, California with respect to race and ethnicity: a matched cohort study

Objectives: To evaluate the effectiveness of city-wide school-located influenza vaccination by race/ethnicity from 2014-2018. Methods: We used multivariate matching to pair schools in the intervention district in Oakland, CA with schools in West Contra Costa County, CA, a comparison district. We estimated difference-in-differences (DIDs) in caregiver-reported influenza vaccination coverage and laboratory-confirmed influenza hospitalization incidence. Results: Differences in influenza vaccination coverage in the intervention vs. comparison site were larger among White and Latino students than Asian/Pacific Islander (API), Black, and multiracial students. Concerns about vaccine effectiveness or safety were more common among Black and multiracial caregivers; logistical barriers to vaccination were more common among White, API, and Latinos. In both sites, hospitalization in 2017-18 was higher in Blacks vs. other races/ethnicities. All-age influenza hospitalization incidence was lower in the intervention site vs. comparison site among White/API individuals in 2016-17 and 2017-18 and Black older adults in 2017-18, but not in other groups. Conclusions: SLIV was associated with higher vaccination coverage and lower influenza hospitalization, but associations varied by race/ethnicity. SLIV alone may be insufficient to ensure equitable health outcomes for influenza.

User fees removal and community-based management of undernutrition in Burkina Faso: what effects on children’s nutritional status?

Objective: To examine the effect of an intervention combining user fees removal with community-based management of undernutrition on the nutrition status in children under 5 years of age in Burkina Faso. Design: The study was a non-equivalent control group post-test-only design based on household survey data collected 4 years after the intervention onset in the intervention and comparison districts. Additionally, we used propensity score weighting to achieve balance on covariates between the two districts, followed by logistic multilevel modelling. Setting: Two health districts in the Sahel region. Participants: Totally, 1116 children under 5 years of age residing in 41 intervention communities and 1305 from 51 control communities. Results: When comparing children living in the intervention district to children living in a non-intervention district, we determined no differences in terms of stunting (OR = 1·13; 95 % CI 0·83, 1·54) and wasting (OR = 1·21; 95 % CI 0·90, 1·64), nor in severely wasted (OR = 1·27; 95 % CI 0·79, 2·04) and severely stunted (OR = 0·99; 95 % CI 0·76, 1·26). However, we determined that 3 % of the variance of wasting (95 % CI 1·25, 10·42) and 9·4 % of the variance of stunting (95 % CI 6·45, 13·38) were due to systematic differences between communities of residence. The presence of the intervention in the communities explained 2 % of the community-level variance of stunting and 3 % of the community-level variance of wasting. Conclusions: With the scaling-up of the national free health policy in Africa, we stress the need for rigorous evaluations and the means to measure expected changes in order to better inform health interventions.

Impact of Seasonal Malaria Chemoprevention in Children 5 to 10 Years in Kita and Bafoulabe Districts, Mali.

Background : Seasonal malaria chemoprevention (SMC) is the administration of complete therapeutic courses of antimalarial to all children 3–59 months old during the malaria transmission season. This study measured coverage, impact and cost of adding SMC in children aged 5-10 years. Methods : A non-randomized, pre-post design, with an intervention (Kita) and control (Bafoulabe) district implemented SMC for children 5-10 years old through the health system in 2017 and 2018. SMC implementation consisted of the administration of SP + AQ at monthly intervals in children 5-10 years in July, August, September and October annually. Baseline and endline household surveys were conducted in both districts. Separate surveys to measure adherence and tolerance to treatment occurred annually in the intervention district (200 households) following each of the four treatment rounds. Routine data on malaria cases tested and treated and information on SMC campaign and treatment costs were collected. Results : A total of 310 and 323 children 5 to 10 years were included in Kita and Bafoulabe respectively in the baseline survey in July 2017, plasmodium infection prevalence was comparable in the two districts (p=0.07): 27.7% in the intervention district (Kita) against 21.7% in the comparison district (Bafoulabé). Mild anemia was found in 14.2% of children in Kita vs 10.5% in Bafoulabé. Household survey found 89.1% of SMC coverage rate, child’s mothers were interviewed with 93.3% during the SMC campaign in Kita. The most side effect reported by parents was vomiting with 9.3%. One year after SMC implementation in 5 to 10 years in Kita, three doses coverage was 81.2%, there was a reduction by 40% (OR=0.60, CI:0.41-0.89) of malaria parasite carriage; 21% and 62% reduction of simple malaria and severe malaria prevalence respectively in the pilot district vs control. Mild anemia and severe anemia were comparable in the two districts. The level of malaria molecular resistance rate remains below the threshold. Quintuple mutation (dhfr triple +dhps437+dhps540) remained <5% after intervention in both districts.Conclusion: The SMC strategy contributed to malaria prevention in 5-10 year old children and should be integrated to SMC for children 3-59 months. Keywords : Malaria, Seasonal Malaria Chemoprevention, Sulfadoxine-Pyriméthamine, Amodiaquine, Anemia.

Does training of Health Extension Workers reduce scabies load in district health facilities in rural Ethiopia?

Introduction: In 2017, Ethiopia included scabies management within the responsibility of health extension workers. In Kamba (the intervention district) workers were trained on scabies management. Whereas, in Arba Minch Zuria (the control district) there was no such training. This study assesses whether decentralization of scabies management to communities would reduce the load on health facilities and allow earlier scabies treatment access. Methodology: All individuals presenting with scabies before (January – June 2018) and after (August 2018-January 2019) the introduction of training (July 2018) in Kamba district and the Arba Minch Zuria district were included. We compared between the two districts in the period before and after training, the numbers of scabies cases presenting to health facilities, their demography, clinical characteristics and treatment. Results: There were 1,891 scabies cases in the intervention district and 809 in the control district. Scabies cases declined in the intervention district from 7.6 to 1.6 per 1,000 population (a 4.8-fold reduction). In the control district, scabies cases increased from 1.3 to 2.4 per 1,000 population (a 1.8-fold increase). In intervention district, the proportion of scabies patients with secondary skin infections reduced from 1,227 (78%, n = 1,565) to 156 (48%, n = 326, P < 0.001). In the control district the difference was insignificant 39 (14%, n = 288) to 86 (17%, n = 521, P = 0.2). Conclusions: Introducing trained health extension workers at community level were associated with reductions in health facility load for scabies and secondary infections. This is a wider community health benefit.

Effectiveness of the Communities Care programme on change in social norms associated with gender-based violence (GBV) with residents in intervention compared with control districts in Mogadishu, Somalia

ObjectiveDetermine the effectiveness of the Communities Care programme (CCP) on change in harmful social norms associated with gender-based violence (GBV) and confidence in provision of services with residents in intervention compared with control district. We hypothesised that residents in the intervention district would report a decrease in support for harmful social norms and increase in confidence in services in comparison with control district.SettingThe study was conducted in Mogadishu, Somalia.ParticipantsIn the intervention district, 192 community members (50% women) completed baseline surveys with 163 (84.9%) retained at endline. In the control district, 195 community members (50% women) completed baseline surveys with 167 (85.6%) retained at endline.InterventionCCP uses facilitated dialogues with community members to catalyse GBV prevention actions and provides training to diverse sectors to strengthen response services for GBV survivors.ResultsResidents in the intervention district had significantly greater improvement in change in social norms: (1) response to sexual violence (b=−0.214, p=0.041); (2) protecting family honour (b=−0.558, p<0.001); and (3) husband’s right to use violence (b=−0.309, p=0.003) compared with control district participants. The greatest change was seen in the norm of ‘protecting family honour’ with a Cohen’s d effect size (ES) of 0.70, followed by the norm ‘husband’s right to use violence’ (ES=0.38), and then the norm of ‘response to sexual violence’ (ES=0.28). Residents in intervention district had a significantly greater increase in confidence in provision of GBV services across diverse sectors than the control district (b=0.318, p<0.001) with an associated effect size of 0.67. There were no significant differences between residents in intervention and control districts on change in personal beliefs on the norms.ConclusionThe evaluation showed the promise of CCP in changing harmful social norms associated with GBV and increasing confidence in provision of services in a complex humanitarian setting.

Knowledge, attitude, and practices: assessing community based health care interventions in urban setting

Background: The urban community based Maternal, and Child Health-MCH interventions were implemented in district one of Kabul city from 2013 to 2016. The study intended to assess the changes in mothers’ knowledge, behaviors and practices toward proportions of birth spacing, Ante Natal Care-ANC visits, vaccinations and health care utilization to estimate interventions success.Methods: To measure the success of implemented interventions, the data were collected from the intervention and the control districts. The district two was selected as control as it had similar demographic characteristics to district one. Semi structured interviews were conducted with randomly selected 341 mothers in district one and 341 mothers from district two.Results: The proportions of mothers who ever wished to utilize a contraceptive method, practiced birth spacing, knowledge about the date that the baby was expected to arrive, preference to give birth in a health facility and completion of all ANC visits were significantly higher in intervention district. Additionally, the proportions of under five children who did not complete all scheduled routine vaccinations were lower in intervention district. It is likely, that implemented interventions have contributed to improve MCH knowledge, attitude and practices in intervention district.Conclusions: The result of study imply that interventions contributed to the increase in mothers’ knowledge and attitude about birth spacing. The interventions have also improved the level of knowledge about expected date of delivery and attitude to prefer giving birth in health facility. While, there is still room for improvement as almost half eligible children in intervention district did not complete all scheduled vaccinations.