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From 2011 to 2018, 142,797 bacteriologically confirmed TB cases were diagnosed in Afghanistan. The number of household members eligible for screening was estimated to be 856,782, of whom 586,292 (81%) were screened for TB and 117,643 (20.1%) were found to be presumptive TB cases. Among the cases screened, 10,896 TB cases (all forms) were diagnosed, 54.4% in females. The number needed to screen to diagnose a single case of TB (all forms) was 53.8; the number needed to test was 10.7. Out of all children under five, 101,084 (85.9%) were initiated on IPT, and 69,273 (68.5%) completed treatment. The study concluded that program performance in contact screening in Afghanistan is high, at 81%, and the yield of TB is also high—close to 10 times higher than the national TB incidence rate. IPT initiation and completion rates are also high as compared to those of many other countries but need further improvement, especially for completion.

Evidence on immunization economics is a critical input for country immunization programs, particularly in low- and middle-income countries (LMICs) with government- and donor-funded vaccination programs. This evidence allows programs to budget for current services, plan for new vaccine introduction, and evaluate the efficiency of service delivery strategies.

Management Sciences for Health (MSH) knows that community readiness is key to epidemic prevention, detection and early response.

To assess study feasibility and key implementation outcomes for the Tika Vaani model, a new approach to educate and empower beneficiaries to improve immunization and child health, a cluster-randomized pilot trial was conducted in rural Uttar Pradesh, India, in 2018. A total of 387 households (184 intervention and 203 control) with children aged 0 to 12 months in 26 villages (13 intervention and 13 control) were included and randomized. Interventions used strategies adapted to disadvantaged populations: (1) mobile health (mHealth): entertaining educational audio capsules (edutainment) and voice immunization reminders via mobile phone and (2) face-to-face: community mobilization activities The trial showed that those interventions could strengthen the delivery of immunization and universal primary health care. Social and behavior change communication via mobile phones proved viable and contributed to standardization and scalability. Face-to-face interactions remain necessary to achieve equity and reach, suggesting the need for ongoing health system strengthening to accompany the introduction of communication technologies.

This study in the Amhara and Oromia regions of Ethiopia assessed the outcomes of tuberculosis (TB) treatment among children younger than 15 years. Retrospective data were collected on treatment outcomes and their determinants for children with TB for the cohorts of 2012-2014 enrolled in 40 hospitals and 137 health centers. Chi-square tests, t-tests, and logistic regression were used for the analysis. Of 2,557 children registered, 1,218 (47.6%) had clinically diagnosed pulmonary TB, 1,100 (43%) had extrapulmonary TB, and 277 (8.9%) had bacteriologically confirmed TB. Among all cases, 2,503 (97.9%) were newly diagnosed and 178 (7%) were HIV positive. Two-thirds of the children received directly observed treatment (DOT) in health centers and the remaining one-third, in hospitals. The treatment success rate (TSR) was 92.2%, and the death rate was 2.8%. The childhood TSR was high compared with those reported in focal studies in Ethiopia, but no national TSR report for children exists for comparison. Multivariate analysis showed that being older-5-9 years and 10-14 years-enrolled in DOT in a health center, and HIV negative were predictors of treatment success, whereas underdosing during the intensive phase of treatment was negatively correlated with treatment success. We recommend more research to determine if intensive monitoring of children with TB, dosage adjustment of anti-TB drugs based on weight changes, and training of health workers on dosage adjustment might improve treatment outcomes.

The Tika Vaani intervention, an initiative to improve basic health knowledge and empower beneficiaries to improve vaccination uptake and child health for underserved rural populations in India, was assessed in a pilot cluster randomized trial. The intervention was delivered through two strategies: mHealth (using mobile phones to send vaccination reminders and audio-based messages) and community mobilization (face-to-face meetings) in rural Indian villages from January to September 2018. We assessed acceptability and implementation fidelity to determine whether the intervention delivered in the pilot trial can be implemented at a larger scale. Findings demonstrated high (86.7%) implementation fidelity. A total of 94% of the target population benefited from the intervention by participating in a face-to-face group meeting or via mobile phone. The participants felt that the strategies were useful means for obtaining information. The clarity of the intervention theory, the motivation, and commitment of the implementers as well as the periodic meetings of the supervisors largely explain the high level of fidelity obtained. Geographic distance, access to a mobile phone, level of education, and gender norms are contextual factors that contributed to heterogeneity in participation. Although the intervention was evaluated in the context of a randomized trial that could explain the high level of fidelity obtained, this evaluation provides confirmatory evidence that the results of the study reflect the underlying theory. The mobile platform coupled with community mobilization was well-received by the participants and could be a useful way to improve health knowledge and change behavior.

The world is facing an unprecedented crisis related to the COVID-19 pandemic with many unknowns, which has led to much confusion and anxiety. Public health measures have for centuries been the cornerstone of the response to epidemics. Among them, physical distancing measures aim to reduce contact between infected and uninfected people. As part of the global COVID-19 response, they have been widely used to slow down the spread of the virus in several countries. Despite their overall acceptance, they have been poorly documented, particularly in Africa, and debates persist on their appropriateness and practicality in the context of low-income countries. This article describes the implementation of these measures in four West-African countries—Mali, Burkina Faso, Senegal and Guinea—and discusses people’s willingness to comply with them. We describe these measures and discuss the importance of considering the socio-cultural, economic and political context to choose the most appropriate and effective measures and propose ways to explore strategies that are potentially better adapted to the African context.

This study was conducted to determine the prevalence of and identify the associated factors of eight or more ANC contacts in Nigeria. We used a nationally representative cross-sectional data from Nigeria Demographic and Health Survey—2018. A total sample of 7,936 women were included in this study. The prevalence of eight or more ANC contacts in Nigeria was approximately 17.4%. Women with at least secondary education were 2.46 times as likely to have eight or more ANC contacts, when compared with women with no formal education. Women who use media were 2.37 times as likely to have eight or more ANC contacts, when compared with women who do not use media. For every unit increase in the time (month) of ANC initiation, there was 53% reduction in the odds of eight or more ANC contacts. Rural women had 60% reduction in the odds of eight or more ANC contacts, when compared with their urban counterparts. Women from North East and North West had 74% and 79% reduction respectively in the odds of eight or more ANC contacts, whereas women from South East, South South and South West were 2.68, 5.00 and 14.22 times respectively as likely to have eight or more ANC contacts when compared with women from North Central. The coverage of eight or more ANC contacts was low and can be influenced by individual-, household-, and community-level factors. There should be concerted efforts to improve maternal socioeconomic status, as well as create awareness among key population for optimal utilization of ANC.

The Philippines has a population of over 90 million people and is one of the 22 highest TB burden countries in the world.To understand the economic cost of non-adherence to TB medicines due to loss to follow up and stock-outs in the Philippines, data were collected on the economic costs of non-adherence to TB medicines and a model was developed to show those costs under different scenarios.The model showed that as many as 1958 and 233 persons are likely to have died as a result of DS-TB and MDR-TB loss to follow up, respectively, and 588 persons are likely to have died as a result of TB medicine stock outs. The related economic impact in each case is likely have been to be as much as US$72.2 million, US$13.4 million and US$21.0 million, respectively. The economic costs of non-adherence to TB medicines due to loss to follow-up and stock-outs represent a significant economic burden for the country and it is likely that the cost of addressing these problems would be much less than this burden and, therefore, a wise investment.

The objective of this study was to measure antimicrobial consumption in Tanzania. From 2017 to 2019, data on all antimicrobials imported into Tanzania were obtained from the Tanzania Medicines and Medical Devices Authority Data, augmented with purchasing data from the Medical Stores Department and data from local manufacturers. Data were collected and analyzed in accordance with the World Health Organization Anatomical Therapeutic Chemical and defined daily doses (DDD) methodology. The average DDD per 1,000 inhabitants per day (DDD/1,000/D) for all antimicrobials was 80.8 ± 39.35. The DDD/1,000/D declined from 136.41 in 2017 to 54.98 in 2018 and 51.02 in 2019. Doxycycline, amoxicillin, and trimethoprim-sulfamethoxazole were the most frequently consumed antibiotics during these years, accounting for 20.01, 16.75, and 12.42 DDD/1,000/D, respectively. The majority of antimicrobial consumption in Tanzania occurred in the private sector, with the proportion of private-sector antibiotic consumption increasing annually from 2017 to 2019. The private sector use of antimicrobials is significantly increasing and should be carefully monitored in accordance with national policies. Future work is necessary to increase reporting of antimicrobial consumption patterns in sub-Saharan Africa.

The Organizational Capacity Assessment Tool can be utilized for the development of baseline and periodic capacity assessments of an organization, helping users to measure how an organization’s capacity changes over time.

The International Medical Products Price Guide (formerly International Drug Price Indicator Guide) contains a spectrum of prices from pharmaceutical suppliers, international development organizations, and government agencies.

Funded by PEPFAR through the US Centers for Disease Control and Prevention (CDC) and implemented by Management Sciences for Health, the Technical Support Services Project (TSSP) worked with the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children (MoHCDGEC) to finalize the National Health Workforce Allocation Optimization (WAO) tool.

The USAID-funded Strengthening Supply Chain Systems (SSCS) supports Uganda’s efforts to strengthen its health supply chain to increase availability of and access to safe, quality-assured essential medicines and health supplies (EMHS) in public and private nonprofit health facilities.

The three-year Care and Treatment for Sustained Support (CaTSS) project was implemented by MSH in close partnership with the Government of Nigeria and local partners.

The Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) is implementing a digital information strategy to improve health system planning and decision making in Tanzania.The MoHCDGEC, in collaboration with the World Health Organization (WHO) and the Technical Support Services Project (TSSP), identified the need for a national health cross-cutting dashboard in January

Forecasting Consumption of Select Reproductive, Maternal, Newborn and Child Health CommoditiesThis guide will assist program managers, service providers, and technical experts when conducting a quantification of commodity needs for the 13 reproductive, maternal, newborn, and child health commodities prioritized by the UN Commission on Life-Saving Commodities for Women and Children.These 13 commodi

The USAID-funded Integrated Health Services Activity (IHSA) is a five-year project implemented in Benin.

The USAID-funded Integrated Health Services Activity (IHSA) is a five-year project implemented in Benin.

PurposeTo assist organizations to map the development of key management components and use these results for planning improvements and monitoring progress.DescriptionThe Management and Organizational Sustainability Tool (MOST) is a structured, participatory process that allows organizations to assess their own management performance, develop a concrete action plan for improvement and carry out the

In order to fight against future epidemics, the world must take action to prevent, detect, and respond to infectious disease outbreaks.  

The Rwandan Ministry of Health partnered with the Integrated Health Systems Strengthening Project (IHSSP) to strengthen and coordinate its health information system. In 2009, when IHSSP was launched, the ministry had multiple systems to gather data from the country’s health services, but the systems used to aggregate and analyze the information were weak and were not interoperable.

This training guide and these tools were created as part of the USAID STOP AI project to help local leaders prepare their communities to respond to widespread disease outbreaks.Facilitator Guide (PDF, 4.8 MB)Pandemic Toolkit (PDF, 9.4 MB)Template Plan (PDF, 1.9 MB)Tool 2: Presentation: Understanding the Threat of an Influenza Pandemic (PPT, 1.5 MB)Tool 3: Health Impact Projection Tool (XLS, 1.2 MB

Purpose:To assist family planing supervisors to evaluate and improve family planning supervision and services.Description:This tool is a computerized instrument for supervisors of family planning services to assess the facility and personnel readiness to provide family planning.

In response to demand from public and private health care organizations for cost-effective, practical, and accessible leadership and management development, Management Sciences for Health (MSH) designed the Virtual Leadership Development Program (VLDP) in 2002.

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