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The aim of the present study was to indentify the epidemiological factors of drug-resistant (DR TB) patients in the northern part of Bangladesh. A cross-sectional study was conducted of registered DR TB patients at two chest diseases hospitals. The present study demonstrated that males (68.9%) were more affected by DR TB than females (31.8%).This study suggested that sex, age, type of treatment, residence, education and smoking status were important factors for getting MDR TB. It is expected that this study can help government to take activities for controlling and prevent MDR TB disease.

We assessed a participatory community and health system intervention to reduce the prevalence of disrespect and abuse during childbirth in Tanzania. After implementation of the combined intervention, the likelihood of women’s reports of disrespectful treatment during childbirth was substantially reduced. These results were observed nearly 1 year after the end of the project’s facilitation of implementation, indicating the potential for sustainability. The results indicate that a participatory community and health system intervention designed to tackle disrespect and abuse by changing the norms and standards of care is a potential strategy to improve the treatment of women during childbirth at health facilities.

TB data for 2015 were combined with cost data using a simple type of cost-benefit analysis in a decision tree model to show the economic burden under different scenarios. In Indonesia, there were an estimated 1, 017,378 new active TB cases in 2015, including multidrug-resistant TB. It is estimated that 417,976 of these cases would be treated and cured, 160,830 would be unsuccessfully treated and would die, 131,571 would be untreated and would achieve cure spontaneously, and 307,000 would be untreated and would die. The total economic burden related to treated and untreated cases would be approximately US$6.9 billion. Loss of productivity due to premature death would be by far the largest element, comprising US$6.0 billion (discounted), which represents 86.6% of the total cost. Loss of productivity due to illness would be US$700 million (10.1%), provider medical costs US$156 million (2.2%), and direct non-medical costs incurred by patients and their households US$74 million (1.1%). The economic burden of TB in Indonesia is extremely high. Detecting and treating more cases would result not only in major reductions in suffering but also in economic savings to society.

At the beginning of the HEAL TB project in 2011, culture and drug susceptibility testing (DST) using solid media was available to the program in two regions to detect drug-resistant tuberculosis (DR-TB) and for monitoring treatment response, which made identifying drug- resistance patterns possible and allowed health care workers to provide more appropriate drug treatment for DR-TB patients.

In Bangladesh tea and rubber garden workers and indigenous communities live in isolated areas with difficulties to access government health facilities. In addition, the level of poverty of some of these groups put them at risk of getting TB.

GeneXpert has revolutionized the diagnosis of tuberculosis (TB) and drug resistant TB (DR-TB) by effectively detecting M. tuberculosis in clinical specimens and RMP resistance in less than two hours without sophisticated laboratories. This enables patients to begin treatment for rifampicin resistant TB on the same day, rather than after several months of ineffective treatment.

The e-TB Manager was used for drug resistant TB case management from 2010. The number of active DR-TB cases being managed in the system increased from 23 in 2010 to 1,037 in 2016.

Together with Borena and Guji zonal health department and the Oromia Regional Health Bureau (RHB), MSH, through the HEAL TB project (December 2015-June 2016) and now through Challenge TB (December 2016-present), identified six districts within the mining areas. Six woreda coordinators were trained and deployed to coordinate case finding and treatment observation.

To determine if children presenting without complaints related to the Integrated Management of Childhood Illness (IMCI) are at greater risk for suboptimal screening for IMCI conditions, we randomly sampled and observed 3072 sick child visits in 33 provinces of Afghanistan. The study indicated that children with non-IMCI complaints are at greater risk of suboptimal screening compared to children with IMCI-related complaints. We concluded that facility and provider capacity needs to be improved, particularly during training, supervision and guideline dissemination, to ensure that all children receive routine screening for common IMCI conditions.

We implemented a group randomized controlled trial in 24 reproductive and child health clinics in eight districts in Mbeya region. Three months pre-intervention, we identified 1924 and 1226 patients established on antiretroviral therapy for six months or more in intervention and control clinics, respectively, of whom 83.4% and 86.9% had one or more post-intervention visits. The unadjusted rate of missed visits declined from 36.5% to 34.4% in intervention clinics and increased from 38.9% to 45.5% in control clinics following the intervention. Interrupted time series analyses demonstrated a net decrease of 13.7% (95% CI [-15.4,-12.1]) for missed visits at six months post-intervention. Similar differential changes were observed for visits missed by 3, 7, 15, or 60 days. Appointment-tracking and community outreach significantly improved appointment-keeping for women on antiretroviral therapy. The facility staff controlled their workload better, identified missing patients rapidly, and worked with existing community organizations. There is now enough evidence to scale up this approach to all antiretroviral therapy and Option B+ reproductive and child health clinics in Tanzania as well as to evaluate the intervention in medical clinics that treat other chronic health conditions.

Uganda’s Ministry of Health in 2012 implemented a comprehensive strategy (SPARS) to build medicines management capacity in public sector health facilities. The approach includes supportive supervision. This structured observational study assesses supportive supervision competency among medicines management supervisors (MMS). The study used structured observations of two groups of five purposely selected MMS—one group supervising facilities with greater medicines management improvement during one year of SPARS and one group with less improvement, based on quantitative metrics. Our results suggest that MMS’ supportive supervision competency is positively related to the SPARS effectiveness scores of the facilities they supervise. We recommend strategies to strengthen supportive supervision behaviors and skills.

MSH has 10 TENs composed of approximately 600 members from 45 countries. Over two-thirds of members are based in field-based projects supported by MSH. Each TEN is focused on a technical area, such as reproductive, maternal, newborn, and child health, HIV/AIDS, and tuberculosis; a health systems function, such as leadership and governance, health care finance, and human resources for health; or cross-cutting topics, such as gender, youth, monitoring and evaluation, and country operations. A review of the literature, development of an operational framework, assessment, and analysis with case examples provide important insights into how the TENs can be used to collaborate with peers around the world and add value to the agency’s mission and vision. MSH now can identify which TENs are ready to be pushed to the next level of functionality to meet MSH’s evolving performance and learning priorities.

MSH authors have published a number of journal articles describing the accredited drug seller implementation experience and lessons learned in Tanzania—home of the flagship ADDO program. A new compendium reviews highlights ranging from robust multi-method quantitative to informative qualitative research. 

Due to its link to various complications during and after pregnancy, the prevention of malaria among pregnant women is regarded as an important strategy for reducing mortality and adverse maternal and neonatal health outcomes, such as maternal anemia, low birth weight, and perinatal deaths. 

Due to its link to various complications during and after pregnancy, the prevention of malaria among pregnant women is an important strategy for reducing mortality and adverse maternal and neonatal health outcomes, such as anemia, low birth weight, and newborn death.  

This conceptual framework was designed to show the influence gender has on supervisor-provider relationships, and how this influence could be explored and addressed through programming and research.

This guide was developed as an abbreviated companion to the longer Management Sciences for Health publication Leaders Who Govern, with two main goals: To facilitate finding practical information about specific aspects of good governance

The Pre-service Integration Guide is designed to assist heads of departments and faculty in pre-service health training institutions that train medical, nursing, pharmacy, laboratory and other allied health professionals to successfully introduce practical and action-oriented leadership and management modules into pre-service curricula for their students.

The objective of the NSP is to improve network effectiveness to meet their member’s needs and enhance their long-term sustainability. The content of the program includes: membership and benefits, distributed leadership, network governance, financial systems and sustainability, and communications for resource mobilization.

A Conference on Epidemic Preparedness November 13, 2017 The Joseph B. Martin Conference Center I Harvard Medical School

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

Several recent studies have attempted to measure the prevalence of disrespect and abuse (D&A) of women during childbirth in health facilities. Variations in reported prevalence may be associated with differences in study instruments and data collection methods. This systematic review and comparative analysis of methods aims to aggregate and present lessons learned from published studies that quantified the prevalence of D&A during childbirth.

Emergencies can often directly impact health systems of an affected region or country, especially in resource-constrained areas. Health system recovery following an emergency is a complex and dynamic process. Health system recovery efforts have often been structured around the World Health Organization’s health systems building blocks as demonstrated by the Post-Disaster Needs Assessment. Although this structure is valuable and well known, it can overlook the intricacies of public health systems. We retrospectively examine public health systems recovery, a subset of the larger health system, following the 2010 Haiti earthquake and cholera outbreak, through the lens of the 10 essential public health services. This framework illustrates the comprehensive nature of and helps categorize the activities necessary for a well-functioning public health system and can complement other assessments. Outlining the features of a public health system for recovery in structured manner can also help lay the foundation for sustainable long-term development leading to a more robust and resilient health system.

The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics. Motives for discontinuation reflect findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

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