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In 2011 the Help Ethiopia Address the Low TB Performance (HEAL TB) Project used WHO or national TB indicators as standards of care (SOC) for baseline assessment, progress monitoring, gap identification, assessment of health workers’ capacity-building needs, and data quality assurance. In this analysis we present results from 10 zones (of 28) in which 1,165 health facilities were supported from 2011 through 2015. The improvement in the median composite score of 13 selected major indicators (out of 22) over four years was significant. The proportion of health facilities with 100% data accuracy for all forms of TB was 55.1% at baseline and reached 96.5%. In terms of program performance, the TB cure rate improved from 71% to 91.1%, while the treatment success rate increased from 88% to 95.3%. In the laboratory area, where there was previously no external quality assurance (EQA) for sputum microscopy, 1,165 health facilities now have quarterly EQA, and 96.1% of the facilities achieved a ≥ 95% concordance rate in blinded rechecking. The SOC approach for supervision was effective for measuring progress, enhancing quality of services, identifying capacity needs, and serving as a mentorship and an operational research tool.

Between December 2014 and September 2016, we conducted a prospective cohort study in eight health facilities in Ethiopia. Eligibility criteria included age 3 months-14 years; being on ART for not more than a month. Of 309 children, 304 were included, 52% were male. During 287.7 person-years of observation (PYO), 24 attritions were recorded, yielding an attrition rate of 8.3 per 100 PYO. Younger children, those from rural areas, and children with anaemia were at higher risk of attrition, especially during the early months of treatment, and therefore should be prioritized during treatment follow-up.

This was a retrospective study of TB data for Kampala City for the period 2011–2015. We extracted data from the TB registers in the 52 diagnostic and treatment units in Kampala. We report on data for children 0 to 14 years. We accessed 33,221 TB patient records, of which 2,333 (7%) were children. The proportion of children with pulmonary TB was 80%. The TB notification rate among children in Kampala City showed a large decline (from 105 to 74 per 100,000) during the period. There was a slight improvement in the treatment success rate among the children.

Clinical monitoring of pediatric HIV treatment remains a major challenge in settings where drug resistance genotyping is not routinely available. As a result, our understanding of drug resistance, and its impact on subsequent therapeutic regimens available in these settings, remains limited. We investigate the prevalence and correlates of HIV-1 drug resistance among 94 participants of the Ethiopia Pediatric HIV Cohort failing first-line combination antiretroviral therapy (cART) using dried blood spot-based genotyping. Overall, 81% (73/90) of successfully genotyped participants harbored resistance mutations. Strikingly, 42% of resistant participants harbored resistance to all four nucleoside reverse transcriptase inhibitors recommended for second-line use in this setting, meaning that there are effectively no remaining cART options for these children. Longer cART duration and prior regimen changes were significantly associated with detection of drug resistance mutations. Replicate genotyping increased the breadth of drug resistance detected in 34% of cases, and thus is recommended for consideration when typing from blood spots. Implementation of timely drug resistance testing and access to newer antiretrovirals and drug classes are urgently needed to guide clinical decision-making and improve outcomes for HIV-infected children on first-line cART in Ethiopia.

Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting and obstructing sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia.

Afghanistan has made remarkable improvements in health indicators since 2005. However, a wide range of barriers prevent rural communities in Afghanistan from accessing tuberculosis (TB) and other health services.

There are more than one million Malawians (HIV prevalence of 10.6%) living with HIV. Nearly 85% of people live in rural or hard-to-reach areas of the country and the sparsely located health facilities are unable to meet their needs.

In 2011, Malawi pioneered an ambitious test-and-treat approach for pregnant and breastfeeding women, known as Option B+. Under this strategy, all HIV-infected pregnant and breastfeeding women are provided with lifelong antiretroviral therapy (ART) regardless of their CD4 count or clinical stage.

In 2008, the USAID Mission invited the Strengthening Pharmaceutical Systems (SPS) Program to provide technical assistance and support to the Government of Afghanistan’s Ministry of Public Health (MoPH) to improve the pharmaceutical system.

Outbreaks can overwhelm weak or fragile health systems that lack the tools, infrastructure, policies, and systems to keep communities healthy and safe. Timely detection, preparedness, and appropriate response are essential for limiting both the loss of human life and crippling political and socio-economic impact of disease outbreaks.

A civil society organisation (CSO) perspective on how UHC can be reached by 2030 Universal Health Coverage 2030 (UHC2030) MSH is the secretariat for the Civil Society Engagement Mechanism of UHC2030, a global movement to build stronger health systems for universal health coverage.

This study compared the yield of TB among contacts of multidrug-resistant tuberculosis (MDR-TB) index cases with that of drug-sensitive TB (DS-TB) index cases in a program setting. The yield of TB among contacts of MDR-TB and DS-TB using GeneXpert was high as compared to population-level prevalence. The likelihood of diagnosing RR (Rifampicin Resistant)-TB among contacts of MDR-TB index cases is higher in comparison with contacts of DS-TB index cases. The use of GeneXpert in DS TB contact investigation has an added advantage of diagnosing RR cases in contrast to using the nationally recommended AFB microscopy for DS TB contact investigation.

Despite the commitment of the Democratic Republic of the Congo (DRC) to expand the family planning method mix and increase access to services, awareness of emergency contraception is low among women, and the method remains underused and poorly integrated in family planning programming. Data from 15 focus group discussions conducted in 2016 among women aged 15–35 were used to examine awareness and perceptions of, and attitudes toward, emergency contraceptives. Emergency contraceptive pills have the potential to address gaps in the family planning method mix in the DRC. Assessing whether women have incomplete or erroneous information about family planning methods can provide better understanding of women's contraceptive choices in low-income countries.

Road traffic injuries (RTIs) are commonly under-reported in low- and-medium-income countries. This study aimed to estimate the number of RTIs and determine the magnitude of under-reporting by traffic police and hospital registries. The police registry captured 14.4% of the estimated number of RTIs and the hospitals captured 60.4%. The estimated number of RTIs was higher than reported by either the police or the hospitals alone. Neither the police nor the hospitals provided accurate data on RTIs, calling for the strengthening of both sources of data.

Building coalitions can amplify stakeholder efforts to carry out effective AMR prevention and control strategies. We have developed and implemented an approach to help local stakeholders kick-start the coalition-building process. The five-step process is to (1) mobilise support, (2) understand the local situation, (3) develop an action plan, (4) implement the plan, and (5) monitor and evaluate. Our experience with the coalition-building approach in Ethiopia, Namibia, Zambia, and with the Ecumenical Pharmaceutical Network shows that coalitions can form in a variety of ways with many different stakeholders, including government, academia, and faith-based organisations, to organise actions to preserve the effectiveness of existing antimicrobials and contain AMR.

We conducted a cross-sectional analysis of 33,744 mother–infant pairs to estimate the use and outcomes of the Malawian programme for the prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). Most women used the Malawian programme for the prevention of MTCT. The risk of MTCT increased if any of the four main steps in the programme were missed.

Challenge TB (CTB) is a global USAID-funded project, working in Afghanistan. CTB/Afghanistan is a five year project effective from January 2015-September 2019. Globally, it is implemented in partnership with MSH, KNCV, WHO, Ministry of Public Health (MoPH)/National Tuberculosis Program (NTP), WHO, JICA, Global Fund and locally, by BPHS implementers.

Technical Highlight Malaria is responsible for about 7% of all deaths in children under five in Madagascar. The USAID Mikolo Project promoted community approaches to prevent and treat malaria by working with health facilities, community health volunteers (CHVs), and families.

We are pleased to share this booklet that summarizes 10 of the best stories we’ve collected from the field. These narratives are a legacy to Madagascar’s health system and for future public health interventions in the country.

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