Background:National tuberculosis(TB)programs increasingly engage with international non-governmental organizations(INGOs),especially to provide TB care in complex settings where community involvement might be required.In Myanmar,however,there is limited data on how such INGO community-based programs are organized and how effective they are.In this study,we describe four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar,and assess their contribution to TB case detection.Methods:We conducted a descriptive study using program data from four INGOs and the National TB Program(NTP)in 2013-2014.For each INGO,we extracted information on its approach and key activities,the number of presumptive TB cases referred and undergoing TB testing,and the number of patients diagnosed with TB and their treatment outcomes.The contribution of INGOs to TB diagnosis in their selected townships was calculated as the proportion of INGO-diagnosed new TB cases out of the total NTP-diagnosed new TB cases in the same townships.Results:All four INGOs implemented community-based TB care in challenging contexts,targeting migrants,post-conflict areas,the urban poor,and other vulnerable populations.Two recruited community volunteers via existing community health volunteers or health structures,one via existing community leaderships,and one directly involved TB infected/affected individuals.Two INGOs compensated volunteers via performance-based financing,and two provided financial and in-kind initiatives.All relied on NTP laboratories for diagnosis and TB drugs,but provided direct observation treatment support and treatment follow-up.A total of 21995 presumptive TB cases were referred for TB diagnosis,with 7383(34%)new TB cases diagnosed and almost all(98%)successfully treated.The four INGOs contributed to the detection of,on average,36%(7383/20663)of the total new TB cases in their respective townships(range:15-52%).Conclusion:Community-based TB care supported by INGOs successfully achieved TB case detec
Background:The China’s 1-3-7 strategy was initiated and extensively adopted in different types of counties(geographic regions)for reporting of malaria cases within 1 day,their confirmation and investigation within 3 days,and the appropriate public health response to prevent further transmission within 7 days.Assessing the level of compliance to the 1-3-7 strategy at the county level is a first step towards determining whether the surveillance and response strategy is happening according to plan.This study assessed if the time-bound targets of the 1-3-7 strategy were being sustained over time.Such information would be useful to improve implementation of the 1-3-7 strategy in China.Methods:This cross-sectional study involved country-wide programmatic data for the period January 1st 2013 to June 30th 2014.Data variables were extracted from the national malaria information system and included socio-demographic information,type of county,date of diagnosis,date of reporting,date of case investigation,case classification(indigenous,or imported,or unknown),focus investigation,date of reactive case detection(RACD),and date of indoor residual spraying(IRS).Summary statistics and proportions were used and comparisons between groups were assessed using the chi-square test.Level of significance was set at a P-value≤0.05.Results:Of a total of 5,688 malaria cases from 731 counties,there were 55(1%)indigenous cases(only in Type 1 and Type 2 counties)and 5,633(99%)imported cases from all types of counties.There was no delay in reporting malaria cases by type of county.In terms of case investigation,97.5%cases were investigated within 3 days with the proportion of delays(1.5%)in type 2 counties,being significantly lower than type 1 counties(4.1%).Regarding active foci,96.4%were treated by RACD and/or IRS.Conclusions:The performance of 1-3-7 strategy was encouraging but identified some challenges that if addressed can further improve implementation.
Shui-Sen ZhouShao-Sen ZhangLi ZhangAafje ECRietveldAndrew RRamsayRony ZachariahKaren BissellRafael Van den BerghZhi-Gui XiaXiao-Nong ZhouRichard ECibulskis
Objective: To improve knowledge and practice of health staff as well as the availability of material resources for diagnosis and management of schistosomiasis in two endemic provinces of DRC(Kinshasa and Bas-Congo).Methods: Structured interviews were performed using questionnaires with staff from 35 healthcare facilities in 9 health zones(HZ) of Kinshasa and 2 HZ in Bas-Congo.Results: Schistosomiasis was reported to be present in all the included HZ.Health staff knew the most important symptoms of schistosomiasis, but advanced symptoms were more accurately reported in Bas-Congo.Knowledge of symptoms related to schistosomiasis such as anemia(P = 0.0 115) and pollakiuria(P = 0.0 260) was statistically different in both two provinces.Kato-Katz technique and urine filtration were unavailable in both provinces.Parasitological diagnosis was mostly performed using the direct smear method.PZQ was available in 70% of the health facilities, all situated in Bas-Congo.Diagnosis and treatment mostly relied on symptoms and cost more in urban area than in rural.Conclusions: Though knowledge on schistosomiasis among health staff appears sufficient, substantial efforts still must be made to improve the availability of diagnostic tools and treatment in the health facilities in DRC.
Background:Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria.As the artemisinin compound is the pillar of effective antimalarial therapies,containing the spread of artemisinin resistance is a national and global priority.The use of insecticide-treated bed nets/long-lasting insecticidal nets(ITNs/LLINs)is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains,and for eventually eliminating malaria.This study aimed at assessing household ownership of,access to,and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures.Methods:Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were analyzed.Based on evidence of artemisinin resistance,Myanmar was divided into tiers 1,2,and 3:townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment(MARC)areas and were compared with tier 3 townships,which were defined as non-MARC areas.The chi-square test was used to compare groups,and the level of significance was set at P≤0.05.Results:Of the 6328 households assessed,97.2%in both MARC and non-MARC areas had at least one bed net(any type),but only 63%of households had ITNs/LLINs.Only 44%of households in MARC areas and 24%in non-MARC areas had adequate numbers of ITNs/LLINs(one ITN/LLIN per two persons,P<0.001).Nearly 44%of household members had access to ITNs/LLINs.Regarding the utilization of ITNs/LLINs,45%of household members used them in MARC areas and 36%used them in non-MARC areas(P<0.001,desired target=100%).Utilization of ITNs/LLINs among children aged below five years and pregnant women(high malaria risk groups)was low,at 44%and 42%,respectively.Conclusions:This study highlights the nationwide shortfalls in the ownership of,access to,and utilization of ITNs/LLINs in Myanmar,which is of particular concern in terms of containing the spread of artemisinin resist
