Country operational research priorities pending.
Formative: To what extent do individuals have quality of life and access to and utilize MMDP services within the healthcare system; and what are the barriers and facilitators (affordability, availability, approachability, acceptability, and appropriateness) of 1) access to and utilization of quality MMDP healthcare services and 2) management of morbidities at home?
Intervention: What is the effect of an integrated health system approach on access to MMDP healthcare services as measured by affordability, accessibility, acceptability, and availability; and on utilization of services and quality of life?
A pilot study to identify meaningful and measurable targets for detecting the control of schistosomiasis-related morbidity in Africa. The overall study is designed to answer the following primary evaluation questions:
- What are the infection levels of Schistosoma mansoni and S. haematobium below which there is little, or no, detectable schistosomiasis-associated morbidity?
- What are the optimal morbidity markers for S. mansoni and S. haematobium?
- What are the optimal species-specific morbidity goals for which schistosomiasis control programs should be aiming?
Coverage Evaluation Survey
Is coverage, or a combination of coverage and systematic non-compliance, more effective than a diagnostic tool at predicting when it is safe to stop triple drug therapy?
Supervisor's Coverage Tool
Is the use of the SCT during IDA feasible to implement at the sub-county scale and does it lead to increased coverage?
Would the same programmatic decisions for Oncho Elimination Mapping be made based off of the Ov16 rapid diagnostic test results as compared to the Ov16 SD ELISA results?
- What is the indicator(s) and accompanying M&E strategy that enables country programs to determine when the risk of ongoing transmission of lymphatic filariasis has been reduced so that triple drug therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) can be stopped with little risk of resurgence of transmission?
- Can the use of a tailored social mobilization package be used to strengthen community and health system participation and achieve >80% coverage for IDA in Kenya?
Main objectives are firstly to identify and understand better the factors behind low and unequal MDA coverage and compliance in trachoma endemic areas in Tanzania and Kenya with nomadic populations, secondly to prioritize factors in terms of amenability to intervention. The researcher will then use the evidence generated to design specific interventions that could improve the reach and impact of campaigns of Zithromax MDA in both countries. While there are contextual differences between nomadic societies throughout Africa, research among the Masai in Tanzania and Kenya should inform programme services in other settings with nomadic populations. Particular attention will be given to gender-sensitivity; that is, interventions that will improve access and use by women as well as men.
To assess the socio-economic factors contributing to low access to MDA, to identify the existing health services opportunities and other outlets specific to various socio-economic groups that could be used for improving access to MDA, and to develop feasible field-applicable strategies that can be used to reach groups with consistently low access to MDA.
To assess the programmatic feasibility of and determine the most appropriate age group and sample strategy for an onchocerciasis mapping survey for ivermectin-naïve areas.
The TUMIKIA Project aims to determine whether combining school- and community-based deworming is more effective at controling and eliminating soil-transmitted helminths (STH or intestinal worms) in Kenya than school-based deworming alone.
The two-year trial will provide the drug albendazole to all residents from 150 communities in Kwale County, Kenya. There are three study groups:
- Base: annual school-based deworming (ages 2-14)
- Increased coverage: annual school- and community-based deworming (ages 2-99)
- Increased coverage and frequency: bi-annual school- and community-based deworming (ages 2-99)
TUMIKIA stands for 'Tuangamize Minyoo Kenya Imarisha Afya,' which means “eradicate worms in Kenya to improve health,” in Swahili.
- To use the Supervisor's Coverage Tool (SCT) to monitor school-based deworming;
- To determine the feasibility of utilizing the Lot Quality Assurance Sampling (LQAS) methodology in a school-based SCT; and
- To apply a checklist in schools to elicit information about the performance of the MDA.
While the Supervisor’s Coverage Tool (SCT), a rapid in-process monitoring tool for improving mass drug administration (MDA) coverage, has been approved by WHO for use in communities, questions still remain about its utility for school-based sampling. As a result, the SCT was implemented in 20 randomly selected schools in each of six sub-counties (used as Supervision Areas) in three Kenyan counties in March 2017. A total of 120 students were selected and interviewed.
Findings and lessons learned:
- The coverage for albendazole was classified as “good”, meaning above the WHO threshold, in 5 of the 6 SAs; however, only 1 SA was classified as having “good” coverage for praziquantel. In 3 of the 6 SAs, the Praziquantel coverage was classified as “inadequate”, including an SA that did not receive a supply of praziquantel to distribute.
- The most common reasons for not swallowing the drugs were students’ absences and drugs being out of stock or expired. The most common reasons for refusing intake of praziquantel were fear of side effects and religious beliefs, including misinformation coming from teachers to students about beliefs that albendazole was safe for all children, whereas praziquantel was dangerous and only reserved for sick children.
- Some of the challenges during the SCT activity were schools that operated half day, schools that had ongoing examinations, and unforeseen closure of a school on the day of SCT implementation, which made the random selection of students difficult. In addition, when an absent student or a student over 15 years of age (ineligible due to age range) was selected, it resulted in a loss of time since the selection needed to be repeated. Class interruptions to conduct the study were also not welcomed by some schools.
- While implementing the SCT in schools seems efficient compared to community SCT implementation, it is important to make sure that enrolment registers are accurate. Often, teachers at the schools with incomplete registers do not want to be held accountable.
- The cost of the SCT could be greatly reduced by implementing it in a shorter time period of three days instead of five, and with a pair of individuals per SA instead of four. The SCT can easily be integrated into routine supervisory activities as part of the MDA, and it can be conducted immediately after the MDA. It is a feasible activity that should be considered for widespread adoption.
Will providing enhanced MDA at the community level while achieving treatment coverage of 75% or greater in children (5-17) and adults substantially decrease S. mansoni infection in previously identified persistent hot-spot communities?
•What is the influence of social and behavioural incentives on the increase in cost-effective demand for deworming medication among adult population?
•What is the impact of social incentives on take-up and cost-effectiveness of deworming treatment?
•What is the impact of consumption incentives on take-up and cost-effectiveness deworming treatment?
•Can any increase in takeup be attributed to signaling effect wherein individuals are motivated to access treatment in order to demonstrate that they have engaged in pro-social behavior?
Is the multiparallel quantitative polymerase chain reaction technique superior to Kato-Katz microscopy in assessing the intensity and prevalence of soil-transmitted helminth infections in stool?
Preliminary Findings and Lessons Learned
- qPCR was more sensitive than Kato-Katz at detecting Ascaris, Trichuris, and hookworm infections in child fecal samples.
- Very few samples were helminth positive by Kato-Katz microscopy that were not also positive by qPCR, suggesting minimal human classification error during microscopy.
- Duplicate qPCR analysis on ~10% of samples by two separate labs (Smith and KEMRI) showed excellent concordance (97-100% agreement for each helminth species).
- A reanalysis of the effect of a combined water, sanitation, and hand washing (WASH) intervention on child helminth infections with qPCR data compared to Kato-Katz data gave very similar results.
A selected number of 5 villages near Lake Victoria shown to maintain very high levels of infection with S. mansoni following at least three rounds of annual praziquantel chemotherapy will be compared with 5 villages where infection rates have been much more responsive to similar levels of treatment, with respect to the following general considerations and questions:
1) What is the general situation for each village with respect to proximity of water bodies where intensive human contact occurs?
2) For each village, what is the role of each major habitat in transmission, as assessed by three separate techniques: water filtration; use of sentinel mice; and standard snail survey techniques?
To determine the current status of LF using a combination of seroepidemiological tools to determine prevalence of circulating filarial antigen (CFA) and antifilarial antibodies.
Preliminary study findings:
- 2,976 individuals (age: 2 to 100 years) were tested for circulating filariail antigen using the immunochromatographic (ICT) test during daytime visits. Night-time blood samples to detect microfilariae (MF) were requested from those who tested positive via the ICT test.
- Out of the 38 persons found to be positive for LF infection by ICT test, 33 provided a night-time blood sample for examination of MF. Overall, nine individuals were found to be MF positive, with the highest prevalence in Ndau Island.
- The current study suggests that LF transmission may be absent in Taita-Taveta and Tana River counties in coastal Kenya and therefore transmission assessment surveys (TAS) should be considered with a view to stopping MDA. By contrast, evidence for ongoing transmission in Kwale, Kilifi and Lamu counties indicates the need for further MDA rounds in these counties.
- Additionally, the study demonstrated the feasibility of conducting integrated serosurveillance of several infectious diseases of public health interest, as well as levels of seroprotection against vaccine preventable diseases. The findings of the current study underscore the added value of using multiplex antibody measurements to guide and monitor LF elimination efforts.
SCORE Data Collection on Mobile Devises
Cost Studies in SCORE Gaining and Sustaining
POC/CCA tool ongoing studies: Use of testing standards; reader differences; ‘Trace’ result analyses
Screening Tool POC/CCA: PCR comparative studies
POC/CCA screening/mapping tool initial Studies
Snail Control follow-up study of P. clarkii 20 years later
Gaining Control: >25% Prevalence MDA strategies; and subtle morbidity of Cohort; Population genetics, and snail monitoring
MDA strategies: Sustaining control at 10 – 24% prevalence