Other indicator category

Morbidity management for hard to reach populations in insecure areas in Burkina Faso: analysis of barriers and determination of the resilience of the health system

The study aims to identify the most effective approaches for case management and delivery of surgical services for IDPs and migrants suffering from LF and/or trachoma in security compromised areas. Barriers to reaching morbidity patients will be assessed, in addition to determinants of the institutionalizatoin of NTD morbidity management within the national health system. Research aims will be addressed through the following key activities: document review and direct inspection protocols to determine health facilities' ability to provide MMDP services; active case finding including creation of WhatsApp groups and SMS messaging to help keep track of patients and refer them to care; key informant interviews with health workers and community leaders to assess behavior change communication strategies for raising awareness among affected individuals; one-on-one interviews and focus group discussions with patients to understand barriers to care; and stakeholder engagement to increase buy-in and identify ways to operationalize MMDP services within national program.

Countries: Burkina Faso

The Neglected Mind-Skin Link: Promoting mental health and wellbeing of people affected by skin NTDs: Formative piloting of the WHO Guide on Mental Health and NTD Integration

This study is designed as a proof-of-concept to test the feasibility and acceptability of a proposed intervention package outlined in a soon to be published WHO manual on NTDs and mental health. The primary output of this study is to adapt a model of intervention from the soon to be published WHO guide on Mental Health and NTDs. The team aims to achieve this output through:

  • Screening 300 individuals for symptoms of depression and anxiety, refer where necessary, and sample 30 of those individuals for participation in qualitative interviews.
  • Conducting peer-led focus group discussions (separate groups for leprosy and LF) to better understand the needs, priorities, and barriers related to affected individuals’ mental wellbeing and quality of life.
  • Conducting a workshop with health leaders, community health workers, nurses, service users, family/caregivers, and experts to develop a feasible and applicable theory of change that aligns with WHO guidelines.
  • Conducting in depth interviews with key stakeholders to assess the developed model’s feasibility and accessibility Conducting quantitative measures for feasibility and acceptability to assess the stepped-care approach model which involves: improved screening, referral, uptake of service, knowledge uptake following training, and an assessment of whether supervision was carried out. They also plan to triangulate health information data to determine uptake of services.
  • Conducting follow-up FGDs with those 30 individuals after a one-month period to understand their experience with primary health center mental health services.
Countries: Nigeria

Integrating Preventive Treatment for Female Genital Schistosomiasis within the National Health System: a Pilot Study in Cote d’Ivoire

This study aims to integrate screening and preventive treatment with praziquantel for FGS into routine HIV and reproductive health care visits for women. A pilot study will be conducted in four health facilities with a target sample size of 4800 women over a six-month period. Trainings will be conducted for health workers and the team will use a participatory design process with key stakeholders to ensure that barriers to integration in the health system and community participation are addressed. A scale-up report will be written with stakeholder engagement and all training materials that were developed will be instantly available for use in other clinics in Cote d’Ivoire. Delivery of praziquantel to the four facilities in the pilot study will utilize existing drug-procurement and delivery systems to ensure sustainability.

Countries: Cote d'Ivoire
Diseases: Schistosomiasis

Utility of screening easy to access population sub groups as a surveillance tool in monitoring interruption of LF transmission

The question of how to conduct post-elimination surveillance is a high priority for the NTD community, given that most NTD programs scale back or shut down completely once elimination as a public health problem is achieved. Few solutions exist and this proposal provides an interesting and useful case study for surveillance moving forward. The study team plans to target 1708 pregnant women as a proxy for measuring LF resurgence in a post-elimination context. As a comparison group, they plan to conduct a prevalence survey of 427 households (1708 participants) in the same community to compare LF prevalence found in each methodology. Each participant at the health facility’s residence will be geo-referenced to understand the coverage area. They also plan to conduct interviews with patients and health workers, a time-motion study, and a cost analysis to assess the additional burden on health care workers and the health system. The study will occur in 14 facilities in one district of Malawi where LF was highly endemic prior to the launch of the program.

Countries: Malawi

Female Genital Schistosomiasis in rural Madagascar: improving community understanding and promoting integration into primary health care services- FIRM-UP

The study will take place in the context of a larger clinical trial (FIRM-UP) that includes 4000 women affected by schistosomiasis. For the current study, the team will develop the following “work packages” to better understand community awareness of FGS, clinical diagnosis, and how to provide enhanced training:

  • Work Package 1: design and implement a community-based awareness campaign, using community surveys, focus group discussions, and in-depth interviews, to determine uptake and acceptability of FGS services. This will be followed with an end-line survey to assess change in the indicators following the campaign.
  • Work Package 2: establish a diagnostic package with digital colposcopy (using smartphones to capture images) and on-site microscopy.
  • Work Package 3: provide a refresher training for FIRM-UP study workers, organize a colposcopy and digital imaging workshop, and extended training for staff coming from other endemic regions in Madagascar. An open-source learning platform (‘Moodle’) will be developed to exchange training and learning materials.
Countries: Madagascar
Diseases: Schistosomiasis

IMPRESS – Improving access to integrated Morbidity management and disability PREvention Services through Stigma reduction for people with lower limb lymphoedema in Ethiopia: Feasibility and quasi-experimental study (year 2)

  • Formative component: What is the capacity of the integrated morbidity management and disability prevention (MMDP) programme to incorporate a stigma reduction intervention for people with lower limb lymphoedema, and what are the barriers and facilitators to this?
  • Intervention component: Is the stigma reduction intervention effective in increasing demand and access to services within an integrated MMDP programme for people with lower limb lymphoedema?
Countries: Ethiopia

Integration of LF morbidity management and disability prevention (MMDP) into community health services: exploring the coverage and equity of community health worker-driven LF MMDP burden assessment and service uptake in Côte d’Ivoire.

This study will test the reliability of community health worker-led (CHW) MMDP burden estimates by having CHWs first estimate MMDP burden, followed by a rigorous population-based survey to get a representative estimate of MMDP burden for the district. Six months later, these cases will be followed up to see whether they accessed the MMDP services and assess the quality of care. The study will examine the accuracy of the CHW estimates, CHWs’ ability to diagnose properly, social biases of health care workers that may prevent equitable care delivery, and the cost comparison of the CHW method vs. population-based survey. In addition, the team plans to conduct an evaluation of the quality of MMDP service provision, including available psychosocial support, at all facilities in the selected health district. Programs need a feasible and reliable method for coming up with MMDP burden estimates for LF and strategies to ensure that people have access to care and utilize that care. This study addresses the two pillars of WHO dossier development for MMDP and will provide the Ministry of Health with essential information to plan and adapt their program to accommodate MMDP services.

Countries: Cote d'Ivoire

Improving Neglected Tropical Disease (NTD) services and integrating into primary health care in Southern Nations, Nationalities, and Peoples' Region (SNNPR), Ethiopia

This study outlines an important first step to understanding NTD program integration in Ethiopia and builds on previous work in SNNPR. The study team plans to carry out significant formative research to better understand what gaps currently exist in the Ethiopian primary health care system that prevent integration of NTD services. They aim to answer the following questions:

  1. What are the current gaps in the Ethiopian primary health care system for implementing integrated NTD services and how can they be addressed?
  2. What is the community’s perception and awareness of selected NTDs and how can it be improved?

Following the gap analysis, the study team, along with the ministry of health and NTD taskforce of Ethiopia, will develop interventions to address these gaps. Outputs of the intervention stage are expected to include the following: a detailed description of the intervention, including case definitions, roles and responsibilities at the different levels of the health system, data recording and reporting mechanisms, referral systems; training manuals for the different primary healthcare system levels, job aids, guidance for supportive supervision. The team has made extensive plans to address issues of sustainability and scalability of the project including a cost analysis of the interventions, developing close partnerships with health facilities’ procurement departments, and close engagement during budget planning exercises of district health offices.

Countries: Ethiopia

Integrating spatial analysis in mixed methods approach to improve MDA Access by reaching underserved and vulnerable populations of Mali in NTD elimination framework

This mixed methods study plans to focus activities around two kinds of mobile, underserved populations: nomadic pastoralists in the rural district of Tominian and economic migrants and displaced groups from conflict areas in the urban district of Kalabancoro. Activities include:

  1. Quantitative questionnaire with a micro-narrative component. Micro-narratives are an established methodology focused on rapidly collecting qualitative data from a large number of participants
  2. Spatial analysis of study participants
  3. In-depth interviews and focus group discussions with health workers and community/opinion leaders
  4. Integrated analysis of the spatial data with questionnaire and micro-narrative data to better describe trends in the targeted vulnerable populations with respect to accessibility and acceptability of NTD program services

The team aims to combine spatial analysis with qualitative data collection to answer the following research questions:

  1. What are the factors leading to low coverage of MDA within underserved and vulnerable populations in Malian community?
  2. How are underserved and vulnerable populations currently being served by the public health interventions/health system?
  3. How effective and efficient is the ISAMA process for NTDs coverage in underserved and vulnerable populations compared to the current data collection and analysis approach?
  4. What critical factors influence the use of ISAMA approach in data analysis system process?
  5. How are characteristics of low coverage geographically distributed and the factors associated in underserved and vulnerable populations?
  6. Who are the underserved populations and what are their characteristics?
Countries: Mali

Developing an appropriate model of care for lymphatic filariasis and leprosy patients who need MMDP services in Bihar State, India

What is the comparative effect of enhancing the existing MMDP services with or without community-based components in significantly reducing the burden of Acute Attacks (AA), Hydrocele, and Mental Health (MH) issues among people affected by LF?

Countries: India

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