A research report submitted to faculty of health sciences in partial fulfillment of the requirement for the degree of Master of Science in Epidemiology in the field of implementation science University of the Witwatersrand, Johannesburg. November, 2017. / Background There is a dearth of information about how well this intervention is conducted in communities (implementation fidelity) as fidelity data are not included in routine program data. Therefore, this study measured the implementation fidelity of mass drug administration for onchocerciasis, lymphatic filariasis, and soil transmitted helminthiasis control, described factors affecting it, and determined the relationship between identified factors and implementation fidelity. Methodology A cross sectional survey was conducted in Nassarawa and Gezawa local government areas of Kano State, Nigeria, where a total 348 community directed distributors were interviewed. Scores were calculated by linearly combining responses obtained using Likert scales. Mean and median of implementation fidelity score were computed. Also, the mean of key determinants were calculated. Adjusted and unadjusted general linear regression models were then fitted to determine the relationship between implementation fidelity and identified determinants. Results The mean(SD) implementation fidelity score was 55.39(8.10) and median(IQR) was 56(60 - 49). Minimum implementation fidelity score obtained was 36 and maximum score was 72. The mean(SD) quality of delivery score, intervention complexity score, facilitation strategy score and participant responsiveness score were 16.77(2.74), 11.03(3.04), 8.83(0.99) and 4.62(0.52) respectively. Evidence of association between some factors and implementation fidelity score were found at p < 0.05. They include: intervention complexity (Adj Coef: -0.62(-0.93 to -0.30), iv facilitation strategies (Adj Coef:-1.68(-3.05 to -0.32), participants responsiveness (Adj Coef: 2.99(1.58 to 4.39), knowledge of NTD (Adj Coef: 0.75(0.36 to 1.13), CDD selection by local government staff (Adj Coef: 7.48(2.85 to 12.11), CDD who volunteered (Adj Coef: 8.38(4.59 to 12.16) CDD with formal training in a health-related field (Adj Coef: 7.34(2.61 to 12.07), and CDD participation in other public health activities (Adj Coef: -6.16(-9.49 to -2.83). Conclusion This study demonstrated the feasibility of measuring implementation fidelity of mass drug administration. In addition, key determinants such as intervention complexity and participant responsiveness were found to be important factors affecting implementation fidelity and could be the target of future implementation strategies. / LG2018

Thesis (Dr.P.H.)--Boston University / The recently classified neglected tropical diseases (NTD), -- onchocerciasis, lymphatic filariasis, schistosomiasis, and soil-transmitted helminthiasis -- are all coendemic in Nigeria. The World Health Organization recommended strategy for addressing these diseases is preventive chemotherapy through annual mass drug administration (MDA) with ivermectin, albendazole, and praziquantel. Integrated delivery of these medicines has become the de facto strategy advocated for in the literature as a means of reducing costs through shared resources. Little empirical evidence, however, exists to support this. This paper explores these diseases and the concept of integration in the context of the global strategies for their control. A literature review was conducted using PubMed to identify articles published containing any of the disease names and costs. Of the 2,028 articles returned, only 14 published between 1998 and 2011 met the criteria for review. All costs were adjusted for inflation. Overall, the mean cost of MDA by any means was 0.83 cents. No data comparing separate MDA to integrated MDA were found. To examine this, a model was created comparing MDA programs with similar distribution strategies and targeting similar diseases. Data from separate articles presenting stand alone MDA were combined to give a mean cost of 0.42 cents to deliver two medicines in two rounds. This was compared with articles showing integrated MDA, which gave a mean cost of 0.25 cents to deliver two medicines in a single round. This suggests a cost savings of 40 percent. To verify this, data from a NTD program in Nigeria that transitioned to integrated MDA was examined in detail. In 2008, eight districts received a single round of ivermectin with albendazole followed at least 1 week later by a single round of praziquantel to school-aged children. The following year, a single round of all three drugs was co-administered. The number of treated individuals was essentially unchanged during both years (1,301,864 in 2008 and 1,297,509 in 2009). The total programmatic costs for the MDA, not including drug and overhead costs, reduced by 41% from $123,624 to $72,870, similar to savings seen in the literature review. Cost savings were attributed largely to transportation and personnel costs. Integrated delivery of medicines is recommended for mature programs targeting these diseases.

BACKGROUND: Trachoma is a leading cause of avoidable blindness. Currently, trachoma is endemic in 57 countries, infects approximately 84 million people globally, and continues to threaten over 10 % of the world’s population with the risk of blindness. Caused by the bacteria Chlamydia trachomatis, blindness due to trachoma is caused by repeated eye infection resulting in the inflammation of the upper eyelid eventually leading the upper lid to pull inward scratching and tearing the cornea causing it to become opaque resulting in loss of vision. The World Health Organization recommends eliminating trachoma as a public health problem using the SAFE strategy: Surgery, Antibiotic, Face washing and Environmental control. OBJECTIVES: This review examined the benefits of the added value of water, sanitation, and hygiene education interventions on preventive mass drug administration for trachoma. METHODS: Trials were identified from MEDLINE, PubMed, and LISTA EBSCO databases using a series of search terms. No restrictions were put on study date, location, design, or language of publication. The abstracts were examined from each of the searches, and any abstract describing risk factors, survey results of mass drug administration (MDA), or providing a general overview of trachoma were automatically discarded. Full text of papers including the combined use of key words including SAFE, WASH, intervention, impact, added value, MDA, azithromycin/ Zithromax® were obtained for review. Twelve full texts articles were retrieved all relevant information were placed in a standardized data extraction form. MAIN RESULTS: Three studies met the complete criteria for inclusion. All studies found a significant change in reduction of active trachoma prevalence. One study focused on the added benefit of antibiotic and environmental components on hygiene education delivered by radio. Another trial compared two villages; the control community performed MDA and the surgery while the intervention village added the F and E components. The final study as well focused the added benefit of ‘F’ and ‘E’ on ‘A’. Two of the three studies found this reduction was from the added benefit of face washing ‘F’ and environmental control ‘E’ to antibiotic use. CONCLUSIONS: In order to eliminate blinding trachoma as a public health problem, recurrence of the active form of the disease must be interrupted before repeated scarring leads to trichiasis. The antibiotic component of the SAFE strategy is a quick fix to the immediate problem. The ‘F’ and ‘E’ components are the more sustainable interventions, yet little research has been done on the actual amount of added value the individual ‘A’‘F’&’E’ components have to one another. After thorough review of the articles, articles were found which documented the ‘F’ and ‘E’ components provide significant value to the overall decrease of prevalence of active. However, the limited results of the search suggest more research can better elucidate the ability of the ‘F’ and ‘E’ components to reduce trachoma prevalence and ultimately impact blinding.

abstract: Neglected tropical diseases (NTDs) comprise of diverse communicable diseases that affect mostly the developing economies of the world, the “neglected” populations. The NTDs Visceral Leishmaniasis (VL) and Soil-transmitted Helminthiasis (STH) are among the top contributors of global mortality and/or morbidity. They affect resource-limited regions (poor health-care literacy, infrastructure, etc.) and patients’ treatment behavior is irregular due to the social constraints. Through two case studies, VL in India and STH in Ghana, this work aims to: (i) identify the additional and potential hidden high-risk population and its behaviors critical for improving interventions and surveillance; (ii) develop models with those behaviors to study the role of improved control programs on diseases’ dynamics; (iii) optimize resources for treatment-related interventions. Treatment non-adherence is a less focused (so far) but crucial factor for the hindrance in WHO’s past VL elimination goals. Moreover, treatment non-adherers, hidden from surveillance, lead to high case-underreporting. Dynamical models are developed capturing the role of treatment-related human behaviors (patients’ infectivity, treatment access and non-adherence) on VL dynamics. The results suggest that the average duration of treatment adherence must be increased from currently 10 days to 17 days for a 28-day Miltefosine treatment to eliminate VL. For STH, children are considered as a high-risk group due to their hygiene behaviors leading to higher exposure to contamination. Hence, Ghana, a resource-limited country, currently implements a school-based Mass Drug Administration (sMDA) program only among children. School staff (adults), equally exposed to this high environmental contamination of STH, are largely ignored under the current MDA program. Cost-effective MDA policies were modeled and compared using alternative definitions of “high-risk population”. This work optimized and evaluated how MDA along with the treatment for high-risk adults makes a significant improvement in STH control under the same budget. The criticality of risk-structured modeling depends on the infectivity coefficient being substantially different for the two adult risk groups. This dissertation pioneers in highlighting the cruciality of treatment-related risk groups for NTD-control. It provides novel approaches to quantify relevant metrics and impact of population factors. Compliance with the principles and strategies from this study would require a change in political thinking in the neglected regions in order to achieve persistent NTD-control. / Dissertation/Thesis / Doctoral Dissertation Applied Mathematics for the Life and Social Sciences 2020

Neglected tropical diseases (NTD) in low- and middle-income countries are still not on target per the World Health Organization's (WHO) elimination goal of 2020. Mass drug administration (MDA) is one of the effective strategies supported by the WHO for the control and subsequent elimination of NTD. This quantitative study explored how supply chain logistic capacity may be hampering MDA coverage in countries in which the diseases are endemic. The study examined secondary data from WHO data bank for MDA coverage, to quantify the relationship between supply chain logistics capacity, as measured by the World Bank's logistics performance index (LPIs), and the control of NTD using MDA. The ecological theory of health behavior was the theoretical framework for this study. The research questions explored whether a low- and/or middle-income country's supply chain infrastructure, logistics services, customs and border procedures, and supply chain reliability, predict the coverage of MDA in controlling NTD. A multiple regression model determined the linear relations between each predictor: supply chain infrastructure (H1), logistics services (H2), custom and border procedures (H3), and supply chain reliability (H4) and the control of neglected diseases as determine by MDA. Results indicated that supply chain capacity, custom and border processes, and supply chain reliability are statistically significant in predictors of MDA coverage in the control of NTD in developing countries. This study may enhance social change by improving supply chain capacity for more effective distribution of PCT drugs, thus helping with the elimination of NTDs and improved health outcomes in low- and middle-income countries.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 5 uppsatser.