Geneva Health Forum Archive

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GHF2014 – PS34 – Malaria Integration in the Post-MDG Agenda

Malaria Integration in the Post-MDG Agenda
Dr. Susanna Hausmann Muela
Senior Health Advisor, Swiss Agency for Development and Cooperation, Switzerland
Dr. Roset Bahmanyar
Global Programme Head, Malaria and Leprocy, Novartis Foundation for Sustainable Development, Switzerland
Dr. Silvia Ferazzi
Technical Officer, Roll Back Malaria Partnership, Switzerland
Ambassador Laurence Ishengoma
Special High Level Adviser to the Minister for Lands, Housing and Human Settlements Development, United Republic of Tanzania
Dr. Flora L. Kessy
Ifakara Health Institute and Novartis Foundation, Tanzania
Dr. Jacques Mader
Regional Health Advisor, Swiss Agency for Development and Cooperation
Dr. Kaspar Wyss
Head of Unit, Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Switzerland
This session will encourage dialogue on how the global malaria community can integrate with non-health sectors to help eliminate malaria and pave the way for sustainable development. It will offer unique opportunity to discuss effective strategies to integrate with the non-health sector to ultimately free the world of malaria.
View Session Invitation Here

PS34_Susanna_Hausmann_MuelaDr. Susanna Hausmann Muela

Trained as an epidemiologist and medical anthropologist, Susanna has been working over the past 20 years in Global and Public Health. She has done field work on health-seeking behaviour and social science aspects of malaria and neglected diseases.  She has published on vulnerability and access to care. Before joining SDC in 2012, she was a lecturer and senior researcher at Autonomous University of Guerrero in Mexico, where she was involved in a Dengue community engagement project. From 2003-2010, she was Deputy CEO of UBS Optimus Foundation, responsible for its Global Health Research grant strategy.  As a Founding Member of Partners of Applied Social Sciences (PASS) International, Susanna has been teaching Medical Anthropology Applied to Public Health in Antwerp and Glasgow.

Photo: Marion NitschDr. Roset Bahmanyar

Edith Roset Bahmanyar is Global Program Head, Malaria and Leprosy, at the Novartis Foundation for Sustainable Development, working with partners on projects aiming at elimination of these diseases. Edith holds a Diploma and a Doctorate in Medicine from the University of Geneva, Switzerland, with a Board Certification in obstetrics and gynecology. Edith also has a Degree in Tropical Medicine and Hygiene from the Prince Leopold II Institute of Tropical Medicine & Hygiene, Antwerp, Belgium, and a Master in Public Health from the Harvard School of Public Health, Harvard University, MA, USA. Prior to joining the Novartis Foundation in March 2014, Edith was Senior Medical Epidemiologist at GlaxoSmithKline Vaccines, working on large multi country studies in Africa to support the RTS,S/AS malaria vaccine development, and provided epidemiological expertise for other disease areas such as Tuberculosis, HIV, and Neglected Tropical Diseases.  Previously, Edith provided technical expertise to Ministries of Health to scale up HIV programs in sub-Saharan Africa, including in Tanzania with Centers for Diseases Control, and in Lesotho with the Elizabeth Glaser Pediatric AIDS Foundation and SolidarMed.

Silvia_FerazziDr. Silvia Ferazzi

Silvia Ferazzi has been working for some 20 years in humanitarian affairs and development in the UN and WHO and in public-private partnerships.  She started her career as a social policy researcher and activist with a primary interest in health, poverty and gender. Her academic and journalistic work resulted in some 20 publications in Italian and international journals and books. Between 2006 and 2010, she led fundraising activities at the Global Fund to Fight AIDS, Tuberculosis and Malaria and at the Global alliance for Improved Nutrition.

Laurence_IshengomaAmbassador Laurence Ishengoma

Ambassador Laurence Ishengoma is currently the Advisor of the Minister on matters related to water, sanitation, human settlement and environment. Previously, from 1976 to 1984, he held various management positions in the Tanzanian Government. In 1985, he was appointed Trade Counsellor in the Tanzanian Embassy in Tokyo, which subsequently launched his diplomatic career. Between 2005 and 2010, he worked for UN-HABITAT as Special Advisor, inter alia, for the Lake Victoria Water and Sanitation Programme and the Lake Tanganyika Water, Sanitation and Environment Programme, which had a major impact on the health programmes in the region. He represented the organisation in various regional group consultations, including with the Economic Communities of EAC, SADC, and COMESA.

Kessey Profile PhotoDr. Flora L. Kessy

Flora Lucas Kessy, a Senior Lecturer in Development Studies at Mzumbe University, Morogoro Tanzania holds a PhD in Agricultural and Consumer Economics with a major in Family and Consumer Economics and a minor in Women and Gender in Global Perspective from University of Illinois at Urbana Champaign, USA. Dr. Kessy has researched and published on issues related to income and non-income poverty, social sectors development and good governance. In particular, she has researched on poverty reduction strategies in Eastern and Southern Africa, poverty escape routes, covariate and idiosyncratic shocks affecting households in Tanzania and social protection. In the area of governance, she is involved in public expenditure studies for the health sector and water sector and the use of evidence for actions to improve maternal and newborn health.

She has provided services to the Government of Tanzania including leading the team that drafted the second cluster (quality of life and social wellbeing) of the National Strategy for Growth and Reduction of poverty (MKUKUTA). She has also provided consultancy services to national and international organizations on on-social-economic development and project evaluation including the World Bank, Swiss Development Cooperation (SDC), UNFPA, UNICEF, DfID and Gatsby Charitable Foundation among others.

Her major community development intervention is the implementation of the access project which aimed at improving access to effective malaria treatment in two districts in Southern Tanzania using interventions designed to increase household resources for accessing health care and improving quality of health care at health facilities. She has also participated in implementing Water, Hygiene and Sanitation (WASH) action research for people living with HV and AIDS.

Wyss Profile PhotoDr. Kaspar Wyss

Kaspar Wyss is a Public Health Specialist, Associate Professor (PD) and Deputy Head of Department at the Swiss Centre for International Health, Swiss Tropical and Public Health Institute.  Kaspar Wyss has strong management and leadership experience and is in charge of a team of 15 staff focusing on health systems development primarily in low- and middle income countries. Activities relate to both research and health system monitoring and performance assessment and he directs a number of research and implementation projects in Africa, Eastern Europe, and Asia. He has further extensive consultancy experiences for a broad range of clients. For the University of Basel (MSc and medical students) and for other courses including the Swiss Inter-University Master of Public Health Program he teaches on health systems.



Dr. Flora Lucas Kessy

Kessey Profile PhotoDr. Flora Lucas Kessy

Senior Lecturer in Development Studies, Mzumbe University, Dar es Salaam Campus College, Tanzania

Flora Lucas Kessy, a Senior Lecturer in Development Studies at Mzumbe University, Morogoro Tanzania holds a PhD in Agricultural and Consumer Economics with a major in Family and Consumer Economics and a minor in Women and Gender in Global Perspective from University of Illinois at Urbana Champaign, USA. Dr. Kessy has researched and published on issues related to income and non-income poverty, social sectors development and good governance. In particular, she has researched on poverty reduction strategies in Eastern and Southern Africa, poverty escape routes, covariate and idiosyncratic shocks affecting households in Tanzania and social protection. In the area of governance, she is involved in public expenditure studies for the health sector and water sector and the use of evidence for actions to improve maternal and newborn health.

She has provided services to the Government of Tanzania including leading the team that drafted the second cluster (quality of life and social wellbeing) of the National Strategy for Growth and Reduction of poverty (MKUKUTA). She has also provided consultancy services to national and international organizations on on-socil-economic development and project evaluation including the World Bank, Swiss Development Cooperation (SDC), UNFPA, UNICEF, DfID and Gatsby Charitable Foundation among others.

Her major community development intervention is the implementation of the access project which aimed at improving access to effective malaria treatment in two districts in Southern Tanzania using interventions designed to increase household resources for accessing health care and improving quality of health care at health facilities. She has also participated in implementing Water, Hygiene and Sanitation (WASH) action research for people living with HV and AIDS.

Dr. Nicholas Banatvala

Nick Banatvala_squareDr. Nick Banatvala

Senior Adviser to the Assistant Director General, Noncommunicable Diseases and Mental Health, World Health Organization, Switzerland.

Dr. Nick Banatvala is currently Senior Adviser to the Assistant Director General (Noncommunicable Diseases and Mental Health) at WHO in Geneva. Current responsibilities include leading development of a global coordination mechanism for the prevention and control of  NCDs, spearheading a newly set up UN NCD Taskforce and leading WHO’s global training programme to build capacity on NCDs for senior policy makers in middle and low-income countries.

Prior to this, Nick was Head of Global Affairs at the Department of Health in England where he led the development and implementation of the UK Government's first-ever global health strategy, its strategy for working with WHO and DH’s bilateral engagement with emerging economies. Before that, he headed up DFID’s work on global health initiatives and scaling up health services. This included leading on the health inputs for the 2005 G8 Gleneagles communiqué. He has represented the UK on a number of international initiatives, including the Global Fund to Fight AIDS, TB and Malaria and GAVI. Prior to this, Nick worked for DFID on health programmes in Pakistan, Afghanistan and the Middle East. Nick has experience of the NGO sector, having worked with the UK aid agency Merlin on development and humanitarian programmes.

Nick trained in paediatrics and infectious diseases and then did public health and epidemiologic research in the UK and at CDC, Atlanta. Nick has also held senior posts in UK public health. Nick has sat on government, non-government and academic boards, as well as national and international committees. He has undertaken consultancies for a number of agencies including the World Bank.

GHF2014 – PS04 – Integrating Traditional and Alternative Medicine into Health Systems

PS04 TUESDAY, 15 APRIL 2014 ROOM: 18 ICON_Fishbowl
Integrating Traditional and Alternative Medicine into Health Systems
Dr. Edward Kelley
Director, Department of Service Delivery and Safety, World Health Organization, Switzerland
Dr. Bertrand Graz
Geneva University, ISG, Switzerland
Making Heath Care Affordable to Poorest Communities Through Acupuncture: India
Mr. Walter Fischer
Founder and Project Manager, Barefoot Acupuncturists, India
Integrating Ayurveda: Clinical Studies on the Ayurvedic Treatment of Rheumatoid Arthritis Offer New Perspectives
Mr. Olivier Talpain
Associate researcher at the University Institute of History of Medicine and Public Health in Lausanne, Switzerland
Dr. Zhang Qi Coordinator, Traditional Medicine, World Health Organization, Switzerland
Research and integration of traditional/complementary medicines into the health system. The case of malaria in Mali and diabetes in Pacific islands.
Dr. Bertrand Graz

MD, MPH, Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
Across the world, traditional medicine (TM) is either the mainstay of health care delivery or serves as a complement to it. In some countries, traditional medicine or non-conventional medicine may be termed complementary medicine (CM).Starting from specific experience, we will discuss WHO Traditional Medicine Strategy 2014-2023, which states that:"The demand for TM/CM is increasing. Many countries now recognize the need to develop a cohesive and integrative approach to health care that allows governments, health care practitioners and, most importantly, those who use health care services, to access T&CM in a safe, respectful, cost-efficient and effective manner. A global strategy to foster its appropriate integration, regulation and supervision will be useful to countries wishing to develop a proactive policy towards this important - and often vibrant and expanding - part of health care.

Kelley_EDr. Edward Kelley

Dr. Kelley directs the Department of Service Delivery and Safety at the World Health Organization.  In this role, he leads WHO’s efforts at strengthing the safety, quality, integration and people centredness of health services globally and manages WHO’s work in a wide range of programmes, including health services integration and regulation, patient safety and quality, blood safety, injection safety, transplantation, traditional medicine, essential and safe surgery and emerging areas such as mHealth for health services and genomics.  Prior to joining WHO, he served as Director of the U.S. National Healthcare Reports for the U.S. Department of Health and Human Services in the Agency for Healthcare Research and Quality. These reports track levels and changes in the quality of care for the American health-care system at the national and state level, as well as disparities in quality and access across priority populations. Dr. Kelley also directed the 28-country Health Care Quality Improvement (HCQI) Project of the Organization of Economic Cooperation and Development. Formerly, Dr. Kelley served as a Senior Researcher and Quality Assurance Advisor for the USAID-sponsored Quality Assurance Project (QAP) and Partnerships for Health Reform Project Plus (PHRPlus). In these capacities, he worked for ten years in West and North Africa and Latin America, directing research on the Integrated Management of Childhood Illness in Niger. Prior to this, Dr. Kelley directed the international division of a large US-based hospital consulting firm, the Advisory Board Company.  His research focuses on patient safety, quality and organization of health services, metrics and measurement in health services and health systems improvement approaches and policies.

Physician and specialist in public health/international health (MPH from John Hopkins University

Dr. Bertrand Graz

Physician and specialist in public health/international health (MPH from John Hopkins University, today with Lausanne and Geneva universities), Bertrand Graz has been conducting development and research activities in Switzerland and in tropical countries, while keeping clinical activity as well. His doctoral thesis led to the validation of a non-surgical treatment for trachomatous trichiasis in Oman and China. After this, he has been leading many studies on the health effects of local traditional practices, such as  herbal treatments for malaria in Mali and diabetes in Palau, early rice feeding in Laos, Greek-Arab medicine in Mauritania, self-care for dysmenorrhoea in Switzerland. Now he aims at studying the effect of such research process in terms of optimisation of health resource's use and public health impact.

PS04_Walter_Fisher_squareMr. Walter Fischer

He has always needed to change lives and jobs whenever he knew he had hit the wall. Since early age, he chose traveling as a major mean to change and grow.  After 4 years of college, studying business and international trade, he started his professional career as export manager in a multinational. A few years later, he left and explored Asia. he went back to a (successful) business before definitely realizing that his way was elsewhere, in something hopefully more meaningful and useful to society. Studying and practicing acupuncture were a life changing experience to him. He finds it fair to share it with those most in need. He is a strong believer in the change we can bring together, with adequate tools and true intention. Humanitarian healthcare faces unlimited challenges, together with different and complementary professional approaches, situation of millions can be improved.

O_Talpain_squareMr. Olivier Talpain

As a former producer of fiction and documentary films myself, I particularly enjoy watching good documentary films. Thanks to Indian film maker Pan Nalin, I discovered Ayurveda for the first time, through his documentary film which struck me. I was impressed by the sophisticated holistic approach of the Ayurvedic system of medicine and the complexity of its medicines. Many Ayurvedic formulations are produced using tens of substances, through several long and complex processes. The testimonies of patients about unhoped-for recoveries touched me. I’ve eventually found it hard to believe that what seemed to be a remarkable blend of knowledge and know-how was kept aside and even threatened. Something didn’t make sense; I had to understand.

When I went back to university to study social sciences, I chose Ayurveda as the key issue of my research. I wrote the final dissertation of my Master in Development Studies on the recognition of Ayurveda through modern scientific research. I focused on two clinical trials on the Ayurvedic treatment of rheumatoid arthritis (1976-2012) that were funded by WHO and NIH-NCCAM. They both showed that the treatment gives positive results.

Still many questions remain. Why was the first study not published by the modern physicians in charge of it? Why is there so little research to assess Ayurveda? I am currently working on a PhD project to find some answers.

Zhang_Qi_squareDr. Zhang Qi

Dr Zhang Qi is leading the Traditional and Complementary Medicine Programme(TCM) in the Department of Service Delivery and Safety(SDS), WHO. He studied both conventional medicine and traditional medicine. He used to be a doctor, researcher and governmental official responsible for traditional medicine in China. He led the work of integration of traditional medicine services into national healthcare system in the department of healthcare services and headed the department of international cooperation, State Administration of Traditional Chinese Medicine, Ministry of Health In China. He used to lead the supervision on services, management and clinical research in the five hospitals affiliated to China Academy of Chinese Medical Science which is the national research institution for traditional Chinese medicine in China.



GHF2014 – PS02 – Integrated Management of Childhood Illness: Where Do We Stand?

Integrated Management of Childhood Illnesses:
Where Do We Stand?

Dr. Lulu Muhe, Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Switzerland
Performance of Community Health Workers in Community Case Management: Uganda
Dr. Agnes Nanyonjo, Research Officer-Public Health, Malaria Consortium Uganda Technical Country Office, Uganda
Dr. Eric A. F. Simões, Professor of Paediatrics, School of Medicine, Department of Paediatrics University of Colorado, Anschutz Medical Campus, United States
The aim of the IMCI strategy introduced in 1996 was to contribute to the reduction of child mortality through appropriate management of major causes of child death including pneumonia, diarrhoea, malaria and malnutrition, improved caregiver knowledge and home care practices during illness, and prevention of illness. As we approach the 2015, what has been the contribution of IMCI in the global progress towards achieving MDG 4. Is the IMCI model still fit for purpose in addressing child survival and the emerging epidemic of non-communicable diseases beyond the 2015?

Nanyonjo Profile PhotoDr. Agnes Nanyonjo

Dr. Nanyonjo is a Research officer-Public Health working with Malaria consortium Uganda. She completed her undergraduate studies from Makerere university Uganda with a bachelor of medicine and bachelor of surgery degree. She specialized in public health from Umeå university Sweden. She is a doctoral student at Karolinska institute.  She has experience working community case management of childhood diseases, HIV/AIDS and sexual and reproductive health of young people.

Eric_Simoes_squareDr. Eric A. F. Simões

Eric Simoes is a Professor of Paediatrics at the School of Medicine Department of Paediatrics University of Colorado Anschutz Medical Campus.

Eric A. F. Simoes, MB, BS, DCH, MD, earned his medical degree from the University of Madras, India, in 1984. He completed paediatric infectious diseases fellowship training at the University of Colorado School of Medicine in 1989, at which time he joined the faculty of the Department of Paediatrics and Children's Hospital Colorado. From 1995 to 1999, he directed the Paediatric Infectious Diseases Fellowship Program. Since 2001 he also has had an appointment as Professor of Paediatric Infectious Diseases and Tropical Child Health with the Department of Paediatrics, Obstetrics, and Gynaecology at the Imperial College of Science and Technology in London, UK.

Eric Simoes has published over 170 journal articles, books, book chapters, scholarly reviews, and abstracts. He is widely sought as a speaker, teacher, and consultant, both nationally and abroad. Worked as a Member, Advisory Committee on Acute Respiratory Infections, World Health Organization 1999-2004

Dr Rifat Atun

RifatAtunDr Rifat Atun is Professor of Global Health Systems at Harvard University, where he is the Director of Global Health Systems Cluster at Harvard University's School of Public Health.

In 2006-13, Dr Atun was Professor of International Health Management and Head of the Health Management Group at Imperial College London. He is an Honorary Professor at the London School of Hygiene and Tropical Medicine. In 2008-12 he served as a member of the Executive Management Team of The Global Fund to Fight AIDS, Tuberculosis and Malaria as the Director of Strategy, Performance and Evaluation Cluster.

Rifat's research focuses on the design and implementation of health systems transformations and their impact on outcomes. His research also explores adoption and diffusion of innovations in health systems (e.g. health technologies, disease control programmes, and primary healthcare reforms), and innovative financing in global health. Organization. Rifat is a co-Investigator and the joint lead for the innovation work stream at the National Centre for Infection Prevention and Management at Imperial College. He is also a co-Investigator and the Theme Lead for 'Organisational Change, Sustainability and Evaluation' at Imperial College and Cambridge University Health Protection Research Unit for Antimicrobial Resistance and Healthcare Associated Infection. He has published widely in the Lancet, PLoS Medicine, Lancet Infectious Diseases, BMJ, AIDS, and Bulletin of the World Health Organization.

Rifat has worked with several governments globally and with the World Bank, World Health Organization, and the UK Department for International Development to design, implement and evaluate health system reform initiatives in more than 20 countries. He has led research and consultancy projects for GSK, Pfizer Inc., the Vodafone Group, Hofmann La Roche,  PA Consulting, and Tata Consulting Services.

Rifat was the Founding Director of the MSc in International Health Management, BSc in Management and Medical Science, and Founding Co-Director of the Masters in Public Health Programme at Imperial College. He has been a director of Imperial College spin out companies operating in areas of health technology.

Rifat is a member of the MRC Global Health Group as the MRC Infections and Immunity Board representative. He serves as  a member of the PEPFAR Scientific Advisory Board, the Norwegian Research Council's Global Health and Vaccination Research (GLOBVAC) Board, the Research Advisory Committee for the Public Health Foundation of India, and the US Institute of Medicine USAID Standing Committee on Strengthening Health Systems. In 2006-08 he served as a Member of the Advisory Committee for WHO Research Centre for Health Development in Japan. He was member of the Strategic Technical Advisory Group of the WHO for Tuberculosis and chaired the WHO Task Force on Health Systems and Tuberculosis Control. In 2009-12 he was the Chair of the STOP TB Partnership Coordinating Board.

Rifat is a Fellow of the Royal College of General Practitioners (UK), Fellow of the Faculty of Public Health of the Royal College of Physicians (UK), and a Fellow of the Royal College of Physicians (UK).

Detecting Malaria in Refugees living in Non-Endemic Area: South Africa

Author(s) Joyce Tsoka-Gwegweni1, Uchenna Okafor2.
Affiliation(s) 1Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa, 2Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
Country - ies of focus South Africa
Relevant to the conference tracks Infectious Diseases
Summary The study presents findings from a research conducted in a refugee population in South African city known to be non-endemic to malaria transmission.
Background It is reported that 64% of malaria cases in South Africa are imported. This is expected given the high influx of refugees into the cities and reports by United Nations High Commission for Refugees that South Africa carries the highest number of asylum seekers globally. Although South Africa has planned to eliminate malaria by 2018, current interventions and research only take place in malaria endemic areas, which are remote and rural.
Objectives The aim of this study is to determine prevalence of malaria infection among a refugee population living in a malaria non-endemic city of KwaZulu-Natal province, South Africa.
Methodology After obtaining relevant approvals and consent, adult refugee participants were recruited from a faith-based facility offering social services in a city of KwaZulu-Natal province. The participants were screened for malaria using rapid diagnostic tests and confirmed with microscopy. Demographic data for the participants were obtained using a closed ended questionnaire.
Results Data were obtained for 303 participants consisting of 52% females and 48% males ranging from 19 to 64 years old. Of these 303 participants, 289 originated from different African countries, mainly central Africa. Two hundred and ninety participants provided a blood sample for screening of malaria. Of these, 3.8% tested positive for rapid diagnostic test and 5.2% for microscopy. The majority of malaria infections were due to Plasmodium falciparum.
Conclusion The study confirms important findings that include the prevalence of asymptomatic malaria infections detected in a refugee population and residing in an urban area of KwaZulu-Natal province that is not endemic for malaria. These findings have important implications for both public health and malaria control in South Africa, particularly since the country has decided to eliminate malaria by 2018. To achieve this goal, South Africa needs to expand research, surveillance and elimination activities to include non-endemic areas and marginalized communities. The findings further emphasize the importance of integrating services such as malaria surveillance into other public health intervention programmes, and provide refugees with full access to public health services. Other implications of the findings and possible challenges threating the success of the malaria elimination process and health service provision in South Africa are discussed.

Performance of Community Health Workers in Community Case Management: Uganda

Author(s) Agnes Nanyonjo1, Edmound Kertho2, Seyi Soremekun3, Frida Kastenge 4, Guus TenAsbroek 5, James Tibenderana6, Karin Kallander7
Affiliation(s) 1Technical, Uganda Country Office, Malaria Consortium, Kampala, Uganda, 2Technical, Uganda Country Oficce, Malaria Consortium, Kampala, Uganda, 3Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom, 4Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom, 5Population Health, London School of Hygiene and Tropical Medicine, Amsterdam, Netherlands, 6Technical, Africa Region Ofiice, Malaria Consortium, Kampala, Uganda, 7Technical, Africa Region Office, Malaria Consortium, Kampala, Uganda.
Country - ies of focus Uganda
Relevant to the conference tracks Health Workforce
Summary Integrated community case management is key child survival strategy in resource poor settings. There is paucity of data on performance of community health workers in this strategy and how this performance can be measured. We report on a study that evaluated the performance of community health workers using case vignettes. Overall community health workers perform well with respect to treatment. However omissions in terms of probing for danger signs and other illness symptoms and provision of general health education required by the treatment guidelines deter community health worker performance.
Background Integrated community case management for malaria, pneumonia and diarrhoea (iCCM) is one of the key interventions tailored towards curbing child mortality in low income countries. In iCCM lay community health workers (CHWs) use a given algorithm provided in a job aid to ask about illness symptoms, assess signs, classify and treat disease or refer severely ill children. They treat malaria with artemether lumefantrine combination, pneumonia with amoxycillin and diarrhoea with oral rehydration salts (ORS) and zinc. They are also required to offer health education regarding disease prevention. Although measurement of performance in itself poses key challenges in terms of choice of method used, assessment and understanding of the performance of CHWs is crucial to ensure high quality care of the sick children.
Objectives The objective of the study was to assess the performance of CHWs while managing children with solitary disease such as malaria alone or mixed infections such as malaria and pneumonia by using case vignettes.
Methodology The study was conducted among a sample of 360 CHWs who had been practicing iCCM for at least three to eight months in eight districts in Midwestern Uganda. CHWs were given four case vignettes; one after the other. Using probing questions the CHWs were asked to describe the actions they would take from the time they encountered the sick child and his/her caregiver to the time they finished the consultation. The CHWs were allowed to use their job aid during the evaluation. One case vignette emulated a 6 months old child with an uncomplicated malaria classification presenting with fever, poor appetite and no danger signs; requiring a malaria rapid diagnostic test, malaria treatment and health education. Another vignette depicted a 3 year old child with diarrhoea and no blood in stool; requiring zinc, ORS and health education. The third vignette was about a child with both cough fast breathing and fever and a history of stiff feet early that morning depicting a child with pneumonia and complicated malaria requiring referral and pre-referral treatment due to the danger sign. The last case was about a child with fever and cough, essentially with uncomplicated malaria but no pneumonia. Each appropriate action, i.e. questions the CHW should have asked, test CHW should have performed and treatment and health education CHW should have given basing on the guidelines, was assigned a weight of one. The average performance score for each CHW was generated on a scale of 0-100. Scores were also sub-analyzed per case managed as well as association with socio-demographic factors, such as sex, literacy and district of the CHWs.
Results Out of all actions that should have been taken for each case, the overall mean performance score of the CHWs was 41.5 (SD 8.6). The mean performance score based on case scenarios was 46.6 (SD 16.3) for the uncomplicated malaria case, 59.3 (SD 15.6) for the case of uncomplicated malaria with cough, 36.5 (SD 13.6) for the diarrhoea case, and 23.5 (SD 14.4) for the case with pneumonia and complicated malaria and. Overall, CHWs ability to state the correct treatment and dose for the simulated case was high, with 93.3% sating the correct treatment for a child case with malaria alone; 94.4% stating the appropriate treatment for a child case with diarrhoea, and 84.4% being able to suggest referral for a child case with a history of a danger sign. However, the problematic areas in the management algorithm that appeared to decrease the overall mean performance score included: a) failure to ask about dangers signs and symptoms that are not mentioned by the caregiver. Overall only 1% of the CHWs remembered to probe for the presence of any danger signs and other symptoms not automatically volunteered by the care taker in at least one of the case scenarios; b) Failure to assess for key illness symptoms. In the pneumonia and complicated malaria case only 22.7% of CHWs mentioned that they would assess the respiratory rate of the child; c) Failure to give pre-referral treatment. Only 28.1% and 9.7% CHWs mentioned that they would give pre-referral treatment for malaria and pneumonia, respectively; d) Failure to give instructions on how to administer the drug, especially in the diarrhoea case scenario where only 40% mentioned at least one instruction they would give to the caretaker regarding how to mix and give ORS; e) Failure to provide general health education and information on when to take the child to the health facility for further treatment. Twenty percent of CHWs did not give caretakers any of the recommended advice. Performance levels were positively associated with the district of the CHWs (p<0.001) and to the increasing number of patients the CHW had seen in the last week (p=0.015).
Conclusion If the case scenarios where a reflection of a real life situation our data suggest that majority of children seen by CHWs would get the appropriate curative treatment or action required. However they would not be able to benefit optimally from their visit to the CHWs due to omitted actions, such as provision of pre-referral treatment, health education and counseling, and demonstration to caregivers on how to give the first dose. Supportive supervision and refresher training of CHWs should which emphasizes strict adherence to treatment algorithms, and which offers strengthening of interpersonal communication skills should be implemented.

Risk Factors and Practices contributing to Newborn Sepsis in Buyende District, Uganda.

Author(s) John Bua1, David Mukanga2, Elizabeth Nabiwemba3
Affiliation(s) 1Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda, 2Bill & Melinda Gates Foundation, Bill & Melinda Gates Foundation, Kampala, Uganda, 3Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
Country - ies of focus Uganda
Relevant to the conference tracks Women and Children
Summary This was a facility based cross sectional study in Kidera sub-county, Buyende district, Uganda. It aimed at identifying potential risk factors and describing practices contributing to newborn sepsis in Buyende district in order to make recommendations that will influence behaviour change at community level. 174 newborns participated. 21.8% were laboratory confirmed to have sepsis. The main causative agent was staphylococcus aureus (31.6%). Risk factors included inappropriate cord care (77.6%) and not practicing routine hand washing (78.2%). Therefore health education messages should target importance of hand washing and cord care for newborns in the communities.
Background In Uganda, it’s estimated that newborn deaths contribute to over 38% of all infant deaths (92,000 in 2010). Despite different mitigation interventions over years, the newborn mortality rate is high at 27/1000 and newborn sepsis contributes to 31% of mortality in Uganda. Therefore, improved strategies that will contribute to the reduction of newborn sepsis need to be developed. However we need to understand the actual practices and risks present that contribute to new cases of sepsis. These need to be put in context, for without reliable evidence it’s difficult to know whether proposed interventions will work.
Objectives To identify potential risk factors and describe practices contributing to newborn sepsis in Buyende district so that recommendations can be made that will influence behaviour change at community level.
The specific study objectives were;
 To assess the prevalence of risk factors for newborn sepsis in Kidera County, Buyende district.
 To describe practices contributing to newborn sepsis within the health facilities.
 To describe practices of mothers or caregivers of newborn contributing to newborn sepsis.
Methodology The study was conducted at Kidera Health Centre, a level IV facility located in Kidera County, Buyende District Eastern Uganda. Kidera health centre is the highest and main referral unit for Buyende District. Kidera Health Centre serves the 5 counties in the district with an estimated population of 248,000 people.This was a health facility based cross sectional study in Kidera sub county, Buyende district. Mothers or care takers of sick newborns and health workers were interviewed. The dependent variable was a newborn having laboratory confirmed sepsis. Independent variables include; social demographics, mother’s ANC, delivery and PNC history, birth weight, gestation age and newborn care practices. Semi-structured questionnaires and Key informant guides were used to collect quantitative and qualitative data.
Results 174 mothers and 174 newborns participated in the study. The majority of the mothers (73%) were peasant farmers. Few of the mothers had attained an education level above primary school (33.9%). The age range for the mothers was from 16 to 44 years (mean: 26.3 years).21.8% of the admitted newborns with signs and symptoms for sepsis were laboratory confirmed. The identified causative agents included; staphylococcus aureus (31.6%), Neisseria meningitides (21.%), streptococcus pyogenes (10.5%) and Haemophilus influenza (5.3%). The causative agents were found to be resistant to some of the commonly used drugs that included; penicillin, chloramphenicol, cloxacillin and gentamycin.Prevalent risk factors included delivery outside the health facility (43.1%), inappropriate cord care (77.6%), care givers not practicing hand washing before handling the newborn (78.2%) and lack of knowledge about newborn care (39.7%).The interview of key informants revealed that the health facility didn’t have resources to offer routine screening for bacterial infections among pregnant women during ANC visits. The available resources were for vertical programs targeting only HIV and malaria. The health facility also had no equipment or a special room were sick newborns in critical condition could be managed appropriately. The other health system challenges identified included lack of antibiotic syrups for treating newborns and inadequate supply of laboratory reagents to investigate causes of ill health in newborns.

Since the study was facility based some sick newborn cases that weren’t brought to the health unit for care could have been missed. However, community health workers in areas served by the health facility were encouraged to refer all cases of sick newborns for care.

Conclusion Most common aetiological agent for newborn sepsis was Staphylococcus aureus followed by Neisseria meningitides. The practice of not routinely washing hands before touching the newborn and inappropriate cord care were leading factors contributing to spread of infection to newborns in the community. Therefore all pregnant women and women in postnatal positions need to be health educated about the importance of hygienic cord care and washing hands before touching the newborn. The health education can be given to mothers attending antenatal, delivery or postnatal at the facility by the health workers. Community health workers, where they exist, can be used to educate mothers in the community about proper newborn care and how to prevent spread of sepsis.

Modelling potential distribution of current and future malaria in Tanzania: An Ecological Niche framework

Author(s) Benjamin Mayala1, Leonard Mboera2, Edwin Michael3
Affiliation(s) 1Disease Surveillance and GIS, National INstitute for Medical Research, Dar es Salaam , Tanzania, 2ICT, NIMR, Dar es Salaam, Tanzania, 3Department of Biological Sciences, University of Notre Dame, Notre Dame, United States.
Country - ies of focus Tanzania
Relevant to the conference tracks Innovation and Technologies
Summary Malaria is endemic in most parts of Tanzania and remains a major cause of morbidity and mortality both in rural and urban areas. Ecological niche modelling (ENM) has been considered a useful tool to assess the potential geographical distribution of various species. The application of such tool is very limited in predicting the potential distribution of diseases, especially when using occurrence (presence). In this study an ensemble model approach was employed to predict the current and future (2050) potential distribution of malaria in Tanzania. The ensemble approach demonstrated an enhanced prediction model compared to the individual model outputs.
Background Malaria is a leading cause of morbidity and mortality accounting for over 30% of the disease burden in Tanzania. Over 95% of the 37.4 million people in the country are at risk of malaria infection. Various factors account for malaria in Tanzania, which include demographic factors, socioeconomic factors, weak health systems, a limited budget, poor governance and accountability, antimalarial drug and insecticide resistance, environmental and climate change, vector migration, and land use patterns. Efforts have been employed to reduce malaria in Tanzania, which include insecticide treated mosquito nets, indoor residual spraying, improved diagnosis by microscopy and rapid diagnostic tests, effective treatment of cases, and implementation of intermittent presumptive treatment of pregnant women. In spite of the many efforts to combat malaria, the disease remains a leading public health problem in most parts of the country. Climate conditions such as precipitation, temperature, and relative humidity have a substantial impact on malaria. Despite the importance of these factors to the distribution of malaria, limited studies have been undertaken to address the association between climatic conditions and malaria epidemics.
Objectives Previous attempts to map the geographical distribution of malaria have focused on a theoretical model that is based on available long-term climate data, as well as empirical models that fit malaria data to environmental factors to predict the number of months during which transmission is possible. These studies have not demonstrated the predictive ability beyond the input data area. Ecological niche modelling (ENM) has been considered a useful tool to assess the potential geographical distribution of species. It has been applied to diseases to assess the potential distribution of vectors. Applications of ENM to study the distribution of malaria using occurrence cases are limited in Tanzania. Here, we adapt modelling techniques, to predict the current and future potential distribution of malaria. The goals of the study were to (i) identify possible distribution areas of malaria using an ensemble approach that integrate multiple individual models to generate a better and more conservative overall solution, (ii) identify the environmental and climate conditions correlated with malaria occurrences, estimate the population at risk, and (iii) determine how future climate change may affect the distribution of malaria in Tanzania.
Methodology Data: Malaria occurrence point data were obtained from the Ministry of Health and Social Welfare. These are reported cases from various health facilities in the country. The Current and future (2050) environmental data used in our study were obtained from CliMond gridded climate data, which represents an improvement on the existing global climate data available for bioclimatic modelling. Thirteen environmental variables were used from CliMond; this included eight bioclimatic variables, monthly minimum and maximum temperatures, monthly precipitation, monthly altitude and relative humidity. The 8-bioclimatic variables were mean temperature of wettest quarter, mean temperature of driest quarter, mean temperature of warmest quarter, mean temperature of coldest quarter, precipitation of wettest quarter, precipitation of driest quarter, precipitation of warmest quarter, and precipitation of coldest quarter. The study also included other variables such as human population density and normalised difference vegetation index (NDVI). To avoid fitting the model into too many environmental variables, we extracted the environmental information from each presence data and performed a Pearson correlation tests to see if any of the layers were too similar to include in a model together.
Data Processing: The environmental data used for model development were imported into ArcGIS 10.1 software in which they were re-projected to the same coordinate system, clipped to an area encompassing the administrative boundaries of Tanzania, resampled to obtain the same pixel resolution of 5km, extracted to obtain same dimensions, and converted to ASCII format.
Models development: We considered eight modeling algorithms for the ENM development, GAM, GLM, GBM, MAXENT, MARS and RF were implemented in biomod2 package in Revolution R software, SVM using dismo package and GARP using a Desktop GARP.
Ensemble Model Prediction: An ensemble approach was adapted in our study by combining the eight model output through a weighted average using two thresholds (i) the 5th percentile of the training presence (5% TP) and (ii) the least training presence (LTP).
To estimate the populations at risk of malaria, we reclassified the ensemble model outputs to binary maps (which have pixel values of 0 - no malaria and 1 - malaria present) using the two thresholds - 5% TP and LPT. ArcGIS tools were used to compute the population and districts predicted at risk to malaria
Results The overall contribution of each environmental variable to all the models ranged from 2% to 62%. Population density was the main variables influencing the potential distribution of malaria in all the models. Relative humidity contributed 10.5% to the model followed by altitude (10%) and precipitation of driest quarter (5.4%). The other variables had less influence. The prediction maps revealed that almost the whole country is endemic for malaria. However, the probability of malaria presence varies spatially. All the models depicted high probability (0.5 or greater) of occurrence of malaria in the east and south coast of Indian Ocean, north regions and along Lake Victoria. The models depicted a medium probability of malaria occurrence along the central and west regions. The ensemble model at 5% TP threshold demonstrated high occurrence of malaria in the east, coast of Indian Ocean, north regions and along Lake Victoria, a pattern from east to central, then low occurrence from central to west and also south parts of the country
The ensemble model future (2050) prediction at 5% TP threshold showed an increase/shift of malaria occurrence in the northern part and towards the central part of the country is expected. High percentage of malaria occurrence is predicted in the southern highlands and southern regions of the country. Some areas are predicted with low percentage occurrence in the central regions and areas in the west of the country. Areas in the north, around Lake Victoria and along the coast of Indian Ocean are predicted to maintain the highest percentage of malaria occurrence.
The current population at risk of malaria is estimated to be 29 and 34 million, and this could rise in the future to 81.58 and 93.7 million. About 79% of the districts are at high risk for malaria, which is predicted to increase to 84% in future
Conclusion A link between climate change and malaria has been described previously; particularly temperature and rainfall are mentioned as the major variables contributing to malaria distribution. The present study, however, shows a lesser contribution of temperature and rainfall in the development of the models, as compared to population density, which depicted the highest contribution. This suggest that (i) population density is the key variable in malaria and (ii) malaria cannot necessary be caused by climate variables, as they may exhibit a smaller role in determining the ecological niche and hence the potential distribution of malaria. However, despite the potential influence of the population variable shown in our model outputs, it is then clear that population density, environmental variables and other factors (than those we used) will need to be included in studies attempting to model malaria endemicity.
Our findings showed high percentage areas predicted by the ensemble for both current and future - 2050, whereas individual models resulted into low predicted areas. The results suggest that ensemble model predictions are more robust than the predictions from individual models.
An important implication of our model is that the predicted distribution of malaria in the various districts in Tanzania can inform the selection of locally appropriate control interventions. The malaria control program can plan better for the distribution of resources by specifically focusing on the areas predicted to be at high risk.