Collaborative governance: The antidote for effective implementation of malaria elimination programme in Nigeria

Objective: The study examined the way inter-governmental collaboration can be improved to enhance malaria elimination programme in Southwestern Nigeria. Methodology: Primary data were collected through the administration of questionnaire and conduct of interviews. The study population comprised all categories of staff in the National Malaria Elimination Programme; staffs of Malaria Elimination Programme in three states and nine Local Governments in Southwestern Nigeria. A sample size of 388 respondents was selected for questionnaire administration from the study population. Interviews were conducted to complement information collected through questionnaire. Data collected were analysed using appropriate statistical methods. Results: The study revealed that increased allocation of funds; establishment of several anti-malaria programmes at all levels of government and integrated decision making were ways collaborative governance can be improved to enhance malaria elimination programme in the study area. Conclusion: The study concluded that collaborative governance is a sine qua non to the effective implementation of government programmes.

Costs of TB services in India (No 1)

BACKGROUND: There is a dearth of economic analysis required to support increased investment in TB in India. This study estimates the costs of TB services from a health systems´ perspective to facilitate the efficient allocation of resources by India´s National Tuberculosis Elimination Programme.METHODS: Data were collected from a multi-stage, stratified random sample of 20 facilities delivering TB services in two purposively selected states in India as per Global Health Cost Consortium standards and using Value TB Data Collection Tool. Unit costs were estimated using the top-down (TD) and bottom-up (BU) methodology and are reported in 2018 US dollars.RESULTS: Cost of delivering 50 types of TB services and four interventions varied according to costing method. Key services included sputum smear microscopy, Xpert® MTB/RIF and X-ray with an average BU costs of respectively US$2.45, US$17.36 and US$2.85. Average BU cost for bacille Calmette-Guérin vaccination, passive case-finding, TB prevention in children under 5 years using isoniazid and first-line drug treatment in new pulmonary and extrapulmonary TB cases was respectively US$0.76, US$1.62, US$2.41, US$103 and US$98.CONCLUSION: The unit cost of TB services and outputs are now available to support investment decisions, as diagnosis algorithms are reviewed and prevention or treatment for TB are expanded or updated in India.

Neglected malaria parasites in hard-to-reach areas of Odisha, India: implications in elimination programme

Background Information on the foci of Plasmodium species infections is essential for any country heading towards elimination. Odisha, one of the malaria-endemic states of India is targeting elimination of malaria by 2030. To support decision-making regarding targeted intervention, the distribution of Plasmodium species infections was investigated in hard-to-reach areas where a special malaria elimination drive, namely Durgama Anchalare Malaria Nirakaran (DAMaN) began in 2017. Methods A cross-sectional survey was conducted in 2228 households during July to November 2019 in six districts, to evaluate the occurrence of Plasmodium species. The species were identified by polymerase chain reaction (PCR) followed by sequencing, in case of Plasmodium ovale. Results Of the 3557 blood specimens tested, malaria infection was detected in 282 (7.8%) specimens by PCR. Of the total positive samples, 14.1% were P. ovale spp. and 10.3% were Plasmodium malariae infections. The majority of P. ovale spp. (75.8%) infections were mixed with either Plasmodium falciparum and/or Plasmodium vivax and found to be distributed in three geophysical regions (Northern-plateau, Central Tableland and Eastern Ghat) of the State, while P. malariae has been found in Northern-plateau and Eastern Ghat regions. Speciation revealed occurrence of both Plasmodium ovale curtisi (classic type) and Plasmodium ovale wallikeri (variant type). Conclusions In the present study a considerable number of P. ovale spp. and P. malariae were detected in a wide geographical areas of Odisha State, which contributes around 40% of the country’s total malaria burden. For successful elimination of malaria within the framework of national programme, P. ovale spp. along with P. malariae needs to be incorporated in surveillance system, especially when P. falciparum and P. vivax spp. are in rapid decline.

Active Case Finding for Tuberculosis in India: A Syntheses of Activities and Outcomes Reported by the National Tuberculosis Elimination Programme

India launched a national community-based active TB case finding (ACF) campaign in 2017 as part of the strategic plan of the National Tuberculosis Elimination Programme (NTEP). This review evaluated the outcomes for the components of the ACF campaign against the NTEP’s minimum indicators and elicited the challenges faced in implementation. We supplemented data from completed pretested data proformas returned by ACF programme managers from nine states and two union territories (for 2017–2019) and five implementing partner agencies (2013–2020), with summary national data on the state-wise ACF outcomes for 2018–2020 published in annual reports by the NTEP. The data revealed variations in the strategies used to map and screen vulnerable populations and the diagnostic algorithms used across the states and union territories. National data were unavailable to assess whether the NTEP indicators for the minimum proportions identified with presumptive TB among those screened (5%), those with presumptive TB undergoing diagnostic tests (>95%), the minimum sputum smear positivity rate (2% to 3%), those with negative sputum smears tested with chest X-rays or CBNAAT (>95%) and those diagnosed through ACF initiated on anti-TB treatment (>95%) were fulfilled. Only 30% (10/33) of the states in 2018, 23% (7/31) in 2019 and 21% (7/34) in 2020 met the NTEP expectation that 5% of those tested through ACF would be diagnosed with TB (all forms). The number needed to screen to diagnose one person with TB (NNS) was not included among the NTEP’s programme indicators. This rough indicator of the efficiency of ACF varied considerably across the states and union territories. The median NNS in 2018 was 2080 (interquartile range or IQR 517–4068). In 2019, the NNS was 2468 (IQR 1050–7924), and in 2020, the NNS was 906 (IQR 108–6550). The data consistently revealed that the states that tested a greater proportion of those screened during ACF and used chest X-rays or CBNAAT (or both) to diagnose TB had a higher diagnostic yield with a lower NNS. Many implementation challenges, related to health systems, healthcare provision and difficulties experienced by patients, were elicited. We suggest a series of strategic interventions addressing the implementation challenges and the six gaps identified in ACF outcomes and the expected indicators that could potentially improve the efficacy and effectiveness of community-based ACF in India.

Status of Lymphatic Filariasis in Security Challenged Areas of Borno State, Nigeria

National lymphatic filariasis elimination programme (NLFEP) of Federal Ministry of Health sets to provide status of LF in the country before 2020. Borno State, situated in the North East political zone of Nigeria with an estimated population of 4.1million had been enmeshed in insurgency for over a decade. Following an initial mapping between 2008 and 2016 in 16 LGAs out of 27 LGAs, it became imperative that the status of LF in the remaining 11 LGAs of Borno State be ascertained in order to have complete data for planning and policy. Using stratified sampling method, eleven communities were selected from the 11 LGAs namely: Abadam, Ngala, Guzamala, Ngazai, Gubio, Mafa, Jere, Biu, Bayo, Askirin/Uba, and Kwayar Kusar. Blood samples were obtained from consented 990 participants and filarial test strip (FTS) were employed to determine their LF status between November 2017 and February 2018. Of the 990 consented participants only 15 (1.5%) were positive for lymphatic filariasis. Ten cases of hydrocele in men were observed in 4 communities namely Bunari (3), Peta (3), Zaramiramga (2) and Uba (2). Considering the number of positive cases by FTS and hydrocele, result showed that hydrocele accounted for 66.7% of the total positive cases within the positive communities. It is advised that the State health workers should continue to properly educate communities on health programmes including LF preventive measures. Also both Federal Ministry of Health and State Ministry of Health sensitize health partners to start LF treatment and morbidity management in all positive communities to fast track elimination of LF.

PERSISTENCE OF MALARIALANTIGEN FOLLOWING ANTIMALARIAL CHEMOTHERAPY IN KOLKATA, WEST BENGAL

Early diagnosis and complete treatment is one of the important aspects of malaria elimination programme worldwide. In many areas the diagnosis is based on detection of malarial antigen using commercially available rapid diagnostic kits. The problem remains with persistence of antigen following parasite clearance by proper treatment. The present work was undertaken to study the pattern of persistent antigen of P. vivax and P. falciparum following antimalarial treatment. Atotal of 300 microscopically positive mono-infected with P. vivax (160) and P. vivax (140) patients were recruited, treated with antimalarial drugs and followed up on day 3, 7, 14, 21 and 28 for persistent parasites and antigen. P. vivax specic pLDH antigen was disappeared from peripheral blood within 14 days post treatment period. P. falciparum specic HRP-2 antigen was persisted even after 28 days of treatment. Depending only on antigen based diagnosis, attention should be paid before treatment, particularly in areas with high malaria transmission

Effects of COVID-19 on national tuberculosis elimination programme strategies during March to May 2020 on Tumkur district, India

Background: the nation-wide lockdown due global pandemic has disrupted a vital strategic intervention resulting in overall 60% decrease in presumptive and diagnostic TB cases during the lockdown period.Methods: A discrete choice experimental (DCE) exploratory operational research conducted during March to May 2020.Results: Health care services were affected 25% reduction in the outpatient department (OPD) in comparison to the previous year the same period. A gradual reduction in negative sputum cases undergoing chest radiography from 54% to 14%. Due to restricted movement LPA tests have been reduced 25% among the diagnosed TB cases, and private referrals to cartridge based nucleic acid amplification test (CBNAAT) services were reduced to 20%.Conclusions: Health services, including national programmes to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained. While experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted. TB patients should take precautions as advised by health authorities to be protected from COVID-19 and continue their TB treatment as prescribed.

Malaria-free Certification in China: Achievements and Lessons Learned from the National Malaria Elimination Programme

Malaria was once one of the most severe public health problems in China. However, after 70 years of integrated interventions, substantial progress has been made, and remarkable milestones have been met in malaria elimination in China. On June 30th, 2021, China was officially certified as a malaria-free country by the World Health Organization. This paper highlights the achievements of, and lessons learned from the malaria elimination programme.

Journey of Tuberculosis Control in India: From then till now

The history of Tuberculosis control in India dates back to 1951 with mass vaccination with BCG and it started as a National Programme in 1962. Radical changes in the form of DOTS were incorporated with the start of Revised National Tuberculosis Control Programme (RNTCP) in 1997. Since then, TB control efforts have witnessed many changes in the form of daily DOTS, Injection free regimen for both drug sensitive & drug resistant TB, moving from fixed Categories of treatment regimen to Individualized treatment regimen based on prior Universal Drug susceptibility testing. Flexibility has been incorporated in the programme to accommodate Private practitioners in the form of various incentives. Introduction of Active case finding strategy has helped in early diagnosis leading to prompt treatments. Engagement of Community and leaders from all sectors and various organizations has helped to reach all communities in this fight against TB. India hopes to End TB by 2025 with rechristening the programme to National TB Elimination Programme (NTEP) and bringing in the much needed changes & flexibilities in the programme.

High Prevalence of Epilepsy in an Onchocerciasis-Endemic Area in Mvolo County, South Sudan: A Door-To-Door Survey

In June 2020, a door-to-door household survey was conducted in Mvolo County, an onchocerciasis-endemic area in South Sudan. A total of 2357 households containing 15,699 individuals agreed to participate in the study. Of these, 5046 (32.1%, 95% CI: 31.4–32.9%) had skin itching and 445 (2.8%, 95% CI: 2.6–3.1%) were blind. An epilepsy screening questionnaire identified 813 (5.1%) persons suspected of having epilepsy. Of them, 804 (98.9%) were seen by a medical doctor, and in 798 (98.1%) the diagnosis of epilepsy was confirmed. The overall epilepsy prevalence was 50.8/1000 (95% CI: 47.6–54.4/1000), while the prevalence of nodding syndrome was 22.4/1000 (95% CI: 20.1–24.9/1000). Younger age, being male, skin itching, blindness, and living in a neighbourhood or village close to the Naam River were risk factors for epilepsy. The annual incidence of epilepsy was 82.8/100,000 (95% CI: 44.1–141.6/100,000). Among children 7–9 years old without epilepsy, 34% were Ov16 seropositive, suggesting high ongoing Onchocerca volvulus transmission, but only 41.9% of them took ivermectin during the last mass distribution. In conclusion, a high prevalence and incidence of epilepsy was observed in Mvolo, South Sudan. Strengthening of the onchocerciasis elimination programme is urgently needed in order to prevent epilepsy in this region.