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A One Health approach to fight antimicrobial resistance in Uganda: Implementation experience, results, and lessons learned

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Biosafety and Health 2024年第2期6卷 125-132页

作者： Reuben Kiggundu J.P.Waswa Niranjan Konduri Hassan Kasuja Marion Murungi Patrick Vudriko Harriet Akello Eric Lugada Cecilia Muiva Esther Were Dinah Tjipura Henry Kajumbula Kate Kikule Emmanuel Nfor Mohan P.Joshi usaid Medicines Technologiesand Pharmaceutical Services ProgramManagement Sciences for HealthKampala 256Uganda usaid Medicines Technologiesand Pharmaceutical Services ProgramManagement Sciences for HealthArlingtonVA 22203USA College of Veterinary Medicine Animal Resources and BiosecurityMakerere UniversityKampala 256Uganda Ministry of Health Uganda Kampala 256Uganda usaid Strengthening Supply Chain Systems Activity Management Sciences for HealthKampala 256Uganda usaid Medicines Technologiesand Pharmaceutical Services ProgramManagement Sciences for HealthNairobi 254Kenya Department of Microbiology College of Health SciencesMakerere UniversityKampala 256Uganda

Uganda has been implementing the Global Health Security Agenda(GHSA)since 2015 to build its capacity according to World Health Organization(WHO)Benchmarks on International Health Regulations Capacities.The country remains prone to outbreaks,with more than 2o disease outbreaks reported in the past five years,including Ebola virus disease,Crimean-Congo haemorrhagic fever,Marburg haemorrhagic fever,measles,yel-low fever,coronavirus disease 2019(COVID-19),and cholera.Antimicrobial resistance(AMR)is an ongoing challenge.Uganda scored capacity level 3 on infection prevention and control(IPC)and antimicrobial steward-ship(AMS)in the 2017 Joint External Evaluation(JEE)assessment.Identified gaps were being addressed after a self-assessment in 2021.This paper describes the technical assistance approaches provided to Uganda by the Medicines,Technologies,and Pharmaceutical Services Program,funded by the United States(U.S.)Agency for International Development,and implemented by Management Sciences for Health.The program,through a One Health approach,supported systematic capacity strengthening based on the JEE's capacity advancement framework for global health security,specifically relating to AMR.The program's interventions impacted 32 WHO benchmark actions(7 for AMR multisectoral coordination,16 for IPC,and 9 for AMS),contributing to Uganda's strengthened GHSA capacity.Leveraging success built on the AMR platform,the program trained 745 health workers in IPC for the Ebola virus and provided support for simulation exercises by eight district IPC teams.The program also worked with the Ministry of Health to coordinate IPC for the COVID-19 response in five health regions,covering 45 districts and reaching 5,452 health workers at 858 health facilities.2024 Chinese Medical Association Publishing House.Published by Elsevier BV.

关键词： One health Antimicrobial resistance Antibiotic resistance Jointexternal evaluation Global health security Uganda Africa WHO Benchmarks for International Health Regulations Capacities

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Routine Supportive Supervision and Management of Medicines and Other Health Products and Technologies in Vihiga County, Kenya

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Pharmacology & Pharmacy 2023年第2期14卷 43-57页

作者： Mukanya Collins Mudogo Oluhano Jerusa Sikuku Eric Mwanje Inonda Justus Anyiendah Mary Amadi Mercy Riungu James Sumbi Victor Ottichilo Wilber Health Products and Technologies Unit Department of Health Services Vihiga County Government Mbale Kenya Department of Health Services Vihiga County Government Mbale Kenya usaid Afya Ugavi Nairobi Kenya PMI usaid Nairobi Kenya County Government of Vihiga Mbale Kenya

Health Products and Technologies (HPTs) are pivotal for an efficient health system. Availability and accessibility to affordable health products are critical indicators towards achieving universal health coverage. Routine supportive supervision, performance monitoring, recognition of efforts and client feedback are vital activities toward health supply chain system strengthening. This is a descriptive paper that describes a model of integrated commodity supportive supervision, and mentorship and its impact on various outcomes of health commodity management. Data were abstracted from the standardized scored checklists used during integrated commodity supportive supervision and supply chain audit in public health facilities in Vihiga County. Scores for the period 2020 to 2022 were analyzed on the eight key areas of interest. The analysis was done using Statistical Package for Social Sciences (SPSS version 26). Results are interpreted at 95% Confidence interval. This paper also shares findings from both quantitative and qualitative data from client exit and facility managers’ interviews. Six complete rounds of supervisions, three clients and service providers’ interviews, and three annual award events have been conducted. We observed trends across six data collections points and compared the results at first point or baseline (January-June 2020) to the results at the last point or end line (April-June 2022). Findings show significant improvements on the eight parameters in terms of mean scores as follows: resolution of issues from previous visits by 35.06% (46.75% - 81.81%);storage of HPTs by 17.41% (68.72% - 86.13%);inventory management by 28.16% (42.67% - 70.83%);availability and use of commodity data management information systems (MIS) tools by 22.39% (74.40% - 96.79%);verification of commodity data by 25.61% (65.56% - 91.17%);availability of guidelines and job aids for commodity management by 46.28% (36.65% - 82.93%). There was an improvement on the mean score on accountability by 20.22% (58.58% - 83.51%). The

关键词： Medicines Health Products and Technologies Health Commodities Supportive Supervision Staff Motivation Customer Feedback

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Spatial Disparity in Availability of Tuberculosis Diagnostic Services Based on Sector and Level of Care in Nigeria

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Journal of Tuberculosis Research 2023年第1期11卷 12-22页

作者： Bethrand Odume Sani Useni Egwuma Efo Degu Dare Elias Aniwada Nkiru Nwokoye Ogoamaka Chukwuogo Chidubem Ogbudebe Michael Sheshi Aminu Babayi Emperor Ubochioma Obioma Chijioke-Akaniro Chukwumah Anyaike Rupert Eneogu Debby Nongo KNCV Nigeria Abuja Nigeria KNCV Netherlands The Hague Netherlands Department of Community Medicine University of Nigeria Nsukka Nigeria NTBLCP FMOH Abuja Nigeria usaid Abuja Nigeria

Background: Delay in Tuberculosis (TB) diagnosis can contribute to late presentation, severe disease, and continued transmission. KNCV TB Foundation Nigeria through the United States Agency for International Development (usaid) funded the TB Local Organization Network (LON) 1 and 2 projects that explored the availability of Tuberculosis services based on sector and levels of care. Methods: TB Patient Pathway Analysis was carried out in 14 states comprising 92 facilities. It involved primary, secondary, and tertiary levels of health care in both the public and private sectors. This was a cross-sectional study under program implementation. Proforma was used to collect data on the available TB diagnostic services. Results: In public health facilities, GeneXpert was available at 100% in tertiary facilities in 8 (57%) states;up to 82% in 4 (33%) states, 50% available at secondary facilities in 2 states, and There is none at the primary facilities. Smear microscopy was available at 100% in tertiary facilities in 9 (64%) states and 3 (25%) states have 50% to 82%;secondary -10 (71%) states have > 70% at facilities;primary 1 (7%) state has it in 61% of facilities. Loop-mediated isothermal amplification (TB-LAMP) in tertiary 2 (17%) states have 20% and 100% respectively;secondary 4 (<30%) states have in 1 or 2 facilities;none for primary facilities. In private health facilities, 79% of states have Smear microscopy at both primary and secondary facilities, and only 2 states (14%) at tertiary facilities. Only 1 (7%) state has GeneXpert in all tertiary facilities, 2 (14%) states have secondary facilities, and 4 states in about 1% of facilities. TB LAMP was not available in any tertiary facility, one (7%) state at secondary with coverage of 1%, and 2 (14%) states at primary both with 4% overall facility coverage. Conclusions: There is an inequitable distribution of TB diagnostic services in both sectors and levels of care in Nigeria. TB care and control will improve with enhanced equitable distribution of TB diagnostic service

关键词： Tuberculosis Diagnostic Services Disparity Sector Level Nigeria

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Historic Cities: Issues of Urban Conservation, edited by Jeff Cody and Francesco Siravo. Getty Conservation Institute, Los Angeles, 2019. 610 pp. $60.00. ISBN9781606065938

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Built Heritage 2021年第1期5卷 1-3页

作者： Earl Kessler Bureau of Humanitarian Assistance USAID55512th StreetNWWashingtonDC 20004USA

Jeff Cody and Francesco Siravo have captured the crisis confronting historic cities and issued a call to action in Historic Cities:Issues of Urban Conservation.The book consolidates thinking about,investigations into and ac-tions taken that embarks us on a journey to educate us about and rescue historic cities for the value they repre-sent to us now and into the future.The world is now URBAN and as much as the Development Set still ro-manticizes rural development at the expense of urban areas,it is cities—all sizes and kinds of cities—that are the future.

关键词： Urban Conservation sizes

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Determinates of Regain in Body Mass Index among Malnourished Aids Patients on Therapeutic Food in Amhara National Regional State, Northwest Ethiopia: A Retrospective Cohort Study

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Open Journal of Epidemiology 2015年第2期5卷 122-128页

作者： Molla Gedefaw Moges Tariku GAMBY College of Medical Sciences Bahir Dar Ethiopia usaid Amhara Region Ethiopia

Although its utilization is greatly disputed, ready-to-use therapeutic food has been started as clinical nutrition care and treatment for malnourished adult AIDS patients since 2011 in Amhara National Regional State. However, factors determining the intended outcome (weight gain) have not been properly investigated. The main objective of the study was to assess improvement in body mass index and to identify its determinant factors. A retrospective cohort study design was conducted. Cluster sampling was employed to select health facilities in which the service was provided in the region. Of the 44 health facilities, nine were selected using lottery method, and all patients receiving the care in these health institutions were included in the study. Using tailored structured checklist, data were collected, organized and cleaned. Using paired T-test existence of difference between the mean of body mass index at admission and at 3rd visit was measured. Finally analysis of association between some selected independent variables with the outcome variable was done using logistic regression model at 95% CI and p 2). Paired T-test revealed that there was a statistically significant difference between mean of body mass index at admission and at the 3rd visit. Good ready-to-use therapeutic food treatment adherence (AOR 11.145;95% CI 6.556, 18.946), moderate acute malnutrition at admission (AOR 6.71;95% CI 2.618, 17.195), good ART adherence (AOR 2.136;95% CI, 1.269, 3.595) and being male (AOR 1.73;95% CI 1.052, 2.850) have a statistically significant contribution for body mass index improvement. The study identifies factors that determine gain in body mass index among AIDS patients on ready-to-use therapeutic food. However, although the study revealed a statistically significant difference between body mass index during enrolment, and after three months, we disagreed with the right and left utilization of imported food because of lack of sustainability, and aid dependency. We rather recommend interventions that encourage hous

关键词： Therapeutic Food Body Mass Index Regain AIDS Ethiopia

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Factors Associated with First-Line Antiretroviral Therapy Failure amongst HIV-Infected African Patients: A Case-Control Study

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World Journal of AIDS 2012年第4期2卷 271-278页

作者： Charles M. Kwobah Ann W. Mwangi Julius K. Koech Gilbert N. Simiyu Abraham M. Siika Department of Behavioral Sciences College of Health Sciences Moi University School of Medicine Eldoret Kenya Department of Medicine College of Health Sciences Moi University School of Medicine Eldoret Kenya usaid-AMPATH Partnership Biostatistics Eldoret Kenya usaid-AMPATH Moi University Clinical Research Centre Eldoret Kenya

Background: Since 2001, anti-retroviral therapy (ART) has been provided to over 75,000 HIV-infected patients at the usaid-Academic Model Providing Access to Healthcare (AMPATH) Partnership in western Kenya. Over 1000 of these patients have switched to second-line ART. We therefore set out to determine factors associated with first-line ART failure amongst these patients. Methods: This case controlled study matched patients (in the ratio 1:2) from the electronic AMPATH Medical Record System on the basis of age, gender, and ART initiation date. Cases were adults (≥18 years) who initiated second-line ART between January 1, 2007 and July 31, 2011 after at least one viral load measurement >5000 copies/ml or satisfying the WHO immunological or clinical failure criteria. Controls were those on non-failing first-line ART with a CD4 count > 400 /ml within the last 12 months, at the time of case incidence. Conditional logistic regression for paired data was used to assess association. We evaluated the strength of association of risk factors using stratified Cox model. Results: Of the 1084 cases and 2149 controls included in the analysis, 62% were female. Median age was 36.5 years (IQR = 30.7 - 43.1);median baseline CD4 cell count was 161 /ml (IQR = 72 - 277);Median time to ART failure was 37 months (IQR = 24 - 47). Low baseline CD4 count < 50 /ml (H.R = 7.07, (95% CI = 4.92 - 10.15);Zidovudine based ART (H.R 1.76, 95% CI = 1.25 - 2.48) and imperfect ART adherence (H.R = 2.77, 95% CI = 2.20 - 3.49) were independently associated with treatment failure. Conclusion: In this setting, low baseline CD4 count, zidovudine-based ART and imperfect adherence are associated with first-line ART treatment failure.

关键词： HIV Treatment ART Failure

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Effectiveness and Safety of 9-Month Treatment Regimen for Multidrug-Resistant Tuberculosis in the Philippines

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Journal of Tuberculosis Research 2022年第2期10卷 75-86页

作者： Vivian S. Lofranco Vincent M. Balanag Jr Lawrence O. Raymond Noel G. Macalalad Alex Golubkov Mary Rosary T. Santiago Anna Marie Celina G. Garfin National Center for Pulmonary Research-Lung Center of the Philippines Quezon City Philippines National TB Reference Laboratory-Research Institute for Tropical Medicine Muntinlupa City Philippines Global Health Bureau Infectious Diseases Office TB Division U.S. Agency for International Development (USAID) Washington USA Disease Prevention and Control-Department of Health Manila Philippines

Background: The Philippines has a burden of drug-resistant tuberculosis (DR-TB). One of the key challenges in the programmatic management of DR-TB (PMDT) is the high rate of loss to follow-up (38% in the 2010 cohort). An urgent need for a shorter, more tolerable, less expensive treatment regimen exists. The aim of the operational study is to determine the efficacy and safety of the short treatment regimen among drug resistant TB. Methods: This is a prospective single-arm cohort study evaluating the effectiveness and safety of a shorter 9 - 11-month treatment regimen (9MTR) for rifampicin-resistant/multi-drug resistant TB (RR/MDR-TB) in 10 PMDT facilities. All eligible consenting adult patients with rifampicin-resistant TB were enrolled and received the standardized 9-month treatment regimen (9MTR), including injectables, with a follow-up after 12 months of treatment completion. Results: A total of 329 patients were enrolled from July 2015 to December 2016. At the 6th month post-enrollment, 256 (77.8%) of them had culture-negative test results. The end-of-treatment success rate was 74.1% (224 [68.0%] were cured and 20 [6.1%] completed the treatment). On the other hand, 10 (3.0%) died, 41 (12.5%) lost to follow-up, 33 (10.0%) withdrawn, 1 (0.3%) treatment failure. In the 12th month after 9MTR completion, among the 244 patients with successful treatment, 198 (81.1%) had culture-negative results, while there were 46 patients whose culture tests were not done. One patient developed TB relapse with fluoroquinolone resistance. The majority of the adverse events were mild that occurred mostly during the first 6 months of treatment. Conclusion: The 9-month treatment regimen had a high treatment success rate with a favorable safety profile. The loss to follow-up was reduced;however, it was still a challenge. The introduction of the 9MTR via operational research had a major impact on building national capacity and infrastructure for the programmatic adoption of a new regimen. Ten PMDT centers received training and experienc

关键词： MDR-TB Short Treatment Regimen Treatment Outcomes Prospective Studies

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Patient Health Seeking Behavior and Choice of Place of Care among Tuberculosis Clients in Selected States in Nigeria

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Journal of Tuberculosis Research 2023年第4期11卷 149-161页

作者： Bethrand Odume Aminu Babayi Ogoamaka Chukwuogo Chidubem Ogbudebe Elias Aniwada Egwuma Efo Degu Dare Useni Sani Nkiru Nwokoye Emperor Ubochioma Obioma-Chijioke Akaniro Debby Nongo Rupert Eneogu Temitayo Lagundoye-Odusote Chukwuma Anyaike Technical and Programs Department KNCV Nigeria Abuja Nigeria Department of Community Medicine Faculty of Medical Sciences University of Nigeria Enugu Campus Enugu Nigeria Technical Department KNCV Tuberculosis Fund The Hague Netherlands The Programs and Coordination Department National Tuberculosis Leprosy & Buruli Control Program Abuja Nigeria Program Management Department HIV/AIDS & TB Office USAID/Nigeria Abuja Nigeria

Background: Tuberculosis (TB) remains a major global public health problem. Early detection and initiation of treatment shortens infectious period and is key to TB control. A considerable proportion of TB patients presenting with advanced symptoms suggests delay in seeking care. As TB control programs rely on passive case finding, TB care-seeking behavior is critical as un-diagnosed cases act as reservoirs for transmission. This study assessed patient health seeking behavior and choice of place of care among TB patients in Nigeria. Methods: This was a pro-gramme implementation, facility-based cross-sectional study in 14 states, 92 facilities across three levels of care. Interviewer-administered semi-structured questionnaires were used. Information on personal characteristics and health seeking behavior was collected from June 2020 to December 2021. The analysis was based on the various healthcare providers where the respondents first sought care. Data analysis was done using IBM SPSS and summarized using frequency and percentages. Chi square test was used for associations of characteristics of patients and choice of place of care at p Results: In all 14 states, distribution of overall first place of seeking care for TB symptoms was: 7208 (75.8%) health facilities (range 57% to 88%), while 2294 (24.2%) visited other places including community pharmacist, patent medicine vendor, traditional/home, un-specified/none. For Health facilities, the majority were at public facilities 6563 (69.1%) and private 641 (6.7%). Moreover, 6 states had >20% of respondents who first sought care at PMVs, while 3 states (Delta, Imo, and Rivers) had 10% of respondents who first sought care at Community Pharmacist. Conclusions: Nearly a quarter of people with TB first sought care outside health facilities, suggesting the need to align availability of services with their needs.

关键词： Patient Pathway Analysis TB Patients TB Treatment Healthcare Facility

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Assessment of Spring Water Quality in the Rural Watersheds of Western Nepal

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Journal of Geoscience and Environment Protection 2019年第11期7卷 39-53页

作者： Anup Gurung Sanot Adhikari Raju Chauhan Sudeep Thakuri Selina Nakarmi Deepak Rijal Bhawani S. Dongol Youth Alliance for Environment Kathmandu Nepal Central Department of Environmental Science Tribhuvan University Kathmandu Nepal Program for Aquatic Natural Resources Improvement (PANI) USAID Kathmandu Nepal

A preliminary study was conducted to analyze the water quality of spring waters in rural watershed of Western Nepal. 155 spring water samples were collected from Jhimruk, Rangun, Bogtan-Lagam Karnali, Thuligad and Middle Karnali watershed. Collection and analysis occurred twice, once in pre-monsoon 2018 and post-monsoon 2018. Various physical and chemical parameters were analyzed by using standard water quality measurements and compared with the Nepal Drinking Water Quality Standard and the World Health Organization Standard Guideline. The results indicate that the turbidity was high during pre-monsoon season. The highest turbidity of 63.8 NTU was observed in the Bogtan-Lagam Karnali watershed. Two spring sources—one in Bogtan-Lagam Karnali and one in Middle Karnali exceeded the health standard for nitrate-N. The phosphate levels were high during the pre-monsoon season in Jhimruk and Rangun watershed in all the studied sites. Dissolved oxygen levels were relatively high during post-monsoon season. Results of the water quality index in all the studied sites revealed that the water quality ranges from being poor to good conditions in the spring sources. The results from this study suggested that the water bodies are relatively good and can be used for domestic purposes after suitable treatment.

关键词： Springs Water Quality Parameters Drinking Sources Nitrate Pollution Monsoon Season

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Analysis of determinants of gross margin income generated through fishing activity to rural households around Lake Ziway and Langano in Ethiopia

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Agricultural Sciences 2013年第11期4卷 595-607页

作者： Dawit Garoma Asefa Admassie Gezahegn Ayele Fekadu Beyene Collage of Agriculture School of Agricultural Economics and Agricultural Business Haramaya University Dire Dawa Ethiopia IFPRI Ethiopian Economics Association Addis Ababa Ethiopia usaid Addis Ababa Ethiopia

This article analyzed determinants of gross margin income from fishing to the rural households around Lake Ziway and Langano in Ethiopia. Four districts adjacent to the two lakes were selected purposively from which 179 respondents drawn randomly. Both primary and secondary information comprises of household structure and assets, climate factors and supportive services were organized. Data analysis employed descriptive statistics, budgetary analysis and the Ricardian method. Budgetary analysis showed positive fish gross margin income (GMI) of ETB 3,023.40 to average fisher. The Ricardian analysis made use of the climate only model (Model 1) and comprehensive model (Model 2). Using Model 1, water level raise due to inflow is vital to earn fair income in addition to the rainfall amount in Season 1, which is supported with positive impact of precipitation water level interaction on fish income. Impact of precipitation was positive in Season 3, due to meher rainfall and withdrawal of fishing labor to join agriculture that minimized over fishing. Using Model 2, precipitation water level interaction has positive impact in Season 2 due to better inflow and Meher rainfall. The interaction term was negative in Season 4 attributed to decreased water level, dry weather and less precipitation. The result also showed positive impact of household members participation, participation in the traditional financial arrangement and capacity to finance operating costs. The study highlights problems facing fishing business like: decreased lake size and water volume, lake turbidity and siltation, open access and weak institutional arrangement to guide fishing efforts, wetland farming and expansion of irrigation to the lake side, cost of fishing materials, minimum sales price as well as poor access to the fish market. Hence, strengthening fishery coperatives, awareness creation, off-farm opportunities, integrated conservation works, reduced wetland farming and acquaintance to social networks were suggested.

关键词： Lake Ziway Lake Langano Fishing Household Gross Margin Ricardian Technique Ethiopia

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