Outreach Training and Supportive Supervision for Quality Malaria Service Delivery: A Qualitative Evaluation in 11 Sub-Saharan African Countries.

Quality improvement of malaria services aims to ensure that more patients receive accurate diagnosis, appropriate treatment, and referral. The Outreach Training and Supportive Supervision Plus (OTSS+) approach seeks to improve health facility readiness and provider competency through onsite supportive supervision, troubleshooting, and on-the-job training. As part of a multicomponent evaluation, qualitative research was conducted to understand the value of the OTSS+ approach for malaria quality improvement. Semistructured key informant interviews, focus group discussions, and structured health facility-based interviews were used to gather stakeholder perspectives at subnational, national, and global levels. Data were collected globally and in 11 countries implementing OTSS+; in-depth data collection was done in four: Cameroon, Ghana, Niger, and Zambia. Study sites and participants were selected purposively. Verbatim transcripts were analyzed thematically, following the Framework approach. A total of 262 participants were included in the analysis; 98 (37.4%) were supervisees, 99 (37.8%) were supervisors, and 65 (24.8%) were other stakeholders. The OTSS+ approach was perceived to improve provider knowledge and skills in malaria service delivery and to improve data and supply management indirectly. Improvements were attributed to a combination of factors. Participants valued the relevance, adaptation, and digitization of supervision checklists; the quality and amount of contact with problem-solving supervisors; and the joint identification of problems and solutions, and development of action plans. Opportunities for improvement were digitized checklist refinement, assurance of a sufficient pool of supervisors, prioritization of health facilities, action plan dissemination and follow-up, and data review and use. The OTSS+ approach was perceived to be a useful quality improvement approach for malaria services.

Explaining the continuing high prevalence of trachomatous trichiasis unknown to the health system in evaluation units: a mixed methods explanatory study in four trachoma-endemic countries.

BACKGROUND: We explored reasons for continuing higher-than-anticipated prevalence of trachomatous trichiasis (TT) unknown to the health system in population-based prevalence surveys in evaluation units where full geographical coverage of TT case finding was reported. METHODS: A mixed-methods study in Ethiopia, Kenya, Nigeria and Tanzania was conducted. We compared data from clinical examination, campaign documentation and interviews with original trachoma impact survey (TIS) results. RESULTS: Of 169 TT cases identified by TIS teams, 130 (77%) were examined in this study. Of those, 90 (69%) were a match (both TIS and study teams agreed on TT classification) and 40 (31%) were a mismatch. Of the 40 mismatches, 22 (55%) were identified as unknown to the health system by the study team but as known to the health system by the TIS team; 12 (30%) were identified as not having TT by the study team but as having TT by the TIS team; and six (15%) were identified as unknown to the health system in the TIS team but as known to the health system by the study team based on documentation reviewed. CONCLUSIONS: Incorrectly reported geographical coverage of case-finding activities, and discrepancies in TT status between TIS results and more detailed assessments, are the key reasons identified for continuing high TT prevalence.

Mental health and disability research in Ghana: a rapid review.

The objective of this rapid review was to explore the current evidence base for mental health and disability research in Ghana. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist was followed. Online databases were used to identify primary studies, systematic reviews, meta-analyses, rapid reviews, or guidelines published between 2010 and 2020. All relevant published (both peer-reviewed articles and grey literature) on mental health and/or disability research conducted in or on Ghana between 2010 and 2020 were included in this review. 4,791 articles were identified in the initial search. After the removal of duplicates, followed by title and abstract screening, 930 articles were selected for full-text review. An additional 8 articles identified from reference lists of included articles were also included in full-text review. After review, 375 articles were selected for inclusion; 234 (62%) were on mental health while the remaining 141 (38%) were on disability. There is an increasing trend in the absolute number of mental health and/or disability studies. Most of the mental health studies included in this review were either observational quantitative studies (n=132; 56%) or observational qualitative studies (n=79; 34%). There were very few interventional studies (n=6; 3%). A similar finding was noted for the disability studies. External funding accounted for 51% of mental health articles. Although there was a steady year-on-year increase in the absolute number of mental health and/or disability studies conducted between 2010 to 2020, there is a need for more intervention studies to evaluate what mental health and/or disability interventions work, for whom, and under what circumstances. These should include evaluations of the cost, benefits, effectiveness, and acceptability of various interventions for policy and planning. Further, there is a need for the Ministry of Health to prioritize research funding for mental health and disability and enhance technical and methodological capacity of researchers to conduct disability and mental health research in Ghana.

Understanding the Role of Gender in Trichiasis Case Finding in Tanzania.

PURPOSE: Despite the importance of trachomatous trichiasis (TT) case-finding activities in national trachoma elimination campaigns, the scientific literature on the determinants of good outcomes - finding and managing all TT cases - is still sparse. In Tanzania, we studied differences in case finding activities and outcomes between male and female case finders. METHODS: This case study was conducted in two districts in Tanzania in 2021-2022. Quantitative data were extracted from case finder forms and outreach registers, and qualitative data were collected through direct observation, interviews, and focus group discussions. RESULTS: Across both districts, more males were trained as case finders (68%). Productivity differences were minor, not statistically significant, between male and female case finders regarding the number of households visited and the number of adults examined. Whether identified by a male or female case finder, similar proportions of men and women suspected to have TT were subsequently managed. There is evidence that suggests that female case finders were more active in supporting suspected and confirmed TT cases to access follow-up services. CONCLUSION: The findings do not suggest that gender balance in the recruitment of TT case finders would have led to better TT campaign outcomes in the study districts. Programmes may benefit from integrating gender considerations in the design and implementation of case finding activities - e.g. in monitoring gender differences among case finders and the relationship with key outcomes. This study also highlights how women with TT face greater barriers to care.

Mental health and disability research priorities and capacity needs in Ghana: findings from a rapid review and research priority ranking survey.

BACKGROUND: Identification of national research agendas for mental health and disability can be supported by well-designed research priority-setting studies. Few low- and middle-income countries (LMICs) have undertaken such studies. OBJECTIVE: To identify mental health and disability research priorities in Ghana. METHODS: A mixed methods study comprising a rapid review, research priority ranking survey, and research capacity needs assessment survey was employed. Participants in the surveys included five expert pools identified from online search and existing database on mental health civil society organisations/non-governmental organisations. The research priority ranking was completed in two stages, using the Child and Nutrition Research Initiative (CHNRI) method to identify priority questions for immediate and short term (0 to 5 years) and medium to long term (>5 years) in stage two. Both surveys were deployed online using google forms. Analysis for the ranking survey involved computing total scores from the CHNRI criteria and generating ranks for the research questions. RESULTS: A total of 68 experts (97% response rate), generated 94 and 92 questions for the short and long term, respectively. Forty experts (58% response rate) completed the ranking stage. The top 10 ranked research questions included: 4 questions addressing health systems; 2 questions on epidemiology; and 4 questions on interventions. All research questions were considered urgent and should be conducted in the immediate to short term (0-5 years). The methodological capacity of researchers to conduct disability and mental health research is weak. CONCLUSION: Our approach has generated an agenda for mental health and disability research priorities for Ghana and demonstrated that it is feasible to employ a systematic methodology for research priority setting that includes key parameters of context and research capacity.

Biology, pathotype, and virulence of Globodera rostochiensis populations from Kenya.

The potato cyst nematodes (PCN), Globodera rostochiensis (Woll.) and G. pallida (Stone), are important pests of potato globally. Due to their extensive damage potential and the challenge of managing them, these nematodes are under strict regulations in many countries; however, despite these regulations, PCN continue to spread into new areas and countries. In Kenya, G. rostochiensis was first reported in 2015 and G. pallida was reported three years later, both in Nyandarua County. Research was conducted to characterize the biology, pathotype, and virulence of G. rostochiensis populations from Kenya in glasshouse and laboratory studies. The development of G. rostochiensis was assessed in roots of susceptible potato 'Désirée' and resistant 'Laura' carrying the H1 resistance gene. The 'HAR1' population from Kenya and 'Ecosse' from Germany were not able to produce females in the roots of the resistant potato 'Laura'. The rate of root penetration by G. rostochiensis juveniles did not differ (p > 0.05) between populations and cultivars. However, in the resistant cultivar, juveniles developed into males only. A total of 736 cumulative degree-days at 6°C base temperature (DD6) were required by 'HAR1' to complete the life cycle on 'Désirée', whereas 'Ecosse' completed the life cycle within 645 DD6. The Kenyan populations lacked obligatory diapause and high numbers of juveniles hatched immediately after maturity. Consequently, the Kenyan populations had the potential to complete up to three reproduction cycles in less than a year. On selected potato cultivars, the populations from Kenya failed to reproduce on 10 out of 13 commercial cultivars tested. The 10 cultivars carried the H1 resistance gene, which suggests that the G. rostochiensis populations tested belong to the Ro1/4 pathotype group. The virulence of the G. rostochiensis populations from Kenya did not differ from that of the standard reference population 'Ecosse' and therefore can be effectively managed with the commercially available potato cultivars carrying the H1 resistance gene.

National approaches to trichiasis surgical follow-up, outcome assessment and surgeon audit in trachoma-endemic countries in Africa.

BACKGROUND: Poor outcomes of trichiasis surgery, including postoperative trichiasis, are common in many trachoma-endemic countries in Africa. To improve outcomes, WHO recommends regular follow-up and outcome assessment of surgical cases plus audit of trichiasis surgeons. AIMS: To assess national approaches to trichiasis surgical follow-up, outcome assessment and audit, and identify national targets for good surgical outcome (defined as the percentage of patients undergoing surgery for trichiasis remaining free of post-operative trichiasis for a defined interval after surgery). METHODS: A cross-sectional survey was carried out between May and July 2018, involving all 29 known-trachoma-endemic countries in Africa. An emailed questionnaire was used to collect information on national targets for surgical outcomes, policies, monitoring and strategies to address underperformance by surgeons. RESULTS: All national programmes provided information; 2 of the 29 had not yet implemented trichiasis surgery as part of their trachoma elimination programme. Findings from 27 countries are therefore reported. Only four countries reported having a national policy for trichiasis surgery follow-up and outcome assessment and only two had a national policy for conducting audits of trichiasis surgeons. Only 9 of the 27 countries had a cut-off point at which poorly performing surgeons would be instructed to discontinue surgery until retraining or other interventions had been undertaken. DISCUSSION: To address the challenge of post-operative trichiasis and other poor outcomes, national trachoma programmes should create and implement policies and systems to follow up patients, assess surgical outcomes and monitor the performance of individual surgeons through post-surgical audits.

Systematic review of the incidence of post-operative trichiasis in Africa.

BACKGROUND: Surgery for trichiasis is one of the pillars of the World Health Organization's strategy for global elimination of trachoma as a public health problem. A high incidence of post-operative trichiasis or other poor surgical outcomes could jeopardize these efforts. In this review, we aimed to summarize the reported incidence of post-operative trichiasis and other poor outcomes of trichiasis surgery in Africa. METHODS: We conducted a systematic literature search using PubMed, Academic Search Premier, Africa-Wide Information, CINAHL and Health Source Nursing through EBSCOhost, Web of Science, and the Cochrane Central Register of Controlled Trials. Reference lists of included studies were also reviewed to identify further potentially relevant publications. All observational and interventional studies that measured post-operative trichiasis in Africa as an outcome of trichiasis surgery were included. RESULTS: Thirty-five papers reporting on 22 studies (9 interventional,13 observational; total 13,737 participants) met the inclusion criteria. The reported incidence of post-operative trichiasis in the included studies ranged from 2% (at 6 weeks after bilamellar tarsal rotation) to 69% (at 3 weeks after anterior lamellar repositioning). The incidence varied by surgical procedure, study design, and length of follow-up. CONCLUSION: Trichiasis surgical outcomes should be improved. National trachoma programmes could benefit from identifying and adopting strategies to improve the performance and quality of their surgical service.

Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya.

OBJECTIVE: To describe the challenges and successes of integrating a public-sector cervical screening program into a large HIV care system in western Kenya. METHODS: The present study was a programmatic description and a retrospective chart review of data collected from a cervical screening program based on visual inspection with acetic acid (VIA) between June 2009 and October 2011. RESULTS: In total, 6787 women were screened: 1331 (19.6%) were VIA-positive, of whom 949 (71.3%) had HIV. Overall, 206 women underwent cryotherapy, 754 colposcopy, 143 loop electrical excision procedure (LEEP), and 27 hysterectomy. Among the colposcopy-guided biopsies, 27.9% had severe dysplasia and 10.9% had invasive cancer. There were 68 cases of cancer, equating to approximately 414 per 100000 women per year. Despite aggressive strategies, the overall loss to follow-up was 31.5%: 27.9% were lost after a positive VIA screen, 49.3% between biopsy and LEEP, and 59.6% between biopsy and hysterectomy/chemotherapy. CONCLUSION: The established infrastructure of an HIV treatment program was successfully used to build capacity for cervical screening in a low-resource setting. By using task-shifting and evidence-based, low-cost approaches, population-based cervical screening in a rural African clinical network was found to feasible; however, loss to follow-up and poor pathology infrastructure remain important obstacles.