How Outreach Training and Supportive Supervision (OTSS) Affect Health Facility Readiness and Health-Care Worker Competency to Prevent and Treat Malaria in Niger: A Secondary Analysis of OTSS Data.

The quality of health services is key to the goal of averting morbidity and mortality from malaria. From July 2020 to August 2021, PMI Impact Malaria supported the implementation of four rounds of Outreach Training and Supportive Supervision (OTSS) in 12 health districts in the two regions of Niger: Dosso and Tahoua. Through OTSS, trained supervisors conducted onsite visits to observe an average of 174 healthcare workers (HCWs) per round in 96 public primary health facilities, managing persons with fever or conducting antenatal care (ANC) consultations, and then provided instant and individualized feedback and onsite training. Data from health facility readiness, case management, and malaria in pregnancy (MiP) checklists across the four rounds were analyzed using Wilcoxon's and the χ2 tests. These analyses highlighted improved facility readiness, including an increased likelihood that HCWs had received classroom training, and facilities had increased availability of guidelines and algorithms by round 4 compared with round 1. Median HCW performance scores showed an improvement in the correct performance and interpretation of malaria rapid diagnostic tests, in classification of malaria as uncomplicated or severe, and in the management of uncomplicated malaria across the four rounds. For MiP services, malaria prevention and the management of pregnant women with malaria also improved from round 1 to round 4. These findings provide further evidence that OTSS can achieve rapid improvements in health facility readiness and HCW competency in managing outpatients and ANC clients.

Clinical Outreach Training and Supportive Supervision Quality-of-Care Analysis: Impact of Readiness Factors on Health Worker Competencies in Malaria Case Management in Cameroon, Mali, and Niger.

Improving the quality of malaria clinical case management in health facilities is key to improving health outcomes in patients. The U.S. President's Malaria Initiative Impact Malaria Project has supported implementation of the Outreach Training and Supportive Supervision (OTSS) approach in 11 African countries to improve the quality of malaria care in health facilities through the collection and analysis of observation-based data on health facility readiness and health provider competency in malaria case management. We conducted a secondary analysis of longitudinal data collected during routine supervision in Cameroon (April 2021-March 2022), Mali (October 2020-December 2021), and Niger (November 2020-September 2021) using digitized checklists to assess how service readiness affects health worker competencies in managing patients with fever correctly and providing those with confirmed uncomplicated malaria cases with appropriate treatment and referral. Linear or logistic regression analyses were conducted to assess the effect of facility readiness and its components on observed health worker competencies. All countries demonstrated significant associations between health facility readiness and malaria case management competencies. Data from three rounds of OTSS visits in Cameroon, Mali, and Niger showed a statistically significant positive association between greater facility readiness scores (including the availability of commodities, materials, and trained staff) and health worker competency in case management. These findings provide evidence that health worker performance is likely affected by the tools and training available to them. These results reinforce the need for necessary tools and properly trained staff if high-quality malaria case management services are to be delivered at health facilities.

Sequestration of steroidal estrogen in aqueous samples using an adsorption mechanism: a systemic scientometric review.

Steroidal estrogens (SEs) remain one of the notable endocrine disrupting chemicals (EDCs) that pose a significant threat to the aquatic environment in this era owing to their interference with the normal metabolic functions of the human body systems. They are currently identified as emerging contaminants of water sources. The sources of SEs are either natural or synthetic active ingredients in oral contraceptive and hormonal replacement therapy drugs and enter the environment primarily from excretes in the form of active free conjugate radicals, resulting in numerous effects on organisms in aquatic habitats and humans. The removal of SEs from water sources is of great importance because of their potential adverse effects on aquatic ecosystems and human health. Adsorption techniques have gained considerable attention as effective methods for the removal of these contaminants. A systemic review and bibliometric analysis of the application of adsorption for sequestration were carried out. Metadata for publications on SE removal utilizing adsorbents were obtained from the Web of Science (WoS) from January 1, 1990, to November 5, 2022 (107 documents) and Scopus databases from January 1, 1949, to November 5, 2022 (77 documents). In total, 137 documents (134 research and 4 review articles) were used to systematically map bibliometric indicators, such as the number of articles, most prolific countries, most productive scholars, and most cited articles, confirming this to be a growing research area. The use of different adsorbents, include activated carbon graphene-based materials, single and multi-walled carbon nanotubes, biochar, zeolite, and nanocomposites. The adsorption mechanism and factors affecting the removal efficiency, such as pH, temperature, initial concentration, contact time and adsorbent properties, were investigated in this review. This review discusses the advantages and limitations of different adsorbents, including their adsorption capacities, regenerative potential, and cost-effectiveness. Recent advances and innovations in adsorption technology, such as functionalized materials and hybrid systems, have also been highlighted. Overall, the bibliographic analysis provides a comprehensive overview of the adsorption technique for the removal of SEs from other sources, serving as a valuable resource for researchers and policymakers involved in the development of efficient and sustainable strategies to mitigate the effects of these emerging contaminants.

Analysis of attitudes and practices influencing adherence to seasonal malaria chemoprevention in children under 5 years of age in the Dosso Region of Niger.

BACKGROUND: Seasonal malaria chemoprevention (SMC) consists of the intermittent administration of a 3 day course of anti-malarial medications during the months of highest malaria risk in the Sahel region, where malaria transmission is highly seasonal. SMC is an effective intervention to reduce episodes of uncomplicated and severe malaria in children. However, morbidity cannot be lowered without adherence to medications. The objective of this study was to examine SMC medication adherence and to identify the attitudes and practices of caregivers during the 2020 SMC campaign in the Dosso region. METHODS: This study was conducted based on data from independent monitoring using random cluster sampling. Adherence levels and the attitudes and practices of caregivers were evaluated using data from caregivers' self-reports and analysed according to Bernard Vrijens' taxonomy. RESULTS: At the initiation of treatment phase, 99% of children (N = 2296) received their first administration of medication, with 90% of caregivers (N = 1436) knowing that the medications help prevent malaria. However, only 56% of caregivers (N = 1856) reported that treatment initiation took place under direct observation by the distributor. At the implementation of treatment phase, 90% of children (N = 2132) took their medication on the second day and 84% (N = 1068) took it the third day. "Forgetting," "not having time," and "the mother's absence" were the main reasons caregivers gave to explain discontinuation of the 3 day course of medication. CONCLUSION: This simple, low-cost survey demonstrated that coverage of SMC and adherence by caregivers to completing the full 3 day medication course was high. The survey also showed that knowledge, attitudes, and practices of some caregivers regarding adherence to medications during the SMC campaign could be improved. Expanding distributors' training, developing and providing them with tools for interpersonal communication, and strengthening supervision could lead to even higher adherence.