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2.
Medicine (Baltimore) ; 98(52): e18476, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876732

RESUMO

The aim of this study was to assess effectiveness of fecal microbiota transplantation (FMT) in treating intestinal failure associated with drug-induced hypersensitivity syndrome (DIHS).A 32-year-old Chinese woman, who developed DIHS-associated multiple organ dysfunction syndrome (MODS) manifesting as combined dysfunction of the intestine, liver, and kidney, was treated with 4 times of FMT at a frequency of once every 6 days. The structure and composition of the patient's fecal microbiota were analyzed by 16S rRNA-based molecular techniques. The clinical outcomes after FMT treatment were assessed by abdominal contrast-enhanced computed tomography (CT), characterization of fecal microbiota, measurement of serum inflammatory markers, and other clinical examinations.After 4 rounds of FMT were administered, the patient showed dramatic improvement in MODS and severe diarrhea with these clinical conditions under control. We consistently observed significant alteration in her gut microbiota, mainly involving considerable enrichment in Firmicutes members and depletion of Proteobacteria opportunistic organisms. Moreover, this reconstituted bacterial community composition correlated with fecal output, T helper cells, and inflammatory markers. Abdominal contrast-enhanced CT scans before and after FMT indicated significant improvement in inflammation and edema within the small intestine and colon of the patient. Notably, after completion of the fourth FMT, the level of inflammation in the intestine and colon had returned to normal. Over 6 months of follow-up, the intestinal mucous remained normal.Our results represent a breakthrough in the clinical management of MODS and suggest new therapeutic avenues to pursue for microbiota-related indications.


Assuntos
Diarreia/terapia , Síndrome de Hipersensibilidade a Medicamentos/complicações , Transplante de Microbiota Fecal , Doença Aguda , Adulto , Diarreia/etiologia , Transplante de Microbiota Fecal/métodos , Feminino , Microbioma Gastrointestinal/genética , Humanos , Intestino Delgado/diagnóstico por imagem , Insuficiência de Múltiplos Órgãos/diagnóstico por imagem , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , RNA Ribossômico 16S/genética , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Zhonghua Xue Ye Xue Za Zhi ; 40(10): 853-855, 2019 Oct 14.
Artigo em Chinês | MEDLINE | ID: mdl-31775486

RESUMO

Objective: To explore the availability and safety of fecal microbiota transplantation for patients with refractory diarrhea after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Four acute leukemia patients suffered from refractory diarrhea after allo-HSCT. One of them was refractory intestinal infection, the others were intestinal graft versus host disease. One or two doses of fecal microbiota, 3.4-6.0 U for one dose, were infused via nasal-jejunal tube. The curative effect and side effects were reviewed. Results: Three cases achieved complete remission while 1 was stable disease. The side effects included fever, abdominal pain and diarrhea, which all were Ⅰ grade. Conclusion: Fecal microbiota transplantation was effective and safe for refractory diarrhea after allo-HSCT.


Assuntos
Diarreia/terapia , Transplante de Microbiota Fecal , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda , Diarreia/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos
4.
Medicine (Baltimore) ; 98(37): e16618, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517810

RESUMO

OBJECTIVE: This meta-analysis assessed the effectiveness of probiotics and synbiotics for acute diarrhea (AD) in children and investigated probiotic formulations, types of interventions, and country factors. METHODS: Randomized, double-blind, placebo-controlled trials evaluating the effects of probiotics or synbiotics on AD were analyzed. We followed the recommendations of the Cochrane Handbook and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risks of systematic errors (bias) and random errors were assessed, and the overall quality of the evidence was evaluated using the Grades of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: The meta-analysis included 34 studies with 4911 patients. Five and 29 studies presented the results of synbiotic and probiotic interventions, respectively. After intervention, the durations of diarrhea (weighted mean difference (WMD) = -16.63 [-20.16; -12.51]) and hospitalization (risk ratio (RR) = 0.59 [0.48; 0.73]) were shorter, the stool frequency on day 3 (WMD = -0.98 [-1.55; -0.40]) was decreased, and the incidence of diarrhea lasting 3 days was lower in the probiotic and synbiotic groups than in the control groups. Furthermore, in the subgroup analyses, synbiotics were more effective than probiotics at reducing the durations of diarrhea and hospitalization, and Saccharomyces and Bifidobacterium were more effective than Lactobacillus at reducing the duration of diarrhea. CONCLUSION: This meta-analysis supports the potential beneficial roles of probiotics and synbiotics for AD in children. Further research is needed to determine problems associated with probiotic/synbiotic mixtures and appropriate dosages.


Assuntos
Diarreia/terapia , Probióticos/uso terapêutico , Simbióticos , Doença Aguda/terapia , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Medicina (B Aires) ; 79(4): 291-294, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487251

RESUMO

Clostridium difficile infection is an increasingly recognized cause of diarrhea in inpatients, frequently associated to high mortality. Vancomycin is the treatment of choice for all Clostridium difficile- associated diarrheas, with different degrees of severity. However, some patients develop refractory forms to that treatment and there are no alternative antibiotic schemes recommended for these cases. Fecal microbiota transplantation has been shown to be successful in a series of cases of severe diarrhea associated with this organism. We present a case of refractory C. difficile infection successfully treated with fecal microbiota transplantation.


Assuntos
Infecções por Clostridium/terapia , Clostridium difficile , Diarreia/terapia , Transplante de Microbiota Fecal , Idoso de 80 Anos ou mais , Infecções por Clostridium/complicações , Diarreia/microbiologia , Feminino , Humanos , Resultado do Tratamento
7.
Zhongguo Zhen Jiu ; 39(8): 832-6, 2019 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-31397127

RESUMO

OBJECTIVE: To observe the efficacy differences between moxibustion combined with umbilical therapy and oral administration of montmorillonite powder (smecta) on diarrhea symptoms in children of different ages. METHODS: A total of 120 children were randomly divided into an observation group and a control group, 60 cases in each group. In the observation group, the children aged under 3 years old were treated with moxibustion at Shenque (CV 8), Zhongwan (CV 12) and Tianshu (ST 25), and each acupoint was treated for less than 3 min, and the total treatment duration was no more than 10 min; the children aged between 3 to 7 years old were treated with moxibustion at Shenque (CV 8), Zhongwan (CV 12), Tianshu (ST 25), Guanyuan (CV 4), Zusanli (ST 36), Pishu (BL 20), Shenshu (BL 23) and Dachangshu (BL 25), each acupoint was treated for less than 3 min, and the total treatment duration was no more than 20 min. After moxibustion, traditional Chinese medicine patch (clove, cinnamon, rhizoma zingiberis, fructus evodiae, hawthorn, rhizoma atractylodis) was applied at Shenque (CV 8). For the children under 1 year old, the medical bag with 30 g powder was heated to 50 ℃ and used for about 30 min; for children over 1 year old, 2-5 g powder was mixed with vinegar and used for 4-8 h each time. The treatment was given once a day, three times as a course of treatment, and a total of one course of treatment was given. The children in the control group were treated with oral administration of montmorillonite powder, 3 g per day for children under 1 year old, 3-6 g per day for children aged 1-2 years old and 6-9 g per day for children over 2 years old. The montmorillonite powder was taken three times a day for 3 days. The diarrhea symptom scores before and after treatment were observed and the clinical efficacy was evaluated. From the first treatment, the recovery cases and recovery time in the two groups were recorded, the recovery cases and recovery time in acute and chronic stages were compared between different age groups. The recurrence was observed 3 months after treatment. RESULTS: Compared before treatment, the diarrhea symptom score after treatment was decreased in the observation group (P<0.05), while there was no significant difference before and after treatment in the control group (P>0.05). After treatment, the score of diarrhea symptoms in the observation group was lower than that in the control group (P<0.05). The total effective rate was 95.0% (57/60) in the observation group, which was superior to 76.7% (46/60) in the control group (P<0.05). The recovery cases of acute stage aged ≤ 1 year old and 5-7 years old, and chronic stage of different age stages in the observation group was insignificantly higher than that in the control group (P>0.05). The recovery time of different age stages and average recovery time in the observation group were shorter than those in the control group (P<0.05). The recovery time of children in acute stage>1 year old and ≤5 years old and average recovery time in the observation group were shorter than those in the control group (P<0.05), while the average recovery time of children in chronic stage in the observation group was shorter than that in the control group (P<0.05). Three months after treatment, the recurrence rate was 0% (0/36) in acute phase and 4.8% (1/21) in chronic phase in the observation group, which were superior to 9.7% (3/31) in acute phase and 46.7% (7/15) in chronic phase in the control group (P<0.05). CONCLUSION: The umbilical therapy combined with moxibustion could improve the symptoms of diarrhea and shorten the recovery time in children of different ages with autumn diarrhea, which have better efficacy than montmorillonite powder.


Assuntos
Diarreia/terapia , Medicina Tradicional Chinesa , Moxibustão , Pontos de Acupuntura , Criança , Pré-Escolar , Humanos , Lactente , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(34): e16949, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441891

RESUMO

BACKGROUND: Acute diarrhea is the 2nd highest prevalence disease among children under 5 years of age. It can cause malnutrition and even death in children, especially in developing country. Traditional Chinese medicine therapy has been applied and already in the guidelines for clinical practice of acute infectious diarrhea in children in China, but there is no specific methods or recommendations due to lacking of evidence. Zusanli acupoint injection as a form of acupuncture therapy, which is proved to be effective in randomised controlled trials (RCTs) and very suitable for children, has been used in acute diarrhea in children for a long time; therefore, a systematic review is necessary to provide available evidence for further study. METHODS: Different studies from various databases will be involved in this study. Only RCTs of children under 5 years of age diagnosed with acute diarrhea using any recognized diagnostic criteria will be included. We will search manually the literature in the databases from China Conference Paper Database. Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, WanFang, Chongqing VIP, and China Biomedical Literature CDROM Database. Primary outcomes: clinical cure rate (clinical cure is defined as the frequency, timing and character of stool back to normal status, as well as disappearance of diarrhea symptoms), diarrhea duration (from admission to the cessation of diarrhea). SECONDARY OUTCOMES: stool frequency within 24 hours, rate of adverse effect. Data will be extracted by 2 researchers independently; risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0. RESULTS: This study will synthesize and provide evidence based on the data of the currently published zusanli (ST36) acupoint injection for acute diarrhea in children under 5 years old, especially in terms of clinical efficacy and safety. CONCLUSION: This systematic review aims to evaluate the benefits and harms of zusanli acupoint injection for acute diarrhea in children under 5 years old reported in RCTs, and provide evidence reference in TCM field for Chinese guidelines on the treatment of acute diarrhea in children. ETHICS AND DISSEMINATION: This study is a systematic review; the outcomes are based on the published evidence, and hence examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. PROSPERO REGISTRATION NUMBER: PROSPERO 2019 CRD42019135275.


Assuntos
Pontos de Acupuntura , Terapia por Acupuntura/métodos , Diarreia/terapia , Terapia por Acupuntura/efeitos adversos , Doença Aguda/terapia , Pré-Escolar , Humanos , Medicina Tradicional Chinesa/métodos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisão Sistemática como Assunto
9.
BMC Public Health ; 19(1): 1028, 2019 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366398

RESUMO

BACKGROUND: The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery. METHODS: Formative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed. RESULTS: A theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others. CONCLUSION: This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.


Assuntos
Cólera/prevenção & controle , Diarreia/terapia , Higiene/normas , Desenvolvimento de Programas , Saneamento/normas , Telemedicina/organização & administração , Qualidade da Água/normas , Bangladesh , Características da Família , Estudos de Viabilidade , Feminino , Desinfecção das Mãos , Hospitais , Humanos , Masculino , Projetos Piloto , Pesquisa Qualitativa , Projetos de Pesquisa , Sabões
12.
Gastroenterology ; 157(3): 859-880, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31351880

RESUMO

BACKGROUND & AIMS: The evaluation of patients with chronic watery diarrhea represents a diagnostic challenge for clinicians because organic causes, including inflammatory bowel disease, microscopic colitis, and chronic infection, must be differentiated from functional diarrhea and diarrhea-predominant irritable bowel syndrome. The purpose of this review is to summarize the available evidence on the usefulness of diagnostic tests in such patients. METHODS: We searched MEDLINE and EMBASE via OVID, from 1978 until April 2017. We included diagnostic test accuracy studies reporting on the use of fecal and blood tests for the evaluation of adult patients with functional diarrhea, including irritable bowel syndrome. We assessed the risk of bias of included studies using a modified version of the Quality Assessment of Diagnostic Accuracy Studies II, and the certainty in the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. We calculated pooled sensitivity and specificity, and the proportion of patients with true and false positive and negative results. We evaluated the following tests: erythrocyte sedimentation rate, C-reactive protein, fecal lactoferrin, fecal calprotectin, serologic tests for celiac disease, tests for bile acid diarrhea, the commercially available version of anti-cytolethal distending toxin B and anti-vinculin antibodies, and tests for Giardia infection. We did not evaluate breath tests for small intestinal bacterial overgrowth, as they are not part of a standard diarrhea workup. RESULTS: Thirty-eight studies proved eligible to evaluate 1 or more of these tests. Erythrocyte sedimentation rate and C-reactive protein were similar at discriminating organic from functional disease, with sensitivity and specificity, respectively, of 0.54-0.78 and 0.46-0.95 for erythrocyte sedimentation rate and 0.73 and 0.78 for C-reactive protein. Among fecal tests, fecal calprotectin in a range of 50-60 µg/g (pooled sensitivity 0.81; 95% confidence interval [CI], 0.75-0.86; pooled specificity 0.87; 95% CI, 0.78-0.92) and fecal lactoferrin in a range of 4.0-7.25 µg/g (pooled sensitivity 0.79; 95% CI, 0.73-0.84; pooled specificity 0.93; 95%CI 0.63-0.99) presented the lowest proportion of false-negative results (low certainty in the evidence). Among tests for celiac disease, IgA tissue transglutaminase presented the best diagnostic test accuracy (sensitivity range, 0.79-0.99; specificity range, 0.90-0.99) with moderate certainty in the evidence. Among tests for bile acid diarrhea, the 75selenium homotaurocholic acid test performed better than serum fibroblast growth factor 19 and 7α-hydroxy-4-cholesten-3-one, but is not available in the United States. There was insufficient evidence to recommend serologic tests for irritable bowel syndrome at this time. There are several good diagnostic tests for Giardia infection. CONCLUSIONS: Moderate to low certainty in the evidence indicates that available fecal and blood tests may play a role in the diagnostic workup of adult patients with functional diarrhea. At the moment, no tests are available to reliably rule in irritable bowel syndrome.


Assuntos
Técnicas de Diagnóstico do Sistema Digestório/normas , Diarreia/diagnóstico , Gastroenterologia/normas , Síndrome do Intestino Irritável/diagnóstico , Doença Crônica , Diagnóstico Diferencial , Diarreia/etiologia , Diarreia/fisiopatologia , Diarreia/terapia , Medicina Baseada em Evidências/normas , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/fisiopatologia , Síndrome do Intestino Irritável/terapia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sociedades Médicas , Fatores de Tempo
14.
J Glob Health ; 9(1): 010505, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31293782

RESUMO

Background: In Kenya, diarrheal disease is the second leading cause of death among children under five. The Government of Kenya launched a national plan to increase coverage of oral rehydration solution (ORS) and zinc by addressing demand and supply-side barriers. This study evaluates progress of ORS and zinc uptake in Kenya according to the national plan from 2011 to 2016. Methods: In 2016, we conducted a nationally representative population-based household survey to estimate coverage of ORS and zinc for treatment of diarrhea cases among children under five. We also used ORS and zinc coverage data from the two most recent Kenya Demographic and Health Surveys in 2008/09 and 2014 to estimate annual changes in coverage rates during the program period. Based on these inputs, we used the Lives Saved Tool to estimate the number of diarrhea deaths averted between 2011 and 2016 due to increased use of ORS and zinc. Results: The 2016 survey results showed that ORS coverage was 42% (95% confidence interval (CI) = 38%, 47%) and zinc coverage was 18% (95% CI = 15%, 23%). The estimated coverage for the combined use of ORS and zinc was 15% in 2016 (95% CI = 12%, 19%). Compared to 2011, an additional 3340 (sensitivity bounds = 2 670, 3 920) diarrhea deaths among children under five were averted due to increases in ORS and zinc coverage. Conclusions: Kenya was successful in catalyzing uptake of combined treatment with ORS and zinc, which rose from 0.8% in 2011 to 15% in 2016. Ongoing efforts are necessary to further build on these gains.


Assuntos
Diarreia/terapia , Hidratação/estatística & dados numéricos , Programas Governamentais , Soluções para Reidratação/uso terapêutico , Zinco/uso terapêutico , Pré-Escolar , Diarreia/mortalidade , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento
16.
J Glob Health ; 9(1): 010801, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263547

RESUMO

Background: In 2013, the World Health Organization (WHO) launched the Rapid Access Expansion (RAcE) programme in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria to increase coverage of diagnostic, treatment, and referral services for malaria, pneumonia, and diarrhea among children ages 2-59 months. In 2017, a final evaluation of the six RAcE sites was conducted to determine whether the programme goal was reached. A key evaluation objective was to estimate the reduction in childhood mortality and the number of under-five lives saved over the project period in the RAcE project areas. Methods: The Lives Saved Tool (LiST) was used to estimate reductions in all-cause child mortality due to changes in coverage of treatment for the integrated community case management (iCCM) illnesses - malaria, pneumonia, and diarrhea - while accounting for other changes in maternal and child health interventions in each RAcE project area. Data from RAcE baseline and endline household surveys, Demographic and Health Surveys, and routine health service data were used in each LiST model. The models yielded estimated change in under-five mortality rates, and estimated number of lives saved per year by malaria, pneumonia and diarrhea treatment. We adjusted the results to estimate the number of lives saved by community health worker (CHW)-provided treatment. Results: The LiST model accounts for coverage changes in iCCM intervention coverage and other health trends in each project area to estimate mortality reduction and child lives saved. Under five mortality declined in all six RAcE sites, with an average decline of 10 percent. An estimated 6200 under-five lives were saved by malaria, pneumonia, and diarrhea treatment in the DRC, Malawi, Niger, and Nigeria, of which approximately 4940 (75 percent) were saved by treatment provided by CHWs. This total excludes Mozambique, where there were no estimated under-five lives saved likely due to widespread stockouts of key medications. In all other project areas, lives saved by CHW-provided treatment contributed substantially to the estimated decline in under-five mortality. Conclusions: Our results suggest that iCCM is a strategy that can save lives and measurably decrease child mortality in settings where access to health facility services is low and adequate resources for iCCM implementation are provided for CHW services.


Assuntos
Administração de Caso/organização & administração , Mortalidade da Criança/tendências , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde , Acesso aos Serviços de Saúde/organização & administração , Mortalidade Infantil/tendências , Pré-Escolar , República Democrática do Congo/epidemiologia , Diarreia/mortalidade , Diarreia/terapia , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Malaui/epidemiologia , Moçambique/epidemiologia , Níger/epidemiologia , Nigéria/epidemiologia , Pneumonia/mortalidade , Pneumonia/terapia , Avaliação de Programas e Projetos de Saúde , Organização Mundial da Saúde
17.
J Glob Health ; 9(1): 010803, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263548

RESUMO

Background: Access to prompt and appropriate treatment is key to survival for children with malaria, pneumonia and diarrhoea. Community-based services are vital to extending care to remote populations. Malaria Consortium supported Niger state Ministry of Health, Nigeria, to introduce and implement an integrated community case management (iCCM) programme for four years in six local government areas (LGAs). The objective was to increase coverage of effective treatment for malaria, pneumonia and diarrhoea among children aged 2-59 months. Methods: The programme involved training, equipping, ongoing support and supervision of 1320 community volunteers (CORPs) to provide iCCM services to their communities in all six LGAs. Demand creation activities were also conducted; these included community dialogues, household mobilization, sensitization and mass media campaigns targeted at programme communities. To assess the level of changes in care seeking and treatment, baseline and endline household surveys were conducted in 2014 and 2017 respectively. For both surveys, a 30×30 multi-stage cluster sampling method was used, the sampling frame being RAcE programme communities. Results: Care-seeking from an appropriate provider increased overall and for each iCCM illness from 78% to 94% for children presenting with fever (P < 0.01), from 72% to 91% for diarrhoea cases (P < 0.01), and from 76% to 89% for cases of cough with difficult or fast breathing (P < 0.05). For diagnosis and treatment, the coverage of fevers tested for malaria increased from 34% to 77% (P < 0.001) and ACT treatments from 57% to 73% (<0.005); 56% of cases of cough or fast breathing who sought care from a CORP, had their respiratory rate counted and 61% with cough or fast breathing received amoxicillin. At endline caregivers sought care from CORPs in their communities for most cases of childhood illnesses (84%) compared to other providers at hospitals (1%) or health centres (9%).This aligns with caregivers' belief that CORPs are trusted providers (94%) who provide quality services (96%). Conclusion: Implementation of iCCM with focused demand creation activities can improve access to quality lifesaving interventions from frontline community providers in Nigeria. This can contribute towards achieving SDGs if iCCM is scaled up to hard-to-reach areas of all states in the country.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde , Diarreia/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Malária/terapia , Pneumonia/terapia , Pré-Escolar , Diarreia/mortalidade , Humanos , Lactente , Malária/mortalidade , Nigéria/epidemiologia , Pneumonia/mortalidade , Avaliação de Programas e Projetos de Saúde
18.
J Glob Health ; 9(1): 010804, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263549

RESUMO

Background: Despite strong evidence of integrated community case management (iCCM) of childhood illnesses being a proven intervention for reducing childhood morbidity and mortality, sustainability remains a challenge in most settings. Community ownership and contribution are important factors in sustainability. The purpose of this study was to document the process and scale achieved for community engagement and mobilisation to foster ownership, service uptake and sustainability of iCCM activities. Methods: A review of data collected by the RAcE project was conducted to describe the scale and achievement of leveraging community resources to support the community-oriented resource persons (CORPs). The Rapid Access Expansion (RAcE)-supported iCCM programme in Niger state (2014-2017), aimed at improving coverage of case management services for malaria, pneumonia, and diarrhoea, among children aged 2-59 months. Resources donated were documented and costed based on the market value of goods and services at the time of donation. These monetary valuations were validated at community dialogue meetings. Descriptive statistics were used to summarise quantitative variables. The mean of the number of CORPs in active service and the percentages of the mobilised resources received by CORPs were calculated. Results: The community engagement activities included 143 engagement and advocacy visits, and meetings, 300 community dialogues, reactivation of 60 ward development committees, and 3000 radio messages in support of iCCM. 79.5% of 1659 trained CORPs were still in active iCCM service at the end of the project. We estimated the costs of all support provided by the community to CORPs in cash and kind as US$ 123 062. Types of support included cash; building materials; farming support; fuel for motorcycles, and transport fares. Conclusions: The achievements of community engagement, mobilisation, and the resources leveraged, demonstrated acceptability of the project to the beneficiaries and their willingness to contribute to uninterrupted service provision by CORPs.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde , Acesso aos Serviços de Saúde/organização & administração , Pré-Escolar , Diarreia/mortalidade , Diarreia/terapia , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Nigéria/epidemiologia , Pneumonia/mortalidade , Pneumonia/terapia , Avaliação de Programas e Projetos de Saúde
19.
J Glob Health ; 9(1): 010805, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263550

RESUMO

Background: Ensuring the quality of health service data is critical for data-driven decision-making. Data quality assessments (DQAs) are used to determine if data are of sufficient quality to support their intended use. However, guidance on how to conduct DQAs specifically for community-based interventions, such as integrated community case management (iCCM) programs, is limited. As part of the World Health Organization's (WHO) Rapid Access Expansion (RAcE) Programme, ICF conducted DQAs in a unique effort to characterize the quality of community health worker-generated data and to use DQA findings to strengthen reporting systems and decision-making. Methods: We present our experience implementing assessments using standardized DQA tools in the six RAcE project sites in the Democratic Republic of Congo, Malawi, Mozambique, Niger, and Nigeria. We describe the process used to create the RAcE DQA tools, adapt the tools to country contexts, and develop the iCCM DQA Toolkit, which enables countries to carry out regular and rapid DQAs. We provide examples of how we used results to generate recommendations. Results: The DQA tools were customized for each RAcE project to assess the iCCM data reporting system, trace iCCM indicators through this system, and to ensure that DQAs were efficient and generated useful recommendations. This experience led to creation of an iCCM DQA Toolkit comprised of simplified versions of RAcE DQA tools and a guidance document. It includes system assessment questions that elicit actionable responses and a simplified data tracing tool focused on one treatment indicator for each iCCM focus illness: diarrhea, malaria, and pneumonia. The toolkit is intended for use at the national or sub-national level for periodic data quality checks. Conclusions: The iCCM DQA Toolkit was designed to be easily tailored to different data reporting system structures because iCCM data reporting tools and data flow vary substantially. The toolkit enables countries to identify points in the reporting system where data quality is compromised and areas of the reporting system that require strengthening, so that countries can make informed adjustments that improve data quality, strengthen reporting systems, and inform decision-making.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Confiabilidade dos Dados , Prestação Integrada de Cuidados de Saúde , Acesso aos Serviços de Saúde/organização & administração , Pré-Escolar , República Democrática do Congo/epidemiologia , Diarreia/mortalidade , Diarreia/terapia , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Malaui/epidemiologia , Moçambique/epidemiologia , Níger/epidemiologia , Nigéria/epidemiologia , Pneumonia/mortalidade , Pneumonia/terapia
20.
J Glob Health ; 9(1): 010810, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263553

RESUMO

Background: Integrated community case management (iCCM) is a strategy to train community health workers (relais communautaires or RECOs in French) in low-resource settings to provide treatment for uncomplicated malaria, pneumonia, and diarrhea for children 2-59 months of age. The package of Ministry of Public Health tools for RECOs in the Democratic Republic of Congo that was being used in 2013 included seven data collection tools and job aids which were redundant and difficult to use. As part of the WHO-supported iCCM program, the International Rescue Committee developed and evaluated a simplified set of pictorial tools and curriculum adapted for low-literate RECOs. Methods: The revised training curriculum and tools were tested in a quasi-experimental study, with 74 RECOs enrolled in the control group and 78 RECOs in the intervention group. Three outcomes were assessed during the study period from Sept. 2015-July 2016: 1) quality of care, measured by direct observation and reexamination; 2) workload, measured as the time required for each assessment - including documentation; and 3) costs of rolling out each package. Logistic regression was used to calculate odds ratios for correct treatment by the intervention group compared to the control group, controlling for characteristics of the RECOs, the child, and the catchment area. Results: Children seen by the RECOs in the intervention group had nearly three times higher odds of receiving correct treatment (adjusted odds ratio aOR = 2.9, 95% confidence interval CI = 1.3-6.3, P = 0.010). On average, the time spent by the intervention group was 10.6 minutes less (95% CI = 6.6-14.7, P < 0.001), representing 6.2 hours of time saved per month for a RECO seeing 35 children. The estimated cost savings amounts to over US$ 300 000 for a four-year program supporting 1500 RECOs. Conclusion: This study demonstrates that, at scale, simplified tools and a training package adapted for low-literate RECOs could substantially improve health outcomes for under-five children while reducing implementation costs and decreasing their workload. The training curriculum and simplified tools have been adopted nationally based on the results from this study.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/educação , Prestação Integrada de Cuidados de Saúde/organização & administração , Pré-Escolar , Currículo , República Democrática do Congo , Diarreia/terapia , Humanos , Lactente , Alfabetização/estatística & dados numéricos , Malária/terapia , Pneumonia/terapia , Avaliação de Programas e Projetos de Saúde
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