Community-based Control Program Research Articles

Systematic review of diabetes mellitus prevalence and determinants of early detection in Africa

Several studies have reported dramatic increase of the prevalence of diabetes mellitus in Africa, and barriers to early detection and treatment, which are cost-effective strategies to prevent and control diabetes mellitus and combat its morbidity and premature mortality. The paper aimed to review the literature on the prevalence of diabetes mellitus and determinants of early detection in Africa. MeSH terms in the PUBMED Medline, LISTA (EBSCO), Cochrane, and Google Scholar in order to identify recent literature published from the year 2012 to 2017. Seven articles were reviewed, and high increase of the prevalence of diabetes mellitus in Africa was found. Evidences of cost-effectiveness with early detection and treatment were found; however, early detection is hindered by several factors that need to be addressed. In addition, the paucity of articles on early detection of diabetes mellitus and community-based prevention and control programs was observed. There is an increasing prevalence of diabetes mellitus in Africa, and there is paucity of evidences on the determinants of early detection and treatment program. Operational studies and community-based interventions aiming to community sensation and screening for diabetes mellitus are highly recommended.

Outcomes of a Community-based Breast Cancer Screening Program in Baltimore City.

African American women have disproportionately high breast cancer (BC) mortality in comparison with White women. Early BC detection rates are lower in African American women than White women, reflecting sub-optimal use of screening mammography particularly among women who are uninsured. A descriptive analysis of a community-based, cancer control program targeted at uninsured African Americans is presented. Program outcomes and correlates of program retention and BC detection are summarized. Data for 5,669 enrollees and 10,357 mammograms were analyzed. Breast cancer was diagnosed in 113 women, 69% at an early stage. The majority (72%) of BC cases were diagnosed during the initial program cycle. The strongest correlates of program retention were non-Hispanic ethnicity and prior mammography (p<.0001). This community-based cancer control program provided an early BC detection benefit to enrollees regardless of whether program services were conducted for only one cycle or were continued at regular intervals.

Regional Survey of Mosquito Control Knowledge and Usage In North Carolina.

Mosquitoes are a nuisance and can transmit pathogens to humans and other animals, resulting in notable morbidity and mortality. Organized mosquito control programs conduct surveillance, source reduction, treatment of mosquito oviposition sites, and adulticiding to protect public health. However, in some regions, there has been a decline in county and municipal mosquito control programs, and homeowners increasingly contract with private mosquito control companies or address mosquito-related issues themselves at the household level. The extent to which these services are being used, the potential for mosquito and/or insecticide exposure around the home, and the access to these services by individuals of different socioeconomic categories are not known. We conducted regional (western, central, eastern) assessments of public perception and knowledge of mosquito control services in a variety of communities of different socioeconomic categories (low, moderate, high) and types (urban, suburban, rural) in 3 North Carolina counties. We also assessed the respondents' basic knowledge of mosquito-borne diseases. Most respondents thought mosquito control was important to protect against both nuisance mosquitoes and mosquito-borne disease. The majority of people would pay ≤$50/year for mosquito control and most thought this should be covered by municipal/county taxes. Many respondents (31%, 95% confidence interval [CI] 26-35%) personally undertake mosquito control on their properties, but only 5.3% (95% CI 3.1-7.5%) contract with professional mosquito control services, with no significant differences between region, community type, or socioeconomic category in the proportion using private mosquito control services. While there were significant differences between factor levels (3 regions, 3 community types, 3 socioeconomic categories) in some responses, there were no significant differences observed between respondents, regardless of factor level, in the willingness to contribute funds to a community-based mosquito control program.

Promoting community malaria control in rural Myanmar through an active community participation program using the participatory learning approach.

Malaria is prevalent in more than 80% of townships in Myanmar. The National Malaria Control Programme (NMCP) has been implementing community-based malaria control programs nationwide. However, these programs are mostly developed and directed by health authorities, while communities are passively involved. This study aimed to increase community participation in malaria control and promote community malaria control knowledge and practice in rural Myanmar. A community-based study, which employed a mixed method approach, collecting data quantitatively and qualitatively, was conducted in two rural villages. The study implemented an active community participation program (ACPP) using the participatory learning approach in a village (ACPP village) but only routine malaria control was given in another village (non-ACPP village). All households with 142 and 96 household representatives from ACPP and non-ACPP villages participated in baseline and endline surveys. The ACPP was evaluated by process and outcome indicators. A spider gram analysis using five process indicators was applied to evaluate the process of the ACPP. Community participation status in malaria control activities and level of community malaria knowledge and practice were determined as outcomes of the ACPP. The spider gram analysis showed that three indicators (needs assessment and planning, leadership and resource mobilization) gained a score of 4, the organization indicator a score of 5 and the management and evaluation indicator a score of 3. The outcome indicators of the program at 6 months showed that the community participation in malaria control activities in the ACPP village had significantly increased (6.9% to 49.3%) (p<0.001). The program promoted community malaria control knowledge and practice in the ACPP village. The mean scores of knowledge, perception, preventive behavior and treatment-seeking behavior were increased significantly, from 3.0 to 5.9 (p<0.001), 20.1 to 21.0 (p<0.001), 3.4 to 4.2 (p<0.001) and 3.1 to 5.6 (p<0.001), respectively. However, no significant change of outcome indicators was found in the non-ACPP village. The ACPP implemented by community volunteers using the participatory learning approach was feasible in community-based malaria control. This study suggests several features in the ACPP model that may be useful strategies for the implementation of the current NMCP programs in similar rural settings; however, the effect of the ACPP over a longer period to ascertain the impact of such community participation has yet to be further studied.

Investigating the differential impact of school and community-based integrated control programmes for soil-transmitted helminths in Timor-Leste: the (S)WASH-D for Worms pilot study protocol.

BackgroundWater, sanitation and hygiene (WASH) interventions represent an important component of soil-transmitted helminth (STH) infection control, alongside the administration of anthelmintic drugs, which are generally targeted to school-aged children. Recent modelling studies have suggested that STH control programmes should be broadened to include all age groups across the community. We describe the protocol for a pilot study investigating the impact of school-versus-community-based delivery of integrated WASH and deworming programmes on STH infections in school-aged children in Timor-Leste.MethodsThe (S)WASH-D for Worms pilot is a two-arm, non-randomised cluster intervention study. The aims are to determine feasibility and acceptability of the intervention and study procedures and to establish proof of principle for the hypothesis that STH control programmes directed to the entire community will lead to greater reductions in STH infections in children than programmes directed only to school-aged children. Of the six participating communities, three receive a school-based integrated WASH and deworming programme and three additionally receive a community-based integrated WASH and deworming programme. The primary outcomes are the proportions of eligible children who enrol in the study and participate in the data collection, and outcomes relating to WASH and deworming programme completion, coverage, and use. Secondary outcomes are the cumulative incidence and mean intensity of STH infection in school-aged children at 6-month follow-up, mean haemoglobin concentration and several anthropometric indices. Results will inform the design of a cluster-randomised controlled trial (RCT).DiscussionThis pilot study is being conducted in preparation for a cluster-RCT investigating the differential impact of school- and community-based integrated STH control programmes on STH infections in school-aged children. It aims to establish feasibility and proof of principle, while results of the subsequent RCT could have significant implications for global STH control policy.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12615001012561 Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0109-4) contains supplementary material, which is available to authorized users.

We Remember… Elders' Memories and Perceptions of Sleeping Sickness Control Interventions in West Nile, Uganda.

The traditional role of African elders and their connection with the community make them important stakeholders in community-based disease control programmes. We explored elders’ memories related to interventions against sleeping sickness to assess whether or not past interventions created any trauma which might hamper future control operations. Using a qualitative research framework, we conducted and analysed twenty-four in-depth interviews with Lugbara elders from north-western Uganda. Participants were selected from the villages inside and outside known historical sleeping sickness foci. Elders’ memories ranged from examinations of lymph nodes conducted in colonial times to more recent active screening and treatment campaigns. Some negative memories dating from the 1990s were associated with diagnostic procedures, treatment duration and treatment side effects, and were combined with memories of negative impacts related to sleeping sickness epidemics particularly in HAT foci. More positive observations from the recent treatment campaigns were reported, especially improvements in treatment. Sleeping sickness interventions in our research area did not create any permanent traumatic memories, but memories remained flexible and open to change. This study however identified that details related to medical procedures can remain captured in a community’s collective memory for decades. We recommend more emphasis on communication between disease control programme planners and communities using detailed and transparent information distribution, which is not one directional but rather a dialogue between both parties.

Prevalence and Other Correlates of Ever Smoking in Saudi Arabia: Results of a National Survey

Background: Updated information on prevalence of ever smoking and its related factors is necessary for planning smoking control programs. Objective(s): The current study aimed at assessing the prevalence and identifying the associated factors and predictors of ever cigarette smoking among the Saudi adult population. Methods: The current study was a secondary analysis of the cross-sectional community-based survey conducted by the WHO in collaboration with the Saudi Ministry of Health in 2005 using WHO STEP wise approach. A multistage, stratified, cluster random sampling was applied to select a total sample of 5000 Saudi adults aged 15 to 64 years. The interview questionnaire included socio-demographic characteristics, status of smoking, and physical activity pattern. Blood pressure, weight and height were measured. Blood samples were drawn for assessment of fasting blood sugar, total and HDL cholesterol. Results: The prevalence of ever smoking was 21.6%. Just over half of the subjects were females, about 23% less than 25 years, while about 11% more than 55 years of age. Ever smoking was significantly associated with male gender, younger age, and lower education and income levels. Of all study subjects 12.5% were categorized as ever smokers and practicing low level of physical activity. Additionally, 15.2% were categorized as ever smokers and non-obese. Ever smoking was significantly associated with low physical activity and non-obesity. No significant association between ever smoking and hypertension, diabetes mellitus or cholesterol level was found. The significant predictors of ever smoking were male gender and lower educational level. Conclusion: Ever smoking was prevalent among Saudi adult population indicating a need to develop community-based and effective tobacco control programs to reduce this risk. Keywords: Ever smoking, prevalence, socio-demographic characteristics, adults, Saudi Arabia

Launching an Interactive Cancer Projects Map: A Collaborative Approach to Global Cancer Research and Program Development.

Ami S. Bhatt F.W.H. and A.S.B. contributed equally to this work. Corresponding author: Ami S. Bhatt, MD, PhD, Departments of Medicine and Genetics, Center for Innovation in Global Health, Stanford University, 269 Campus Dr, Stanford, CA 94305; e-mail: asbhatt@stanford.edu Despite living in a connected world, many research projects are developed with a so-called “convenience bias,” resulting in partnerships based on existing professional networks and collaborations. In addition, community-based cancer control programs are often implemented independently to address specific urgent and existing needs. Consequently, these projects and programs do not benefit as much as they could from best practices and protocols developed through other long-term engagements. As the global burden of cancer increases, cancer researchers and program managers are likely to benefit from a more complete understanding of ongoing work in cancer control. The limited availability of tools for collaboration and sharing of best practices have resulted in a call to action for the scientific community to partner on the development of a platform that provides knowledge of existing resources and expertise.

Severe Complicated Malaria in High Risk Areas of Mon State, Myanmar, 2006-2012

Cases of severe complicated malaria in Myanmar had declined during 2006-2012, yet some townships in the southeastern part continued to report poor outcome of malaria patients in spite of applying similar interventions as other high-risk areas. The purpose of this paper was to understand the reasons behind the poor malaria outcome of some townships in Mon State. We described trends and distribution of severe complicated malaria cases in 2006-2012. During 2006-2012, Yae Township contributed one-third to half of all severe complicated malaria cases in Mon State every year. In 2012, more than 25% of confirmed malaria cases were reported from high risk areas, including Beelin, Kyaikhto, Thaton and Yae Townships. Among these townships, Yae and Kyaikhto reported higher proportion of severe complicated malaria cases among under five children and pregnant women in 2012. In addition, fewer number of malaria cases was detected by village health volunteers than basic health staff in these townships, which might be due to inaccessibility to health services. Strengthening surveillance system and community-based malaria control program in Yae and Kyaikhto might reduce severe complicated malaria in these areas.

Knowledge and perceptions about malaria in communities in four districts of the Central African Republic.

BackgroundImplementation of malaria control strategies may face major social and cultural challenges. Hence, understanding local knowledge about malaria helps in designing sustainable community-based malaria control programmes. We designed a pilot survey in communities in the Central African Republic to evaluate recognition of malaria symptoms, perceptions of the causes of malaria and knowledge of key preventive measures.MethodsThis cross-sectional study was conducted in four districts. Households were selected by multi-stage cluster random sampling, with villages (in Lobaye, Ouham and Ouaka) and boroughs (in Bangui City) as first-stage units and households as second-stage units. A total of 2920 householders were interviewed.ResultsMost of the respondents attributed malaria to mosquito bites (65.5%), but less than 50% were familiar with the classical symptoms of malaria. Hygiene and sanitation were the most frequently mentioned methods for preventing malaria (81.1%). Despite the relatively high rate of ownership of insecticide-treated nets (72.1%), community perception of these nets as a preventive measure against mosquito bites was very low (6.5%).ConclusionsThe correct perceptions that mosquitoes cause malaria transmission and of environmental management for prevention are encouraging; however, awareness about the usefulness of insecticide treated-nets for malaria prevention must be raised. This study provided the national malaria control programme with baseline data for planning appropriate health education in communities.

Communities of excellence in tobacco control: changes in local policy and key outcomes.

The Oklahoma Communities of Excellence in Tobacco Control (CX) program was established in 2004. Thirty-three CX grants have been funded to implement comprehensive tobacco control programs in 50 counties and one tribal nation. To describe local tobacco policy gains within CX counties and short-term and intermediate outcomes such as Oklahoma Tobacco Helpline registration and awareness, quit attempts, and home smoking bans among adults. A before-and-after study design examined outcomes within CX counties and among CX urban and rural counties. Comparisons were made with non-funded counties when possible. Local policy tracking databases were reviewed for the number of policies implemented from 2004 to 2013 in CX counties. Population-level tobacco indicators, using Helpline registration and 2004-2010 Behavioral Risk Factor Surveillance System data, quantified changes over time. Data were collected in 2003-2013 and analyzed in 2013. Eight hundred thirty-one legislated and voluntary policies were implemented in CX counties and high levels of Helpline registration were maintained. Statistically significant increases were observed in CX counties for the proportion of smokers making a quit attempt, Helpline awareness, and home smoking bans among smokers. These observed increases were greater in rural CX counties than urban. Non-CX counties only experienced a statistically significant increase in Helpline awareness. Using community-based best practices in tobacco control while focusing on social norm change, CX counties experienced positive changes in smoking-related attitudes and behaviors. This study expands the evidence base for statewide tobacco control programming and underscores the value of community-based tobacco control programs.

The single water-surface sweep estimation method accurately estimates very low (n=4) to low-moderate (n=25-100) and high (n>100) Aedes aegypti (Diptera: Culicidae) pupae numbers in large water containers up to 13 times faster than the exhaustive sweep and total count method and without any sediment contamination.

To confirm that a single water-surface sweep-net collection coupled with three calibration factors (2.6, 3.0 and 3.5 for 1/3, 2/3 and 3/3 water levels, respectively) (WSCF) could accurately estimate very low to high Aedes aegypti pupae numbers in water containers more rapidly than the exhaustive 5-sweep and total count (ESTC) method recommended by WHO. Both methods were compared in semi-field trials using low (n=25) to moderate (n=50-100) pupae numbers in a 250-l drum at 1/3, 2/3 and 3/3 water levels, and by their mean-time determinations using 200 pupae in three 220- to 1024-l water containers at these water levels. Accuracy was further assessed using 69.1% (393/569) of the field-based drums and tanks which contained <100 pupae. The WSCF method accurately estimated total populations in the semi-field trials up to 13.0 times faster than the ESTC method (all P<0.001); no significant differences (all P-values≥0.05) were obtained between the methods for very low (n=4) to low-moderate (n=25-100) and high (n>100) pupae numbers/container and without sediment disturbance. The simple WSCF method sensitively, accurately and robustly estimated total pupae numbers in their principal breeding sites worldwide, containers with >20l water volumes, significantly (2.7- to 13.0-fold: all P-values <0.001) faster than the ESTC method for very low to high pupae numbers/container without contaminating the clean water by sediment disturbance which is generated using the WHO-recommended ESTC method. The WSCF method seems ideal for global community-based surveillance and control programmes.

Evaluation of a community-based tobacco control intervention in five remote north Queensland Indigenous communities

This study aimed to assess the impact of a complex community-based tobacco control program in eight remote north Queensland Indigenous communities with high rates of tobacco use. A community-based tobacco intervention trial was conducted over one year in five intervention sites and three control sites in far north Queensland with predominantly Aboriginal and Torres Strait Islander populations. The intervention was composed of six components: a school-based education program ‘Smokin’ No Way’, ‘SmokeCheck’ tobacco brief intervention training for health workers, assistance to develop workplace smoke-free policies, an Event Support Program, ‘Smoke Rings’ support group and enforcement of tobacco sales legislation. Household surveys of self-reported tobacco use were conducted at baseline and one year after the interventions, along with interviews with key individuals and organisations, to assess intervention implementation. It was found that there was a modest effect on self-reported daily tobacco use and mean number of cigarettes smoked weekly after 12 months in intervention communities. There were non-significant declines in self-reported smoking and mean cigarettes smoked per week in aggregated control communities. Independent evaluation of fidelity of implementation found major shortcomings in actual program delivery. To enhance success of future interventions, fidelity of implementation should be ensured and a longer implementation period utilised.

Opisthorchiasis: from pathogenesis to control

Opisthorchiasis caused by Opisthorchis viverrini infection is a major public health in Thailand and neighboring Mekong countries. The infection is associated with cholangitis, cholecystitis, gallstones, hepatomegaly, periductal fibrosis and cholangio-carcinoma (CCA). The rates of CCA in regions where the parasite is endemic are unprecedented. The liver fluke induces severe inflammation of the bile ducts, resulting in oxidative and nitrative DNA damage of the biliary epithelium. Opisthorchis specific proinflammatory cytokine/chemokine, specifically IL-6 and IL-8 production through biliary TLR4 activation was observed, supports inflammatory mechanism of the infected bile ducts. Elevation of IL-6 production is associated with advanced periductal fibrosis in infected individuals. IL-6 can induce inflammation, anti-apoptosis, cell transformation and eventually malignancy. Moreover, liver fluke excretory-secretory products can stimulate cell proliferation and inhibit biliary cell apoptosis when cells underwent oxidative stress. These cells are thus stimulated to hyper-proliferate, providing an additional potential mechanism by which inflamed biliary epithelial cells become neoplastic in opisthorchiasis-associated CCA. For liver fluke control, extensive community-based control program using an EcoHealth/One Health approach was carried out at endemic Lawa Lake of Khon Kaen province with successful results. The Lawa model is now recognized nationally and internationally, and being expanding to other parts of Thailand.

Epilepsy prevalence, potential causes and social beliefs in Ebonyi State and Benue State, Nigeria

Epilepsy is a common neurological disorder in Nigeria. Many individuals are affected in rural areas, although prevalence data is not available. In this study we aimed to establish the prevalence of epilepsy in a rural community in south-east Nigeria, a community suspected for having a high number of people living with epilepsy. We compared this with the prevalence in a nearby semi-urban community in north-central Nigeria. In both communities we identified potential causes of epilepsy and obtained information on the social beliefs regarding epilepsy. We used door-to-door surveys and focus group discussions. The epilepsy prevalence in the rural community was 20.8/1000 [95% confidence interval (CI): 15.7-27.4]. The prevalence in the semi-rural community was lower, namely 4.7/1000 [CI: 3.2-6.9]. The difference in prevalence was highly significant (χ(2)-test, p<0.0001). In both communities most people with epilepsy were in the age range of 7-24 years. Causes that might be contributory to the prevalence of epilepsy in both communities included poor obstetric practices, frequent febrile convulsions, head trauma, meningitis and neurocysticercosis. In both communities we found stigma of people with epilepsy. In conclusion, the epilepsy prevalence in the semi-urban community is similar to that in industrialized countries. In contrast, the rural community has a much higher prevalence. This may require the establishment of specific community-based epilepsy control programs. Community interventions should focus on treatment of acute epilepsy and on stigma reduction.

Acute schistosomiasis diagnosis: a new tool for the diagnosis of schistosomiasis in a group of travelers recently infected in a new focus of Schistosoma mansoni

The diagnosis of schistosomiasis mansoni on early stages of infection is important to prevent late morbidity. A simple, cheap, sensitive and specific assay for routine diagnosis of schistosome infection based on the detection of specific IgG for schistosomula tegument antigens (ELISA-SmTeg) was developed by our group. We describe here an acute outbreak involving a travel group of 80 individuals from a non-endemic area of the State of Minas Gerais, Brazil. These individuals were in contact with a freshwater pool where Biomphalaria glabrata was found. Results obtained from our new methodology were compared to IgG antibody titers against soluble worm antigenic preparation (SWAP) by ELISA and, also to parasitological examination, nuclear magnetic resonance and clinical findings. ELISA-SmTeg was capable of detecting 64 positive cases among the 80 individuals participating at the survey with a positivity ratio of 80% and a higher sensitivity than ELISA-SWAP that was only sensitive for 56% of positive cases. Besides, a significant correlation was found for the severity of the infection and the specific IgG titers against SmTeg. Our data showed that ELISA-SmTeg might serve as the initial diagnostic tool for acute stages of the infection in community-based helminth control programs or for the surveillance of individuals from non-endemic areas.

Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention

The nation-wide, community-based intensive hypertension detection and control program, as well as universal health insurance coverage, may well be contributing factors for helping Japan rank near the top among countries with the longest life expectancy. We sought to examine the cost-effectiveness of such a community-based intervention program, as no evidence has been available for this issue. The hypertension detection and control program was initiated in 1963 in full intervention and minimal intervention communities in Akita, Japan. We performed comparative cost-effectiveness and budget-impact analyses for the period 1964-1987 of the costs of public health services and treatment of patients with hypertension and stroke on the one hand, and incidence of stroke on the other in the full intervention and minimal intervention communities. The program provided in the full intervention community was found to be cost saving 13 years after the beginning of program in addition to the fact of effectiveness that; the prevalence and incidence of stroke were consistently lower in the full intervention community than in the minimal intervention community throughout the same period. The incremental cost was minus 28,358 yen per capita over 24 years. The community-based intensive hypertension detection and control program was found to be both effective and cost saving. The national government's policy to support this program may have contributed in part to the substantial decline in stroke incidence and mortality, which was largely responsible for the increase in Japanese life expectancy.

Discussions with adults and youth to inform the development of a community-based tobacco control programme

Project Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth (ACTIVITY) is a community-based group randomized intervention trial focused on disadvantaged youth (aged 10-19 years) residing in 14 low-income communities (slums and resettlement colonies) in Delhi, India. This article discusses the findings of Focus Group Discussions (FGDs) conducted to inform the development and test the appropriateness of Project ACTIVITY's intervention model. The findings of the FGDs facilitated the understanding of factors contributing to increased tobacco uptake and cessation (both smoking and smokeless tobacco) among youth in this setting. Twenty-two FGDs were conducted with youth (10-19 years) and adults in two urban slums in Delhi. Key findings revealed: (i) youth and adults had limited knowledge about long-term health consequences of tobacco use; (ii) socio-environmental determinants and peer pressure were important variables influencing initiation of tobacco use; (iii) lack of motivation, support and sufficient skills hinder tobacco cessation and (iv) active involvement of community, family, religious leaders, local policy makers and health professionals is important in creating and reinforcing tobacco-free norms. The results of these FGDs aided in finalizing the intervention model for Project ACTIVITY and guided its intervention development.

Translating Cancer Prevention and Control Research into the Community Setting: Workforce Implications

A gap exists between cancer prevention research and its translation into community practice. Two strategies to reduce this gap are community-based participatory research (CBPR) and dissemination research. CBPR offers an avenue to engage academic and community partners, thereby providing mechanisms for joint learning and application of knowledge. Dissemination research examines the movement of evidence-based public health and clinical innovations to practice settings. While applying these approaches may reduce the gap between research and practice, the cancer prevention workforce may be inadequate in size, insufficiently trained, lack resources and incentives, or face structural barriers to effectively participate in CBPR and disseminate evidence-based research findings into practice. Information on translating cancer prevention information to communities and workforce implications was obtained from a panel of experts and through a review of the literature on CBPR and dissemination research. The expert panel and literature review identified major barriers to successfully conducting CBPR and dissemination research in community settings. Barriers included inadequate policies; insufficient networking and communication infrastructures; unsupportive research cultures, climates, and mindsets; inadequate researcher and practitioner education; and limited CBPR and dissemination research with adequate study designs. No specific estimates of the cancer prevention workforce were found; however, indirect evidence for a shortfall were identified. We recommend expanding CBPR training for academic and community partners; increasing funding for dissemination research and practice; supporting proven partnerships; and providing strategic coordination for government agencies, research institutions, nongovernmental organizations, and the private sector to foster better dissemination of information and integration of community-based cancer prevention and control programs and practices. Specific challenges and needs that must be addressed to improve the translation of cancer prevention research into community settings were identified.

Cross-sectional survey of malaria prevalence in tsunami-affected districts of Aceh Province, Indonesia

BackgroundMalaria is endemic to Indonesia. However, there are few prevalence data available from Aceh Province because of the long-standing separatist conflict and decentralization of the public health system. The Mentor Initiative, which specializes in malaria control in humanitarian emergencies, was one of the non-governmental organizations to respond to the 2004 Indian Ocean tsunami in Aceh. Data on malaria prevalence were gathered to guide and evaluate programmatic efforts.FindingsThe Mentor Initiative conducted community-based malaria prevalence surveys in 2005 and 2006 in five districts along the tsunami-affected western coastline. A total of 11,763 individuals in 3,771 households were tested. The overall slide positivity rate in 2005 and 2006 for all Plasmodium species was 2.1% (n = 252, 95% CI 1.9%-2.4%). Slide positivity rates ranged from 0 to 55% among villages. Overall, 57% of the 252 cases were infected with P. falciparum (n = 144, 95% CI 51.0%-63.3%), and 40.1% were infected with P. vivax (n = 101, 95% CI 34.0%-46.1%), with 0.03% (n = 7, 95% CI 0.8%-4.8%) being mixed infections. Males were significantly more likely to be affected than females (2.8% vs 1.5%, p < 0.01). Infection was more common in those over the age of 5 (2.3% vs. 0.6%, p < 0.01).ConclusionsLocal prevalence data are needed to design effective community-based malaria control programs, as endemicity varies greatly within districts. Certain villages were found to be hyperendemic, with slide positivity rates far higher than average in Indonesia. There is a need for ongoing malaria surveillance in Aceh Province to monitor prevention and treatment efforts.