Household Coverage Research Articles

Real-time coverage surveys and monitoring during emergency vaccination campaigns in insecure humanitarian contexts of DRC and Somalia

Purpose: Mass vaccination campaigns in low-resource settings traditionally rely on ground coordination and post-campaign activities to assess coverage and programmatic performance. However, complex humanitarian crises in highly insecure settings present increased limitations on informational and operational access, suppressing accurate measurement and achievement of target coverage rates. To mitigate these contextual constraints, a real-time monitoring strategy implemented concurrently with immunisation activities may quickly identify and address low coverage causes before the campaign concludes. Methods & Materials: Independent monitoring approaches were implemented during two recent emergency outbreak vaccination campaigns for yellow fever in the Democratic Republic of Congo (DRC) and cholera in Somalia. Enumerators conducted post-vaccination exit interviews and focus group discussions (nDRC = 591, nSomalia = 3025) with children and adults at clinical sites, and a two-stage, stratified clustered community household coverage survey (mDRC = 300, mSomalia = 1684). Daily coverage rates, barriers to uptake, and indicators of community awareness, mobilisation and communications strategies, and service delivery were captured. Results: DRC beneficiaries indicated high levels of service satisfaction while also highlighting a lack of visual communication materials and insufficient instruction from clinical staff. Respondents in Somalia experienced good service delivery and emphasised lower understanding around adverse events reporting. Knowledge of cholera disease and prevention strategies centred around hand washing and clean drinking water, varying by age group. Primary barriers of vaccination were incompatible working hours (DRC) and distance to clinical sites (Somalia). Daily coverage indicators from the household survey identified low coverage areas and demonstrated final rates of 93.1% (DRC) [87.4,98.8] and 99.08% (Somalia) [98.64,99.41]. Conclusion: Collective results from the monitoring activities regularly informed coordinators in real-time, allowing them to refine outreach strategies during the campaign. Changes included identifying new communications and information sources, modifying campaign messaging to correct erroneous community perceptions, and targeting geographical areas. The resultant increasing daily coverage trends demonstrate that this monitoring framework can act as a vital source of independent evaluation during emergency vaccination campaigns. It enables immediate feedback and operational modification to increase coverage. This is crucial when pre-campaign information is incomplete and post-campaign activities may be limited or delayed.

Is it feasible to carry out active case finding for tuberculosis in community-based settings?

Introduction and Objective:To achieve elimination of tuberculosis by 2025, identifying the remaining 25% of missed cases would play a major role. But there is paucity of evidence on this statement. This study aimed to assess feasibility of active case finding for tuberculosis in selected region of Puducherry.Methods:Community based survey was conducted by groups of trained undergraduate medical students. During January 2018, all residents of study area were assessed for presence of presumptive symptoms related to tuberculosis. Presumptive cases of tuberculosis were identified as per the programme definition and the same were facilitated to undergo follow up necessary investigations to rule out tuberculosis through frequent domiciliary visits. The data collection was done using mobile based Epicollect open access app. Feasibility was assessed using indicators namely household coverage, proportions of presumptive cases identified and undergone follow up investigations, number needed to screen for presumptive and confirmed cases of tuberculosis and average time spent per person.Results:Of the 2252 houses, 1746 were covered resulting in a response rate of 77.5% and included 6606 residents. Of the 55 presumptive cases identified (55/6606) 51 underwent investigations (51/55). Two new cases of tuberculosis were diagnosed in this survey. To identify one presumptive and confirmed case 120, 3303 people need to be screened respectively.Conclusion:Active case finding for tuberculosis is feasible provided the health system is able to invest adequate human resources and referral linkages to support peripheral centres.

Validation studies for population-based intervention coverage indicators: design, analysis, and interpretation.

BackgroundPopulation-based intervention coverage indicators are widely used to track country and program progress in improving health and to evaluate health programs. Indicator validation studies that compare survey responses to a “gold standard” measure are useful to understand whether the indicator provides accurate information. The Improving Coverage Measurement (ICM) Core Group has developed and implemented a standard approach to validating coverage indicators measured in household surveys, described in this paper.MethodsThe general design of these studies includes measurement of true health status and intervention receipt (gold standard), followed by interviews with the individuals observed, and a comparison of the observations (gold standard) to the responses to survey questions. The gold standard should use a data source external to the respondent to document need for and receipt of an intervention. Most frequently, this is accomplished through direct observation of clinical care, and/or use of a study-trained clinician to obtain a gold standard diagnosis. Follow-up interviews with respondents should employ standard survey questions, where they exist, as well as alternative or additional questions that can be compared against the standard household survey questions.ResultsIndicator validation studies should report on participation at every stage, and provide data on reasons for non-participation. Metrics of individual validity (sensitivity, specificity, area under the receiver operating characteristic curve) and population-level validity (inflation factor) should be reported, as well as the percent of survey responses that are “don’t know” or missing. Associations between interviewer and participant characteristics and measures of validity should be assessed and reported.ConclusionsThese methods allow respondent-reported coverage measures to be validated against more objective measures of need for and receipt of an intervention, and should be considered together with cognitive interviewing, discriminative validity, or reliability testing to inform decisions about which indicators to include in household surveys. Public health researchers should assess the evidence for validity of existing and proposed household survey coverage indicators and consider validation studies to fill evidence gaps.

Toward Model-Generated Household Listing in Low- and Middle-Income Countries Using Deep Learning

While governments, researchers, and NGOs are exploring ways to leverage big data sources for sustainable development, household surveys are still a critical source of information for dozens of the 232 indicators for the Sustainable Development Goals (SDGs) in low- and middle-income countries (LMICs). Though some countries’ statistical agencies maintain databases of persons or households for sampling, conducting household surveys in LMICs is complicated due to incomplete, outdated, or inaccurate sampling frames. As a means to develop or update household listings in LMICs, this paper explores the use of machine learning models to detect and enumerate building structures directly from satellite imagery in the Kaduna state of Nigeria. Specifically, an object detection model was used to identify and locate buildings in satellite images. In the test set, the model attained a mean average precision (mAP) of 0.48 for detecting structures, with relatively higher values in areas with lower building density (mAP = 0.65). Furthermore, when model predictions were compared against recent household listings from fieldwork in Nigeria, the predictions showed high correlation with household coverage (Pearson = 0.70; Spearman = 0.81). With the need to produce comparable, scalable SDG indicators, this case study explores the feasibility and challenges of using object detection models to help develop timely enumerated household lists in LMICs.

Health costs and benefits from a pilot rural sanitation intervention in India

Abstract India hosts two-thirds of the global population defecating in the open and faces a worrying trend of districts declared ‘water scarce’. This paper aims to assess the costs and health benefits of sanitation interventions undertaken by the National Rural Drinking Water Security Pilot Project in India between 2012 and 2015. To achieve this goal, a pretest–posttest control group study was undertaken in two study areas located in Karnataka and Uttar Pradesh states. Full software and infrastructure costs were included as well as health endpoints, sourced from primary health centers. In Karnataka, latrine coverage of households increased from 16% to 59% in villages with high level of interventions, and from 7% to 18% in villages with lower levels of intervention. In Uttar Pradesh, coverage increased from 33% to 70% in high intervention villages and from 27% to 39% in the low intervention villages. We found health-related net benefits of USD 13 and USD 10 per person per year and benefit/cost ratios of 2.5 and 5.0 in Karnataka Uttar Pradesh, respectively. Given the positive economic returns on the intervention in culturally heterogeneous sites of southern and northern India, this intervention has potential for bringing significant benefits to the Indian population.

High national and sub-national coverage of iodised salt in India: evidence from the first National Iodine and Salt Intake Survey (NISI) 2014-2015.

The National Iodine and Salt Intake Survey (NISI) 2014-2015 was undertaken to estimate household iodised salt coverage at national and sub-national levels in India. Cross-sectional survey with multistage stratified random sampling. India was divided into six geographic zones (South, West, Central, North, East and North-East) and each zone was further stratified into rural and urban areas to yield twelve distinct survey strata. The target respondent from each household was selected as per predefined priority; wife of the household head, followed by women of reproductive age, followed by any adult available during the visit. Households (n 5717) were surveyed and salt samples (n 5682) were analysed. Household coverage of iodised salt (iodine≥5 ppm) was 91·7 (95 % CI 91·0, 92·7) %. Adequately iodised salt (iodine≥15 ppm) was consumed in 77·5 (95 % CI 76·4, 78·6) % of households. Significant differences in coverage were seen across six geographic regions, with North and North-East zones on the verge of achieving the universal salt iodisation target of >90 % coverage. Coverage of households with adequately iodised salt (adjusted OR; 95 % CI) was significantly less in rural households (0·55; 0·47, 0·64), lower/backward castes (0·84; 0·72, 0·98), deprived households (0·72; 0·61, 0·85) as assessed by multidimensional poverty index, households with non-diverse diet (0·73; 0·62, 0·86) and households using non-packaged salt (0·48; 0·39, 0·59) and non-refined salt (0·17; 0·15, 0·20). India is within striking reach of achieving universal salt iodisation. However, significant differentials by rural/urban, zonal and socio-economic indicators exist, warranting accelerated efforts and targeted interventions for high-risk groups.

Iodine deficiency in pregnant women after the adoption of the new provincial standard for salt iodization in Zhejiang Province, China

BackgroundZhejiang has achieved the goal of elimination of iodine deficiency disorders (IDD) via the implementation of universal salt iodization (USI) since 2011. Iodine content in household table salt decreased from the national standard (35 ppm) to the Zhejiang provincial standard (25 ppm) in 2012. It is crucial to periodically monitor iodine status in pregnant women because IDD in pregnancy have adverse effects on fetal neurodevelopment.MethodsWe carried out a cross-sectional study between April 2014 and September 2015 in the eight sentinel surveillance counties across Zhejiang Province, where IDD was previously known to be endemic. A total of 1304 pregnant women participated and provided a random spot urine sample and a household table salt sample. Urinary iodine concentration (UIC) was determined using arsenic-cerium catalytic spectrophotometry. Iodine content in salt was measured using a titration method with sodium thiosulphate.ResultsOverall, the median UIC of the total study population of pregnant women was 129.3 μg/L, with a higher UIC in inland (152.54 μg/L) and a lower UIC in coastal counties (107.54 μg/L). Household coverage of iodized salt was 94.6% and the rate of adequately iodized salt was 89.9%.ConclusionsOur results indicate deficient iodine status in the pregnant population of Zhejiang, according to the lower cut-off value of optimal iodine nutrition (150 μg/L) recommended by the World Health Organization. In addition to sustaining USI, more efforts are urgently needed to improve iodine intake in women during pregnancy, especially those residing in the coastal counties.

Household coverage with Long Lasting Insecticidal Nets and factors associated with net use among school children in Butiama District, Tanzania

Background: The National Malaria Control Program (NMCP) distributed free Long Lasting Insecticidal Nets (LLINs) to reduce malaria transmission. Available data shows high prevalence of malaria among school pupils in Butiama. Establishment of the current net ownership and malaria burden was needed. No routine health system that monitors malaria control interventions such as LLINs coverage and use. Demographic health surveys are done at an interval of several years and therefore may not be an ideal means for routine monitoring of malaria interventions. Use of school pupil's report have been shown to be a good proxy for the community estimation of malaria burden and assessing effectiveness of malaria interventions. Methods & Materials: We conducted a cross sectional survey among primary school pupils in Butiama District. Pupils were interviewed using structured questionnaire regarding LLINs coverage, perceived safety and factors associated with net use. Then a malaria test from a finger prick using malaria Rapid Diagnostic Test (mRDT) and Blood Slide (BS) for microscopy was taken. Data analysis was done using STATA statistical software Results: A total of 590 school pupils aged between 6-19 years participated in this study. The overall ownership of at least one ITN was 95.4% with a universal coverage of 69.7%. The average number of nets per household was 3 ± 1.72. The most mentioned source of LLINs in households was free mass distribution 78.5% followed by School Net Program (SNP) 30%. In households with at least one LLIN, 92.4% of the under-fives slept under LLINs a night before survey while 75.6% of school pupils did. The overall malaria parasite prevalence by mRDT in school children at Butiama District was found to be 16.1%. Malaria prevalence was significantly lower among pupils who slept under ITNs than those who did not, (P = 0.029). The prevalence of malaria among school children was 6.4% by microscope blood slide. Conclusion: Malaria prevalence has declined in Butiama District among school children compared to the previous studies. Universal coverage of LLINs is not yet attained. Further studies should be done in Butiama to look at what factors contributes to high malaria transmission in Butiama despite of high LLINs coverage and use.

Assessment of adequately iodised salt consumption in Telangana state, India

Background: Salt used in the household is the most common way for iodine fortification to prevent the public health concerns of iodine deficiency disorders. The objective of the study was to assess household coverage with adequately iodized salt in Telangana State, India.Methods: Secondary data published in the District Level Household and Facility Survey-4 is analyzed.Results: Overall, 55.7 percent of the households were using cooking salt which was iodized at the recommended level of 15 ppm or more. Around 60.8 percent of households in urban areas used salt with 15 ppm or more iodine content compared with 51.9 percent of households in rural areas though the difference was not significant.Conclusions: The coverage of adequately iodized salt in the state was below the national average. To further expand the coverage of adequately iodized salt, researchers and policy makers should take action.

Knowledge, attitudes and practices related to malaria: The case of community health workers in Leona, Sakal district, Senegal

Introduction Community management of malaria reduces the problem of access to care for remote and/or landlocked populations. In the Leona area, since 2010, the Millennium Villages Project has put in place a community-based mechanism integrating mobile technology for overall household coverage. The objective of the study was to identify gaps in knowledge, attitudes and practices about malaria among community health workers (CHWs). Method This was a descriptive and analytical cross-sectional study conducted from March 21 to April 15, 2016. It involved a comprehensive sampling of 51 CHWs, and 2,023 cases of fever registered in the records from January 1 to December 31, 2015. The data was collected using three media: an observation grid, a questionnaire and a observation grid. The questionnaire served as a basis for individual interviews focusing on the level of knowledge of signs, diagnostic means, and simple malaria treatment modalities. The observation grid made it possible to assess the availability of the material and the equipment of the agent, as well as the mastery of the rapid screening test, the management of malaria (follow-up of the flow chart, therapeutic management) and register filling. The reference parameters were the guidelines of the National Malaria Control Program (NMCP). The data was entered and analyzed with the Epi-info 3.5.3 software. Results The 51 CHWs included two categories: home care providers were 12 (23.5%) and community relays 39 (76.5%). The sex ratio was 0.2. The age ranged from 17 to 47, with an average of 29.4 (±8.3) years. Of the CHWs, 13.7% had a good level of knowledge about malaria; and 80.4% mastered the rapid screening test (RST) technique. A total of 2023 patients had been identified with 89 (4.4%) cases of fever, of which 80 (89.8%) had RST. Out of 80 RSTs, the number of errors was 3 (3.75%). All confirmed cases were treated according to the NMCP guidelines. The filling of the registers was exhaustive for 93.8% of the CHWs. The level of knowledge of CHWs was statistically higher among those aged 25 and over (P = 0.029), and home care providers (P = 0.005). The correct filling of the registers was more common among the educated (P = 0.0005), trained (P = 0.001), supervised (0.0001), and the Relay category (P = 0.0002). Conclusion The CHWs can respect the directives of the NMCP. For this, they must be supported by regular retraining and supervision. This would allow better preventive and curative coverage of malaria for remote and isolated populations.

Forecasting the effectiveness of indoor residual spraying for reducing dengue burden.

BackgroundHistorically, mosquito control programs successfully helped contain malaria and yellow fever, but recent efforts have been unable to halt the spread of dengue, chikungunya, or Zika, all transmitted by Aedes mosquitoes. Using a dengue transmission model and results from indoor residual spraying (IRS) field experiments, we investigated how IRS-like campaign scenarios could effectively control dengue in an endemic setting.Methods and findingsIn our model, we found that high levels of household coverage (75% treated once per year), applied proactively before the typical dengue season could reduce symptomatic infections by 89.7% (median of 1000 simulations; interquartile range [IQR]:[83.0%, 94.8%]) in year one and 78.2% (IQR: [71.2%, 88.0%]) cumulatively over the first five years of an annual program. Lower coverage had correspondingly lower effectiveness, as did reactive campaigns. Though less effective than preventative campaigns, reactive and even post-epidemic interventions retain some effectiveness; these campaigns disrupt inter-seasonal transmission, highlighting an off-season control opportunity. Regardless, none of the campaign scenarios maintain their initial effectiveness beyond two seasons, instead stabilizing at much lower levels of benefit: in year 20, median effectiveness was only 27.3% (IQR: [-21.3%, 56.6%]). Furthermore, simply ceasing an initially successful program exposes a population with lowered herd immunity to the same historical threat, and we observed outbreaks more than four-fold larger than pre-intervention outbreaks. These results do not take into account evolving insecticide resistance, thus long-term effectiveness may be lower if new, efficacious insecticides are not developed.ConclusionsUsing a detailed agent-based dengue transmission model for Yucatán State, Mexico, we predict that high coverage indoor residual spraying (IRS) interventions can largely eliminate transmission for a few years, when applied a few months before the typical seasonal epidemic peak. However, vector control succeeds by preventing infections, which precludes natural immunization. Thus, as a population benefits from mosquito control, it gradually loses naturally acquired herd immunity, and the control effectiveness declines; this occurs across all of our modeled scenarios, and is consistent with other empirical work. Long term control that maintains early effectiveness would require some combination of increasing investment, complementary interventions such as vaccination, and control programs across a broad region to diminish risk of importation.

Pradhan Mantri Jan Dhan Yojana (PMJDY): The Biggest Financial Inclusion Initiative in the World

The present study seeks to review the current status of the Pradhan Mantri Jan Dhan Yojana (PMJDY) and financial inclusion in India. For the sustainable development of the Indian economy, the Government of India launches Pradhan Mantri Jan Dhan Yojana (PMJDY) on 28th August 2014. Financial inclusion is an innovative idea which empowers the alternative techniques to encourage the banking traditions and acts as an enabler in reducing the poverty. A total of 18.28 crores accounts have been opened in rural areas by public sector bank, Regional Rural Bank (RRB) and private sector bank by 7th Feb 2018. Thus, 31.07 crores accounts have been opened in rural and urban areas. An amount of 74534.79 crores was in accounts which were opened under PMJDY. Household coverage was 100% in the district wise account opening report of Haryana state, while household coverage found 100 per cent in North Zone of India except J&K (99.71%). We can say that PMJDY scheme is playing a significant role in creating a universal platform for financial services for every citizen of India.

Decision support system for Pradhan Mantri Ujjwala Yojana

Pradhan Mantri Ujjwala Yojana (PMUY) is a flagship energy policy initiated by the government of India to provide women below poverty line (BPL) access to clean energy fuel, Liquefied Petroleum Gas (LPG). This policy has led to the empowerment of women and protection against health hazards. A decision support system (DSS) is proposed to quantitatively analyse the implementation of PMUY in real time. This approach is first of its kind for analysis of a national level energy policy. The system uses mixed integer linear programming approach to mathematically formulate the policy using input parameters, decision variables and their relationships. The DSS requires input parameters namely distributing capacity of a LPG dealer, subsidised cylinders available per connection, number of households, and LPG penetration required. We have analysed different scenarios varying the input parameters mentioned. The decision support system has deterministically found the number of dealers required and LPG penetration in a region projecting both BPL and aggregate household coverage. The system helps in making sound decisions based on quantitative modelling ensuring optimal implementation of the policy. This kind of decision support system can be formulated for various policies to make sound decisions based on strong quantitative evidences.

New Statistical Approach to Apportion Dietary Sources of Iodine Intake: Findings from Kenya, Senegal and India.

Progress of national Universal Salt Iodization (USI) strategies is typically assessed by household coverage of adequately iodized salt and median urinary iodine concentration (UIC) in spot urine collections. However, household coverage does not inform on the iodized salt used in preparation of processed foods outside homes, nor does the total UIC reflect the portion of population iodine intake attributable to the USI strategy. This study used data from three population-representative surveys of women of reproductive age (WRA) in Kenya, Senegal and India to develop and illustrate a new approach to apportion the population UIC levels by the principal dietary sources of iodine intake, namely native iodine, iodine in processed food salt and iodine in household salt. The technique requires measurement of urinary sodium concentrations (UNaC) in the same spot urine samples collected for iodine status assessment. Taking into account the different complex survey designs of each survey, generalized linear regression (GLR) analyses were performed in which the UIC data of WRA was set as the outcome variable that depends on their UNaC and household salt iodine (SI) data as explanatory variables. Estimates of the UIC portions that correspond to iodine intake sources were calculated with use of the intercept and regression coefficients for the UNaC and SI variables in each country’s regression equation. GLR coefficients for UNaC and SI were significant in all country-specific models. Rural location did not show a significant association in any country when controlled for other explanatory variables. The estimated UIC portion from native dietary iodine intake in each country fell below the minimum threshold for iodine sufficiency. The UIC portion arising from processed food salt in Kenya was substantially higher than in Senegal and India, while the UIC portions from household salt use varied in accordance with the mean level of household SI content in the country surveys. The UIC portions and all-salt-derived iodine intakes found in this study were illustrative of existing differences in national USI legislative frameworks and national salt supply situations between countries. The approach of apportioning the population UIC from spot urine collections may be useful for future monitoring of change in iodine nutrition from reduced salt use in processed foods and in households.

Financial Inclusion After PMJDY: A Case Study of Gubbi Taluk, Tumkur

Pradhan Mantri Jan-Dhan Yojana (PMJDY) was introduced in August 2014 and has achieved record success in terms of ensuring almost 100 percent household coverage. The study attempts to examine the success of PMJDY in six Gram Panchayats of Gubbi. The study finds that new accounts have been opened by women, small and marginal farmers, and rural people with no formal education. The properly run, Common Service Centres have served an important purpose of facilitating financial services to rural population. Interestingly, demonetisation did not have any long term impact on the behaviour of users nor bankers but money lenders improved their services. The other financial schemes of the government pertaining to pension, insurance and social security have yet to make an inroad into rural sector. However, digitalization of the economy needs to be carefully addressed because many respondents were not comfortable in using online, internet, ATM and mobile banking.

Assessment of household use of iodized salt and adequacy of salt iodization: a cross-sectional National Study in Saudi Arabia

ObjectivesThis study was conducted to assess household coverage with iodized salt in Saudi Arabia, and to determine adequacy of salt iodization.MethodsA school-based cross-sectional study using WHO 30-cluster survey methodology.ResultsAnalysis of 4242 salt samples using qualitative rapid test kit (RTK) revealed that 68.7% (95% CI 67.3–70.1%) were iodized with significant regional differences (p < 0.001). The highest iodized salt samples came from Makkah (82.3%), Riyadh (81.1%) and Maddinah (76.2%) regions, while the least iodized salt samples came from Hail (31.3%), Baha (53.0%), and Northern Borders (57.5%) regions. The national weighted proportion of households consuming iodizes salt was 69.8% (95% CI 69.4–71.2), which is below the Universal Salt Iodization (USI) goal (≥90% coverage). For validation, a quantitative iodometric titration method was used to analyze 775 representative salt samples screened iodized by RTK; iodine content of ≥15 ppm was found in 95.2% (95% CI 93.9–96.5) of samples with median iodine content 51 ppm (mean 50.4 ± 21.8). More than 70% of the iodized salt samples contained iodine concentration higher than the recommended national level (15–40 ppm).ConclusionsThe study revealed inadequate consumption of iodized salt among Saudi households and explored marked regional heterogeneity. The majority of iodized salt samples contained iodine concentration more than the recommended level. These findings imply the need to launch a public awareness campaign on use of iodized salt. Legislation to ban production and sale of non-iodized salt sale for human consumption might be considered. A well-functioning monitoring system at factory level and surveillance system are crucially needed to ensure proper salt iodization and intake.

Long lasting insecticidal bed nets ownership, access and use in a high malaria transmission setting before and after a mass distribution campaign in Uganda.

IntroductionUganda is conducting a second mass LLIN distribution campaign and Katakwi district recently received LLINs as part of this activity. This study was conducted to measure the success of the campaign in this setting, an area of high transmission, with the objectives to estimate LLIN ownership, access and use pre and post campaign implementation.MethodsTwo identical cross sectional surveys, based on the Malaria Indicator Survey methodology, were conducted in three sub-counties in this district (Kapujan, Magoro and Toroma), six months apart, one before and another after the mass distribution campaign. Data on three main LLIN indicators including; household LLIN ownership, population with access to an LLIN and use were collected using a household and a women’s questionnaire identical to the Malaria Indicator Survey.ResultsA total of 601 and 607 households were randomly selected in survey one and two respectively. At baseline, 60.57% (56.53–64.50) of households owned at least one net for every two persons who stayed in the household the night before the survey which significantly increased to 70.35% (66.54–73.96) after the campaign (p = 0.001). Similarly, the percentage of the household population with access to an LLIN significantly increased from 84.76% (82.99–86.52) to 91.57% (90.33–92.81), p = 0.001 and the percentage of household population that slept under an LLIN the night before the survey also significantly increased from 56.85% (55.06–58.82) to 81.72% (76.75–83.21), p = 0.001.ConclusionThe LLIN mass campaign successfully achieved the national target of over eighty-five percent of the population with access to an LLIN in this setting, however, universal household coverage and use were fourteen and three percent points less than the national target respectively. This is useful for malaria programs to consider during the planning of future campaigns by tailoring efforts around deficient areas like mechanisms to increase universal coverage and behavior change communication.

Trachoma Elimination: Approaches, Experiences and Performance of Interventions in Amhara Regional State, Ethiopia

Background: Trachoma is caused by conjunctival infection with a Bacteria, Chlamydia trachomatis. According to WHO grading system trachomatous trichiasis (TT), leads to irreversible blindness. Amhara national state of Ethiopia has the highest burden of TT. Despite huge efforts the region has big backlog and far from the target. Methodology/Principal findings: We carried out a review and trend analysis on previous years of Trachoma intervention in the region. We also designed a logical frame work, which bring all actors together. Then the new approach of TT surgery intervention frame work ''The MUST was implemented. The regional total TT backlog as of June 2017 was found to be 245,504. From all the surgeries carried out between 2012 and mid-2017, 32% (11687) was done only in 2016. All the ten zones of the region showed dramatic performance than ever after the new approach implemented in the region. East Gojjam [31.9% (73742)] followed by South Gondar [12.3% (28491)] zones took the highest share of TT surgery performances of the national regional state (NRS) during in the era of new approach reporting periods (2015-mid 2017). From the total of 23 districts (woredas) of the region which clear their TT backlog, eight of them are found to be in East Gojjam zone. South Gondar perform 36.4% (14,978) in 2016 from all the reporting periods of TT surgeries conducted during 2012-mid 2017. Facial cleanliness coverage among school children was found to be 90.4% and 90.8% in 2016 and mid 2017 respectively. Household latrine ownership coverage was 68.2% (6,805) and 68.5% (6772) during the same reporting periods respectively. Conclusions: Amhara national state has still huge TT backlog. The new approach showed an assurance of clearing TT backlog before 2020. The sustainable intervention (hygiene and environmental) are not yet strong like treatment-based interventions.

Prevalence of iodine deficiency among school children and access to iodized salt in Zambia

This study, which covered all the ten provinces of Zambia, aimed at assessing the Iodine Deficiency prevalence, and access to adequately iodised salt in the country. It was carried out in 2011 and entailed determining the urinary iodine concentration (UIC) among 1, 283 school children from 30 selected schools and the amount of iodine in 875 salt samples collected from the households of the children. The iodine concentration was also determined in salt samples collected from 365 salt traders near the selected schools. Each of the salt traders was requested to complete a questionnaire. In addition, a questionnaire was administered to 75 teachers from the selected schools. The Urinary Iodine Concentration (UIC) was assayed by the Sandell-Kolthoff reaction, after digesting the urine with Ammonium Persulfate at 100oC. The iodine concentration in the salt was determined using the quantitative titrimetric method. The data for the UIC and salt iodine plus data from questionnaires were analysed using Excel and Statistical Package for Social Sciences version 15 (SPSS 15). The median urinary iodine concentration (MUIC) was 248.5μg/l and the Interquartile Range (IQR) was 145 – 380 μg/L. These results indicated that Iodine Deficiency was not of public health concern among children in Zambia at the time of this study. However, the proportion of households with access to adequately iodised salt (15-40 ppm iodine) was 53%, which is below the recommended target of 90% or more household coverage. Results from questionnaires indicated that the challenges faced by the Zambian Government in attaining Universal Salt Iodisation (USI) include: (i) lack of sustainability of local salt iodisation in local salt producing areas, (ii) weak enforcement of the law on salt iodisation, (iii) poor packaging and storage of salt by traders and households, (iv) limited knowledge of the link between lack of iodine in salt and iodine deficiency, and (v) relatively high cost of imported iodised salt in local salt producing areas. Keywords: Iodized, Salt, Iodine Deficiency, Universal Salt Iodisation, Zambia

Implementation strategies to increase access and demand of long-lasting insecticidal nets: a before-and-after study and scale-up process in Mozambique

BackgroundThe universal coverage bed nets campaign is a proven health intervention promoting increased access, ownership, and use of bed nets to reduce malaria burden. This article describes the intervention and implementation strategies that Mozambique carried out recently in order to improve access and increase demand for long-lasting insecticidal nets (LLINs).MethodsA before-and-after study with a control group was used during Stage I of the implementation process. The following strategies were tested in Stage I: (1) use of coupons during household registration; (2) use of stickers to identify the registered households; (3) new LLIN ascription formula (one LLIN for every two people). In Stage II, the following additional strategies were implemented: (4) mapping and micro-planning; (5) training; and (6) supervision. Odds ratio (OR) and 95% confidence interval (CI) were used to compare and establish differences between intervened and control districts in Stage I. Main outcomes were: percentage of LLINs distributed, percentage of target households benefited.ResultsIn Stage I, 87.8% (302,648) of planned LLINs were distributed in the intervention districts compared to 77.1% (219,613) in the control districts [OR: 2.14 (95% CI 2.11–2.16)]. Stage I results also showed that 80.6% (110,453) of households received at least one LLIN in the intervention districts compared to 72.8% (87,636) in the control districts [OR: 1.56 (95% CI 1.53–1.59)]. In Stage II, 98.4% (3,536,839) of the allocated LLINs were delivered, covering 98.6% (1,353,827) of the registered households.ConclusionsStage I results achieved better LLINs and household coverage in districts with the newly implemented strategies. The results of stage II were also encouraging. Additional strategies adaptation is required for a wide-country LLIN campaign.