Malaria case management by community health workers in the Central African Republic from 2009–2014: overcoming challenges of access and instability due to conflict

Ruckstuhl, Laura; Lengeler, Christian; Moyen, Jean Methode; Garro, Helle; Allan, Richard

doi:10.1186/s12936-017-2005-7

Cited by 35 publications

(33 citation statements)

References 14 publications

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“…This is especially true in less-permissive environments, where high levels of mistrust are common and CHWs social standing can provide them with some level of protection. Indeed, CHW programs in the Central African Republic demonstrated that they could continue some level of care at all times, reach those most vulnerable populations, and maintain disease surveillance activities even in conflict zones (31).…”

Section: Future Opportunities: Recommendations For Engaging Communitymentioning

confidence: 99%

Community Health Workers and Pandemic Preparedness: Current and Prospective Roles

Boyce

Katz

2019

Front. Public Health

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Despite the importance of community health workers (CHWs) to health systems in resource-constrained environments, relatively little has been written about their contributions to pandemic preparedness. In this perspective piece, we draw from the response to the 2014 Ebola and 2015 Zika epidemics to review examples whereby CHWs contributed to health security and pandemic preparedness. CHWs promoted pandemic preparedness prior to the epidemics by increasing the access to health services and products within communities, communicating health concepts in a culturally appropriate fashion, and reducing the burdens felt by formal healthcare systems. During the epidemics, CHWs promoted pandemic preparedness by acting as community-level educators and mobilizers, contributing to surveillance systems, and filling health service gaps. Acknowledging the success CHWs have had in these roles and in previous interventions, we propose that the cadre may be better engaged in pandemic preparedness in the future. Some practical strategies for achieving this include training and using CHWs to communicate One Health information to at-risk communities prior to outbreaks, pooling them into a reserve health corps to be used during public health emergencies, and formalizing agreements and strategies to promote the early engagement of CHWs in response actions. Recognizing that CHWs already play a role in pandemic preparedness, we feel that expanding the roles and responsibilities of CHWs represents a practical means of improving pandemic and community-level resilience.

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Section: Future Opportunities: Recommendations For Engaging Communitymentioning

confidence: 99%

Community Health Workers and Pandemic Preparedness: Current and Prospective Roles

Boyce

Katz

2019

Front. Public Health

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“…At a global level, studies show that in a mediumsized country, conflict can increase malnutrition by 3.3%, reduce life expectancy by 1 year, increase infant mortality by up to 10%, and cause other public health problems due to lack of access to drinking water, food and health services [7]. Although the epidemiological profile and burden of disease of countries in conflict has changed in the last decades, infectious diseases like malaria, tuberculosis, leishmaniasis, cholera, acute diarrheal disease and poliomyelitis, continue to be serious problems [8][9][10]. Conflict can also have devastating effects on sexual and reproductive health, neonatal health, mental disorders and noncommunicable diseases, such as cancer, hypertension and diabetes [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Health in conflict and post-conflict settings: reproductive, maternal and child health in Colombia

et al. 2020

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Background: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. Objective: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. Methods: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. Results: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the postconflict context. Conclusions: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.

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“…However, despite efforts to control malaria through multiple schemes coordinated by the National Malaria Control Program (NMCP), malaria continues to be the major public health problem according to the scientific literature and the CAR country profile in the World Malaria Report. In 2010, two studies showed prevalence rates of 65.8% and 64.9%, respectively, in children at the Bangui Pediatric Complex (CPB) and in pregnant women in the Ouham-Pendé Prefecture [8,9].…”

Section: Introductionmentioning

confidence: 99%

Falciparum Malaria in Febrile Patients at Sentinel Sites for Influenza Surveillance in the Central African Republic from 2015 to 2018

Nzoumbou‐Boko

Yambiyo

Ngoagouni

et al. 2020

Interdisciplinary Perspectives on Infectious Diseases

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Malaria is a major public health issue in the Central African Republic (CAR) despite massive scale-up of malaria interventions. However, no information is available on the incidence of malaria in febrile illness cases or on the distribution of malaria infection according to demographic characteristics, which are important indicators and valuable epidemiological surveillance tools. This study therefore aimed to characterize malaria in the network of sentinel sites set up for influenza surveillance. A retrospective analysis was conducted to explore the data from these sentinel sites from 2015 to 2018. The Paracheck-Pf® rapid diagnosis test kit was used to screen for malaria in febrile illness cases. A total of 3609 malaria cases were identified in 5397 febrile patients, giving an incidence rate of 66.8%. The age group of 1–4 years was the most affected by malaria (76.0%). Moreover, prevalence varied across different sentinel sites, with the Bossembele Health Center, located in a rural area, showing an incidence of 96%, the Saint Joseph Health Center in a semiurban area of Bangui showing an incidence of 75%, and the Bangui Pediatric Complex in an urban site with an incidence of only 44.6%. Malaria transmission was holoendemic over the four-year study period, and malaria incidence decreased from 2016 to 2018. The incidence of malaria coinfection with influenza was 6.8%. This study demonstrated clear microspatial heterogeneity of malaria. Malaria was consistently the most frequent cause of febrile illness. Including sites in different climate zones in the CAR will allow for a more representative study.

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Malaria case management by community health workers in the Central African Republic from 2009–2014: overcoming challenges of access and instability due to conflict

Cited by 35 publications

References 14 publications

Community Health Workers and Pandemic Preparedness: Current and Prospective Roles

Community Health Workers and Pandemic Preparedness: Current and Prospective Roles

Health in conflict and post-conflict settings: reproductive, maternal and child health in Colombia

Falciparum Malaria in Febrile Patients at Sentinel Sites for Influenza Surveillance in the Central African Republic from 2015 to 2018

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