Malaria Elimination in Haiti: Challenges, Progress and Solutions

Adrien, Paul; Boncy, Paul Jacques; Lemoine, Jean Frantz; Existe, Alexandre; Juin, Stanley; Amouzou, Sénou; Thimoté, Gabriel; Andrécy, Lesly L.; Marseille, Samson; Dély, Patrick; Pierre, Wilnique; Barais, Robert; Corvil, S.; Lucien, Mentor Ali Ber; Mondésir, L; Rizvi, Khulood; Parke, Dana; Zervos, Marcus J.

doi:10.15761/cmid.1000113

Cited by 10 publications

(7 citation statements)

References 14 publications

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“…Numerous studies have established the importance of tailoring community-based elimination interventions to the local sociocultural context to increase their effectiveness and uptake [ 21 , 22 ]. However, very little is known about community perceptions in Haiti regarding malaria in general, and these community-based interventions in particular—an evidence gap that has recently been acknowledged in the literature [ 19 , 23 , 24 ]. The goal of this study was to develop a robust understanding of how to tailor, implement and promote malaria elimination strategies that could be considered by the Haitian Ministry of Health and its partners.…”

Section: Introductionmentioning

confidence: 99%

“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

Druetz

Andrinopoulos

Boulos³

et al. 2018

Malar J

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BackgroundHaiti and the Dominican Republic, the only two Caribbean countries with endemic malaria transmission, are committed to eliminating malaria. With a Plasmodium falciparum prevalence under 1% and a highly focal transmission, the efforts towards elimination in Haiti will include several community-based interventions that must be tailored to the local sociocultural context to increase their uptake. However, little is known about local community perceptions regarding malaria and the planned elimination interventions. The aim of this study is to develop a robust understanding of how to tailor, implement and promote malaria elimination strategies in Haiti.MethodsA cross-sectional qualitative study was conducted December 2015–August 2016 in Grande-Anse and the North Department in Haiti. Data collection included key informant interviews (n = 51), in-depth interviews (n = 15) and focus group discussions (n = 14) with health workers, traditional healers, teachers, priests or pastors, informal community leaders, public officials, and community members. Following a grounded theory approach, transcripts were coded and analysed using content analysis. Coded text was sorted by the types of interventions under consideration by the malaria elimination programme.ResultsThe level of knowledge about malaria was low. Many participants noted community beliefs about malaria being caused by magical phenomena in addition to vector-borne transmission. Participants described malaria as a problem rooted in the environment, with vector control the most noted method of prevention. Though participants noted malaria a severe disease, it ranked lower than other health problems perceived as more acute. Access barriers to healthcare were described including a lack of bed nets. Some distrust about pills, tests, and foreigners in general was expressed, and in few cases linked to previous experience with malaria campaigns under dictatorial regimes.ConclusionsThere are several potential barriers and opportunities to implement community-based malaria elimination interventions in rural Haiti. Elimination efforts should include the collaboration of voodoo priests and other traditional healers, be coupled with solutions to wider community concerns or other health interventions, and learn from previous or similar programmes, such as the campaign to eliminate lymphatic filariasis. It is essential to engage with communities and gain their trust to successfully implement targeted aggressive elimination activities.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2553-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

Druetz

Andrinopoulos

Boulos³

et al. 2018

Malar J

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“…Further study revealed the Nepalese origins of this strain (35). The lab also plays follows the ongoing progress in the elimination of malaria in Haiti (36).…”

Section: The Role Of the Laboratory In The Health Systemmentioning

confidence: 83%

The Path to Implementation of A Clinical Laboratory System in A Developing Country

Lucien

Sakandé²,

Masetti³

et al. 2021

Preprint

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Background An effective laboratory system is an essential component of a public health system caring for patients with communicable and non-communicable diseases. Unfortunately, in developing countries this system is often sub-optimal, which negatively impacts health care. This paper describes the current situation of the clinical laboratory sector in Haiti and highlights challenges that exist in Haiti and other developing countries as they try to establish a clinical laboratory system. Method A cross-sectional survey was conducted in 30 laboratories across Haiti from January 19 to February 4, 2016. The laboratories surveyed were public or mixed public-private sector facilities belonging to different levels of the healthcare hierarchy. Labs were visited and directors of the health care institutions, lab managers, and members of their teams were interviewed and National Public Health Laboratory documents and information about the legal framework of the laboratory system was reviewed. Results The National Laboratory of Public Health is the reference lab for the national lab network and plays a key role in epidemiologic surveillance. Investigators felt that that the general conditions in the nation’s labs (83%) are good, but numerous deficiencies are identified. Electricity is often limited and 86% of facilities have mixed energy system. Bacterial cultures and susceptibilities are not performed. Most of the lab technologists (88.2%) have received only 2 two-year training certificates, while only the remainder (11.8%) had completed three-year programs training. Few continuing education opportunities are available. Equipment repair is available in more facilities (83%) than routine maintenance (63%) and is complicated by the diversity of brands employed. A total of 93% of the labs participate in the quality control program run by the National Lab. Conclusion The establishment of an effective national laboratory system requires coordination and input from many areas, including regulation of the sector, training of the technicians, sound infrastructure (including a stable supply of electricity) and dependable communications. Achieving this in developing countries will only be possible if different actors, national and international, coordinate their efforts.

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“…Altogether, this evidence suggests that targeting activities to the geographically clustered cases is warranted in Artibonite, where 60% of all hsRDT-positive cases were identified at two adjacent venues [35,36]. By contrast, transmission is still relatively high in Grand'Anse, warranting broader and more intensive control interventions with any targeting focused on the coast [2,3].…”

Section: Discussionmentioning

confidence: 98%

“…Haiti and the Dominican Republic are committed to eliminating malaria [1][2][3]. The island they share (Hispaniola) remains the only one in the Caribbean with endemic malaria transmission, with the majority of cases being reported in Haiti [2,4].…”

Section: Introductionmentioning

confidence: 99%

Programmatic options for monitoring malaria in elimination settings: easy access group surveys to investigate Plasmodium falciparum epidemiology in two regions with differing endemicity in Haiti

Druetz

Stresman

Ashton

et al. 2020

BMC Med

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Background: As in most eliminating countries, malaria transmission is highly focal in Haiti. More granular information, including identifying asymptomatic infections, is needed to inform programmatic efforts, monitor intervention effectiveness, and identify remaining foci. Easy access group (EAG) surveys can supplement routine surveillance with more granular information on malaria in a programmatically tractable way. This study assessed how and which type of venue for EAG surveys can improve understanding malaria epidemiology in two regions with different transmission profiles. Methods: EAG surveys were conducted within the departments of Artibonite and Grand'Anse (Haiti), in regions with different levels of transmission intensity. Surveys were conducted in three venue types: primary schools, health facilities, and churches. The sampling approach varied accordingly. Individuals present at the venues at the time of the survey were eligible whether they presented malaria symptoms or not. The participants completed a questionnaire and were tested for Plasmodium falciparum by a highly sensitive rapid diagnostic test (hsRDT). Factors associated with hsRDT positivity were assessed by negative binomial random-effects regression models.

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Malaria Elimination in Haiti: Challenges, Progress and Solutions

Cited by 10 publications

References 14 publications

“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

The Path to Implementation of A Clinical Laboratory System in A Developing Country

Programmatic options for monitoring malaria in elimination settings: easy access group surveys to investigate Plasmodium falciparum epidemiology in two regions with differing endemicity in Haiti

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