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Integrating an infectious disease programme into the primary health care service: a retrospective analysis of Chagas disease community-based surveillance in Honduras.

Hashimoto K, Zúniga C, Nakamura J, Hanada K - BMC Health Serv Res (2015)

Bottom Line: In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection.Overall surveillance performance improved from 46 to 84 on a 100 point-scale.Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points.

View Article: PubMed Central - PubMed

Affiliation: Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA. hashimok@gmail.com.

ABSTRACT

Background: Integration of disease-specific programmes into the primary health care (PHC) service has been attempted mostly in clinically oriented disease control such as HIV/AIDS and tuberculosis but rarely in vector control. Chagas disease is controlled principally by interventions against the triatomine vector. In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection. This paper retrospectively analyses the effects and process of integrating a Chagas disease vector surveillance system into health centres.

Methods: We evaluated the effects of integration at six pilot sites in western Honduras during 2008-2011 on; surveillance performance; knowledge, attitude and practice in schoolchildren; reports of triatomine bug infestation and institutional response; and seroprevalence among children under 15 years of age. The process of integration of the surveillance system was analysed using the PRECEDE-PROCEED model for health programme planning. The model was employed to systematically determine influential and interactive factors which facilitated the integration process at different levels of the Ministry of Health and the community.

Results: Overall surveillance performance improved from 46 to 84 on a 100 point-scale. Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points. Seroprevalence declined from 3.4% to 0.4%. Health centres responded to the community bug reports by insecticide spraying. As key factors, the health centres had potential management capacity and influence over the inhabitants' behaviours and living environment directly and through community health volunteers. The National Chagas Programme played an essential role in facilitating changes with adequate distribution of responsibilities, participatory modelling, training and, evaluation and advocacy.

Conclusions: We found that Chagas disease vector surveillance can be integrated into the PHC service. Health centres demonstrated capacity to manage vector surveillance and improve performance, children's awareness, vector report-response and seroprevalence, once tasks were simplified to be performed by trained non-specialists and distributed among the stakeholders. Health systems integration requires health workers to perform beyond their usual responsibilities and acquire management skills. Integration of vector control is feasible and can contribute to strengthening the preventive capacity of the PHC service.

No MeSH data available.


Related in: MedlinePlus

The PRECEDE-PROCEED model for health programme planning adapted to analysis of Chagas disease surveillance system in PHC services.
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Fig1: The PRECEDE-PROCEED model for health programme planning adapted to analysis of Chagas disease surveillance system in PHC services.

Mentions: We analysed the process and effects of implementation of the vector surveillance system in the health centres using the PRECEDE-PROCEED (predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation – policy, regulatory, and organisational constructs in educational and environmental development) model for health programme planning [21]. PRECEDE is a framework designed to assess health-related behaviours and environment from epidemiological, social, behavioural, educational, administrative and political perspectives. The subsequent PROCEED stage allows planning, implementation and evaluation of public health interventions based on the assessment (Figure 1). We considered the establishment of Chagas disease surveillance systems at health centres as health programme planning, and we hypothesized that the model would facilitate a holistic and systematic analysis for determining key factors at different administrative levels of the Ministry of Health and the community.Figure 1


Integrating an infectious disease programme into the primary health care service: a retrospective analysis of Chagas disease community-based surveillance in Honduras.

Hashimoto K, Zúniga C, Nakamura J, Hanada K - BMC Health Serv Res (2015)

The PRECEDE-PROCEED model for health programme planning adapted to analysis of Chagas disease surveillance system in PHC services.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4383207&req=5

Fig1: The PRECEDE-PROCEED model for health programme planning adapted to analysis of Chagas disease surveillance system in PHC services.
Mentions: We analysed the process and effects of implementation of the vector surveillance system in the health centres using the PRECEDE-PROCEED (predisposing, reinforcing, and enabling constructs in educational/ecological diagnosis and evaluation – policy, regulatory, and organisational constructs in educational and environmental development) model for health programme planning [21]. PRECEDE is a framework designed to assess health-related behaviours and environment from epidemiological, social, behavioural, educational, administrative and political perspectives. The subsequent PROCEED stage allows planning, implementation and evaluation of public health interventions based on the assessment (Figure 1). We considered the establishment of Chagas disease surveillance systems at health centres as health programme planning, and we hypothesized that the model would facilitate a holistic and systematic analysis for determining key factors at different administrative levels of the Ministry of Health and the community.Figure 1

Bottom Line: In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection.Overall surveillance performance improved from 46 to 84 on a 100 point-scale.Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points.

View Article: PubMed Central - PubMed

Affiliation: Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA. hashimok@gmail.com.

ABSTRACT

Background: Integration of disease-specific programmes into the primary health care (PHC) service has been attempted mostly in clinically oriented disease control such as HIV/AIDS and tuberculosis but rarely in vector control. Chagas disease is controlled principally by interventions against the triatomine vector. In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection. This paper retrospectively analyses the effects and process of integrating a Chagas disease vector surveillance system into health centres.

Methods: We evaluated the effects of integration at six pilot sites in western Honduras during 2008-2011 on; surveillance performance; knowledge, attitude and practice in schoolchildren; reports of triatomine bug infestation and institutional response; and seroprevalence among children under 15 years of age. The process of integration of the surveillance system was analysed using the PRECEDE-PROCEED model for health programme planning. The model was employed to systematically determine influential and interactive factors which facilitated the integration process at different levels of the Ministry of Health and the community.

Results: Overall surveillance performance improved from 46 to 84 on a 100 point-scale. Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points. Seroprevalence declined from 3.4% to 0.4%. Health centres responded to the community bug reports by insecticide spraying. As key factors, the health centres had potential management capacity and influence over the inhabitants' behaviours and living environment directly and through community health volunteers. The National Chagas Programme played an essential role in facilitating changes with adequate distribution of responsibilities, participatory modelling, training and, evaluation and advocacy.

Conclusions: We found that Chagas disease vector surveillance can be integrated into the PHC service. Health centres demonstrated capacity to manage vector surveillance and improve performance, children's awareness, vector report-response and seroprevalence, once tasks were simplified to be performed by trained non-specialists and distributed among the stakeholders. Health systems integration requires health workers to perform beyond their usual responsibilities and acquire management skills. Integration of vector control is feasible and can contribute to strengthening the preventive capacity of the PHC service.

No MeSH data available.


Related in: MedlinePlus