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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 mean performance index of the six pilot sites for the Chagas disease vector surveillance system by the National Chagas Programme, Departmental Health Offices, health centres and community health volunteers from 2009 to 2011.
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Fig2: The mean performance index of the six pilot sites for the Chagas disease vector surveillance system by the National Chagas Programme, Departmental Health Offices, health centres and community health volunteers from 2009 to 2011.

Mentions: The surveillance system performance improved throughout national, departmental, health centre and community levels in all six pilot sites. The average score increased from 46 in March 2009, 73 in October 2009, 77 in March 2010, and 83 in August 2010 to 84 in February 2011 (Figure 2). The health centres, which served as the managerial focal points of surveillance system, recorded 43, 74, 77, 86 and 88 in the respective evaluations. Common deficiencies noted were risk map updating, monthly data reporting to the upper administrative offices, and timely response to the bug reports.Figure 2


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 mean performance index of the six pilot sites for the Chagas disease vector surveillance system by the National Chagas Programme, Departmental Health Offices, health centres and community health volunteers from 2009 to 2011.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: The mean performance index of the six pilot sites for the Chagas disease vector surveillance system by the National Chagas Programme, Departmental Health Offices, health centres and community health volunteers from 2009 to 2011.
Mentions: The surveillance system performance improved throughout national, departmental, health centre and community levels in all six pilot sites. The average score increased from 46 in March 2009, 73 in October 2009, 77 in March 2010, and 83 in August 2010 to 84 in February 2011 (Figure 2). The health centres, which served as the managerial focal points of surveillance system, recorded 43, 74, 77, 86 and 88 in the respective evaluations. Common deficiencies noted were risk map updating, monthly data reporting to the upper administrative offices, and timely response to the bug reports.Figure 2

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