Suchergebnisse

There is still debate on whether communities of practice (COP) can be formed or created. Many have claimed that they provide a venue to share knowledge which translates to action. In South and Southeast Asia, international development partners have invested in many capacity building initiatives to set-up and/or improve eHealth implementations in countries. While interest and resources for this increase, many challenges are still left unresolved due to repeated mistakes and undocumented experiences. The Asia eHealth Information Network (AeHIN) is a community of health informatics professionals organised to share knowledge and improve the use of ICT in health systems strengthening. Objectives: This study examined how AeHIN emerged as a knowledge sharing platform, identified best practices it adopted, and developed a model that could sustain itself as a COP. Methods: A sociometric survey was used to map knowledge sharing connections of pioneer members with interviews to substantiate findings and a 20-hour participant observation to triangulate data. UCINET 6.0 was used to analyse social network data while qualitative data were coded. Results: Defining roles of health informatics professionals inside the COP influences the type of information, resources, and capacities that can enter a network. The nature of its subgroups determines potentials and barriers to the network. Twelve best practices were identified to sustain a health informatics COP. It is recommended that a learning network is an appropriate model for this type of COP and an understanding of country-specific political structure is important to support participation. Conclusion: AeHIN is a COP model whose activities have a life of their own. While some prove successful, others die down or are discontinued. This unique design proved to be fitting for a group of health informatics professionals as it accommodates success and failures crucial for project implementations.

BACKGROUND: Zoonoses are an increasing concern worldwide, particularly in low- and middle-income countries. People with close contact with animals are at high risk for contracting and transmitting the zoonotic diseases. OBJECTIVES: To determine health literacy of livestock farmers toward biosecurity to prevent zoonotic diseases. METHODS: This cross-sectional mixed-methods study was conducted in Thai Nguyen Province, Vietnam, where livestock and farming are the main occupation. The questionnaire survey was submitted to 218 farmers who have close contact with livestock. In addition, 8 farmers were invited to an in-depth interview to further explore the health literacy. RESULTS: Half of the participants were men. The average age (standard deviation) of the participants was 49.3(11.5) years. The median years with experience in farming was 15 years. The majority (82.0%) of the participants had moderate health literacy level regarding zoonoses. Improper use of antibiotics was referred by 58.0% of participants, including antibiotic use as feeding supplements (34.0%) and the use of human antibiotics to treat sick animals (24.0%). Many participants were unaware of zoonotic prevention measures and due to this had practices such as not wearing protective equipment (60.0%), an absence of acaricides to prevent vector infestations (52.0%), an absence of disinfection measures (42.0%), low rate of rabies vaccination (54.0%), and do not quarantining sick animals (38.0%). In-depth interviews revealed great concern among farmers about a collective lack of participation from local veterinarians, health workers, and government authorities in zoonoses-prevention efforts. Statistical models showed that farm scale, ethnic groups, and perceived income were associated with the overall health literacy about zoonoses. CONCLUSION: Comprehensive health education related to zoonotic diseases is recommended to improve overall knowledge, including routes of transmission, symptoms and consequences of diseases, and antibiotic usage. In addition, ...

Immunization is a core component of the human right to health. However, accessibility to the Expanded Program on Immunization (EPI) might be difficult among migrant children. This study aims to assess the vaccination coverage of migrant children under a mobile immunization program, initiated by the Thai government in 2014. A cross-sectional, mixed-methods study was conducted in five districts along the Thailand–Myanmar border during July–December 2018. The immunization history during their first year of life was obtained. Focus group discussions were conducted among stakeholders to explore their satisfaction toward the immunization service. Mothers/guardians of 1707 migrant children participated in the survey, with a 71% response rate. The vaccination coverage increased during 2014–2017. The highest vaccination coverage was observed for Bacillus Calmette-Guérin vaccine, with 83.2% coverage in 2017. The vaccination coverage of three doses of diphtheria-tetanus-pertussis vaccine and Hepatitis B vaccine and oral polio vaccine increased from 34.8% in 2014 to 56.3% in 2017. For measles-containing vaccine, the vaccination coverage increased from 32.4% in 2014 to 54.6% in 2017. Overall, all stakeholders were satisfied with the immunization service. Increased workload and communication barriers were the main factors that influenced the satisfaction toward the immunization program.

Abstract

Background
This study aims to assess the situation of communicable diseases under national surveillance in the Cyclone Nargis-affected areas in Myanmar (Burma) before and after the incident.


Methods
Monthly data during 2007, 2008 and 2009 from the routine reporting system for disease surveillance of the Myanmar Ministry of Health (MMOH) were reviewed and compared with weekly reporting from the Early Warning and Rapid Response (EWAR) system. Data from some UN agencies, NGOs and Tri-Partite Core Group (TCG) periodic reviews were also extracted for comparisons with indicators from Sphere and the Inter-Agency Standing Committee.


Results
Compared to 2007 and 2009, large and atypical increases in diarrheal disease and especially dysentery cases occurred in 2008 following Cyclone Nargis. A seasonal increase in ARI reached levels higher than usual in the months of 2008 post-Nargis. The number of malaria cases post-Nargis also increased, but it was less clear if this reflected normal seasonal patterns or was specifically associated with the disaster event. There was no significant change in the occurrence of other communicable diseases in Nargis-affected areas. Except for a small decrease in mortality for diarrheal diseases and ARI in 2008 in Nargis-affected areas, population-based mortality rates for all other communicable diseases showed no significant change in 2008 in these areas, compared to 2007 and 2009. Tuberculosis control programs reached their targets of 70% case detection and 85% treatment success rates in 2007 and 2008. Vaccination coverage rates for DPT 3rd dose and measles remained at high though measles coverage still did not reach the Sphere target of 95% even by 2009. Sanitary latrine coverage in the Nargis-affected area dropped sharply to 50% in the months of 2008 following the incident but then rose to 72% in 2009.


Conclusion
While the incidence of diarrhea, dysentery and ARI increased post-Nargis in areas affected by the incident, the incidence rate for other diseases and mortality rates did not increase, and normal disease patterns resumed by 2009. This suggests that health services as well as prevention and control measures provided to the Nargis-affected population mitigated what could have been a far more severe health impact.

The adaptive immune response to vaccination or infection can lead to the production of specific antibodies to neutralize the pathogen or recruit innate immune effector cells for help. The non-neutralizing role of antibodies in stimulating effector cell responses may have been a key mechanism of the protection observed in the RV144 HIV vaccine trial. In an extensive investigation of a rich set of data collected from RV144 vaccine recipients, we here employ machine learning methods to identify and model associations between antibody features (IgG subclass and antigen specificity) and effector function activities (antibody dependent cellular phagocytosis, cellular cytotoxicity, and cytokine release). We demonstrate via cross-validation that classification and regression approaches can effectively use the antibody features to robustly predict qualitative and quantitative functional outcomes. This integration of antibody feature and function data within a machine learning framework provides a new, objective approach to discovering and assessing multivariate immune correlates. ; U.S. Military HIV Research Program ; Collaboration for AIDS Vaccine Discover (OPP1032817) ; National Institutes of Health (U.S.) (3R01AI080289-02S1) ; National Institutes of Health (U.S.) (5R01AI080289-03) ; United States. Army Medical Research and Materiel Command (National Institute of Allergy and Infectious Diseases (U.S.) Interagency Agreement Y1-AI-2642-12) ; Henry M. Jackson Foundation for the Advancement of Military Medicine (U.S.) (United States. Dept. of Defense Cooperative Agreement W81XWH-07-2-0067)

Dihydroartemisinin-piperaquine, the current first-line drug for uncomplicated malaria caused by Plasmodium falciparum and Plasmodium vivax in Cambodia, was previously shown to be of benefit as malaria chemoprophylaxis when administered as a monthly 3-day regimen. We sought to evaluate the protective efficacy of a compressed monthly 2-day treatment course in the Royal Cambodian Armed Forces. The safety and efficacy of a monthly 2-day dosing regimen of dihydroartemisinin-piperaquine were evaluated in a two-arm, randomized, double-blind, placebo-controlled cohort study with 2:1 treatment allocation. Healthy military volunteers in areas along the Thai-Cambodian border where there is a high risk of malaria were administered two consecutive daily doses of 180 mg dihydroartemisinin and 1,440 mg piperaquine within 30 min to 3 h of a meal once per month for a planned 4-month period with periodic electrocardiographic and pharmacokinetic assessment. The study was halted after only 6 weeks (69 of 231 projected volunteers enrolled) when four volunteers met a prespecified cardiac safety endpoint of QTcF (Fridericia's formula for correct QT interval) prolongation of >500 ms. The pharmacodynamic effect on the surface electrocardiogram (ECG) peaked approximately 4 h after piperaquine dosing and lasted 4 to 8 h. Unblinded review by the data safety monitoring board revealed mean QTcF prolongation of 46 ms over placebo at the maximum concentration of drug in serum (Cmax) on day 2. Given that dihydroartemisinin-piperaquine is one of the few remaining effective antimalarial agents in Cambodia, compressed 2-day treatment courses of dihydroartemisinin-piperaquine are best avoided until the clinical significance of these findings are more thoroughly evaluated. Because ECG monitoring is often unavailable in areas where malaria is endemic, repolarization risk could be mitigated by using conventional 3-day regimens, fasting, and avoidance of repeated dosing or coadministration with other QT-prolonging medications. (This study has been ...