Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia
Introduction The WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first to implement an integrated approach and evaluate its impact.Methods A retrospective stud...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-01-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/9/1/e012599.full |
| _version_ | 1797334966589194240 |
|---|---|
| author | Laura Dean Mark Taylor Sally Theobald Zeela Zaizay Karsor K. Kollie Lent Jones Otis Kpadeh Gartee Nallo Darwosu Borbor Maneesh Phillip Tiawanlyn G Godwin-Akpan Deborah Fulamuso Mensah Anna Wickenden Jewel T Kollie Emerson Rogers Martyn Stewart |
| author_facet | Laura Dean Mark Taylor Sally Theobald Zeela Zaizay Karsor K. Kollie Lent Jones Otis Kpadeh Gartee Nallo Darwosu Borbor Maneesh Phillip Tiawanlyn G Godwin-Akpan Deborah Fulamuso Mensah Anna Wickenden Jewel T Kollie Emerson Rogers Martyn Stewart |
| author_sort | Laura Dean |
| collection | DOAJ |
| description | Introduction The WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first to implement an integrated approach and evaluate its impact.Methods A retrospective study of three of five CM-NTD-endemic counties that implemented the integrated approach was compared with cluster-matched counties with non-integrated CM-NTD. We compared trends in CM-NTD integrated versus non-integrated county clusters. We conducted a pre-post comparison of WHO high-level outcomes using data collected during intervention years compared with baseline in control counties. Changes in health outcomes, effect sizes for different diseases and rate ratios with statistically significant differences were determined. Complementary qualitative research explored CM-NTD stakeholders’ perceptions, analysed through the framework approach, which is a transparent, multistage approach for qualitative thematic interdisciplinary data analysis.Results The detection rates for all diseases combined improved significantly in the intervention compared with the control clusters. Besides leprosy, detection rates improved with large effects, over fourfold increase with statistically significant effects for individual diseases (p<0.000; 95% CI 3.5 to 5.4). Access to CM-NTD services increased in integrated counties by 71 facilities, compared with three facilities in non-integrated counties. Qualitative findings highlight training and supervision as inputs underpinning increases in case detection, but challenges with refresher training, medicine supply and incentives negatively impact quality, equity and access.Conclusions Integrating CM-NTDs improves case detection, accessibility and availability of CM-NTD services, promoting universal health coverage. Early case detection and the quality of care need further strengthening. |
| first_indexed | 2024-03-08T08:28:58Z |
| format | Article |
| id | doaj.art-f780047bb8764a79bc2bfe4887cad313 |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-03-08T08:28:58Z |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-f780047bb8764a79bc2bfe4887cad3132024-02-02T03:55:08ZengBMJ Publishing GroupBMJ Global Health2059-79082024-01-019110.1136/bmjgh-2023-012599Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in LiberiaLaura Dean0Mark Taylor1Sally Theobald2Zeela Zaizay3Karsor K. Kollie4Lent Jones5Otis Kpadeh6Gartee Nallo7Darwosu Borbor8Maneesh Phillip9Tiawanlyn G Godwin-Akpan10Deborah Fulamuso Mensah11Anna Wickenden12Jewel T Kollie13Emerson Rogers14Martyn Stewart15International Public Health, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UKTropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UKInternational Public Health, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UKAction Transforming Lives, Congo Town Back Road Monrovia, LiberiaHealth Services, Ministry of Health, Congo Town Back Road, Monrovia, LiberiaThe University of Liberia, Pacific Institute for Research Evaluation, Monrovia, LiberiaThe University of Liberia, Pacific Institute for Research Evaluation, Monrovia, LiberiaThe University of Liberia, Pacific Institute for Research Evaluation, Monrovia, LiberiaCuttington University Graduate School Research Student, Monrovia, LiberiaEffect Hope, 90 Allstate Parkway Markham ON L3R 6H3, Ontario, CanadaAmerican Leprosy Missions Liberia, Monrovia, LiberiaAmerican Leprosy Missions, 27 Jungle Road Accra, GhanaInternational Public Health, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UKA. M. Dogliotti School of Medicine, University of Liberia, Monrovia, LiberiaHealth Services, Ministry of Health, Congo Town Back Road, Monrovia, LiberiaEducation, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UKIntroduction The WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first to implement an integrated approach and evaluate its impact.Methods A retrospective study of three of five CM-NTD-endemic counties that implemented the integrated approach was compared with cluster-matched counties with non-integrated CM-NTD. We compared trends in CM-NTD integrated versus non-integrated county clusters. We conducted a pre-post comparison of WHO high-level outcomes using data collected during intervention years compared with baseline in control counties. Changes in health outcomes, effect sizes for different diseases and rate ratios with statistically significant differences were determined. Complementary qualitative research explored CM-NTD stakeholders’ perceptions, analysed through the framework approach, which is a transparent, multistage approach for qualitative thematic interdisciplinary data analysis.Results The detection rates for all diseases combined improved significantly in the intervention compared with the control clusters. Besides leprosy, detection rates improved with large effects, over fourfold increase with statistically significant effects for individual diseases (p<0.000; 95% CI 3.5 to 5.4). Access to CM-NTD services increased in integrated counties by 71 facilities, compared with three facilities in non-integrated counties. Qualitative findings highlight training and supervision as inputs underpinning increases in case detection, but challenges with refresher training, medicine supply and incentives negatively impact quality, equity and access.Conclusions Integrating CM-NTDs improves case detection, accessibility and availability of CM-NTD services, promoting universal health coverage. Early case detection and the quality of care need further strengthening.https://gh.bmj.com/content/9/1/e012599.full |
| spellingShingle | Laura Dean Mark Taylor Sally Theobald Zeela Zaizay Karsor K. Kollie Lent Jones Otis Kpadeh Gartee Nallo Darwosu Borbor Maneesh Phillip Tiawanlyn G Godwin-Akpan Deborah Fulamuso Mensah Anna Wickenden Jewel T Kollie Emerson Rogers Martyn Stewart Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia BMJ Global Health |
| title | Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia |
| title_full | Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia |
| title_fullStr | Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia |
| title_full_unstemmed | Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia |
| title_short | Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia |
| title_sort | multimethod evaluation of health services integration for neglected tropical diseases requiring case management in liberia |
| url | https://gh.bmj.com/content/9/1/e012599.full |
| work_keys_str_mv | AT lauradean multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT marktaylor multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT sallytheobald multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT zeelazaizay multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT karsorkkollie multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT lentjones multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT otiskpadeh multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT garteenallo multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT darwosuborbor multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT maneeshphillip multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT tiawanlynggodwinakpan multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT deborahfulamusomensah multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT annawickenden multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT jeweltkollie multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT emersonrogers multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia AT martynstewart multimethodevaluationofhealthservicesintegrationforneglectedtropicaldiseasesrequiringcasemanagementinliberia |