American Journal of Tropical Medicine and Hygiene
May 2016; 94 (5)
http://www.ajtmh.org/content/current

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Perspective Piece
Modeling Key Malaria Drugs’ Impact on Global Health: A Reason to Invest in the Global Health Impact Index
Nicole Hassoun
Am J Trop Med Hyg 2016 94:942-946; Published online February 8, 2016, doi:10.4269/ajtmh.15-0409
Abstract
Millions of people cannot access good quality essential medicines they need for some of the world’s worst diseases like malaria. The World Health Organization estimates that, in 2013, 198 million people became sick with malaria and 584,000 people died of the disease, while the Institute for Health Metrics Evaluation estimates that there were 164,929,872 cases of malaria in 2013 and 854,568 deaths in 2013. There are many attempts to model different aspects of the global burden of tropical diseases like malaria, but it is also important to measure success in averting malaria-related death and disability. This perspective proposes investing in a systematic effort to measure the benefits of health interventions for malaria along the lines of a model embodied in the Global Health Impact Index (global-health-impact.org).

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Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis
Steven J. Hoffman, G. Emmanuel Guindon, John N. Lavis, Harkanwal Randhawa, Francisco Becerra-Posada, Masoumeh Dejman, Katayoun Falahat, Hossein Malek-Afzali, Parasurama Ramachandran, Guang Shi, and C. A. K. Yesudian
Abstract
Research evidence continues to reveal findings important for health professionals’ clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals’ knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals’ knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices “often or very often” (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals’ knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.

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Effectiveness of Oral Cholera Vaccine in Haiti: 37-Month Follow-Up
Karine Sévère, Vanessa Rouzier, Stravinsky Benedict Anglade, Claudin Bertil, Patrice Joseph,
Alexandra Deroncelay, Marie Marcelle Mabou, Peter F. Wright, Florence Duperval Guillaume,
and Jean William Pape
Am J Trop Med Hyg 2016 94:1136-1142; Published online February 29, 2016, doi:10.4269/ajtmh.15-0700
Abstract
The first oral cholera vaccine (OCV) campaign, since its prequalification by the World Health Organization, in response to an ongoing cholera epidemic (reactive vaccination) was successfully conducted in a poor urban slum of approximately 70,000 inhabitants in Port-au-Prince, Haiti, in 2012. Vaccine coverage was 75% of the target population. This report documents the impact of OCV in reducing the number of culture-confirmed cases of cholera admitted to the Groupe Haïtien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) cholera treatment center from that community in the 37 months postvaccination (April 2012–April 30, 2015). Of 1,788 patients with culture-confirmed cholera, 1,770 (99%) were either from outside the vaccine area (1,400 cases) or from the vaccinated community who had not received OCV (370 cases). Of the 388 people from the catchment area who developed culture-confirmed cholera, 370 occurred among the 17,643 people who had not been vaccinated (2.1%) and the remaining 18 occurred among the 52,357 people (0.034%) who had been vaccinated (P < 0.001), for an efficacy that approximates 97.5%. Despite not being designed as a randomized control trial, the very high efficacy is a strong evidence for the effectiveness of OCV as part of an integrated package for the control of cholera in outbreak settings.

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Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia
Hailay D. Teklehaimanot, Awash Teklehaimanot, Aregawi A. Tedella, and Mustofa Abdella
Am J Trop Med Hyg 2016 94:1157-1169; Published online February 29, 2016, doi:10.4269/ajtmh.15-0192
Abstract
In 2004, Ethiopia introduced a community-based Health Extension Program to deliver basic and essential health services. We developed a comprehensive performance scoring methodology to assess the performance of the program. A balanced scorecard with six domains and 32 indicators was developed. Data collected from 1,014 service providers, 433 health facilities, and 10,068 community members sampled from 298 villages were used to generate weighted national, regional, and agroecological zone scores for each indicator. The national median indicator scores ranged from 37% to 98% with poor performance in commodity availability, workforce motivation, referral linkage, infection prevention, and quality of care. Indicator scores showed significant difference by region (P < 0.001). Regional performance varied across indicators suggesting that each region had specific areas of strength and deficiency, with Tigray and the Southern Nations, Nationalities and Peoples Region being the best performers while the mainly pastoral regions of Gambela, Afar, and Benishangul-Gumuz were the worst. The findings of this study suggest the need for strategies aimed at improving specific elements of the program and its performance in specific regions to achieve quality and equitable health services.