A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study).

Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-care tests, training and mentorship, compared with usual care, among sick children 2 to 59 months old presenting to primary care facilities for an acute illness in Tanzania (ClinicalTrials.

Experiences of community health workers on adopting mHealth in rural Malawi: A qualitative study.

Background: The use of mobile health technology (mHealth) by community health workers (CHWs) can strengthen community-based service delivery and improve access to and quality of healthcare.

Objective: This qualitative study sought to explore experiences and identify factors influencing the use of an integrated smartphone-based mHealth called by CHWs in rural Malawi.

Methods: Using pre-tested interview guides, between August and October 2022, we conducted eight focus group discussions with CHWs ( = 69), four in-depth interviews with CHW supervisors, and eight key informant interviews in Neno District, Malawi.

Prevalence and predictors of residual antibiotics in children's blood in community settings in Tanzania.

Objectives: Children account for a significant proportion of antibiotic consumption in low- and middle-income countries, with overuse occurring in formal and informal health sectors. This study assessed the prevalence and predictors of residual antibiotics in the blood of children in the Mbeya and Morogoro regions of Tanzania.

Methods: The cross-sectional community-based survey used two-stage cluster sampling to include children aged under 15 years.

Non-communicable disease care in Sierra Leone: a mixed-methods study of the drivers and barriers to retention in care for hypertension.

Objective: To retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone.

Design: Convergent mixed-methods study.

Setting: Koidu Government Hospital, a secondary-level hospital in Kono District.

A digital health algorithm to guide antibiotic prescription in pediatric outpatient care: a cluster randomized controlled trial.

Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital clinical decision support algorithm in combination with C-reactive protein test, hemoglobin test, pulse oximeter and mentorship, to guide health-care providers in managing acutely sick children under 15 years old. To evaluate the impact of ePOCT+ compared to usual care, we conducted a cluster randomized controlled trial in Tanzanian primary care facilities.

Impact of a teen club model on HIV outcomes among adolescents in rural Neno district, Malawi: a retrospective cohort study.

Objective: To compare the impact of a teen club model to the standard care model on HIV treatment outcomes among adolescents (10-19 years of age).

Design: Retrospective cohort study.

Setting: HIV clinics in Neno district, Malawi.

Modular Clinical Decision Support Networks (MoDN)-Updatable, interpretable, and portable predictions for evolving clinical environments.

Clinical Decision Support Systems (CDSS) have the potential to improve and standardise care with probabilistic guidance. However, many CDSS deploy static, generic rule-based logic, resulting in inequitably distributed accuracy and inconsistent performance in evolving clinical environments. Data-driven models could resolve this issue by updating predictions according to the data collected.

How do disease control measures impact spatial predictions of schistosomiasis and hookworm? The example of predicting school-based prevalence before and after preventive chemotherapy in Ghana.

Background: Schistosomiasis and soil-transmitted helminth infections are among the neglected tropical diseases (NTDs) affecting primarily marginalized communities in low- and middle-income countries. Surveillance data for NTDs are typically sparse, and hence, geospatial predictive modeling based on remotely sensed (RS) environmental data is widely used to characterize disease transmission and treatment needs. However, as large-scale preventive chemotherapy has become a widespread practice, resulting in reduced prevalence and intensity of infection, the validity and relevance of these models should be re-assessed.

A roadmap for using DHIS2 data to track progress in key health indicators in the Global South: experience from sub-saharan Africa.

High quality health data as collected by health management information systems (HMIS) is an important building block of national health systems. District Health Information System 2 (DHIS2) software is an innovation in data management and monitoring for strengthening HMIS that has been widely implemented in low and middle-income countries in the last decade. However, analysts and decision-makers still face significant challenges in fully utilizing the capabilities of DHIS2 data to pursue national and international health agendas.

Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Protocol for a Mixed Method Systematic Review.

Background: Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa.

Objective: This mixed method systematic review will explore the impact of mHealth use by CHWs on the use of the maternal health continuum of care (antenatal care, intrapartum care, and postnatal care [PNC]), as well as barriers and facilitators of mHealth use by CHWs when supporting maternal health services.

Longitudinal borehole functionality in 15 rural Ghanaian towns from three groundwater quality clusters.

Objective: In sub-Saharan Africa, 45% of the rural population uses boreholes (BHs). Despite recent gains in improved water access and coverage, parallel use of unimproved sources persists. Periodic infrastructure disrepair contributes to non-exclusive use of BHs.

Investigating seasonal patterns in enteric infections: a systematic review of time series methods.

Foodborne and waterborne gastrointestinal infections and their associated outbreaks are preventable, yet still result in significant morbidity, mortality and revenue loss. Many enteric infections demonstrate seasonality, or annual systematic periodic fluctuations in incidence, associated with climatic and environmental factors. Public health professionals use statistical methods and time series models to describe, compare, explain and predict seasonal patterns.

A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi.

Background: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC).

Implementation of a non-communicable disease clinic in rural Sierra Leone: early experiences and lessons learned.

This study is an evaluation of the first cohort of patients enrolled in an outpatient non-communicable disease clinic in Kono, Sierra Leone. In the first year, the clinic enrolled 916 patients. Eight months after the enrollment of the last patient, 53% were still active in care, 43% had been lost to follow-up (LTFU) and 4% had defaulted.

Rural Ghanaian households are more likely to use alternative unimproved water sources when water from boreholes has undesirable organoleptic characteristics.

Sustainable Development Goal (SDG) 6 aims to achieve universal access to safe drinking water sources. However, the health benefits of meeting this goal will only be fully realized if improved sources are used to the exclusion of unimproved sources. Very little is known about how rural African households balance the use of improved and unimproved water sources when multiple options are present.

Prediction of hookworm prevalence in southern India using environmental parameters derived from Landsat 8 remotely sensed data.

Soil-transmitted helminth infections propagate poverty and slow economic growth in low-income countries. As with many other neglected tropical diseases, environmental conditions are important determinants of soil-transmitted helminth transmission. Hence, remotely sensed data are commonly utilised in spatial risk models intended to inform control strategies.

The use of remotely sensed environmental parameters for spatial and temporal schistosomiasis prediction across climate zones in Ghana.

Schistosomiasis control in sub-Saharan Africa is enacted primarily through preventive chemotherapy. Predictive models can play an important role in filling knowledge gaps in the distribution of the disease and help guide the allocation of limited resources. Previous modeling approaches have used localized cross-sectional survey data and environmental data typically collected at a discrete point in time.

Assessment of urogenital schistosomiasis knowledge among primary and junior high school students in the Eastern Region of Ghana: A cross-sectional study.

Background: Knowledge of urogenital schistosomiasis can empower individuals to limit surface water contact and participate in mass drug administration campaigns, but nothing is currently known about the schistosomiasis knowledge that schoolchildren have in Ghana. We developed and implemented a survey tool aiming to assess the knowledge of urogenital schistosomiasis (treatment, transmission, prevention, symptoms) among science teaches and primary and junior high school students in the Eastern Region of Ghana.

Methods: We developed a 22-question knowledge survey tool and administered it to 875 primary and 938 junior high school students from 74 schools in 37 communities in the Eastern Region of Ghana.

Contextualizing Schistosoma haematobium transmission in Ghana: Assessment of diagnostic techniques and individual and community water-related risk factors.

Objectives: The study assessed associations between Schistosoma haematobium infection (presence of parasite eggs in urine or hematuria) and self-reported metrics (macrohematuria, fetching surface water, or swimming) to evaluate their performance as proxies of infection in presence of regular preventive chemotherapy. It also examined community water characteristics (safe water access, surface water access, and groundwater quality) to provide context for schistosomiasis transmission in different types of communities and propose interventions.

Methods: Logistic regression was used to assess the associations between the various measured and self-reported metrics in a sample of 897 primary school children in 30 rural Ghanaian communities.

Improving spatial prediction of Schistosoma haematobium prevalence in southern Ghana through new remote sensors and local water access profiles.

Background: Schistosomiasis is a water-related neglected tropical disease. In many endemic low- and middle-income countries, insufficient surveillance and reporting lead to poor characterization of the demographic and geographic distribution of schistosomiasis cases. Hence, modeling is relied upon to predict areas of high transmission and to inform control strategies.

Physicochemical parameters affecting the perception of borehole water quality in Ghana.

Rural Ghanaian communities continue using microbiologically contaminated surface water sources due in part to undesirable organoleptic characteristics of groundwater from boreholes. Our objective was to identify thresholds of physical and chemical parameters associated with consumer complaints related to groundwater. Water samples from 94 boreholes in the dry season and 68 boreholes in the rainy season were analyzed for 18 parameters.

Agreement among Four Prevalence Metrics for Urogenital Schistosomiasis in the Eastern Region of Ghana.

Few studies assess agreement among eggs, measured hematuria, and self-reported metrics. We assessed agreement among four metrics at a single time point and analyzed the stability of infection across two time points with a single metric. We used data from the Eastern Region of Ghana and constructed logistic regression models.