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  1. Article ; Online: Factors Affecting the Performance of HRP2-Based Malaria Rapid Diagnostic Tests.

    Martiáñez-Vendrell, Xavier / Skjefte, Malia / Sikka, Ruhi / Gupta, Himanshu

    Tropical medicine and infectious disease

    2022  Volume 7, Issue 10

    Abstract: The recent COVID-19 pandemic has profoundly impacted global malaria elimination programs, resulting in a sharp increase in malaria morbidity and mortality. To reduce this impact, unmet needs in malaria diagnostics must be addressed while resuming malaria ...

    Abstract The recent COVID-19 pandemic has profoundly impacted global malaria elimination programs, resulting in a sharp increase in malaria morbidity and mortality. To reduce this impact, unmet needs in malaria diagnostics must be addressed while resuming malaria elimination activities. Rapid diagnostic tests (RDTs), the unsung hero in malaria diagnosis, work to eliminate the prevalence of
    Language English
    Publishing date 2022-09-25
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 2414-6366
    ISSN (online) 2414-6366
    DOI 10.3390/tropicalmed7100265
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  2. Article ; Online: Use of a health worker-targeted smartphone app to support quality malaria RDT implementation in Busia County, Kenya: A feasibility and acceptability study.

    Skjefte, Malia / Cooper, Shawna / Poyer, Stephen / Lourenço, Christopher / Smedinghoff, Sam / Keller, Brett / Wambua, Tonny / Oduor, Christine / Frade, Sasha / Waweru, Wycliffe

    PloS one

    2024  Volume 19, Issue 3, Page(s) e0295049

    Abstract: Malaria rapid diagnostic tests (mRDTs) are an essential diagnostic tool in low-resource settings; however, administration and interpretation errors reduce their effectiveness. HealthPulse, a smartphone mRDT reader application, was developed by Audere to ... ...

    Abstract Malaria rapid diagnostic tests (mRDTs) are an essential diagnostic tool in low-resource settings; however, administration and interpretation errors reduce their effectiveness. HealthPulse, a smartphone mRDT reader application, was developed by Audere to aid health workers in mRDT administration and interpretation, with an aim to improve the mRDT testing process and facilitate timely decision making through access to digitized results. Audere partnered with PSI and PS Kenya to conduct a pilot study in Busia County, Kenya between March and September 2021 to assess the feasibility and acceptability of HealthPulse to support malaria parasitological diagnosis by community health volunteers (CHVs) and private clinic health workers (private clinic HWs). Metadata was interpreted to assess adherence to correct use protocols and health worker perceptions of the app. Changes to mRDT implementation knowledge were measured through baseline and endline surveys. The baseline survey identified clear mRDT implementation gaps, such as few health workers correctly knowing the number of diluent drops and minimum and maximum wait times for mRDT interpretation, although health worker knowledge improved after using the app. Endline survey results showed that 99.6% of health workers found the app useful and 90.1% found the app easy to use. Process control data showed that most mRDTs (89.2%) were photographed within the recommended 30-minute time frame and that 91.4% of uploaded photos passed the app filter quality check on the first submission. During 154 encounters (3.5% of all encounters) a health worker dispensed an artemisinin-based combination therapy (ACT) to their patient even with a negative mRDT readout. Overall, study results indicated that HealthPulse holds potential as a mobile tool for use in low-resource settings, with future supportive supervision, diagnostic, and surveillance benefits. Follow-up studies will aim to more deeply understand the utility and acceptance of the HealthPulse app.
    MeSH term(s) Humans ; Mobile Applications ; Kenya ; Feasibility Studies ; Pilot Projects ; Malaria/diagnosis ; Diagnostic Tests, Routine/methods ; Antimalarials/therapeutic use
    Chemical Substances Antimalarials
    Language English
    Publishing date 2024-03-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0295049
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  3. Article ; Online: Measuring quality of facility-based ITN distribution in Ghana.

    Nuñez, Luigi / Skjefte, Malia / Asamoah, Obed E / Owusu, Prince / Malm, Keziah L / Miller, Jane E

    Malaria journal

    2023  Volume 22, Issue 1, Page(s) 222

    Abstract: Background: Continuous distribution channels are effective methods to deliver malaria interventions such as insecticide treated nets (ITNs) to pregnant women attending antenatal care clinics and children under five attending immunization visits. ... ...

    Abstract Background: Continuous distribution channels are effective methods to deliver malaria interventions such as insecticide treated nets (ITNs) to pregnant women attending antenatal care clinics and children under five attending immunization visits. Facility-based and provider-based checklists were used during supportive supervision visits to measure the quality of facility-based services and interventions. This study looks at ITN distributions at health facilities in Ghana, with the aim of providing insights on how quality can be measured and monitored.
    Methods: Various quality improvement approaches for malaria services occur in Ghana. Selected indicators were analysed to highlight the similarities and differences of how the approaches measured how well the channel was doing. Generally, the approaches assessed (1) service data management, (2) logistics data management, and (3) observation of service provision (ITN issuance, malaria education, ITN use and care education). Two approaches used a binary (Yes/No) scale, and one used a Likert scale.
    Results: Results showed that most data reported to the national HMIS is accurate. Logistics data management remained an issue at health facilities, as results showed scores below average across facility stores, antenatal care, and immunization. Though the supervision approaches differed, overall results indicated that almost all eligible clients received ITNs, data were recorded accurately and reported on-time, and logistics was the largest challenge to optimal distribution through health facilities.
    Conclusion: The supervision approaches provided valuable insights into the quality of facility-based ITN distribution. Ghana should continue to implement supportive supervision in their malaria agenda, with additional steps needed to improve reporting of collected data and increase the number of facilities visited for supportive supervision and the frequency. There were various supervision approaches used with no clear guidance on how to measure quality of facility-based ITN distribution, so there is also need for the global community to agree on standardized indicators and approaches to measuring quality of facility-based ITN distribution. Additionally, future studies can review the effect of multiple rounds of supervision visits on the quality of ITN distribution as well as understand the facilitators and barriers to scaling up supervision of facility-based ITN distribution.
    MeSH term(s) Child ; Humans ; Female ; Pregnancy ; Ghana ; Insecticide-Treated Bednets ; Malaria/prevention & control ; Pregnant Women ; Surveys and Questionnaires ; Insecticides
    Chemical Substances Insecticides
    Language English
    Publishing date 2023-08-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2091229-8
    ISSN 1475-2875 ; 1475-2875
    ISSN (online) 1475-2875
    ISSN 1475-2875
    DOI 10.1186/s12936-023-04626-y
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  4. Article ; Online: Successful implementation of ITN distribution through health facilities in Ghana.

    Nuñez, Luigi / Skjefte, Malia / Asamoah, Obed E / Owusu, Prince / Malm, Keziah / Miller, Jane E

    Malaria journal

    2023  Volume 22, Issue 1, Page(s) 224

    Abstract: Background: Global efforts to reduce malaria burden include distribution of insecticide-treated mosquito nets through mass campaigns and routine channels. Ghana's National Malaria Elimination Programme (NMEP) distributes insecticide-treated bed nets ( ... ...

    Abstract Background: Global efforts to reduce malaria burden include distribution of insecticide-treated mosquito nets through mass campaigns and routine channels. Ghana's National Malaria Elimination Programme (NMEP) distributes insecticide-treated bed nets (ITNs) through various channels, including to pregnant women at antenatal care (ANC) visits and children at vaccination visits through child welfare clinics (CWC). This study assessed historical ITN distribution throughout ANCs and CWCs across Ghana and the characteristics of high performing facilities.
    Methods: Monthly data on routine ITN distribution was provided from Ghana's national health information management system for the years 2016-2021. Analyses were conducted to assess the performance of ITN distribution at ANC and CWC across time, ecological zone, regions, districts, facility ownership, and facility type. Univariate and multivariate logistic regressions were performed to predict the odds of ANC and CWC issuing rates greater or equal to 80% for a given facility type or ownership.
    Results: In 2021, 93% of women who attended their first antenatal care visit and 92% of children under five who received their second dose of the measles-rubella vaccine (MR2) had received an ITN. At the regional level, 94% of regions (n = 15/16) maintained the NSP target issuing rate of 80% throughout 2020 and 2021. While there were no clear differences in issuing rates between ecological zones, district-level differences were present across the six years. All health facility types performed at or above 80% in 2021 for both ANC and CWC. Odds ratios demonstrated differences in the likelihood of meeting the 80% issuing rate goal among different facility types as well as private versus public ownership when comparing ANC and CWC.
    Conclusion: By 2021, Ghana had improved its ITN issuing rates since the initial year of analysis, surpassing the 80% target by issuing nets to over 90% of pregnant women and young children attending ANC and CWC. Future work can explore the reasons for national and subnational differences in issuing rates as well as help understand additional characteristics of high performing facilities. Additionally, it is necessary to identify and expand on the drivers for improved performance over the time period.
    MeSH term(s) Child ; Humans ; Female ; Pregnancy ; Child, Preschool ; Ghana ; Malaria/prevention & control ; Ownership ; Prenatal Care ; Insecticide-Treated Bednets ; Health Facilities ; Mosquito Control
    Language English
    Publishing date 2023-08-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2091229-8
    ISSN 1475-2875 ; 1475-2875
    ISSN (online) 1475-2875
    ISSN 1475-2875
    DOI 10.1186/s12936-023-04592-5
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  5. Article ; Online: The prioritization and development of key social and structural indicators to address gaps in a framework for monitoring the Strategies toward Ending Preventable Maternal Mortality (EPMM): Results of an iterative expert technical consultation.

    Jolivet, R Rima / Skjefte, Malia / Gausman, Jewel / Langer, Ana

    Journal of global health

    2021  Volume 11, Page(s) 4057

    Abstract: Background: Since 2014, iterative technical work has captured stakeholder demand and channeled it toward improving maternal health measurement, to support SDG 3.1. Strategies toward Ending Preventable Maternal Mortality (EPMM) (2015) turned a broad lens ...

    Abstract Background: Since 2014, iterative technical work has captured stakeholder demand and channeled it toward improving maternal health measurement, to support SDG 3.1. Strategies toward Ending Preventable Maternal Mortality (EPMM) (2015) turned a broad lens on upstream systemic determinants of maternal health and survival highlighted in 11 Key Themes. A monitoring framework was developed to help countries track progress across these domains. This process yielded requests for additional indicators where stakeholders identified gaps for tracking EPMM Key Themes. In response, two technical consultations aimed at affirming the measurement gaps, specifying the constructs for measurement, and fully elaborating the metadata to allow them to be monitored.
    Methods: Measures for development were prioritized based on multi-stakeholder dialogues in five countries, and data collected from government officials and UN partners in twenty countries on perceived need for proposed additional indicators. Sixty-one participants representing expertise in measure development and the topical areas covered took part across both consultations. Measures were developed through two simultaneous participatory online consultations stratified by focus area, comprising videos, discussion forums, polls, and live Zoom meetings.
    Results: Eight candidate indicators relevant to priority recommendations in the EPMM Strategies are presented. Each includes a definition, numerator and denominator (if applicable), method of estimation, disaggregation factors, preferred data source(s), and expected periodicity. Four address gaps in measures of fundamental rights-related determinants of maternal health at national and subnational level, including women's reproductive autonomy; participative accountability for maternal health outcomes; and Respectful Maternity Care. Four strengthen the ability to count, track, and link births and maternal deaths and causes of death.
    Conclusions: The proposed indicators correspond to specific EPMM Key Themes, filling gaps identified by multiple stakeholders, and respond to calls for a broadened approach to measurement and for indicators that track the social and health-systems determinants of maternal health. They reflect inputs and aspirations of numerous stakeholders, gathered over time and across various platforms. The iterative, discursive exploration of the concepts for measurement and the need for metrics to track them responds to recent calls for measure development to be carried out in more inclusive ways, and to be primarily concept- and user-driven.
    MeSH term(s) Female ; Humans ; Maternal Death ; Maternal Health ; Maternal Health Services ; Maternal Mortality ; Pregnancy ; Referral and Consultation
    Language English
    Publishing date 2021-10-09
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2741629-X
    ISSN 2047-2986 ; 2047-2986
    ISSN (online) 2047-2986
    ISSN 2047-2986
    DOI 10.7189/jogh.11.04057
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  6. Article ; Online: Practical diagnostic algorithms for Chagas disease: a focus on low resource settings.

    Gabaldón-Figueira, Juan Carlos / Skjefte, Malia / Longhi, Silvia / Escabia, Elisa / García, Lady Juliette / Ros-Lucas, Albert / Martínez-Peinado, Nieves / Muñoz-Calderón, Arturo / Gascón, Joaquim / Schijman, Alejandro Gabriel / Alonso-Padilla, Julio

    Expert review of anti-infective therapy

    2023  Volume 21, Issue 12, Page(s) 1287–1299

    Abstract: Introduction: Chagas disease, caused by parasite : Areas covered: This review outlines existing algorithms, and proposes new ones focused on point-of-care testing.: Expert opinion: Integrating point-of-care testing into existing diagnostic ... ...

    Abstract Introduction: Chagas disease, caused by parasite
    Areas covered: This review outlines existing algorithms, and proposes new ones focused on point-of-care testing.
    Expert opinion: Integrating point-of-care testing into existing diagnostic algorithms in certain endemic areas will increase access to timely diagnosis and treatment. However, additional research is needed to validate the use of these techniques across a wider geography, and to better understand the cost-effectiveness of their large-scale implementation.
    MeSH term(s) Humans ; Chagas Disease/diagnosis ; Chagas Disease/epidemiology ; Trypanosoma cruzi ; Point-of-Care Testing ; Rapid Diagnostic Tests ; Algorithms
    Language English
    Publishing date 2023-11-24
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2181279-2
    ISSN 1744-8336 ; 1478-7210
    ISSN (online) 1744-8336
    ISSN 1478-7210
    DOI 10.1080/14787210.2023.2279110
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  7. Article ; Online: COVID-19 vaccine acceptance among pregnant women and mothers of young children: results of a survey in 16 countries.

    Skjefte, Malia / Ngirbabul, Michelle / Akeju, Oluwasefunmi / Escudero, Daniel / Hernandez-Diaz, Sonia / Wyszynski, Diego F / Wu, Julia W

    European journal of epidemiology

    2021  Volume 36, Issue 2, Page(s) 197–211

    Abstract: With the development of multiple effective vaccines, reducing the global morbidity and mortality of COVID-19 will depend on the distribution and acceptance of COVID-19 vaccination. Estimates of global vaccine acceptance among pregnant women and mothers ... ...

    Abstract With the development of multiple effective vaccines, reducing the global morbidity and mortality of COVID-19 will depend on the distribution and acceptance of COVID-19 vaccination. Estimates of global vaccine acceptance among pregnant women and mothers of young children are yet unknown. An understanding of the challenges and correlates to vaccine acceptance will aid the acceleration of vaccine administration within these populations. Acceptance of COVID-19 vaccination among pregnant women and mothers of children younger than 18-years-old, as well as potential predictors, were assessed through an online survey, administered by Pregistry between October 28 and November 18, 2020. 17,871 total survey responses from 16 countries were obtained. Given a 90% COVID-19 vaccine efficacy, 52.0% of pregnant women (n = 2747/5282) and 73.4% of non-pregnant women (n = 9214/12,562) indicated an intention to receive the vaccine. 69.2% of women (n = 11,800/17,054), both pregnant and non-pregnant, indicated an intention to vaccinate their children. Vaccine acceptance was generally highest in India, the Philippines, and all sampled countries in Latin America; it was lowest in Russia, the United States and Australia. The strongest predictors of vaccine acceptance included confidence in vaccine safety or effectiveness, worrying about COVID-19, belief in the importance of vaccines to their own country, compliance to mask guidelines, trust of public health agencies/health science, as well as attitudes towards routine vaccines. COVID-19 vaccine acceptance and its predictors among women vary globally. Vaccination campaigns for women and children should be specific for each country in order to attain the largest impact.
    MeSH term(s) Adolescent ; Adult ; Aged ; COVID-19/prevention & control ; COVID-19 Vaccines/therapeutic use ; Child ; Child, Preschool ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Intention ; Internationality ; Middle Aged ; Mothers/psychology ; Mothers/statistics & numerical data ; Patient Acceptance of Health Care/psychology ; Patient Acceptance of Health Care/statistics & numerical data ; Pregnancy ; Pregnancy Complications, Infectious/prevention & control ; Pregnant Women/psychology ; SARS-CoV-2 ; Young Adult
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2021-03-01
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 632614-6
    ISSN 1573-7284 ; 0393-2990
    ISSN (online) 1573-7284
    ISSN 0393-2990
    DOI 10.1007/s10654-021-00728-6
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  8. Article ; Online: Five-year serological and clinical evolution of chronic Chagas disease patients in Cochabamba, Bolivia

    Jimy Pinto / Malia Skjefte / Julio Alonso-Padilla / Daniel Franz Lozano Beltran / Lilian Victoria Pinto / Aina Casellas / Mery Elena Arteaga Terrazas / Karen Alejandra Toledo Galindo / Roxana Challapa Quechover / María Escobar Caballero / Alejandra Perez Salinas / Mario Castellón Jimenez / Sergi Sanz / Joaquim Gascón / Faustino Torrico / María Jesús Pinazo

    PLoS Neglected Tropical Diseases, Vol 17, Iss

    2023  Volume 12

    Keywords Arctic medicine. Tropical medicine ; RC955-962 ; Public aspects of medicine ; RA1-1270
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
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  9. Article ; Online: Five-year serological and clinical evolution of chronic Chagas disease patients in Cochabamba, Bolivia.

    Pinto, Jimy / Skjefte, Malia / Alonso-Padilla, Julio / Lozano Beltran, Daniel Franz / Pinto, Lilian Victoria / Casellas, Aina / Arteaga Terrazas, Mery Elena / Toledo Galindo, Karen Alejandra / Challapa Quechover, Roxana / Escobar Caballero, María / Perez Salinas, Alejandra / Castellón Jimenez, Mario / Sanz, Sergi / Gascón, Joaquim / Torrico, Faustino / Pinazo, María Jesús

    PLoS neglected tropical diseases

    2023  Volume 17, Issue 12, Page(s) e0011498

    Abstract: Background: Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected infectious disease that exerts the highest public health burden in the Americas. There are two anti-parasitic drugs approved for its treatment-benznidazole and ... ...

    Abstract Background: Chagas disease, caused by the parasite Trypanosoma cruzi, is a neglected infectious disease that exerts the highest public health burden in the Americas. There are two anti-parasitic drugs approved for its treatment-benznidazole and nifurtimox-but the absence of biomarkers to early assess treatment efficacy hinders patients´ follow-up.
    Methodology/principal findings: We conducted a longitudinal, observational study among a cohort of 106 chronically T. cruzi-infected patients in Cochabamba (Bolivia) who completed the recommended treatment of benznidazole. Participants were followed-up for five years, in which we collected clinical and serological data, including yearly electrocardiograms and optical density readouts from two ELISAs (total and recombinant antigens). Descriptive and statistical analyses were performed to understand trends in data, as well as the relationship between clinical symptoms and serological evolution after treatment. Our results showed that both ELISAs documented average declines up to year three and slight inclines for the following two years. The recorded clinical parameters indicated that most patients did not have any significant changes to their cardiac or digestive symptoms after treatment, at least in the timeframe under investigation, while a small percentage demonstrated either a regression or progression in symptoms. Only one participant met the "cure criterion" of a negative serological readout for both ELISAs by the final year.
    Conclusions/significance: The study confirms that follow-up of benznidazole-treated T. cruzi-infected patients should be longer than five years to determine, with current tools, if they are cured. In terms of serological evolution, the single use of a total antigen ELISA might be a more reliable measure and suffice to address infection status, at least in the region of Bolivia where the study was done. Additional work is needed to develop a test-of-cure for an early assessment of drugs´ efficacy with the aim of improving case management protocols.
    MeSH term(s) Humans ; Bolivia ; Chagas Disease/parasitology ; Nitroimidazoles/therapeutic use ; Trypanosoma cruzi ; Trypanocidal Agents/therapeutic use ; Chronic Disease
    Chemical Substances benzonidazole (YC42NRJ1ZD) ; Nitroimidazoles ; Trypanocidal Agents
    Language English
    Publishing date 2023-12-29
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 2429704-5
    ISSN 1935-2735 ; 1935-2735
    ISSN (online) 1935-2735
    ISSN 1935-2735
    DOI 10.1371/journal.pntd.0011498
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