Manyeh Alfred Kwesi, Chirwa Tobias, Ramaswamy Rohit, Baiden Frank, Ibisomi Latifat
Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa.
Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
Trop Med Health. 2021 Feb 18;49(1):16. doi: 10.1186/s41182-021-00305-3.
Over a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 11 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment to improve the lymphatic filariasis mass drug administration towards eliminating the disease. Therefore, this study aimed to evaluate the process and impact of the lymphatic filariasis context-specific evidence-based quality improvement intervention in the Bole District of Northern Ghana.
A cross-sectional mixed methods study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the context-specific evidence-based quality improvement intervention was employed. Quantitative secondary data was extracted from the neglected tropical diseases database. A community survey was conducted with 446 randomly selected participants. Qualitative data were collected from 42 purposively selected health workers, chiefs/opinion leaders and community drug distributors in the study area.
The evaluation findings showed an improvement in social mobilisation and sensitisation, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication and adherence to the direct observation treatment strategy. We observed an increase in coverage ranging from 0.1 to 12.3% after implementing the intervention at the sub-district level and reducing self-reported adverse drug reaction. The level of reach, effectiveness and adoption at the district, sub-district and individual participants' level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in lymphatic filariasis hotspot districts based on initial context-specific needs assessment.
The study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve lymphatic filariasis mass drug administration towards eliminating the disease as a public health problem.
在加纳通过大规模药物管理实施全球消除淋巴丝虫病战略的十多年里，在2000年确定的最初98个流行区中，仍有11个区存在该疾病的传播。在进行初步需求评估后，在加纳北部的博莱区实施了一项针对具体情况的循证质量改进干预措施，以改善淋巴丝虫病大规模药物管理，从而消除该疾病。因此，本研究旨在评估在加纳北部博莱区实施的针对淋巴丝虫病具体情况的循证质量改进干预措施的过程和影响。
采用横断面混合方法研究，使用RE-AIM（覆盖范围、有效性、采用情况、实施情况和维持情况）框架来评估针对具体情况的循证质量改进干预措施。从被忽视热带病数据库中提取定量二级数据。对446名随机选择的参与者进行了社区调查。从研究区域内42名有目的地选择的卫生工作者、酋长/意见领袖和社区药物分发者那里收集了定性数据。
评估结果显示，在社会动员和宣传、对淋巴丝虫病和大规模药物管理过程的了解、服药意愿以及对直接观察治疗策略的依从性方面都有所改善。在分区层面实施干预措施后，我们观察到覆盖率提高了0.1%至12.3%，同时自我报告的药物不良反应有所减少。在区、分区和个体参与者层面的覆盖范围、有效性和采用情况表明，基于最初针对具体情况的需求评估，针对具体情况的循证质量改进干预措施在淋巴丝虫病热点地区实施是可行的。
该研究为未来应用RE-AIM框架评估针对具体情况的循证质量改进干预措施（以改善淋巴丝虫病大规模药物管理，从而消除作为公共卫生问题的该疾病）奠定了基础。
