Health Services, Ministry of Health, Congo Town Back Road, Monrovia, Liberia
International Public Health, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UK.
BMJ Glob Health. 2024 Jan 18;9(1):e012599. doi: 10.1136/bmjgh-2023-012599.
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.
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.
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.
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.
世界卫生组织（WHO）的被忽视热带病（NTD）路线图强调了将需要病例管理（CM）的 NTD 纳入卫生系统的重要性。利比里亚的 NTD 规划是首批实施综合方法并评估其影响的规划之一。
对实施综合方法的五个 NTD-CM 流行县中的三个县与未实施综合方法的 NTD-CM 对照县进行了回顾性研究。我们比较了综合与非综合 NTD 县集群的趋势。我们使用干预年份收集的数据与对照县的基线数据进行了 WHO 高级别结果的前后比较。确定了健康结果的变化、不同疾病的效应大小以及具有统计学意义差异的比率比。补充的定性研究通过框架方法探讨了 CM-NTD 利益相关者的看法，框架方法是一种透明的、多阶段的定性主题跨学科数据分析方法。
与对照集群相比，干预集群中所有疾病的检出率均显著提高。除麻风病外，检出率均有所提高，且对个别疾病的影响较大，增加了四倍以上，具有统计学意义（p<0.000；95%CI 3.5 至 5.4）。与非综合县相比，综合县的 CM-NTD 服务提供点增加了 71 个。定性结果突出了培训和监督作为支撑病例检出率增加的投入，但复训、药品供应和激励措施方面的挑战对质量、公平性和可及性产生负面影响。
整合 CM-NTD 可提高病例检出率、CM-NTD 服务的可及性和可利用性，促进全民健康覆盖。早期病例检出和护理质量需要进一步加强。
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