Background: Community volunteers (CVs) are uniquely positioned to contribute to vaccine preventable diseases surveillance, but are often not engaged for this purpose. With increased community awareness, CVs can strengthen the detection and reporting for Acute Flaccid Paralysis (AFP) and other vaccine preventable diseases. CORE Group Partner Project (CGPP) community volunteers were trained and closely followed up to conduct surveillance for AFP/Measles/NNT cases by moving house to house in there vicinity.

Objective: To evaluate the community base surveillance program, through assessing CVs contribution in AFP case detection and reporting in pastoralist and hard-to-reach CORE Group implementation areas of Ethiopia.

Methodology: Acute Flaccid Paralysis (AFP) surveillance data from World Health Organization (WHO) Ethiopia office and CORE Group reports of January to December 2021 was compared to evaluate the CVs contribution, in early AFP case detection and reporting. Furthermore, reported AFP cases were compared by source (CVs reported versus health facilities identified cases) in CGPP-Ethiopia implementation areas.

Findings: During 2021, community volunteers reported 26 (20.5 %) AFP cases out of the total cases reported from the project areas. The average (days) time from onset of illness to detection by CVs were 4.8 days compared to 6.4 days for health facilities identified cases. The average time (days) between onset of illness and second stool collection were 7.8 days for CVs reported cases, compared to 9.7 days for HF identified cases.

Conclusion and Recommendations: When trained, sensitized and closely followed-up, CVs can effectively contribute to the timeliness of the surveillance system. They were able to report cases earlier when compared to HFs identified cases. Community Based Surveillance program can fill the gap in Health Facility Based Surveillance program. Projects should incorporate CVs into surveillance system and identify ways to motivate them to continue this work.

Background: In the developing world, lack of adequate resources and robust healthcare infrastructure makes collecting field level information difficult. Cost, logistics, and access to remote sites often result in inaccurate data. Without this information, it is difficult for programs to make informed decisions.

Objective: To evaluate the contribution of mHealth for real-time information and evidence-based decision making in pastoralist and hard-to-reach CORE Group Partners Project(CGPP) implementation areas in Ethiopia.

Methods: A cross-sectional retrospective study using secondary data was conducted in 80 CGPP implementation Districts. Project surveillance and WHO AFP data from 2017 to 2021 was used to compare cases reported by community volunteers(CVs) with health facility data. Additionally, project data and reports from 2019 to 2021 were used to evaluate the added value of mobile technology in supervision visits and mapping. Quantitative data was analyzed using SPSS Version 26.0.

Results: During the five year period, 616 AFP cases were reported, of which 156 (26%) reported by CVs. Cases reported through the CVs using web based phone reporting were, on average, reported 1.25 days quicker than those reported through health facilities. The average time from notification-to-investigation were faster by 0.16 days for cases reported through the digital-system. From onset-of-symptoms to stool sample collection were also faster.

CGPP’s use of digital tools for different program functions show their ability to improve real-time data use. CGPP’s mobile phone-based checklist for facility supervision allowed for easier data collection and follow-up, greater transparency, reduced errors, and real-time data availability. GIS-supported digital checklist to map 112 formal and informal border crossing points was critical to the establishment of 13 crossing point vaccination sites. Mobile data collection during evaluation activities improved data quality avoiding data entry errors and improving data completeness by designing mandatory fields and logic-checks, and allowing for daily review and feedback.

Conclusion: Data access in remote and pastoralist communities presents a challenge. Digitized tools used for mapping, supervision, and evaluation contributed to better data access, quality, use for decision making, in all of the applications presented. Projects should continue to seek opportunities to implement digital data collection solutions, particularly in remote and hard-to-reach areas.

The prevalence of non-communicable diseases, particularly hypertension, is increasing globally and disproportionately impacts those living in low- and middle-income countries (LMICs). One population that is particularly at risk are displaced persons living in LMICs. To improve the health outcomes of this population, the effective implementation of evidence-based interventions (EBIs) is needed. A systematic review was undertaken to summarize the evaluation of implementation and effectiveness outcomes, and to report on the use of implementation science in hypertension treatment and management among displaced persons living in LMICs. Studies included those that reported EBIs for managing hypertension within LMICs, reported implementation research outcomes, and were published in English. Overall, 10 articles were included in this systematic review. Three overarching themes emerged: the utilization of and adherence to hypertension medication, the use of technology to support the management of hypertension, and health education related to help-seeking behaviors. Common barriers that were reported were perception of the quality of care provided, adherence to hypertension medication, availability of medication, and comorbidities. A need for additional studies focusing specifically on implementation outcomes of EBIs for hypertension is clearly demonstrated as it is critically important to implement effective strategies to treat and manage hypertension among displaced persons. This is particularly important as the number of displaced persons around the world is projected to increase over the next several years as a result of humanitarian crises, conflict, and mass migration due to the effects of climate change.

Context: Amidst recovery from the impact of the COVID-19 pandemic, the monkeypox outbreak has signaled continued threats to global health security. This study examined user generated content from Twitter to understand public perceptions about the monkeypox outbreak and to compare contents of the discourse based on themes and sentiments using computational text analysis.

Method: We retrieved English-language tweets posted between 22 May to 27 June, 2022 to perform lexicon-based sentiment analysis to identify sentiment polarity and the emotions expressed in Twitter discourse related to the monkeypox outbreak while structural topic modeling was used to identify and examine latent themes.

Result: We analyzed 214,706 tweets posted by 111,325 users. More than half (51.2%) of the tweets expressed negative sentiments. The mean sentiment score was -0.36 (SD, 1.02). Fear was the most common in the monkeypox discourse (21.1%), followed by trust and anticipation. There were 23 emerging themes identified in monkeypox related discourses. The most widely discussed topic was related to “monkeypox and gay men” (7.70%), followed by “media scare” (7.69%), “global health emergency” (6.69%), outbreak in non-endemic countries” (6.15%), and “mask mandate” (5.40%).

Conclusion and Discussion: Public health agencies can leverage evidence generated from social media data to guide policies and programs to mitigate further spread of disease outbreaks.

Background: Project Concern International (PCI) supported the Government run COVID-19 vaccination drive in 5 districts in Uttar Pradesh under its USAID funded CORE Group Partners Project (CGPP). The paper examines the extent, nature, and type of rumors that inflicted the pace of COVID-19 vaccination drive and how CGPP tackled the menace.

Methodology: All the Community Mobilizers (CMs) were asked to report the rumors every week. The collection of rumors was analyzed at the district level and a consolidated report was generated to devise strategies to progressively counter them. In the process, CGPP has accumulated one of the largest reservoirs of rumors that emanated from the field. A content analysis of rumors was performed.

Results: Tracking of rumors over six months from 250 rural and urban sites suggest that nearly 80% of the rumors were reported from over 90% sites. Only 10% were unique to certain sites. Rumor gripped both rural and urban sites, but the former experienced more variety. Over time, the rumors changed shape. For example, the fear of death and developing diseases in the beginning were replaced with doubts on the action efficacy. The basket of rumors included some positive stories such as vaccination cures blindness, but it was short lived and less pervasive. Social media, friends and acquaintances remained the primary source. While hesitancy stemmed from the rumors, it declined fast as more and more people received the vaccine. Frequent updates on the scientific knowledge about the eligibility criteria, the interval between doses and side effects also gave rise to rumors. CGPP countered the ever-growing myths and misconceptions with improved risks communications and the involvement of local influencers and Community Action Groups (CAG) formed specifically to support the CMs and the government vaccination drive.

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Conclusion and recommendations: Hyperlocal solutions were more useful for site specific rumors. The trust between the program and its recipients was critical to counter the rumors. The use of a community cadre with years of rapport with the community helped CGPP gain trust. CGPP used simple contextually relevant examples to explain scientific messages in lay terms. It resonated well amidst information glut.

Objectives: Hemoglobinopathies refer to genetic disorders involving abnormal production or structure of hemoglobin molecules, most commonly thalassemias and sickle cell. Approximately 7% of the world’s population are carriers; though, it is unclear how many countries established registries to track prevalence of hemoglobinopathies. We conducted a systematic review to document the availability and characteristics of hemoglobinopathies registries and surveillance systems in 204 countries.

Methods: We systematically searched PubMed, EMBASE, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), Scientific Electronic Library Online (SCIELO), Global Index Medicus (GIM), and PsycINFO for published peer-reviewed studies that collected or summarized data from hemoglobinopathies registries, defined as a collection of information or databases organized by institutions. No language or geographic location restrictions were placed. Governmental websites were systematically searched, and web-based search engines were used to investigate registry presence by country.

Results: Of the 301 studies identified based on titles and abstracts, 208 were reviewed in full-text. 41 studies were found to have relevant data. Publication years ranged from 1987–2023 and the findings were mostly from Spain, Italy, USA, and Greece. Most studies (39/41) were published between 2000-2023. Only one was published in 1987 (Sicily, Italy) and one in 1990 (Singapore). Combining with results of targeted searches, we identified 49% of countries having some manner of hemoglobinopathies registry. Despite 49% global coverage, no country has publicly accessible hemoglobinopathies registries data; data quality is unknown. Countries in Asia (66%; 29/44) and Europe (50%; 25/50) have the highest coverage, whereas countries in Africa (44%; 24/54) and Oceania (13%; 2/15) have the lowest. Hemoglobinopathies registries in Asia are concentrated in high-resource countries (e.g., Saudi Arabia, Japan), with notable gaps in the Middle East, where hemoglobinopathies are historically endemic. Despite also being historically endemic regions, most low-resource countries in Africa do not have hemoglobinopathies registries. Countries in Southern Europe (e.g., Italy, Greece) established newborn screening and population-based registries for hemoglobinopathies in the 1980s.

Conclusion: We observed notable gaps in the surveillance of hemoglobinopathies. To promote global health equity, efforts are needed to quantify the burden of disease of hemoglobinopathies, and to further understand the associated morbidity and mortality.

Background: Healthcare delivery faces a myriad of challenges globally with well-documented health inequities between rural and urban populations. Yet, researchers and policy makers have limited understanding of what factors contribute to these inequities.

Methods: We analyzed the 2020 Commonwealth Fund International Health Policy (IHP) Survey—a nationally representative self-reported survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States (US). We compared the association of area type (rural or urban) with ten health indicators across three domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individual’s age and sex.

Results: The mean number of geographic health disparities in the 11 countries was 1.9, although there was a wide variation among the 11 nations. The US had statistically significant geographic health disparities in five of the ten indicators, the most of any country. Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. In the US, living in a rural area was associated with having lower odds of having mental health conditions [OR=.89], experiencing material hardship [OR=.87] and higher odds of difficulty accessing after hours care [OR=1.29], having an avoidable emergency department visit in the past two years [OR=2.15], and having a regular provider or place of care [OR= 1.32].

Conclusions: This study has identified geographic health disparities across ten indicators in 11 developed nations. Public health policy makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity.

Context: In 2021, CDC launched an agency-wide health equity (HE) Strategy. In a unique collaboration, CDC’s Global Health Center (GHC) partnered with HHS’s Equity Training Assistance Center (ETAC) and CDC Vietnam to pilot the first training on the Strategy to an overseas CDC office, with the goals of establishing a shared understanding of HE and learning how to embed HE in CDC Vietnam’s work.

Methods: In February 2022, we conducted a needs assessment among CDC Vietnam staff, which informed training goals. Key Vietnamese and American CDC Vietnam staff worked alongside ETAC and the GHC in an iterative fashion to contextualize domestic U.S. HE training for Vietnam. ETAC trainers conducted the virtual training over two consecutive mornings in September 2022 for all CDC Vietnam staff. We offered pre- and post- surveys at the training to all participants, as well as online assessments one and five months afterward.

Results: Proportion endorsing at least moderate familiarity with HE concepts increased from 29% (17/58) in the pre-survey to 86% (48/56) in the post-survey. After one month, 89% (33/37) agreed that the training helped them understand how to advance HE through their work, and 62% (23/37) agreed that they had adequate training to integrate HE into their work. The most commonly endorsed ideas for the continued advancement of HE into staff’s work included sharing best practices from other places (84%, 31/37) and more training on policies/systems (84%, 31/37). After five months, 81% (21/26) stated they had taken action to advance HE, including reading more about topics covered in the training (67%, 14/21) and applying HE strategies from the training to their job (43%, 9/21).

Conclusion: Close engagement with Vietnamese staff was critical to contextualizing CDC’s HE Strategy for overseas offices. Training resulted in more familiarity with HE and actions taken to advance HE. CDC Vietnam subsequently created a Taskforce to develop a HE roadmap, including opportunities for further trainings on policies/systems and experience sharing. Based on this pilot, GHC, ETAC, and CDC Vietnam are developing a “train the trainer” strategy for ongoing, sustainable HE capacity building for other overseas CDC offices around the globe.

Widespread vaccination acceptance is essential to prevent and end pandemics. However, sub-optimal vaccination coverage poses a widespread threat to global health. Therefore, it is critical to identify community driven strategies to increase vaccine acceptance. In Ghana, just 36% of the eligible population is vaccinated against COVID-19. In response to stagnating vaccination rates and limited knowledge of the drivers of low vaccine acceptance, JSI and the Ghana Health Service tested the integration of human-centered design (HCD) into the COVID-19 microplanning process in an urban district of Accra. We engaged health workers and community members in an HCD-integrated microplanning workshop aimed to strengthen health teams’ capacity to use behavioral insights for immunization programming, with a focus on COVID-19 vaccination.

As part of a process to improve program implementation for COVID-19 vaccination, we utilized pre- and post-workshop questionnaires and interviews and conducted a rapid synthesis to examine health worker and community member perspectives on the facilitators, barriers, value, and effects of HCD-incorporated microplanning. We also conducted follow-up interviews with health workers after implementation of co-designed solutions identified in the workshops.

Participants considered HCD-incorporated microplanning valuable as a method of increasing community engagement, which is not typically part of the process. Community members and health workers considered community involvement valuable because it offers an opportunity to identify and better understand context-specific challenges to vaccination and solutions to overcome them, increases community ownership and commitment to vaccination, and increases understanding of vaccine service delivery. In follow-up interviews, health workers indicated that the community engagement resulted in plans that were more effective and higher-quality, with all interviewees reporting that they believe COVID-19 vaccination increased in their catchment areas.

The HCD-incorporated microplanning process helped facilities engage with community members, providing an opportunity to involve community members in planning and delivery of other health services. In fact, health workers and community members recommended incorporating HCD into microplanning for routine immunization, family planning, mass drug administration, and long-lasting insecticide bed net distribution. Lessons from integrating HCD into the COVID-19 microplanning process can inform design and provision of routine immunization and other primary health services.

Context: Childhood obesity is a growing concern in México. The Mexican government has implemented strategies such as a special tax on high-calorie products and new warning food labeling to combat this epidemic. FAO and WHO promote food-based dietary guidelines (FBDGs) to send a visual message where whoever observes the image can understand its objectives. The Mexican Official Regulations recommend using “El Plato del Bien Comer” (The Plate of Good Eating) (EPBC) image as a graphic tool to promote healthy eating. To analyze the comprehension of the EPBC graphic design and its visual message, a questionnaire was designed and validated.

Methods: A descriptive cross-sectional study was conducted in a border city in northern Mexico with sixth graders during 2022-2023 using cluster probability sampling. The sample was calculated with a 95% confidence level and CI ±4. A questionnaire designed and adapted from the FAO questionnaire for knowledge, attitudes and practices on FBDGs was used, it was subjected to expert review, pilot testing and internal consistency analysis. The dimensions considered were: a) identification of the EPBC illustration, b) classification of foods by group, and c) understanding the EPBC graphic design.

Results: 483 children aged 11 years were surveyed. 49% were male and 51% female; 76.4% belonged to the urban area and 23.6% to the rural area. 83% identified the image; a similar percentage showed ability to classify the foods by groups; in the image 69% were unable to identify the food groups, 30% were confused about the colors by food group (green, yellow, and red) and 83% did not know the meaning of the legend “combine” included in the design.

Conclusion and discussion: The design of the EPBC appears to be confusing with respect to its classification based on food groups, color schemes, depictions of food items, and accompanying descriptors, thereby potentially compromising its comprehensibility. The results of this research will serve as scientific evidence to suggest improvements to the Mexican national recommendations for the use of this tool. In the next phase of this project, a redesign of the image will be proposed, with its respective pretest for assessing comprehensibility.