Following Guidelines for Drug-Resistant Tuberculosis: “Yes, it’s a challenge”

BACKGROUND: Drug-resistant tuberculosis (DR-TB) is a major contributor to antimicrobial resistance (AMR) globally and is projected to be responsible for up to a quarter of AMR-associated deaths in the future. Management of DR-TB is increasingly decentralised to primary healthcare settings, and simultaneously becoming more complex due to a growing range of treatment options (e.g. novel agents, shorter regimens). This is reflected in the numerous recent updates to international guidelines and as such understanding the barriers and enablers to how healthcare workers access and use guidelines is vital. MATERIAL AND METHODS: We used an established psychological framework – the theoretical domains framework (TDF) – to construct and analyse an online survey and focus groups to explore healthcare workers current use of DR-TB guidelines in South Africa. We aimed to identify barriers and enablers with which to direct future attempts at improving guideline use. RESULTS: There were 19 responses to the online survey and 14 participants in two focus groups. 28% used the most up-to-date national guidelines, 79% accessed guidelines primarily on electronic devices. The TDF domains of ‘Social Influences’ (mean Likert score = 4.3) and ‘Beliefs about Consequences’ (4.2) were key enablers, with healthcare workers encouraged to use guidelines and also recognising the value in doing so. ‘Environmental Resources’ (3.7) and ‘Knowledge’ (3.3) were key barriers with limited, or variable access to guidelines and lack of confidence using them being notable issues. This was most noted for certain subgroups: children, HIV co-infected, pregnant women (2.7). DISCUSSION: Current use of DR-TB guidelines in South Africa is suboptimal. Planned interventions should focus on overcoming the identified key barriers and might include an increased use of digital tools

MEWAR: Development of a Cross-Platform Mobile Application and Web Dashboard System for Real-Time Mosquito Surveillance in Northeast Brazil

Mosquito surveillance is a crucial process for understanding the population dynamics of mosquitoes, as well as implementing interventional programs for controlling and preventing the spread of mosquito-borne diseases. Environmental surveillance agents who performing routine entomological surveys at properties in areas where mosquito-borne diseases are endemic play a critical role in vector surveillance by searching and destroying mosquito hotspots as well as collate information on locations with increased infestation. Currently, the process of recording information on paper-based forms is time-consuming and painstaking due to manual effort. The introduction of mobile surveillance applications will therefore improve the process of data collection, timely reporting, and field worker performance. Digital-based surveillance is critical in reporting real-time data; indeed, the real-time capture of data with phones could be used for predictive analytical models to predict mosquito population dynamics, enabling early warning detection of hotspots and thus alerting fieldworker agents into immediate action. This paper describes the development of a cross-platform digital system for improving mosquito surveillance in Brazil. It comprises of two components: a dashboard for managers and a mobile application for health agents. The former enables managers to assign properties to health workers who then survey them for mosquitoes and to monitor the progress of inspection visits in real-time. The latter, which is primarily designed as a data collection tool, enables the environmental surveillance agents to act on their assigned tasks of recording the details of the properties at inspections by filling out digital forms built into the mobile application, as well as details relating to mosquito infestation. The system presented in this paper was co-developed with significant input with environmental agents in two Brazilian cities where it is currently being piloted

GADSA: Decision Support App for Antibiotics Prescribing in Nigeria

GADSA (Gamified Antimicrobial Stewardship Decision Support App) is a decision support tool to improve evidence-based prescribing, designed to be used at the point-of-care to help clinicians comply with guidelines in their everyday practice. The app represents a novel cross-platform, mobile decision support tool, integrating principles from serious games and gamification, to improve compliance with prescription guidelines of Surgical Antibiotic Prophylaxis (SAP) in Nigeria. This paper focuses on the decision support component of the mobile application, integrating the World Health Organisation and Sanford guidelines for SAP prescriptions

Assessing the Relationship between various Climatic Risk Factors & Mosquito Abundance in Recife, Brazil

Recife is one of many regions in the North Eastern section of Brazil to be hit hard by the Zika virus outbreak in 2015. Zika infection is caused by the arboviruses transmitted by the Aedes mosquitoes which are abundant in Brazil. It is a known fact that increased abundance of the Aedes mosquito is typically associated with standing (or stagnant) water which serves as a reservoir or hotspot for breeding. Apart from the presence of standing (or stagnated) water in human dwellings, it is important to consider other intermediate factors that drive the mosquitoes to increase in population size. We consider the example of a set of climate conditions such as land surface temperature, humidity, precipitation, seasonality etc. These are typical risk factors that must be taken into consideration especially for the spatial and early warning prediction of breeding hotspots for the Aedes mosquito species responsible for transmitting Zika viruses in Brazil. In this work-in-progress study, we bring together historical records from a mosquito surveillance and control programme conducted by the Centre for Environmental Surveillance Agency in Recife and open source climate information. We use a population-based ecological study design to explore the regional-level spatial-temporal relationship between the prevalence of households detected to have increased mosquito larvae density and environmental risk factors such as temperature and precipitation

ZIKA Virus: Prediction of Aedes Mosquito Larvae Occurrence in Recife (Brazil) using Online Extreme Learning Machine and Neural Networks

Geographical maps showing the abundance of the Aedes species (\textitA. Aegypti andA. Albopictus ) in Latin America plays a crucial role in the fight against the Zika Virus (ZIKV). They aid in the identification of sites that promotes mosquito breeding and transmission of ZIKV. In the case of Brazil, one of the greatest factors that favours rapid mosquito reproduction is the presence of stagnated water in the environment. This could be in the form of non-flowing water filled in tanks, barrels, discarded tires, and many other containers situated in human dwellings. After the ZIKV outbreak from 2015, the environmental agency in Brazil have intensively been engaged with routine surveillance of water bodies present in households and the environment to destroy mosquito breeding hotspots as public health measure to prevent vector-to-human transmission of ZIKV. The objective of this study is to use data from their routine surveillance to showcase how our predictive framework based on Neural Networks and Online Extreme Learning Machine (OELM) can predict for Recife (Brazil) at a health district-level the following: firstly, the spatial distribution of the number of properties with water containers contaminated with the Aedes mosquito larvae responsible for ZIKV; and secondly, the spatial distribution of properties with the Aedes mosquito larvae stratified by type of water container. The ultimate goal for this research is to subsequently implement these models to their real-time surveillance data so as an early warning system is present to flag-out spatially the mosquito hotspots on the fly. This system will be built to guide policy makers for directing resources for controlling the mosquito populations thereby limiting transmission to humans