A qualitative review of implementer perceptions of the national community-level malaria surveillance system in Southern Province, Zambia

BACKGROUND: Parts of Zambia with very low malaria parasite prevalence and high coverage of vector control interventions are targeted for malaria elimination through a series of interventions including reactive case detection (RCD) at community level. When a symptomatic individual presenting to a community health worker (CHW) or government clinic is diagnostically confirmed as an incident malaria case an RCD response is initiated. This consists of a CHW screening the community around the incident case with rapid diagnostic tests (RDT) and treating positive cases with artemether-lumefantrine (AL, Coartem™) in accordance with national policy. Since its inception in 2011, Zambia’s RCD programme has relied on anecdotal feedback from staff to identify issues and possible solutions. In 2014, a systematic qualitative programme review was conducted to determine perceptions around malaria rates, incentives, operational challenges and solutions according to CHWs, their supervisors and district-level managers. METHODS: A criterion-based sampling framework based on training regime and performance level was used to select nine rural health posts in four districts of Southern Province. Twenty-two staff interviews were completed to produce English or bilingual (CiTonga or Silozi + English) verbatim transcripts, which were then analysed using thematic framework analysis. RESULTS: CHWs, their supervisors and district-level managers strongly credited the system with improving access to malaria services and significantly reducing the number of cases in their area. The main implementation barriers included access (e.g., lack of rain gear, broken bicycles), insufficient number of CHWs for programme coverage, communication (e.g. difficulties maintaining cell phones and “talk time” to transmit data by phone), and inconsistent supply chain (e.g., inadequate numbers of RDT kits and anti-malarial drugs to test and treat uncomplicated cases). CONCLUSIONS: This review highlights the importance of a community surveillance system like RCD in shaping Zambia’s malaria elimination campaign by identifying community-based infections that might otherwise remain undetected. At this stage the system must ensure it can meet growing public demand by providing CHWs the tools and materials they need to consistently carry out their work and expand programme reach to more isolated communities. Results from this review will be used to plan programme scale-up into other parts of Zambia

Economic analysis of agricultural enterprises in Turkey according to their level of success Análise econômica de empresas agrícolas na Turquia de acordo com seu nível de sucesso

In this study, agricultural enterprises in Turhal, Tokat were grouped based on their degree of success, their structural characteristics have been identified and their outcomes of activities discussed. The objective of the study was to determine the aspects that render successful agricultural enterprises different from other agricultural enterprises. The point to be achieved through the study is to assist agricultural enterprises with a more effective utilization of existing means in order to help them to develop. Data has been collected from 71 agricultural enterprises, which have been determined by Neyman's Method that is a stratified sampling method, via questionnaires. The Criterion of Agricultural Income Per Enterprise Land Decar has been applied for the classification of the enterprises according to their level of success. When the agricultural income was sufficiently examined in the enterprises, moderate successful and unsuccessful enterprises cannot obtain agricultural income to meet family labor force cost. Their agricultural level is quite below the sum of the family labour wage equivalent and the real interest of the equivalent capital. Therefore, the agricultural income of the examined enterprises is considered insufficient. The rate of the net product to the active capital is 3.45% in successful enterprises, 0.57% in those with moderate success, and for the unsuccessful ones, it has a negative value of -2.22%. This ratio for successful enterprises is close to 5%. Accordingly, the successful enterprises work more efficiently in comparison to the other enterprise groups.<br>Neste estudo, empresas agrícolas de Turhal, Tokat foram agrupadas com base em seu grau de sucesso, suas características foram identificadas e seus resultados de atividades discutidos. O objetivo do estudo é determinar os aspectos que diferenciam empresas agrícolas de sucesso das demais. O ponto a ser alcançado pelo estudo é assistir as empresas agrícolas com um uso mais efetivo. O ponto a ser alcançado pelo estudo é assistir as empresas agrícolas com um uso mais efetivo dos meios existentes, para ajudar a desenvolvê-las. Foram utilizados dados de 71 empresas selecionadas pelo método estratificado de Neyman, através de questionários. O "Criterion of Agricultural Income Per Interprise Land Decar" foi aplicado para a classificação em relação ao nível de sucesso. Quando a renda agrícola foi suficientemente examinada, as empresas de sucesso moderado e as sem sucesso não podem obter renda agrícola suficiente para atender ao custo do trabalho familiar. Seu nível agrícola está muito abaixo da soma dos salários familiares e do juro real do capital equivalente. Por isso, a renda agrícola das empresas examinadas é considerada insuficiente. A relação entre o produto líquido e o capital ativo é 3,45% nas empresas de sucesso, 0,57% nas de moderado sucesso e -2,22% nas sem sucesso. Nesta relação, o limite do juro normal é de 5% para empresas de sucesso. Assim, empresas de sucesso trabalham mais eficientemente em comparação a outros grupos empresarias