Evaluation Research and the Psychiatric Hospital: Blending Management and Inquiry in Clinical Sociology

This paper discusses the multiple roles sociologists play in conducting evaluation research in a large state psychiatric hospital. The key to understanding this form of clinical sociology is its blending of management and inquiry in a unique organizational context. The authors, sociologists who have both served as directors of the Buffalo Psychiatric Center\u27s program evaluation unit since its founding in 1979, present examples of the unit\u27s work, discussing the role sociologists play in the collection, analysis and reporting of data used by hospital administrators for strategic planning, continuous quality improvement programs, and the monitoring of patterns and trends for census management, workload and staffing projections. The conduct of program evaluation and applied research in mental health care has been influenced by public policy, budgetary constraints, changes in national standards used in accrediting psychiatric hospitals, and the introduction of personal computers into the workplace. Several suggestions for improving the training of sociologists interested in this form of clinical practice are offered

Applications of GIS and Spatial Statistics for Malaria Research in Rural Zambia: Evaluation of Risk Factors and Risk Mapping in Nchelenge District and Elimination Strategies in Macha

Objective: The goals of this dissertation project were to understand malaria transmission dynamics in two different settings in Zambia. The specific aims in Nchelenge District, an uncontrolled transmission setting, were to describe the individual-, household- and environmental-level risk factors for malaria (Paper 1); and to generate and validate seasonal malaria risk maps (Paper 2). The specific aims in Macha District, a low transmission setting, were to describe factors associated with sustained bednet use (Paper 3), and determine the efficiency of reactive case detection and focal drug administration in treating infections missed by passive surveillance (Paper 4). Methods: Both sites are part of the International Center for Excellence in Malaria Research (ICEMR) for southern Africa. Satellite images are used to generate sampling frames, and households randomly selected for enrollment. Questionnaires, blood samples, mosquitoes and GPS coordinates are collected. Multilevel models with random effects were built for the odds of RDT positivity in Nchelenge District (Paper 1). Logistic regression and prediction models were used to create seasonal malaria risk maps and validated using RMSE in Nchelenge District (Paper 2). A multi-level longitudinal model with random intercepts was generated to determine factors associated with bednet use in Macha District (Paper 3). A simulation model was constructed to predict the distribution of RDT and PCR cases of malaria, to determine the efficiency of reactive case detection and focal drug administration in Macha District (Paper 4). Results: Age, report of symptoms, and proximity to certain ecological features increased risk of malaria infection, and varied by season (Paper 1). Risk maps accurately predicted household malaria risk; prediction was best in the rainy season and for smaller households (<4 members) (Paper 2). Several factors including presence of nuisance mosquitoes and distance to healthcare facilities affected reported bednet use (Paper 3). Reactive case detection identified and treated RDT positive cases that cluster around index households; focal drug administration would treat PCR positive RDT negative cases missed otherwise (Paper 4). Conclusions: In high transmission settings, spatial targeting of high-risk areas and populations is necessary to reduce malaria transmission; risk maps and school-based interventions may be suggested. In a low transmission setting, sustained use of personal protective measures and implementation of active case detection strategies to treat every remaining case is necessary for elimination

Building resilience in communities most vulnerable to environmental stressors

Evidence suggests that the frequency and intensity of environmental hazards such as floods, cyclones, and droughts may be increasing, leading to high volatility in many parts of the world. The impact of these events falls unequally on the most vulnerable individuals, households, and communities. To fully understand and address the needs of vulnerable communities, the Population Council is building on its existing research, deep global research expertise, and proven approaches in reaching and working with vulnerable populations to examine how humans interact with their environments and explore how to test and develop successful strategies for building resilience. This report presents an overview of the areas where the Council can leverage research to develop, test, and scale up evidence-based programs and interventions to strengthen resilience in the communities where we work

Corneal ulceration and episcleritis associated with Wiskott–Aldrich syndrome

AbstractPurposeTo present anterior segment ophthalmic manifestations of Wiskott–Aldrich syndrome (WAS), a rare X-linked primary immune-deficiency.ObservationsA 15-year old male with WAS presented with multiple corneal ulcers of the left eye. Once resolved, this was followed by separate episodes of episcleritis in the left eye and corneal infiltrates of the right eye. Successful treatment included topical antibiotics and anti-inflammatories.ConclusionsOcular manifestations of WAS, due to secondary infection and inflammation, may be severe. This case report emphasizes the importance of prompt ophthalmic evaluation and treatment of these patients

Evidence to inform an integrated social and behavior change strategy in the Sahel

Breakthrough RESEARCH completed this literature review, which summarized the evidence, or lack thereof, in the Sahel, to establish a rationale for the planned RISE II SBC evaluation as described in the study protocol. The literature review provides an overview of the health and development challenges in the region, along with priority health behaviors and their determinants followed by a description of SBC programmatic approaches that have addressed behavioral determinants and health outcomes in the region

Time for malaria control in school-age children.

School-age children bear an under-appreciated burden of malaria. Across sub-Saharan Africa, the prevalence of infection peaks in this age-group, and an estimated 200 million school-age children are at risk of malaria. Infection in this age group not only threatens child health and education, but also serves as a source of onward parasite transmission, undermining elimination efforts. It is assumed that universal malaria interventions, such as bed nets and access to prompt diagnosis and treatment, cover this age group. However, school-age children are the group least likely to benefit from these interventions. Thus, interventions specifically targeting this age group are needed. Schools provide ready access to this population and are successfully employed to address other health concerns in schoolchildren, such as school-feeding for nutritional deficiencies and deworming campaigns for control of helminth infections

Factors Associated With Sustained Use of Long-Lasting Insecticide-Treated Nets Following a Reduction in Malaria Transmission in Southern Zambia

Understanding factors influencing sustained use of long-lasting insecticide-treated nets (LLIN) in areas of declining malaria transmission is critical to sustaining control and may facilitate elimination. From 2008 to 2013, 655 households in Choma District, Zambia, were randomly selected and residents were administered a questionnaire and malaria rapid diagnostic test. Mosquitoes were collected concurrently by light trap. In a multilevel model, children and adolescents of 5-17 years of age were 55% less likely to sleep under LLIN than adults (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.35, 0.58). LLIN use was 80% higher during the rainy season (OR = 1.8; CI = 1.5, 2.2) and residents of households with three or more nets were over twice as likely to use a LLIN (OR = 2.1; CI = 1.4, 3.1). For every increase in 0.5 km from the nearest health center, the odds of LLIN use decreased 9% (OR = 0.9; CI = 0.88, 0.98). In a second multilevel model, the odds of LLIN use were more than twice high if more than five mosquitoes (anopheline and culicine) were captured in the house compared with households with no mosquitoes captured (OR = 2.1; CI = 1.1, 3.9). LLIN use can be sustained in low-transmission settings with continued education and distributions, and may be partially driven by the presence of nuisance mosquitoes

Spatial and Temporal Changes in Household Structure Locations Using High-Resolution Satellite Imagery for Population Assessment: An Analysis in Southern Zambia, 2006-2011

Satellite imagery is increasingly available at high spatial resolution and can be used for various purposes in public health research and programme implementation. Comparing a census generated from two satellite images of the same region in rural southern Zambia obtained four and a half years apart identified patterns of household locations and change over time. The length of time that a satellite image-based census is accurate determines its utility. Households were enumerated manually from satellite images obtained in 2006 and 2011 of the same area. Spatial statistics were used to describe clustering, cluster detection, and spatial variation in the location of households. A total of 3821 household locations were enumerated in 2006 and 4256 in 2011, a net change of 435 houses (11.4% increase). Comparison of the images indicated that 971 (25.4%) structures were added and 536 (14.0%) removed. Further analysis suggested similar household clustering in the two images and no substantial difference in concentration of households across the study area. Cluster detection analysis identified a small area where significantly more household structures were removed than expected; however, the amount of change was of limited practical significance. These findings suggest that random sampling of households for study participation would not induce geographic bias if based on a 4.5-year-old image in this region. Application of spatial statistical methods provides insights into the population distribution changes between two time periods and can be helpful in assessing the accuracy of satellite imagery

COVID-19-related knowledge, attitudes, and practices among adolescents and young people in Bihar and Uttar Pradesh, India: Study description

To control the spread of COVID-19 in India and to aid the efforts of the Ministry of Health and Family Welfare (MOHFW), the Population Council and other non-governmental organizations are conducting research to assess residents’ ability to follow sanitation and social distancing precautions under a countrywide lockdown. The Population Council COVID-19 study team is implementing rapid phone-based surveys to collect information on knowledge, attitudes and practices, as well as needs, among 2,041 young people (ages 19-23 years) and/or an adult household member, sampled from an existing prospective cohort study with a total sample size of 20,574 in Bihar (n=10,433) and Uttar Pradesh (n=10,141). Baseline was conducted from April 3-22; subsequent iterations of the survey are planned to be conducted on a monthly basis. Baseline findings on awareness of COVID-19 symptoms, perceived risk, awareness of and ability to carry out preventive behaviors, misconceptions, and fears will inform the development of government and other stakeholders’ interventions and/or strategies. We are committed to openly sharing the latest versions of the study description, questionnaires, deidentified or aggregated datasets, and preliminary results. Data and findings can also be shared with partners working in COVID-19 response

Evaluation of the Operational Challenges in Implementing Reactive Screen-And-Treat and Implications of Reactive Case Detection Strategies for Malaria Elimination in a Region of Low Transmission in Southern Zambia

Background: As malaria transmission declines in many regions of sub-Saharan Africa, interventions to identify the asymptomatic reservoir are being deployed with the goals of improving surveillance and interrupting transmission. Reactive case detection strategies, in which individuals with clinical malaria are followed up at their home and household residents and neighbours are screened and treated for malaria, are increasingly used as part of malaria elimination programmes. Methods: A reactive screen-and-treat programme was implemented by the National Malaria Control Centre in Southern Province, Zambia, in which individuals residing within 140 m of an index case were screened with a malaria rapid diagnostic test (RDT) and treated if positive. The operational challenges during the early stages of implementing this reactive screen-and-treat programme in the catchment area of Macha Hospital in Southern Province, Zambia were assessed using rural health centre records, ground truth evaluation of community health worker performance, and data from serial cross-sectional surveys. The proportion of individuals infected with Plasmodium falciparum who were identified and treated was estimated by simulating reactive screen-and-treat and focal drug administration cascades. Results: Within the 1st year of implementation, community health workers followed up 32 % of eligible index cases. When index cases were followed up, 66 % of residents were at home in the index households and 58 % in neighbouring households. Forty-one neighbouring households of 26 index households were screened, but only 13 (32 %) were within the 140-m screening radius. The parasite prevalence by RDT was 22 % in index households and 5 % in neighbouring households. In a simulation model with complete follow-up, 22 % of the total infected population would be detected with reactive screen-and-treat but 57 % with reactive focal drug administration. Conclusions: With limited resources, coverage and diagnostic tools, reactive screen-and-treat will likely not be sufficient to achieve malaria elimination in this setting. However, high coverage with reactive focal drug administration could be efficient at decreasing the reservoir of infection and should be considered as an alternative strategy