Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review.

BACKGROUND: Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS: We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS: Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION: This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field

Diversity of anopheline species and their <it>Plasmodium</it> infection status in rural Bandarban, Bangladesh

<p>Abstract</p> <p>Background</p> <p>Historically, the Chittagong Hill Tracts (CHT) of Bangladesh was considered hyperendemic for malaria. To better understand the contemporary malaria epidemiology and to develop new and innovative control strategies, comprehensive epidemiologic studies are ongoing in two endemic unions of Bandarban district of CHT. Within these studies entomological surveillance has been undertaken to study the role of the existing anopheline species involved in the malaria transmission cycle throughout the year.</p> <p>Methods</p> <p>CDC miniature light traps were deployed to collect anopheline mosquitoes from the sleeping room of the selected houses each month in a single union (Kuhalong). Molecular identification was carried out for available <it>Anopheles</it> species complexes. Circumsporozoite proteins (CSP) for <it>Plasmodium falciparum</it>, <it>Plasmodium vivax</it>-210 (Pv-210) and <it>Plasmodium vivax</it>-247(Pv-247) were detected by Enzyme-linked immunosorbent assay (ELISA) from the female anopheline mosquitoes. To confirm CSP-ELISA results, polymerase chain reaction (PCR) was also performed.</p> <p>Results</p> <p>A total of 2,837 anopheline mosquitoes, of which 2,576 were female, belonging to 20 species were collected from July 2009 -June 2010. <it>Anopheles jeyporiensis</it> was the most abundant species (18.9%), followed by <it>An. vagus</it> (16.8%) and <it>An. kochi</it> (14.4%). ELISA was performed on 2,467 female mosquitoes of 19 species. 15 (0.6%) female anophelines belonging to eight species were found to be positive for <it>Plasmodium</it> infection by CSP-ELISA. Of those, 11 (0.4%) mosquitoes were positive for <it>P. falciparum</it> and four (0.2%) for Pv-210. No mosquito was found positive for Pv-247. <it>An. maculatus</it> (2.1%, 2/97) had the highest infection rate followed by <it>An. umbrosus</it> (1.7%, 2/115) and <it>An. barbirostris</it> (1.1%, 2/186). Other infected species were <it>An. nigerrimus</it>, <it>An. nivipes, An. jeyporiensis</it>, <it>An. kochi</it>, and <it>An. vagus</it>. Out of 11 <it>P. falciparum</it> CSP positive samples, seven turned out to be positive by PCR. None of the samples positive for Pv-210 was positive by PCR. In terms of abundance and incrimination, the results suggest that <it>An. maculatus</it>, <it>An. jeyporiensis</it> and <it>An. nivipes</it> play important roles in malaria transmission in Kuhalong.</p> <p>Conclusion</p> <p>The findings of this study suggest that even in the presence of an insecticide impregnated bed-net intervention, a number of <it>Anopheles</it> species still play a role in the transmission of malaria. Further investigations are required to reveal the detailed biology and insecticide resistance patterns of the vector mosquito species in endemic areas in Bangladesh in order to assist with the planning and implementation of improved malaria control strategies.</p