Developing a Model of Community of Practice Among Health Informatics Professionals in South and Southeast Asia

There is still debate on whether communities of practice (COP) can be formed or created. Many have claimed that they provide a venue to share knowledge which translates to action. In South and Southeast Asia, international development partners have invested in many capacity building initiatives to set-up and/or improve eHealth implementations in countries. While interest and resources for this increase, many challenges are still left unresolved due to repeated mistakes and undocumented experiences. The Asia eHealth Information Network (AeHIN) is a community of health informatics professionals organised to share knowledge and improve the use of ICT in health systems strengthening. Objectives: This study examined how AeHIN emerged as a knowledge sharing platform, identified best practices it adopted, and developed a model that could sustain itself as a COP. Methods: A sociometric survey was used to map knowledge sharing connections of pioneer members with interviews to substantiate findings and a 20-hour participant observation to triangulate data. UCINET 6.0 was used to analyse social network data while qualitative data were coded. Results: Defining roles of health informatics professionals inside the COP influences the type of information, resources, and capacities that can enter a network. The nature of its subgroups determines potentials and barriers to the network. Twelve best practices were identified to sustain a health informatics COP. It is recommended that a learning network is an appropriate model for this type of COP and an understanding of country-specific political structure is important to support participation. Conclusion: AeHIN is a COP model whose activities have a life of their own. While some prove successful, others die down or are discontinued. This unique design proved to be fitting for a group of health informatics professionals as it accommodates success and failures crucial for project implementations

Spatio-temporal effects of estimated pollutants released from an industrial estate on the occurrence of respiratory disease in Maptaphut Municipality, Thailand

BACKGROUND: Maptaphut Industrial Estate (MIE) was established with a single factory in 1988, increasing to 50 by 1998. This development has resulted in undesirable impacts on the environment and the health of the people in the surrounding areas, evidenced by frequent complaints of bad odours making the people living there ill. In 1999, the Bureau of Environmental Health, Department of Health, Ministry of Public Health, conducted a study of the health status of people in Rayong Province and found a marked increase in respiratory diseases over the period 1993–1996, higher than the overall prevalence of such diseases in Thailand. However, the relationship between the pollutants and the respiratory diseases of the people in the surrounding area has still not been quantified. Therefore, this study aimed to determine the spatial distribution of respiratory disease, to estimate pollutants released from the industrial estates, and to quantify the relationship between estimated pollutants and respiratory disease in the Maptaphut Municipality. RESULTS: Disease mapping showed a much higher risk of respiratory disease in communities adjacent to the Maptaphut Industrial Estate. Disease occurrence formed significant clusters centred on communities near the estate, relative to the weighted mean centre of chimney stacks. Analysis of the rates of respiratory disease in the communities, categorized by different concentrations of estimated pollutants, found a dose-response effect. Spatial regression analysis found that the distance between community and health providers decreased the rate of respiratory disease (p < 0.05). However, after taking into account distance, total pollutant (p < 0.05), SO(2 )(p < 0.05) and NO(x )(p < 0.05) played a role in adverse health effects during the summer. Total pollutant (p < 0.05) and NO(x )(p < 0.05) played a role in adverse health effects during the rainy season after taking into account distance, but during winter there was no observed relationship between pollutants and rates of respiratory disease after taking into account distance. A 12-month time-series analysis of six communities selected from the disease clusters and the areas impacted most by pollutant dispersion, found significant effects for SO(2 )(p < 0.05), NO(x )(p < 0.05), and TSP (p < 0.05) after taking into account rainfall. CONCLUSION: This study employed disease mapping to present the spatial distribution of disease. Excessive risk of respiratory disease, and disease clusters, were found among communities near Maptaphut Industrial Estate. Study of the relationship between estimated pollutants and the occurrence of respiratory disease found significant relationships between estimated SO(2), NO(x), and TSP, and the rate of respiratory disease

Application of mobile-technology for disease and treatment monitoring of malaria in the "Better Border Healthcare Programme"

<p>Abstract</p> <p>Background</p> <p>The main objective of this study was to assess the effectiveness of integrating the use of cell-phones into a routine malaria prevention and control programme, to improve the management of malaria cases among an under-served population in a border area. The module for disease and treatment monitoring of malaria (DTMM) consisted of case investigation and case follow-up for treatment compliance and patients' symptoms.</p> <p>Methods</p> <p>The module combining web-based and mobile technologies was developed as a proof of concept, in an attempt to replace the existing manual, paper-based activities that malaria staff used in treating and caring for malaria patients in the villages for which they were responsible. After a patient was detected and registered onto the system, case-investigation and treatment details were recorded into the malaria database. A follow-up schedule was generated, and the patient's status was updated when the malaria staff conducted their routine home visits, using mobile phones loaded with the follow-up application module. The module also generated text and graph messages for a summary of malaria cases and basic statistics, and automatically fed to predetermined malaria personnel for situation analysis. Following standard public-health practices, access to the patient database was strictly limited to authorized personnel in charge of patient case management.</p> <p>Results</p> <p>The DTMM module was developed and implemented at the trial site in late November 2008, and was fully functioning in 2009. The system captured 534 malaria patients in 2009. Compared to paper-based data in 2004-2008, the mobile-phone-based case follow-up rates by malaria staff improved significantly. The follow-up rates for both Thai and migrant patients were about 94-99% on Day 7 <it>(Plasmodium falciparum) </it>and Day 14 <it>(Plasmodium vivax) </it>and maintained at 84-93% on Day 90. Adherence to anti-malarial drug therapy, based on self-reporting, showed high completion rate for <it>P. falciparum</it>-infected cases, but lower rate for <it>P. vivax </it>cases. Patients' symptoms were captured onto the mobile phone during each follow-up visit, either during the home visit or at Malaria Clinic; most patients had headache, muscle pain, and fatigue, and some had fever within the first follow-up day (day7/14) after the first anti-malarial drug dose.</p> <p>Conclusions</p> <p>The module was successfully integrated and functioned as part of the malaria prevention and control programme. Despite the bias inherent in sensitizing malaria workers to perform active case follow-up using the mobile device, the study proved for its feasibility and the extent to which community healthcare personnel in the low resource settings could potentially utilize it efficiently to perform routine duties, even in remote areas. The DTMM has been modified and is currently functioning in seven provinces in a project supported by the WHO and the Bill & Melinda Gates Foundation, to contain multi-drug resistant malaria on the Thai-Cambodian border.</p

Development of temporal modelling for forecasting and prediction of malaria infections using time-series and ARIMAX analyses: A case study in endemic districts of Bhutan

<p>Abstract</p> <p>Background</p> <p>Malaria still remains a public health problem in some districts of Bhutan despite marked reduction of cases in last few years. To strengthen the country's prevention and control measures, this study was carried out to develop forecasting and prediction models of malaria incidence in the endemic districts of Bhutan using time series and ARIMAX.</p> <p>Methods</p> <p>This study was carried out retrospectively using the monthly reported malaria cases from the health centres to Vector-borne Disease Control Programme (VDCP) and the meteorological data from Meteorological Unit, Department of Energy, Ministry of Economic Affairs. Time series analysis was performed on monthly malaria cases, from 1994 to 2008, in seven malaria endemic districts. The time series models derived from a multiplicative seasonal autoregressive integrated moving average (ARIMA) was deployed to identify the best model using data from 1994 to 2006. The best-fit model was selected for each individual district and for the overall endemic area was developed and the monthly cases from January to December 2009 and 2010 were forecasted. In developing the prediction model, the monthly reported malaria cases and the meteorological factors from 1996 to 2008 of the seven districts were analysed. The method of ARIMAX modelling was employed to determine predictors of malaria of the subsequent month.</p> <p>Results</p> <p>It was found that the ARIMA (p, d, q) (P, D, Q)^smodel (p and P representing the auto regressive and seasonal autoregressive; d and D representing the non-seasonal differences and seasonal differencing; and q and Q the moving average parameters and seasonal moving average parameters, respectively and s representing the length of the seasonal period) for the overall endemic districts was (2,1,1)(0,1,1)¹²; the modelling data from each district revealed two most common ARIMA models including (2,1,1)(0,1,1)¹²and (1,1,1)(0,1,1)¹². The forecasted monthly malaria cases from January to December 2009 and 2010 varied from 15 to 82 cases in 2009 and 67 to 149 cases in 2010, where population in 2009 was 285,375 and the expected population of 2010 to be 289,085. The ARIMAX model of monthly cases and climatic factors showed considerable variations among the different districts. In general, the mean maximum temperature lagged at one month was a strong positive predictor of an increased malaria cases for four districts. The monthly number of cases of the previous month was also a significant predictor in one district, whereas no variable could predict malaria cases for two districts.</p> <p>Conclusions</p> <p>The ARIMA models of time-series analysis were useful in forecasting the number of cases in the endemic areas of Bhutan. There was no consistency in the predictors of malaria cases when using ARIMAX model with selected lag times and climatic predictors. The ARIMA forecasting models could be employed for planning and managing malaria prevention and control programme in Bhutan.</p

Respondent-driven sampling on the Thailand-Cambodia border. I. Can malaria cases be contained in mobile migrant workers?

<p>Abstract</p> <p>Background</p> <p>Reliable information on mobility patterns of migrants is a crucial part of the strategy to contain the spread of artemisinin-resistant malaria parasites in South-East Asia, and may also be helpful to efforts to address other public health problems for migrants and members of host communities. In order to limit the spread of malarial drug resistance, the malaria prevention and control programme will need to devise strategies to reach cross-border and mobile migrant populations.</p> <p>Methodology</p> <p>The Respondent-driven sampling (RDS) method was used to survey migrant workers from Cambodia and Myanmar, both registered and undocumented, in three Thai provinces on the Thailand-Cambodia border in close proximity to areas with documented artemisinin-resistant malaria parasites. 1,719 participants (828 Cambodian and 891 Myanmar migrants) were recruited. Subpopulations of migrant workers were analysed using the Thailand Ministry of Health classification based on length of residence in Thailand of greater than six months (long-term, or M1) or less than six months (short-term, or M2). Key information collected on the structured questionnaire included patterns of mobility and migration, demographic characteristics, treatment-seeking behaviours, and knowledge, perceptions, and practices about malaria.</p> <p>Results</p> <p>Workers from Cambodia came from provinces across Cambodia, and 22% of Cambodian M1 and 72% of Cambodian M2 migrants had been in Cambodia in the last three months. Less than 6% returned with a frequency of greater than once per month. Of migrants from Cambodia, 32% of M1 and 68% of M2 were planning to return, and named provinces across Cambodia as their likely next destinations. Most workers from Myanmar came from Mon state (86%), had never returned to Myanmar (85%), and only 4% stated plans to return.</p> <p>Conclusion</p> <p>Information on migratory patterns of migrants from Myanmar and Cambodia along the malaria endemic Thailand-Cambodian border within the artemisinin resistance containment zone will help target health interventions, including treatment follow-up and surveillance.</p

Malaria Elimination in the Greater Mekong Subregion: Challenges and Prospects

Malaria is a significant public health problem and impediment to socioeconomic development in countries of the Greater Mekong Subregion (GMS), which comprises Cambodia, China’s Yunnan Province, Lao People’s Democratic Republic, Myanmar, Thailand, and Vietnam. Over the past decade, intensified malaria control has greatly reduced the regional malaria burden. Driven by increasing political commitment, motivated by recent achievements in malaria control, and urged by the imminent threat of emerging artemisinin resistance, the GMS countries have endorsed a regional malaria elimination plan with a goal of eliminating malaria by 2030. However, this ambitious, but laudable, goal faces a daunting array of challenges and requires integrated strategies tailored to the region, which should be based on a mechanistic understanding of the human, parasite, and vector factors sustaining continued malaria transmission along international borders. Malaria epidemiology in the GMS is complex and rapidly evolving. Spatial heterogeneity requires targeted use of the limited resources. Border malaria accounts for continued malaria transmission and represents sources of parasite introduction through porous borders by highly mobile human populations. Asymptomatic infections constitute huge parasite reservoir requiring interventions in time and place to pave the way for malaria elimination. Of the two most predominant malaria parasites, Plasmodium falciparum and P. vivax, the prevalence of the latter is increasing in most member GMS countries. This parasite requires the use of 8-aminoquinoline drugs to prevent relapses from liver hypnozoites, but high prevalence of glucose-6-phosphate dehydrogenase deficiency in the endemic human populations makes it difficult to adopt this treatment regimen. The recent emergence of resistance to artemisinins and partner drugs in P. falciparum has raised both regional and global concerns, and elimination efforts are invariably prioritized against this parasite to avert spread. Moreover, the effectiveness of the two core vector control interventions—insecticide-treated nets and indoor residual spraying—has been declining due to insecticide resistance and increased outdoor biting activity of mosquito vectors. These technical challenges, though varying from country to country, require integrated approaches and better understanding of the malaria epidemiology enabling targeted control of the parasites and vectors. Understanding the mechanism and distribution of drug-resistant parasites will allow effective drug treatment and prevent, or slow down, the spread of drug resistance. Coordination among the GMS countries is essential to prevent parasite reintroduction across the international borders to achieve regional malaria elimination

Are there any changes in burden and management of communicable diseases in areas affected by Cyclone Nargis?

<p>Abstract</p> <p>Background</p> <p>This study aims to assess the situation of communicable diseases under national surveillance in the Cyclone Nargis-affected areas in Myanmar (Burma) before and after the incident.</p> <p>Methods</p> <p>Monthly data during 2007, 2008 and 2009 from the routine reporting system for disease surveillance of the Myanmar Ministry of Health (MMOH) were reviewed and compared with weekly reporting from the Early Warning and Rapid Response (EWAR) system. Data from some UN agencies, NGOs and Tri-Partite Core Group (TCG) periodic reviews were also extracted for comparisons with indicators from Sphere and the Inter-Agency Standing Committee.</p> <p>Results</p> <p>Compared to 2007 and 2009, large and atypical increases in diarrheal disease and especially dysentery cases occurred in 2008 following Cyclone Nargis. A seasonal increase in ARI reached levels higher than usual in the months of 2008 post-Nargis. The number of malaria cases post-Nargis also increased, but it was less clear if this reflected normal seasonal patterns or was specifically associated with the disaster event. There was no significant change in the occurrence of other communicable diseases in Nargis-affected areas. Except for a small decrease in mortality for diarrheal diseases and ARI in 2008 in Nargis-affected areas, population-based mortality rates for all other communicable diseases showed no significant change in 2008 in these areas, compared to 2007 and 2009. Tuberculosis control programs reached their targets of 70% case detection and 85% treatment success rates in 2007 and 2008. Vaccination coverage rates for DPT 3^rddose and measles remained at high though measles coverage still did not reach the Sphere target of 95% even by 2009. Sanitary latrine coverage in the Nargis-affected area dropped sharply to 50% in the months of 2008 following the incident but then rose to 72% in 2009.</p> <p>Conclusion</p> <p>While the incidence of diarrhea, dysentery and ARI increased post-Nargis in areas affected by the incident, the incidence rate for other diseases and mortality rates did not increase, and normal disease patterns resumed by 2009. This suggests that health services as well as prevention and control measures provided to the Nargis-affected population mitigated what could have been a far more severe health impact.</p

Directly-observed therapy (DOT) for the radical 14-day primaquine treatment of Plasmodium vivax malaria on the Thai-Myanmar border

<p>Abstract</p> <p>Background</p> <p><it>Plasmodium vivax </it>has a dormant hepatic stage, called the hypnozoite, which can cause relapse months after the initial attack. For 50 years, primaquine has been used as a hypnozoitocide to radically cure <it>P. vivax </it>infection, but major concerns remain regarding the side-effects of the drug and adherence to the 14-day regimen. This study examined the effectiveness of using the directly-observed therapy (DOT) method for the radical treatment of <it>P. vivax </it>malaria infection, to prevent reappearance of the parasite within the 90-day follow-up period. Other potential risk factors for the reappearance of <it>P. vivax </it>were also explored.</p> <p>Methods</p> <p>A randomized trial was conducted from May 2007 to January 2009 in a low malaria transmission area along the Thai-Myanmar border. Patients aged ≥ 3 years diagnosed with <it>P. vivax </it>by microscopy, were recruited. All patients were treated with the national standard regimen of chloroquine for three days followed by primaquine for 14 days. Patients were randomized to receive DOT or self-administered therapy (SAT). All patients were followed for three months to check for any reappearance of <it>P. vivax</it>.</p> <p>Results</p> <p>Of the 216 patients enrolled, 109 were randomized to DOT and 107 to SAT. All patients recovered without serious adverse effects. The vivax reappearance rate was significantly lower in the DOT group than the SAT group (3.4/10,000 person-days vs. 13.5/10,000 person-days, <it>p </it>= 0.021). Factors related to the reappearance of vivax malaria included inadequate total primaquine dosage received (< 2.75 mg/kg), duration of fever ≤ 2 days before initiation of treatment, parasite count on admission ≥ 10,000/µl, multiple <it>P. vivax</it>-genotype infection, and presence of <it>P. falciparum </it>infection during the follow-up period.</p> <p>Conclusions</p> <p>Adherence to the 14-day primaquine regimen is important for the radical cure of <it>P. vivax </it>malaria infection. Implementation of DOT reduces the reappearance rate of the parasite, and may subsequently decrease <it>P. vivax </it>transmission in the area.</p