PDF(Pubmed)
Abstract：
The WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first to implement an integrated approach and evaluate its impact.
A retrospective study of three of five CM-NTD-endemic counties that implemented the integrated approach was compared with cluster-matched counties with non-integrated CM-NTD. We compared trends in CM-NTD integrated versus non-integrated county clusters. We conducted a pre-post comparison of WHO high-level outcomes using data collected during intervention years compared with baseline in control counties. Changes in health outcomes, effect sizes for different diseases and rate ratios with statistically significant differences were determined. Complementary qualitative research explored CM-NTD stakeholders\' perceptions, analysed through the framework approach, which is a transparent, multistage approach for qualitative thematic interdisciplinary data analysis.
The detection rates for all diseases combined improved significantly in the intervention compared with the control clusters. Besides leprosy, detection rates improved with large effects, over fourfold increase with statistically significant effects for individual diseases (p<0.000; 95% CI 3.5 to 5.4). Access to CM-NTD services increased in integrated counties by 71 facilities, compared with three facilities in non-integrated counties. Qualitative findings highlight training and supervision as inputs underpinning increases in case detection, but challenges with refresher training, medicine supply and incentives negatively impact quality, equity and access.
Integrating CM-NTDs improves case detection, accessibility and availability of CM-NTD services, promoting universal health coverage. Early case detection and the quality of care need further strengthening.
A retrospective study of three of five CM-NTD-endemic counties that implemented the integrated approach was compared with cluster-matched counties with non-integrated CM-NTD. We compared trends in CM-NTD integrated versus non-integrated county clusters. We conducted a pre-post comparison of WHO high-level outcomes using data collected during intervention years compared with baseline in control counties. Changes in health outcomes, effect sizes for different diseases and rate ratios with statistically significant differences were determined. Complementary qualitative research explored CM-NTD stakeholders\' perceptions, analysed through the framework approach, which is a transparent, multistage approach for qualitative thematic interdisciplinary data analysis.
The detection rates for all diseases combined improved significantly in the intervention compared with the control clusters. Besides leprosy, detection rates improved with large effects, over fourfold increase with statistically significant effects for individual diseases (p<0.000; 95% CI 3.5 to 5.4). Access to CM-NTD services increased in integrated counties by 71 facilities, compared with three facilities in non-integrated counties. Qualitative findings highlight training and supervision as inputs underpinning increases in case detection, but challenges with refresher training, medicine supply and incentives negatively impact quality, equity and access.
Integrating CM-NTDs improves case detection, accessibility and availability of CM-NTD services, promoting universal health coverage. Early case detection and the quality of care need further strengthening.
摘要：
背景：WHO被忽视的热带病（NTD）路线图强调了将需要病例管理（CM）的NTD纳入卫生系统的重要性。利比里亚的NTD方案是首批实施综合办法并评估其影响的方案之一。
方法：对实施整合方法的五个CM-NTD地方病县中的三个进行了回顾性研究，并将其与具有非整合CM-NTD的集群匹配县进行了比较。我们比较了CM-NTD整合和非整合县集群的趋势。我们使用干预期间收集的数据与对照县的基线进行了世卫组织高级别结果的事前比较。健康结果的变化，确定了不同疾病的效应大小和具有统计学差异的比率。补充定性研究探讨了CM-NTD利益相关者的看法，通过框架方法分析，这是一个透明的，定性专题跨学科数据分析的多阶段方法。
结果：与对照组相比，干预措施中所有疾病合并的检出率显着提高。除了麻风病,检测率提高了很大的影响，增加四倍以上，对个别疾病有统计学意义(p<0.000；95%CI3.5至5.4)。综合县获得CM-NTD服务的机会增加了71个设施，与非一体化县的三个设施相比。定性发现突出了培训和监督，因为支持案件检测的投入增加了。但是挑战进修培训，药品供应和激励措施对质量产生负面影响，公平和准入。
结论：整合CM-NTDs可以改善病例检测，CM-NTD服务的可访问性和可用性，促进全民健康覆盖。早期病例发现和护理质量需要进一步加强。
方法：对实施整合方法的五个CM-NTD地方病县中的三个进行了回顾性研究，并将其与具有非整合CM-NTD的集群匹配县进行了比较。我们比较了CM-NTD整合和非整合县集群的趋势。我们使用干预期间收集的数据与对照县的基线进行了世卫组织高级别结果的事前比较。健康结果的变化，确定了不同疾病的效应大小和具有统计学差异的比率。补充定性研究探讨了CM-NTD利益相关者的看法，通过框架方法分析，这是一个透明的，定性专题跨学科数据分析的多阶段方法。
结果：与对照组相比，干预措施中所有疾病合并的检出率显着提高。除了麻风病,检测率提高了很大的影响，增加四倍以上，对个别疾病有统计学意义(p<0.000；95%CI3.5至5.4)。综合县获得CM-NTD服务的机会增加了71个设施，与非一体化县的三个设施相比。定性发现突出了培训和监督，因为支持案件检测的投入增加了。但是挑战进修培训，药品供应和激励措施对质量产生负面影响，公平和准入。
结论：整合CM-NTDs可以改善病例检测，CM-NTD服务的可访问性和可用性，促进全民健康覆盖。早期病例发现和护理质量需要进一步加强。
