Operational Research in

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Operational Research in Tropical and
Communicable Diseases DIVISION OF COMMUNICABLE
DISEASES, WHO/EMRO (http//www.emro.who.int/tdr
/) Intercountry Training Workshop on Research
Methods In TB and other Communicable
Diseases October, 13-22, Cairo, Egypt
EMRO DCD/TDR SMALL GRANTS SCHEME
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OBJECTIVES OF THE SCHEME

• To strengthen operational research in tropical
  and communicable diseases in EMR
• To support research contributing to prevention,
  control and treatment of tropical and
  communicable diseases
• To increase the research capacity of researchers
  in the Region
• To promote the integrated approach in tropical
  and communicable diseases research

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Mandate of the Scheme
ACADEMIC INSTITUTIONS
CONTROL PROGRAMMES
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PROPOSALS SUBMITTED AND ACCEPTED IN THE SMALL
GRANTS SCHEME 1992-2002
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SMALL GRANTS SCHEME-TOPICS

• 1992 Leishmaniasis
• 1993 Schistosomiasis
• 1995 Malaria
• 1996 All Tropical Diseases
• 1997 Insect Borne Diseases
• 1998
• 1999 Leish, Mal, Sch
• 2000 Leish, Mal, TB
• 2001 Fil, Leish,Mal,TB

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SMALL GRANTS SCHEME-TOPICS IN 2002

• Communicable Diseases In (TDR)Agenda
•           
•   Leishmaniasis
•            L. filariasis
•                Leprosy
•                Malaria
•    Tuberculosis
• Schistosomiasis
•              

• Communicable Diseases of Regional Importance
•             Brucellosis
•               Echinococcosis
• Haemophilus Influenza B
•               Haemorrhagic fever
•               HIV/AIDS STDs
•               Measles
•               Meningitis
• Neonatal tetanus

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(No Transcript)
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CONDUCTED EPIDEMIOLOGICAL STUDIESResults
Sm 21
Sm 6 Fil 9
VL 1.3
MAL 12
S.m 22-35 S.h 7-18 VL 35 Kala azar
13/100,000/2 y
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CONDUCTED EPIDEMIOLOGICAL STUDIES Results
NEED
NEED
NEED
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• Vector Control Studies Results
• Efficacy of ITN and larvivorous fish
• (Sudan, Somalia)
• Integrated snail control in Schistosomiasis
  (Yemen, Egypt)
• Susceptibility of P.papatasi to insecticides
  (Egypt)
• Zoonotic Diseases Results
• Control of Reservoirs of ZCL and ZVL (Tunisia,
  Iran)

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Evaluation of new diagnostic tools for field
conditions Results

• DAT for diagnosis of VL (Sudan)
• Evaluation of DAT (Morocco)
• Testing Field stain for Malaria Diagnosis
  (Sudan)
• Evaluation of (ICT) for rapid diagnosis of
  Filariasis (Egypt)
• FDA test for rapid diagnosis of Schistosomiasis
  (Egypt)

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QUALITY OF CARE STUDIES SGS2000 projects

• Is private sector following NTP guidelines in
  diagnosis and management of PTB
• (Somalia, Pakistan, Iran )
• Somalia Among 100 registered doctors, 32 had
  treated TB patients during the prior 12 months,
  but only one had notified the case to the
  National TB Programme. Thirty three (66) of all
  the doctors knew the most important symptoms of
  tuberculosis, and 32 (60) doctors indicated
  sputum smear microscopy as the most important
  diagnostic test. Only four doctors prescribed the
  correct regimen, and only seven advocated direct
  observation of drug taking. Suboptimal knowledge
  of TB diagnosis was more common among private
  practitioners (OR 95 CI 2.1, 1.1 - 4-3).
• Conclusion TB patients are mainly treated in the
  private sector, and few doctors follow the
  guidelines of the National TB Programme in
  Somalia.

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QUALITY OF CARE STUDIES SGS2000 projects

• Pakistan Out of 884 private medical
  practitioners in two cities, a sample of 245 was
  interviewed using a semi questionnaire. Most of
  them (86) had provided treatment to PTB
  patients. Less than 1 is aware that cough more
  than 3 weeks alone is the main symptom suggesting
  pulmonary TB, and that sputum microscopy alone is
  the basis of diagnosis. The majority
  self-diagnose and treat patients and only a
  small proportion refer them to the TB Center.
  None of the private medical practitioners is
  following National TB Control Guidelines in
  prescribing drugs or ensures that anti-TB drugs
  are taken under supervision. Only 2 try to
  contact a patient on anti-TB treatment if s/he
  does not return.
• Conclusion private medical practitioners are not
  following National TB control guidelines in
  diagnosing, treating and follow up of pulmonary
  TB patients.

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QUALITY OF CARE STUDIES SGS2000 projects

• Recommendations of the 2 studies
• Private medical practitioners should be trained
  on the National TB Control Guidelines
• A functional collaboration needs to be
  established between private medical practitioners
  and National TB Control Program, whereby the
  overall process of diagnosis, treatment and
  follow up of pulmonary tuberculosis patients
  should be monitored closely in order to provide
  high quality TB services.
• Mass awareness should be raised to identify main
  symptom of pulmonary tuberculosis.
• Affordable and accessible Sputum Examination
  facilities should be made available.

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QUALITY OF CARE STUDIES SGS2000 projects
Does routine home visit improve return of late
patients?(Djibouti, Iraq ) Iraq home visiting
was highly effective in improving return of late
coming patients. The success rate was 94.1
compared to 76.7 in the control group.Defaulter
rate was 0.9 and 10 in the intervention and
control groups respectively. Smear conversion at
the end of the treatment was significantly better
in the intervention group (92.9)) compared to
the control group (75). Conclusion- Home
visiting by trained personnel significantly
improved the compliance of patients, treatment
success rate, smear conversion rate and reduced
the defaulter rate.
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QUALITY OF CARE STUDIES SGS2000 projects

• Effect of involvement of members of Iraqi Women
  Federation (IWF) on the outcome of the strategy
  of DOTS on Pulmonary Tuberculosis patients in
  Iraq.
• Iraq Involvement of the IWF resulted into a
  significantly higher cure rates (83.7) in the
  intervention compared to control group (68.6).
  Similarly, all PTB in the intervention group were
  compliant compared to 86 in the control group.
  The number of doses missed was a significant
  risk factor for treatment failure, at a cut off
  point of 8 doses. Smear conversion rates was
  significantly higher in the intervention group
  and was dependent upon the duration of follow up
  (RR 95C.I 8.5, 2.03- 36.67) .
• Conclusion involvement of non governmental
  organizations would significantly improve the
  cure rate, smear conversion rates and the
  compliance rates of pulmonary tuberculosis

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QUALITY OF CARE STUDIES SGS2000 projects

• Progress Reports.
• Irregular treatment intake as a risk factor for
  treatment failure (Egypt)
• Does routine home visit improve return of late
  patients?(Djibouti)

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SGS2001 TB projects

• Community KAP study on Tuberculosis Iraqi
  population.
• Prospective follow-up study of a positive
  tuberculosis skin test primary school pupils in
  Baghdad.
• Prevalence of pulmonary tuberculosis among
  juvenile detainees in Karachi, Pakistan.
• Gender differences in utilization pattern and
  outcome of respiratory Tuberculosis.
• Studying gender perspectives in knowledge,
  attitudes and practices concerning tuberculosis
  in Pakistan 's Sindh province.
• Does providing free sputum microscopy service and
  free anti-TB drugs to general practitioners (GPs)
  help in their case notification to NTP?
• Comparison of daily and three times a week home
  visit of patients with pulmonary TB in Zahedan.
• Gender differences and Tuberculosis Prospects
  for better control in Syria.
• Community and individual factors influencing the
  health seeking behaviour of tuberculosis
  defaulters.

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SGS2002 TB projects

• Multicountry study (2002) Case finding in TB
  patients Diagnostic and Treatment Delay and
  their determinants (7 EMR countries )
• Tuberculosis detection in private laboratories,
  Tehran, IRAN
• Involvement of private sector in Tuberculosis
  control, Lahej governorate, Yemen.

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HOW TO ACCESS THE CALL FOR APPLICATIONS?

• -EMRO WEB SITE www.emro.who.int
• -DCD WEB SITES
• www.emro.who.int/tdr
• www.emro.who.int/stb
• www.emro.who.int/rbm
• www.emro.who.int/asd
• -Distributed to the MOH, WR offices, and
  institutions of the Region (between
  January-March)

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• PROCESS
• The call includes eligibility criteria, research
  priorities, and the requested format.
• Selected letters of intent are assisted during
  finalization of protocols.
• Contract issued and first instalment released.

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• -At half way implementation (6 m), progress
  technical and financial reports should be
  submitted, followed by release of 2nd instalment.
• -At the end of the year, final technical and
  financial reports should be submitted, followed
  by release of last instalment.
• -Copies of Final reports are sent to MOH control
  programmes, and WRs,(process of disseminating
  results)

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• --All publications originating from the research
  should be communicated to the scheme (reprints)
  (process of disseminating results)
• -The final reports are summarized, proof cleared
  by authors, and posted on the final reports
  series section of the web site (process of
  disseminating results)
• -Follow up on the implementation of study results
  and recommendations (bridging the gap between
  knowledge and practice)