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James N Newell

Publications and source records attributed to James N Newell.

8 recordsLinked to original sources
PubMed2006

Family-member DOTS and community DOTS for tuberculosis control in Nepal: cluster-randomised controlled trial.

BACKGROUND: A key component of the DOTS strategy for tuberculosis control (short-course chemotherapy following WHO guidelines) is direct observation of treatment. WHO technical guidelines recommend that health workers should undertake this part of the strategy, but will also accept direct observation of treatment in the community; WHO does not think that a family member should undertake this role. Supporting evidence for these recommendations is not available. The Nepal national tuberculosis programme asked us to develop and test a strategy of direct observation of treatment for the hill districts of Nepal, where direct observation of treatment by health workers is not feasible. We aimed to assess the success rates of two DOTS strategies developed for such areas. METHODS: Between mid-July, 2002, and mid-July, 2003, we undertook a cluster-randomised controlled trial to compare two strategies-community DOTS and family-member DOTS--in ten hill and mountain districts of Nepal. Districts were used as the unit of randomisation. Primary outcome was success rate (proportion of registered patients who achieved cure or completed treatment), and analysis was by intention to treat. FINDINGS: Five districts (549 patients) were allocated to community DOTS and five (358 patients) were allocated family-member DOTS. Community DOTS and family-member DOTS achieved success rates of 85% and 89%, respectively (odds ratio of success for community DOTS relative to family-member DOTS, 0.67 [95% CI 0.41-1.10]; p=0.09). Estimated case-finding rates were 63% with the community strategy and 44% with family-member DOTS. INTERPRETATION: The family-member DOTS and community DOTS strategies can both attain international targets for treatment success under programme conditions, and thus are appropriate for the hill and mountain districts of Nepal. Both strategies might also be appropriate in other parts of the world where directly observed treatment by health workers is not feasible. Our findings lend support to adoption of this patient-responsive approach to direct observation of treatment within global tuberculosis control policy.

Adolescent↗
PubMed2006

Government-NGO collaboration: the case of tuberculosis control in Bangladesh.

This study analyzes the basic concepts and key issues of existing collaboration between government and non-governmental organizations (NGOs) in health care, using as an example the implementation of the DOTS (formerly an abbreviation for directly observed treatment, short course) strategy for tuberculosis (TB) control in Bangladesh. It also examines efforts by the Government of Bangladesh to improve health services delivery, especially for the poor, through collaboration with NGOs. Data were collected in 2001 and 2002 as a part of the process of developing a public-private partnership model for TB care in Bangladesh. Analyses of existing collaboration models in TB control strongly suggest that the government and NGO sectors can be complementary in controlling TB. We found an increasing trend of government collaborating with NGOs in implementing TB control programmes. The study indicates that government-NGO collaboration is an effective way of improving access to and quality of TB and other health care services.

Bangladesh↗
PubMed2004

Control of tuberculosis in an urban setting in Nepal: public-private partnership.

OBJECTIVES: To implement and evaluate a public-private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. METHODS: A local working group developed a public-private partnership for control of TB, which included diagnosis by private practitioners, direct observation of treatment and tracing of patients who missed appointments by nongovernmental organizations, and provision of training and drugs by the Nepal National TB Programme (NTP). The public-private partnership was evaluated through baseline and follow-up surveys of private practitioners, private pharmacies, and private laboratories, together with records kept by the Nepal NTP. FINDINGS: In the first 36 months, 1328 patients with TB were registered in the public-private partnership. Treatment success rates were >90%, and <1% of patients defaulted. Case notification of sputum-positive patients in the study area increased from 54 per 100 000 to 102 per 100 000. The numbers of patients with TB started on treatment by private practitioners decreased by more than two-thirds, the number of private pharmacies that stocked anti-TB drugs by one-third, the number of pharmacies selling anti-TB drugs by almost two-thirds, and sales of anti-TB drugs in pharmacies by almost two-thirds. Private practitioners were happy to refer patients to the public-private partnership. Not all private practitioners had to be involved: many patients bypassed private practitioners and went directly to free DOTS centres. CONCLUSIONS: A combination of the strengths of private practitioners, nongovernmental organizations, and the public sector in a public-private partnership can be used to provide a service that is liked by patients and gives high rates of treatment success and increased rates of patient notification. Similar public-private partnerships are likely to be replicable elsewhere, as inputs are not large and no special requirements exist.

Antitubercular Agents↗
PubMed2002

The relationship between disease control strategies and health system development: the case of TB.

This paper focuses on the lack of dialogue and policy consonance between those taking the lead in health systems change and those developing specific disease control strategies. In the first part, the origins and characteristics of this situation are explained using, as an example, TB control. Attention is then paid to the development of disease control friendly health systems. Four aspects of policy development are analysed paying particular attention to TB control: analysis of policy context, mechanisms for collaboration between policy actors; agreement on decision-making processes; development of common aims and objectives. Although the focus is on TB control, the principles illustrated carry some relevance for other disease control programmes.

Communicable Disease Control↗
PubMed2002

A systematic review of current knowledge of HIV epidemiology and of sexual behaviour in Nepal.

OBJECTIVE: To systematically review information on HIV epidemiology and on sexual behaviour in Nepal with a view to identifying gaps in current knowledge. METHODS: Systematic review covering electronic databases, web-based information, personal contact with experts and hand searching of key journals. RESULTS: HIV-1 seroprevalence has been rising rapidly in association with high-risk behaviours, with current levels of 40% amongst the nation's injecting drug users and approaching 20% amongst Kathmandu's female commercial sex workers (FCSWs). HIV seroprevalence remains low in the general population (0.29% of 15-49 year olds). There are significant methodological limitations in many of the seroprevalence studies identified, and these estimates need to be treated with caution. There are extensive migration patterns both within the country and internationally which provide the potential for considerable sexual networking. However, studies of sexual behaviour have focused on FCSWs and the extent of sexual networks within the general population is largely unknown. CONCLUSIONS: Whilst some of the ingredients are present for an explosive HIV epidemic in Nepal, crucial knowledge on sexual behaviour in the general population is missing. Research on sexual networking is urgently required to guide HIV control in Nepal. There is also a need for further good-quality epidemiological studies of HIV seroprevalence.

Adolescent↗
PubMedDate not supplied

A model for effective involvement of private medical practitioners in TB care.

The purpose of this paper is to propose a process to help to develop a new model for partnerships in tuberculosis (TB) control, based on experiences to date. We start by identifying the essential service components needed in order to deliver quality care. Secondly, we identify the main partners in a collaboration or partnership. We describe a generic model linking the partners and the components. This model is then used to describe and analyse successful partnerships currently in existence, identifying those features that produced a successful outcome regarding increased access, coverage and quality for TB control. Finally, we illustrate how the process and generic model has been used to develop a locally appropriate model for partnerships in TB control, taking Bangladesh as our example.

Bangladesh↗