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Jenny Hill

Publications and source records attributed to Jenny Hill.

7 recordsLinked to original sources
PubMed2007

Delivery of insecticide-treated net services through employer and community-based approaches in Kenya.

BACKGROUND AND OBJECTIVES: Many approaches have been used to deliver insecticide-treated nets (ITNs) to African communities in different settings. Between 1992 and 2002, the African Medical and Research Foundation (AMREF), Kenya, used two ITN delivery models: the employer-based approach and the community-based approach. These two approaches have never been compared in order to inform their potential for future ITN delivery. We aimed to (1) compare the extent of ITN ownership, use and retreatment coverage in different population groups in the employer and community-based models and (2) identify options for improving people's acceptance and use of treatment/retreatment services. METHODS: Qualitative and quantitative methods for data collection and analysis. A total of 2095 household heads were interviewed in the quantitative study, while purposively selected groups and key informants participated in the qualitative study. RESULTS: Net coverage (both treated and untreated nets) and retreatment rates with insecticides were significantly higher at employer-based sites (54.3%) than at community-based sites (35.0%). Bed net ownership has increased significantly since the start of AMREF interventions in 1998 in employer-based sites (from 27% to 61.1%); in community-based sites, it has either decreased (urban area, from 29.0% to 16.5%) or increased (rural area, from 17.0% to 49.1%). Retreatment rates in all sites were negatively influenced by the lack of information, cash and availability of insecticides. Satisfaction with the form of payment and services delivered was higher in employer-based sites. This was attributed to employers providing credit for the purchase of nets and retreatment kits and the employers' medical teams giving information on malaria and making follow-up visits on workers who fell ill. CONCLUSIONS: Employer-based delivery of ITNs was more successful than community-based delivery in attaining both high coverage with ITNs and higher rates of net retreatment. Methods used for the retreatment of nets, forms of payment and communication strategies should be convenient to communities. Organized community groups may continue to play an important role in remote rural areas.

Adolescent↗
PubMed2006

Insecticide-treated nets.

Insecticide-treated nets (ITNs) are the most powerful malaria control tool to be developed since the advent of indoor residual spraying (IRS) and chloroquine in the 1940s, and as such they have been an important component of global and national malaria control policies since the mid-1990s. Yet a decade later, coverage is still unacceptably low: only 3% of African children are currently sleeping under an ITN, and only about 20% are sleeping under any kind of net. This review charts the scientific, policy and programmatic progress of ITNs over the last 10 years. Available evidence for the range of programmatic delivery mechanisms used at country level is presented alongside the key policy debates that together have contributed to the evolution of ITN delivery strategies over the past decade. There is now global consensus around a strategic framework for scaling up ITN usage in Africa, which recognizes a role for both the public sector (targeting vulnerable groups to promote equity) and the private sector (sustainable supply). So, while progress with increasing coverage to date has been slow, there is now global support for the rapid scale-up of ITNs among vulnerable groups by integrating ITN delivery with maternal and child health programmes (and immunization in particular), at the same time working with the private sector in a complementary and supportive manner to ensure that coverage can be maintained for future generations of African children.

Animals↗
PubMed2006

Reaching the Abuja target for intermittent preventive treatment of malaria in pregnancy in African women: a review of progress and operational challenges.

OBJECTIVE: To review progress with the implementation of intermittent preventive treatment (IPT) for the control of malaria in pregnancy in sub-Saharan Africa (SSA), in order to identify facilitating factors and operational challenges for scaling up IPT delivery. METHODS: Information on the status of IPT policy, programme and coverage indicators was extracted from published sources. Information on country experiences from both published and unpublished literature was supplemented with semi-structured interviews with malaria programme managers. RESULTS: Whilst countries in SSA have made important progress with IPT implementation, coverage levels remain low. High antenatal clinic (ANC) attendance alone is not sufficient to ensure high IPT coverage. Staff shortages, poor drug supply, poor ANC access and poor health worker practices are some of the operational challenges in delivering IPT. CONCLUSION: Country experiences show that IPT can be introduced and scaled up relatively quickly and effectively where there is political will, effective integration between malaria and reproductive health programmes, adequate funding and drug supply, high ANC attendance and community receptiveness. There is however urgent need to better document best practices and lessons as a basis for developing simplified guidelines for dissemination to countries embarking on IPT implementation.

Africa South of the Sahara↗
PubMed2006

Comparative efficacy of chloroquine and sulphadoxine--pyrimethamine in pregnant women and children: a meta-analysis.

OBJECTIVE: To compare the efficacy of chloroquine and sulphadoxine-pyremethamine against Plasmodium falciparum infection in pregnant women and in children from the same endemic areas of Africa, with the aim of determining the level of correspondence in efficacy determinations in these two risk groups. METHODS: Meta-analysis of nine published and unpublished in vivo antimalarial efficacy studies in pregnant women and in children across five African countries. RESULTS: Pregnant women (all gravidae) were more likely to be sensitive than children to both chloroquine (odds ratio: 2.07; 95% confidence interval: 1.5, 2.9) and sulphadoxine-pyrimethamine (odds ratio: 2.66; 95% confidence interval: 11.1, 6.7). Pregnant women demonstrated an almost uniform increased sensitivity for peripheral parasite clearance at day 14 compared with children. This finding was consistent across a wide range of drug sensitivities. Primigravidae at day 14 showed lower clearance to antimalarial drugs than multigravidae (P<0.05). There was no significant difference between parasite clearance in primigravidae and in children. CONCLUSION: The greater drug sensitivity in pregnant women probably indicates differences in host susceptibility rather than parasite resistance. Parasite sensitivity patterns in children may be a suitable guide to antimalarial policy in pregnant women.

Adolescent↗
PubMed2005

Experience of targeting subsidies on insecticide-treated nets: what do we know and what are the knowledge gaps?

Widespread coverage of vulnerable populations with insecticide-treated nets (ITNs) constitutes an important component of the Roll Back Malaria (RBM) strategy to control malaria. The Abuja Targets call for 60% coverage of children under 5 years of age and pregnant women by 2005; but current coverage in Africa is unacceptably low. The RBM 'Strategic Framework for Coordinated National Action in Scaling-up Insecticide-Treated Netting Programmes in Africa' promotes coordinated national action and advocates sustained public provision of targeted subsidies to maximise public health benefits, alongside support and stimulation of the private sector. Several countries have already planned or initiated targeted subsidy schemes either on a pilot scale or on a national scale, and have valuable experience which can inform future interventions. The WHO RBM 'Workshop on mapping models for delivering ITNs through targeted subsidies' held in Zambia in 2003 provided an opportunity to share and document these country experiences. This paper brings together experiences presented at the workshop with other information on experiences of targeting subsidies on ITNs, net treatment kits and retreatment services (ITN products) in order to describe alternative approaches, highlight their similarities and differences, outline lessons learnt, and identify gaps in knowledge. We find that while there is a growing body of knowledge on different approaches to targeting ITN subsidies, there are significant gaps in knowledge in crucial areas. Key questions regarding how best to target, how much it will cost and what outcomes (levels of coverage) to expect remain unanswered. High quality, well-funded monitoring and evaluation of alternative approaches to targeting ITN subsidies is vital to develop a knowledge base so that countries can design and implement effective strategies to target ITN subsidies.

Africa↗
PubMed2003

A rapid assessment approach for public health decision-making related to the prevention of malaria during pregnancy.

OBJECTIVE: To develop a rapid field assessment methodology to address the burden of malaria during pregnancy and the options for intervening within the existing antenatal care system in Kenya. METHODS: Surveys consisting of questionnaires, sampling of blood for parasitaemia and anaemia, and birth outcome assessment were conducted in antenatal clinics, delivery units, and in the community in Kisumu and Mombasa, Kenya. FINDINGS: The rates of maternal anaemia and severe anaemia, were, respectively, 79% and 8% in Kisumu, and 95% and 24% in Mombasa. The rates of placental parasitaemia were 27% and 24% and the rates of low birth weight were 18% and 24% in Kisumu and Mombasa, respectively. Women with placental parasitaemia had a higher incidence of low birth weight compared with women without placental parasitaemia in both Kisumu (28% vs 16%, P=0.004) and Mombasa (42% vs 20%, P=0.004). A total of 95% and 98% of women in Kisumu and Mombasa, respectively, reported attending an antenatal clinic during their previous pregnancy. CONCLUSION: This methodology can be used by ministries of health to collect data for decision-making regarding malaria control during pregnancy; it can also provide a baseline measurement on which to evaluate subsequent interventions.

Adult↗