Browsing by Person "King, Carina"

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Enablers and barriers to implementing cholera interventions in Nigeria: a community–based system dynamics approach
(Oxford University Press (OUP), 2024-07-26) Elimian, Kelly; Diaconu, Karin; Ansah, John; King, Carina; Dewa, Ozius; Yennan, Sebastian; Gandi, Benjamin; Forsberg, Birger Carl; Ihekweazu, Chikwe; Alfvén, Tobias
Nigeria accounts for a substantial cholera burden globally, particularly in its northeast region, where insurgency is persistent and widespread. We used participatory group model building (GMB) workshops to explore enablers and barriers to implementing known cholera interventions, including water, sanitation, and hygiene (WASH), surveillance and laboratory, case management, community engagement, oral cholera vaccine, and leadership and coordination, as well as explore leverage points for interventions and collaboration. The study engaged key cholera stakeholders in the northeastern states of Adamawa and Bauchi, as well as national stakeholders in Abuja. Adamawa and Bauchi States’ GMB participants comprised 49 community members and 43 healthcare providers, while the 23 national participants comprised government ministry, department and agency staff, and development partners. Data were analysed thematically and validated via consultation with selected participants. The study identified four overarching themes regarding the enablers and barriers to implementing cholera interventions: (1) political will, (2) health system resources and structures, (3) community trust and culture, and (4) spill-over effect of COVID-19. Specifically, inadequate political will exerts its effect directly (e.g., limited funding for prepositioning essential cholera supplies) or indirectly (e.g., overlapping policies) on implementing cholera interventions. The healthcare system structure (e.g., centralisation of cholera management in a state capital) and limited surveillance tools weaken the capacity to implement cholera interventions. Community trust emerges as integral to strengthening the healthcare system’s resilience in mitigating the impacts of cholera outbreaks. Lastly, the spill-over effects of COVID-19 helped promote interventions similar to cholera (e.g., WASH) and directly enhanced political will. In conclusion, the study offers insights into the complex barriers and enablers to implementing cholera interventions in Nigeria’s cholera-endemic settings. Strong political commitment, strengthening the healthcare system, building community trust, and an effective public health system can enhance the implementation of cholera interventions in Nigeria.
External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia
(International Society of Global Health, 2021-10-09) Rees, Chris A.; Hooli, Shubhada; King, Carina; McCollum, Eric D.; Colbourn, Tim; Lufesi, Norman; Mwansambo, Charles; Lazzerini, Marzia; Madhi, Shabir Ahmed; Cutland, Clare; Nunes, Marta; Gessner, Bradford D.; Basnet, Sudha; Kartasasmita, Cissy B.; Mathew, Joseph L.; Zaman, Syed Mohammad Akram uz; Paranhos-Baccala, Glaucia; Bhatnagar, Shinjini; Wadhwa, Nitya; Lodha, Rakesh; Aneja, Satinder; Santosham, Mathuram; Picot, Valentina S.; Sylla, Mariam; Awasthi, Shally; Bavdekar, Ashish; Pape, Jean-William; Rouzier, Vanessa; Chou, Monidarin; Rakoto-Andrianarivelo, Mala; Wang, Jianwei; Nymadawa, Pagbajabyn; Vanhems, Philippe; Russomando, Graciela; Asghar, Rai; Banajeh, Salem; Iqbal, Imran; MacLeod, William; Maulen-Radovan, Irene; Mino, Greta; Saha, Samir; Singhi, Sunit; Thea, Donald M.; Clara, Alexey W.; Campbell, Harry.; Nair, Harish; Falconer, Jennifer; Williams, Linda J.; Horne, Margaret; Strand, Tor; Qazi, Shamim A.; Nisar, Yasir B.; Neuman, Mark I.
Background Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores. Methods We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules. Results The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73). Conclusions In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting.
Influences of community engagement and health system strengthening for cholera control in cholera reporting countries
(BMJ Publishing Group, 2023-12-06) Baličević, Stephanie Ayres; Elimian, Kelly Osezele; King, Carina; Diaconu, Karin; Akande, Oluwatosin Wuraola; Ihekweazu, Vivianne; Trolle, Hanna; Gaudenzi, Giulia; Forsberg, Birger; Alfven, Tobias
The 2030 Global Task Force on Cholera Control Roadmap hinges on strengthening the implementation of multistranded cholera interventions, including community engagement and health system strengthening. However, a composite picture of specific facilitators and barriers for these interventions and any overlapping factors existing between the two, is lacking. Therefore, this study aims to address this shortcoming, focusing on cholera-reporting countries, which are disproportionately affected by cholera and may be cholera endemic. A scoping methodology was chosen to allow for iterative mapping, synthesis of the available research and to pinpoint research activity for global and local cholera policy-makers and shareholders. Using the Arksey and O’Malley framework for scoping reviews, we searched PubMed, Web of Science and CINAHL. Inclusion criteria included publication in English between 1990 and 2021 and cholera as the primary document focus in an epidemic or endemic setting. Data charting was completed through narrative descriptive and thematic analysis. Forty-four documents were included, with half relating to sub-Saharan African countries, 68% (30/44) to cholera endemic settings and 21% (9/44) to insecure settings. We identified four themes of facilitators and barriers to health systems strengthening: health system cooperation and agreement with external actors; maintaining functional capacity in the face of change; good governance, focused political will and sociopolitical influences on the cholera response and insecurity and targeted destruction. Community engagement had two themes: trust building in the health system and growing social cohesion. Insecurity and the community; cooperation and agreement; and sociopolitical influences on trust building were themes of factors acting at the interface between community engagement and health system. Given the decisive role of the community–health system interface for both sustained health system strengthening and community engagement, there is a need to advocate for conflict resolution, trust building and good governance for long-term cholera prevention and control in cholera reporting countries.