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Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Rural Madagascar.
Rakotonanahary, Rado J L; Andriambolamanana, Herinjaka; Razafinjato, Benedicte; Raza-Fanomezanjanahary, Estelle M; Ramanandraitsiory, Vero; Ralaivavikoa, Fiainamirindra; Tsirinomen'ny Aina, Andritiana; Rahajatiana, Lea; Rakotonirina, Luc; Haruna, Justin; Cordier, Laura F; Murray, Megan B; Cowley, Giovanna; Jordan, Demetrice; Krasnow, Mark A; Wright, Patricia C; Gillespie, Thomas R; Docherty, Michael; Loyd, Tara; Evans, Michelle V; Drake, John M; Ngonghala, Calistus N; Rich, Michael L; Popper, Stephen J; Miller, Ann C; Ihantamalala, Felana A; Randrianambinina, Andriamihaja; Ramiandrisoa, Bruno; Rakotozafy, Emmanuel; Rasolofomanana, Albert; Rakotozafy, Germain; Andriamahatana Vololoniaina, Manuela C; Andriamihaja, Benjamin; Garchitorena, Andres; Rakotonirina, Julio; Mayfield, Alishya; Finnegan, Karen E; Bonds, Matthew H.
  • Rakotonanahary RJL; PIVOT NGO, Ranomafana, Madagascar.
  • Andriambolamanana H; PIVOT NGO, Ranomafana, Madagascar.
  • Razafinjato B; PIVOT NGO, Ranomafana, Madagascar.
  • Raza-Fanomezanjanahary EM; Madagascar Ministry of Public Health, Antananarivo, Madagascar.
  • Ramanandraitsiory V; PIVOT NGO, Ranomafana, Madagascar.
  • Ralaivavikoa F; PIVOT NGO, Ranomafana, Madagascar.
  • Tsirinomen'ny Aina A; PIVOT NGO, Ranomafana, Madagascar.
  • Rahajatiana L; PIVOT NGO, Ranomafana, Madagascar.
  • Rakotonirina L; PIVOT NGO, Ranomafana, Madagascar.
  • Haruna J; PIVOT NGO, Ranomafana, Madagascar.
  • Cordier LF; PIVOT NGO, Ranomafana, Madagascar.
  • Murray MB; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States.
  • Cowley G; PIVOT NGO, Ranomafana, Madagascar.
  • Jordan D; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States.
  • Krasnow MA; Centre Valbio, Ranomafana, Madagascar.
  • Wright PC; Department of Biochemistry, Stanford University, Stanford, CA, United States.
  • Gillespie TR; Centre Valbio, Ranomafana, Madagascar.
  • Docherty M; Institute for the Conservation of Tropical Environments, Stony Brook University, Stony Brook, NY, United States.
  • Loyd T; Department of Anthropology, Stony Brook University, Stony Brook, NY, United States.
  • Evans MV; Centre Valbio, Ranomafana, Madagascar.
  • Drake JM; Department of Environmental Sciences and Program in Population Biology, Ecology, and Evolutionary Biology, Emory University, Atlanta, GA, United States.
  • Ngonghala CN; Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
  • Rich ML; Centre Valbio, Ranomafana, Madagascar.
  • Popper SJ; PIVOT NGO, Ranomafana, Madagascar.
  • Miller AC; Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, United States.
  • Ihantamalala FA; Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, United States.
  • Randrianambinina A; Department of Mathematics, University of Florida, Gainesville, FL, United States.
  • Ramiandrisoa B; Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States.
  • Rakotozafy E; Center for African Studies, University of Florida, Gainesville, FL, United States.
  • Rasolofomanana A; PIVOT NGO, Ranomafana, Madagascar.
  • Rakotozafy G; Brigham and Women's Hospital, Boston, MA, United States.
  • Andriamahatana Vololoniaina MC; Partners in Health, Boston, MA, United States.
  • Andriamihaja B; PIVOT NGO, Ranomafana, Madagascar.
  • Garchitorena A; Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States.
  • Rakotonirina J; PIVOT NGO, Ranomafana, Madagascar.
  • Mayfield A; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States.
  • Finnegan KE; PIVOT NGO, Ranomafana, Madagascar.
  • Bonds MH; Centre Valbio, Ranomafana, Madagascar.
Front Public Health ; 9: 654299, 2021.
Article in English | MEDLINE | ID: covidwho-1348570
ABSTRACT
There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district-community, primary care centers, hospital-including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Diagnostic study / Observational study Topics: Vaccines Limits: Humans Language: English Journal: Front Public Health Year: 2021 Document Type: Article Affiliation country: Fpubh.2021.654299

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Diagnostic study / Observational study Topics: Vaccines Limits: Humans Language: English Journal: Front Public Health Year: 2021 Document Type: Article Affiliation country: Fpubh.2021.654299