Community-based interventions found valuable
Systematic reviews look at impact on diseases of poverty
A series of 8 systematic reviews evaluating the evidence on community-based interventions has been published in the Journal of Infectious Diseases of Poverty. It finds significant reductions in disease prevalence and increased prevention and control with this approach. It also makes recommendations for where this could be most useful, identifies challenges and policy implications, and lists areas where more research is still needed.
Even though there are many effective and simple interventions and tools, delivery to the affected populations has proven difficult due to weak public health systems in many developing countries. Community-based delivery platforms are increasingly being proposed not only to ensure sustainability and combat co-infections, but also to build capacity to integrate care among the various programmes.
While many previous reviews described the process and effectiveness of integrated community-based interventions under real life field conditions, this series of papers, commissioned by TDR and financially supported by the European Union, evaluates how well the interventions improve disease or prevention outcomes.
The authors systematically analysed existing literature on community-based interventions for the “neglected tropical diseases”, as well as for malaria, tuberculosis and HIV/AIDS. The work was led by Zulfiqar A. Bhutta, Chair of the Department of Paediatrics and Child Health at The Aga Khan University in Pakistan. Professor Bhutta’s systematic review group is the most recognized and productive team now in a developing country, with 12 Cochrane reviews published in 2010-11 alone.
Mothers’ and childrens’ health is improved
The review found that adding interventions into the existing community-delivered programmes at schools (since children bear the major burden of these diseases) and immunization campaigns was effective. School-based platforms significantly reduced soil-transmitted helminths’ prevalence and intensity, as well as the incidence of schistosomiasis and anemia.
Community programmes were also successful in insecticide spraying, delivery of insecticide-treated nets and curtains, and educating the community. Malaria and anemia prevalence were reduced, and the qualitative synthesis suggests that higher coverage for net distribution and preventive treatment for pregnant women (IPT) could be achieved at a lower cost with community-based systems.
The review found overall that community delivery platforms offer a unique opportunity to reach the vulnerable and inaccessible groups, and recommended future studies to evaluate the impact of these strategies on morbidity and mortality outcomes, and to integrate management of the neglected tropical diseases into other better-resourced programmes for mutual and maximum benefit.
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