Preventing Importation of Poliovirus in the Horn of Africa: The Success of the Cross-Border Health Initiative in Kenya and Somalia
Preventing Importation of Poliovirus in the Horn of Africa: The Success of the Cross-Border Health Initiative in Kenya and Somalia
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DOI：
10.4269/ajtmh.19-0040
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发表时间：
2019-01-01
影响因子：
3.3
通讯作者：
Stamidis, Katherine V.
中科院分区：
文献类型：
--
作者：
Arale, Ahmed;Lutukai, Mercy;Stamidis, Katherine V.
2013年，非洲之角(HOA)爆发了野生脊髓灰质炎病毒(WPV)，引发了国家和区域为中断持续传播而采取的积极、协调的应对措施。肯尼亚、索马里、埃塞俄比亚、南苏丹和其他HOA国家都有一系列导致疫情爆发的复杂因素：边境漏洞百出、人口稀少、武装冲突造成的不安全以及卫生系统薄弱，卫生设施持续资源不足，导致流动人口的低质量护理和免疫覆盖率低。因此，WPV输入的持续风险需要跨国界和跨部门的合作。有必要在国家以下一级评估和解决持续存在的沟通差距，以提高免疫复盖率和监测活动的吸引力。本文描述了一种使对话和促进进程制度化的系统办法，以便在肯尼亚和索马里之间建立一个可持续和有效的联合跨界卫生平台。它审查了一种称为跨境卫生倡议(CBHI)的业务模式，以支持国家间的联合协作和协调努力。为了评估CBHI的进展情况，作者使用了常规免疫和补充免疫活动(脊髓灰质炎)的人口覆盖率调查数据，急性弛缓性麻痹(AFP)监测数据，以及边境地区和边境卫生设施制定的计划数据。经过项目培训的社区卫生志愿人员一直是难以到达的社区和卫生设施之间的关键纽带，也是支助人手不足的卫生设施的极好资源。作者得出结论，CBHI在加强边境地区的免疫覆盖率、疾病监测和快速暴发反应方面是有效的。CBHI有潜力解决其他超越国界的公共卫生威胁。
In 2013, the outbreak of wild poliovirus (WPV) in the Horn of Africa (HOA) triggered an aggressive, coordinated national and regional response to interrupt continued transmission. Kenya, Somalia, Ethiopia, South Sudan, and other HOA countries share a range of complex factors that enabled the outbreak: porous and sparsely populated borders, insecurity due to armed conflicts, and weak health systems with persistently under-resourced health facilities resulting in low-quality care and low levels of immunization coverage in mobile populations. Consequently, the continued risk of WPV importation demanded cross-border and intersectoral collaboration. Assessing and addressing persistent communication gaps at the subnational levels were necessary to gain traction for improved immunization coverage and surveillance activities. This article describes a systematic approach to institutionalizing processes of dialogue and facilitation that can provide for a sustainable and effective joint cross-border health platform between Kenya and Somalia. It examines an operational model called the Cross-Border Health Initiative (CBHI) to support joint intercountry collaboration and coordination efforts. To evaluate progress of the CBHI, the authors used data from population coverage surveys for routine immunization and supplemental immunization activities (for polio), from acute flaccid paralysis (AFP) surveillance, and from plans developed by border districts and border health facilities. The project-trained community health volunteers have been a critical link between the hard-to-reach communities and the health facilities as well as an excellent resource to support understaffed health facilities. The authors conclude that the CBHI has been effective in bolstering immunization coverage, disease surveillance, and rapid outbreak response in border areas. The CBHI has the potential to address other public health threats that transcend borders.