William Brieger

Johns Hopkins University | JHU · Department of International Health

Background The double burden of malnutrition among children remains a public health challenge in South Africa. In response, the government of South Africa developed the National Health Policy and Implementation Guidelines for school-going children in 2003. This policy was subsequently upgraded to ‘The Integrated School Health Programme’ in 2012. An...

Background In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged by the worst Ebola epidemic in history from 2014 to 2016. T...

Background: Community health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes are...

Background: Community health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes ar...

Background Subsequent to the demonstrated potential of community health workers (CHWs) in strengthening health systems to improve health outcomes, recent literature has defined context and guidelines for integrating CHW programs into mainstream health systems. However, quantitative measures for assessing the extent of CHW program integration into n...

Background The paucity of Human Resources for Health (HRH) is a major global health challenge. The World Health Organization (WHO) recognizes the potentials that Community Health Workers (CHWs) have in closing the gap of an inadequate supply of human resources for health (HRH). However, weak CHW integration into national health systems curtails eff...

Background Recent global reports highlighted the importance of addressing the quality of care in all settings including fragile and conflict-affected situations (FCS), as a central strategy for the attainment of sustainable development goals and universal health coverage. Increased mortality burden in FCS reflects the inability to provide routine s...

Background : Recent global reports highlighted the importance of addressing the quality of care in all settings including fragile and conflict-affected situations (FCS), as a central strategy for the attainment of sustainable development goals and universal health coverage. Increased mortality burden in FCS reflects the inability to provide routine...

Background Measuring and improving equitable access to care is a necessity to achieve universal health coverage. Pre-pandemic estimates showed that most conflict-affected and fragile situations were off-track to meet the Sustainable Development Goals on health and equity by 2030. Yet, there is a paucity of studies examining health inequalities in t...

Background Measuring and improving equitable access to care is a necessity to achieve universal health coverage. Pre-pandemic estimates showed that most conflict-affected and fragile situations were off-track to meet the Sustainable Development Goals on health and equity by 2030. Yet, there is a paucity of studies examining health inequalities in t...

Background: The effectiveness of community health workers (CHWs) in delivering community-based preventive services is often curtailed by inadequate or complete lack of integration of the CHW programmes into national health systems. Although literature has defined the context and guidelines for integrating CHW programmes into health systems, indicat...

Background Burkina Faso is among ten countries with the highest rates of malaria cases and deaths in the world. Delivery and coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) is insufficient in Burkina Faso; In a 2016 survey, only 22% of eligible women had received their third dose of IPTp. It is also an extremely rural c...

Background Partial artemisinin resistance is suspected if delayed parasite clearance (ie, persistence of parasitaemia on day 3 after treatment initiation) is observed. Validated markers of artemisinin partial resistance in southeast Asia, Plasmodium falciparum kelch13 (Pfkelch13) R561H and P574L, have been reported in Rwanda but no association with...

Background In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations’ characteristics, determine their perception on the current health services, an...

Abstract Background Malaria in pregnancy is responsible for 8–14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine–pyrimethamine be administered at each ANC visit starting as ea...

Background: Malaria in pregnancy is responsible for 8–14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine be administered at each ANC visit starting as early as p...

Background: Malaria in pregnancy is responsible for 8–14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine be administered at each ANC visit starting as early as p...

Background Malaria in pregnancy is responsible for 8–14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine be administered at each ANC visit starting as early as po...

Background Access to community-based healthcare services is one of the key characteristics in successful public health policy. In Mali, community-based interventions do not reach nomadic communities, remote and hard-to-reach areas. Methods: In order to determine a better healthcare strategy for these nomadic populations, we conducted a cross-sectio...

Background: Patent medicine vendors (PMVs) is one of a major source of medicines for ailments in Nigeria. Criticism of PMVs focuses on drug quality, dispensing practices, and their lack of formal health care training. While studies in African context have documented the customer-PMV interactions, and the economic behavior of PMVs, there is dearth o...

World Malaria Day 2019 stresses that each person and organization needs to make the effort to reach zero malaria transmission. World Health Day in 2019 also highlights the importance of universal health coverage (UHC). The article reviews the progress towards UHC for malaria interventions.

As the proportion of actual malaria cases among febrile illness patients declines, concern has risen that transmission might continue among people with subclinical or asymptomatic malaria. Here we explore the extent of this problem and new directions in parasitological testing needed to ensure continued progress toward elimination in each endemic c...

Eight countries in the Sahel region of West Africa are embarking on a joint venture known as the Sahel Malaria Elimination Initiative (SaME). They are mirroring a similar effort known as the Elimination Eight by eight countries in the southern African region. These efforts are bolstered by a 2017 malaria elimination framework document by the World...

Malaria and food security are health and development issues that have appeared together in global frameworks since at least 1978. This paper starts by reviewing the three most well-known frameworks, and then continues by examining the functional connections as to how these affect people and programmes in malaria endemic areas.

The Concept of Primary Health Care (PHC) was formalized in 1978 when The World Health Organization and UNICEF convened a major conference in the then Alma Ata in Kazakhstan. The resulting Alma Ata Declaration resulted in advocacy for Health for All, which had evolved into Universal Health Coverage. The Declaration outlined important principles such...

Background • Malaria is the leading cause of consultation, hospitalization and death in Burkina Faso. • In 2015, the health management information system reported 23,634 severe malaria cases at referral hospitals among them, 1,634 deaths. • Since 2014, IMC has provided support to the national malaria control program (NMCP) to train 1,819 providers,...

Malaria is preventable and treatable, yet remains the most prevalent parasitic endemic disease in Africa. This article analyzes prospective observational data from the Malaria Awareness Program (MAP), an interactive malaria education initiative led by home-based care workers to improve participant knowledge of malaria as a precursor to increased up...

The evidence continues to point to a warming of the Earth. Professor Bill Brieger looks at the initial likely winners and losers of the malaria transmission map across Africa Climate itself is a basic determinant of the distribution of malaria in the world. s the UU enters for isease ontrol ann reeention) eeplainss liiate can innuence all three coo...

Ayo Ojebode Interviews William Brieger about his community intervention work while working at the University of Ibadan

Feature Asymptomatic malaria Asymptomatic and submicroscopic malaria: the danger in the cases we don't see William R Brieger discusses the complexities that the end-game in the defeat of malaria is going to have to face.

The goals of finding ‘efficient, cheap, and safe’ antimalarial drugs whilst ensuring efficacious combinations is needed to fight the threat of growing artemisinin resistance. It appears that CQ and its analogues may have a second chance at saving lives.

Background: The need to expand malaria diagnosis alongside policy requirements for mandatory testing before treatment motivates exploration of non-invasive rapid diagnostic tests (RDTs). We report the outcome of the first cross-sectional, single-blind clinical performance evaluation of a Urine Malaria Test (UMT) for Plasmodium falciparum ( Pf ) mal...

Background: Throughout Nigeria malaria is an endemic disease. Efforts to treat malaria can also be combined with other illnesses including pneumonia and diarrhea, which are killing children under five years of age. The use of Rapid Diagnostic Test (RDT) aids early diagnosis of malaria and informs when other illnesses should be considered. Those wi...

Despite a stated goal of achieving universal coverage, the National Health Insurance Scheme of Nigeria had achieved only 4% coverage 12 years after it was launched. This study assessed the plans of the National Health Insurance Scheme to achieve universal health insurance coverage in Nigeria by 2015 and discusses the challenges facing the scheme in...

In 2010, at the same time as the national roll out of the Free Health Care Initiative (FHCI), which removed user fees for facility based health care, trained community health volunteers (CHVs) were deployed to provide integrated community case management of diarrhea, malaria and pneumonia to children under 5 years of age (U5) in Kambia and Pujehun...

Background: Nutrition interventions targeting the first 1000 days show promise to improve nutritional status, but they require effective implementation. Formative research is thus invaluable for developing such interventions, but there have been few detailed studies that describe this phase of work within the Scaling Up Nutrition (SUN) movement....

Community-directed interventions (CDIs) have the potential for fulfilling the promise of primary health care by reaching underserved populations in various settings. CDI has been successfully tested by expanding access to additional health services like malaria case management through local effort in communities where ivermectin distribution is ong...

A paucity of skilled health providers is a considerable impediment to reducing maternal, infant, and under-five mortality for many low-resource countries. Although evidence supports the effectiveness of community health workers (CHWs) in delivering primary healthcare services, shifting tasks to this cadre from providers with advanced training has b...

Malaria continues to be a life-threatening illness throughout Sub-Saharan Africa, with pregnant women and children being particularly vulnerable and an estimated 10 000 women and 200 000 newborns dying each year as a result of malaria in pregnancy (MIP). Since 2004, WHO has supported a three-pronged MIP approach: (1) intermittent preventive treatme...

The doubly labeled water (DLW) method is used to measure free-living energy expenditure in humans. Inherent to this technique is the assumption that natural abundances of stable isotopes (2)H and (18)O in body water remain constant over the course of the measurement period and after elimination of the loading dose of doubly-labeled water will retur...

Community-directed interventions (CDIs) have the potential for fulfilling the promise of primary health care by reaching underserved populations in various settings. CDI has been successfully tested by expanding access to additional health services like malaria case management through local effort in communities where ivermectin distribution is ong...

Despite recent improvements in malaria prevention strategies, malaria case management remains a weakness in Northern Nigeria, which is underserved and suffers the country's highest rates of under-five child mortality. Understanding malaria care-seeking patterns and comparing case management outcomes to World Health Organization (WHO) and Nigeria's...

Seeking of appropriate and quality care for childhood illnesses is a major challenge in much of Africa including Bauchi State, Nigeria. In advance of an intervention to improve available care in the most common points of service (POS), government primary health care centers (PHCs) and patent medicine vendors (PMV), a survey was done of child caregi...

Objective To examine whether community health volunteers induced significant changes in care seeking and treatment of ill children under five 2 years after their deployment in two underserved districts of Sierra Leone.MethodsA pre-test–post-test study with intervention and comparison groups was used. A household cluster survey was conducted among c...

Background: Pregnant women and infants are particularly vulnerable to malaria. National malaria in pregnancy (MIP) programs in Malawi, Senegal, and Zambia were reviewed to identify promising strategies that have helped these countries achieve relatively high coverage of MIP interventions as well as ongoing challenges that have inhibited further pr...

Standard health-service delivery aimed toward improving maternal and childhealth status remains elusive in Nigeria because of inaccuracies in data documentation leading to a lack of relatively stable evidence. Through a community-health project, this study tested the accuracy of record keeping in primary healthcare services in nine clinics run in I...

In Nigeria malaria causes approximately 11% of maternal deaths. Malaria is responsible for 63% of hospital admissions and 70% of illness among pregnant women. While intermittent preventive treatment (IPTp) and Long Lasting Insecticide-treated Nets (LLINs) are supposed to be given to pregnant women to prevent the disease, coverage is poor. Unfortuna...

To investigate the characteristics of women in Nigeria who are likely to take sulfadoxine/pyrimethamine (SP) as recommended for the prevention of malaria in pregnancy to reduce maternal and child mortality rates. A cross-sectional survey of 1380 women was conducted using a structured questionnaire. The women had given birth within 6months prior to...

Newly affluent developing world cities increasingly adopt the same unfortunate low-density suburban paradigm that shaped cities in the industrialized world. Identified by a World Bank report as a "mini-Los Angeles," Kuala Lumpur is a sentinel example of the results of unrestrained sprawl in the developing world. Factors driving sprawl included gove...

Evidence suggests that while efforts are made to reduce the burden of uncomplicated malaria, many children and others die of other febrile illness . Therefore, integrated case management of febrile illness is being promoted with early and proper diagnosis of malaria using rapid diagnostic test kits (RDTs) or microscopy. The studey intended to asses...

Malaria has seen a steady decline in Rwanda, yet certain vulnerable groups such as pregnant women experience life-threatening episodes of malaria. In order to move closer to malaria elimination, Rwanda needed an accurate estimate of prevalence of malaria in pregnancy. A sample of 4050 newly pregnant women was chosen in six districts and 38 antenata...

Addressing malaria in pregnancy requires urgent attention to a number of issues. Key among these is assisting partnerships to support national policies and activities for increasing coverage of malaria prevention and care for pregnant womenwith a focus on national guidance and standard operating procedures, facilitating coordination between the mal...

To assess individual compliance with annual ivermectin treatment in onchocerciasis-endemic villages. Multi-site study in eight APOC-sponsored projects in Cameroon, Nigeria and Uganda to identify the socio-demographic correlates of compliance with ivermectin treatment. A structured questionnaire was administered on 2305 persons aged 10 years and abo...