Prof. Johanna Hanefeld, PhD, Centre for international health protection, Robert-Koch-Institute

Health-systems and community-based factors involved in STH infections, particularly relevant Ascaris infections, are key to combat the diseases especially in children, including to ensuring that no one is left behind. While mass administered public health interventions showed positive results, variability in success needs to be better understood, as it has been inferred that health systems access, social determinants, e.g., low income, but also other covariants for burden, e.g., chemotherapy (1), cause decisive differences. Kenya has implemented and evaluated coverage of its STH infection program for over a decade (2), however, also here variability in implementation is still observed as shown by us previously (3). The pathways through which social determinants affect health outcomes remain however elusive. The present project will answer following open questions: i) what are the barriers and enablers for health systems access at community level for Ascaris infections in selected high burden settings and how these are enabled by different models of health service provision? ii) which is the social and economic distribution of Ascaris infections, and which social determinant affect the STH infection control programs in the communities? We will build on our expertise in the conceptualization of health systems as complex adaptive systems, where access to and quality of services received depends on the dynamic interaction between health care workers and patients (4-6). DR1 will focus on STH infections at the health systems/services level in Kenya, whereas DR2 will be concerned with effects at the community level and how to address these through better interventions in Kenya.

References:
1) Sartorius et al. 2021, doi: 10.1016/S2214-109X(20)30398-3; 2) Mwandawiro, et al. 2019, doi: 10.1186/s13071-019-3322-1; 3) Okoyo et al. 2020, doi: 10.1371/journal.pntd.0008604; 4) Hanefeld et al. 2017, doi: 10.2471/BLT.16.179309; 5) Hanefeld et al. 2018, doi: 10.1093/heapol/czx183; 6) Topp et al. 2015, doi: 10.1093/heapol/czu029.