Thomas Druetz | Université de Montréal (original) (raw)

Papers by Thomas Druetz

American Journal of Tropical Medicine and Hygiene, 2023

Targeting malaria interventions in elimination settings where transmission is heterogeneous is es... more Targeting malaria interventions in elimination settings where transmission is heterogeneous is essential to ensure the efficient use of resources. Identifying the most important risk factors among persons experiencing a range of exposure can facilitate such targeting. A cross-sectional household survey was conducted in Artibonite, Haiti, to identify and characterize spatial clustering of malaria infections. Household members (N 5 21,813) from 6,962 households were surveyed and tested for malaria. An infection was defined as testing positive for Plasmodium falciparum by either a con- ventional or novel highly sensitive rapid diagnostic test. Seropositivity to the early transcribed membrane protein 5 antigen 1 represented recent exposure to P. falciparum. Clusters were identified using SaTScan. Associations among individual, household, and environmental risk factors for malaria, recent exposure, and living in spatial clusters of these outcomes were evaluated. Malaria infection was detected in 161 individuals (median age: 15 years). Weighted malaria prevalence was low (0.56%; 95% CI: 0.45–0.70%). Serological evidence of recent exposure was detected in 1,134 individuals. Bed net use, household wealth, and elevation were protective, whereas being febrile, over age 5 years, and living in either households with rudimentary wall material or farther from the road increased the odds of malaria. Two predominant over- lapping spatial clusters of infection and recent exposure were identified. Individual, household, and environmental risk factors are associated with the odds of individual risk and recent exposure in Artibonite; spatial clusters are primarily associated with household-level risk factors. Findings from serology testing can further strengthen the targeting of interventions.

Targeting malaria interventions in elimination settings where transmission is heterogeneous is es... more Targeting malaria interventions in elimination settings where transmission is heterogeneous is essential to ensure the efficient use of resources. Identifying the most important risk factors among persons experiencing a range of exposure can facilitate such targeting. A cross-sectional household survey was conducted in Artibonite, Haiti, to identify and characterize spatial clustering of malaria infections. Household members (N 5 21,813) from 6,962 households were surveyed and tested for malaria. An infection was defined as testing positive for Plasmodium falciparum by either a conventional or novel highly sensitive rapid diagnostic test. Seropositivity to the early transcribed membrane protein 5 antigen 1 represented recent exposure to P. falciparum. Clusters were identified using SaTScan. Associations among individual, household, and environmental risk factors for malaria, recent exposure, and living in spatial clusters of these outcomes were evaluated. Malaria infection was detected in 161 individuals (median age: 15 years). Weighted malaria prevalence was low (0.56%; 95% CI: 0.45-0.70%). Serological evidence of recent exposure was detected in 1,134 individuals. Bed net use, household wealth, and elevation were protective, whereas being febrile, over age 5 years, and living in either households with rudimentary wall material or farther from the road increased the odds of malaria. Two predominant overlapping spatial clusters of infection and recent exposure were identified. Individual, household, and environmental risk factors are associated with the odds of individual risk and recent exposure in Artibonite; spatial clusters are primarily associated with household-level risk factors. Findings from serology testing can further strengthen the targeting of interventions.

BMC Health Services Research, 2023

Background Improving infant immunization completion and promoting equitable vaccination coverage ... more Background Improving infant immunization completion and promoting equitable vaccination coverage are crucial to reducing global under-5 childhood mortality. Although there have been hypotheses that the impact of the COVID-19 pandemic would decrease the delivery of health services and immunization campaigns in low-and middleincome countries, the available evidence is still inconclusive. We conducted a study in rural Burkina Faso to assess changes in vaccination coverage during the pandemic. A secondary objective was to examine long-term trends in vaccination coverage throughout 2010-2021. Methods Using a quasi-experimental approach, we conducted three rounds of surveys (2019, 2020, 2021) in rural Burkina Faso that we pooled with two previous rounds of demographic and household surveys (2010, 2015) to assess trends in vaccination coverage. The study population comprised infants aged 0-13 months from a sample of 325 households randomly selected in eight districts (n = 736). We assessed vaccination coverage by directly observing the infants' vaccination booklet. Effects of the pandemic on infant vaccination completion were analyzed using multi-level logistic regression models with random intercepts at the household and district levels.

Critical Public Health, 2023

The COVID-19 pandemic in the Canadian province of Quebec has increased demand for labour in long-... more The COVID-19 pandemic in the Canadian province of Quebec has
increased demand for labour in long-term care facilities, or ‘Centre
d’hébergement de soins de longue durée (CHSLDs)’. This study explored
the challenges experienced by Certified Nurse Assistants (CNAs) in
CHSLDs in Montreal, Quebec’s largest city, during the COVID-19 pandemic
and how these challenges affected their job retention.

Reproductive Health, 2022

Background In 2019, Burkina Faso was one of the first countries in Sub-Saharan Africa to introduc... more Background In 2019, Burkina Faso was one of the first countries in Sub-Saharan Africa to introduce a free family planning (FP) policy. This process evaluation aims to identify obstacles and facilitators to its implementation, examine its coverage in the targeted population after six months, and investigate its influence on the perceived quality of FP services. Methods This process evaluation was conducted from November 2019 through March 2020 in the two regions of Burkina Faso where the new policy was introduced as a pilot. Mixed methods were used with a convergent design. Semi-directed interviews were conducted with the Ministry of Health (n = 3), healthcare workers (n = 10), and women aged 15–49 years (n = 10). Surveys were also administered to the female members of 696 households randomly selected from four health districts (n = 901). Results Implementation obstacles include insufficient communication, shortages of consumables and contraceptives, and delays in reimbursement from ...

Additional file 1. Questionnaire used to record consultation details at health facility or commun... more Additional file 1. Questionnaire used to record consultation details at health facility or community health worker site.

Additional file 2. Codes.

Additional file 1. Interviews and focus groups guides.

Additional file 1. Fittings to Two-Component Finite Mixture Models for Antigen Data Collected by ... more Additional file 1. Fittings to Two-Component Finite Mixture Models for Antigen Data Collected by both Assay Protocols and Sample Types for Low Seroprevalence Antigens. Histograms are displayed for log-transformed MFI-bg values for the four least immunogenic malaria antigens as fit to a two-component finite mixture model. On each panel, estimates for lognormal mean and variance are displayed for the two components.

Additional file 2. Maximum Likelihood Estimates from Finite Mixture Model Comparing Standard to O... more Additional file 2. Maximum Likelihood Estimates from Finite Mixture Model Comparing Standard to OneStep Protocols and Serum to Blood Elutions from Haiti Samples.

Additional file 1. Â Interview guide for key informant interviews.

Additional file 7. ROC curves for recall of blood test, recall of positive blood test, recall of ... more Additional file 7. ROC curves for recall of blood test, recall of positive blood test, recall of malaria diagnosis by clinician, and recall of any anti-malarial being prescribed.

Additional file 4. Random effects multivariate logistic regression models of sensitivity, specifi... more Additional file 4. Random effects multivariate logistic regression models of sensitivity, specificity and accuracy of caregiver recall of treatment with ACT, corrected by visual aids, prescriptions and packaging.

Additional file 4. Increasing Incubation Times for the OneStep Assay Increases MFI-bg Assay Signa... more Additional file 4. Increasing Incubation Times for the OneStep Assay Increases MFI-bg Assay Signal for Selected Malaria Antigens. Hyperimmune serum for malaria antigens was serially-diluted and incubated for 15, 30, 60, or 90Â min with OneStep protocol, or assayed with standard protocol.

Background: Every year 40,000 people die of malaria in Burkina Faso. In 2010, the Burkinabe ̀ aut... more Background: Every year 40,000 people die of malaria in Burkina Faso. In 2010, the Burkinabe ̀ authorities implemented a national malaria control program that provides for the distribution of mosquito nets and the home-based treatment of children with fever by community health workers. The objective of this study was to measure the implementation fidelity of this program. Methods:We conducted a case study in two comparable districts (Kaya and Zorgho). Data were collected one year after the program’s implementation through field observations (10 weeks), documentary analysis, and individual interviews with stakeholders (n = 48) working at different levels of the program. The analysis framework looked at the fidelity of (i) the intervention’s content, (ii) its coverage, and (iii) its schedule. Results: The program’s implementation was relatively faithful to what was originally planned and was comparable in the two districts. It encountered certain obstacles in terms of the provision of ...

La disparition de la communaute en sante publique et sante mondiale : origine semantique, pragmat... more La disparition de la communaute en sante publique et sante mondiale : origine semantique, pragmatique ou contextuelle 1 ? Valery Ridde 2 Thomas Druetz 3 « Tendance lourde » disent souvent les experts en sondage et autres specialistes du marketing. Dans le domaine de la sante publique, au sens large du terme, il nous semble deceler depuis plusieurs annees une evaporation, non seulement du terme de sante communautaire, mais plus simplement de celui de communaute. Dans ce texte qui n'a pas d'autres pretentions que de partager une reflexion, on ne reviendra pas sur les definitions conceptuelles ou theoriques de la communaute, ou de leur implication pour les interventions, des auteurs plus qualifies que nous, en ont fait l'analyse depuis longtemps (Saillant, 2004 ; Vibert, 2006 ; Vibert et autres, 2012). On tentera plus modestement d'evoquer que la sante communautaire, ou plus largement la place de la communaute en sante publique, reste, au pire en declin, et au mieux, en...

BMC Health Services Research, 2020

Background Over the past decade, an increasing number of low- and middle-income countries have re... more Background Over the past decade, an increasing number of low- and middle-income countries have reduced or removed user fees for pregnant women and/or children under five as a strategy to achieve universal health coverage. Despite the large number of studies (including meta-analyses and systematic reviews) that have shown this strategy’s positive effects impact on health-related indicators, the repercussions on women’s empowerment or gender equality has been overlooked in the literature. The aim of this study is to systematically review the evidence on the association between user fee policies in low- and middle-income countries and women’s empowerment. Methods A systematic scoping review was conducted. Two reviewers conducted the database search in six health-focused databases (Pubmed, CAB Abstracts, Embase, Medline, Global Health, EBM Reviews) using English key words. The database search was conducted on February 20, 2020, with no publication date limitation. Qualitative analysis o...

BMC Public Health, 2020

Background Prompt and effective malaria diagnosis and treatment is a cornerstone of malaria contr... more Background Prompt and effective malaria diagnosis and treatment is a cornerstone of malaria control. Case management guidelines recommend confirmatory testing of suspected malaria cases, then prescription of specific drugs for uncomplicated malaria and for severe malaria. This study aims to describe case management practices for children aged 1–59 months seeking treatment with current or recent fever from public and private, rural and urban health providers in Mali. Methods Data were collected at sites in Sikasso Region and Bamako. Health workers recorded key information from the consultation including malaria diagnostic testing and result, their final diagnosis, and all drugs prescribed. Children with signs of severe diseases were ineligible. Consultations were not independently observed. Appropriate case management was defined as both 1) tested for malaria using rapid diagnostic test or microscopy, and 2) receiving artemisinin combination therapy (ACT) and no other antimalarials i...

Emerging Infectious Diseases, 2020

American Journal of Tropical Medicine and Hygiene, 2023

Targeting malaria interventions in elimination settings where transmission is heterogeneous is es... more Targeting malaria interventions in elimination settings where transmission is heterogeneous is essential to ensure the efficient use of resources. Identifying the most important risk factors among persons experiencing a range of exposure can facilitate such targeting. A cross-sectional household survey was conducted in Artibonite, Haiti, to identify and characterize spatial clustering of malaria infections. Household members (N 5 21,813) from 6,962 households were surveyed and tested for malaria. An infection was defined as testing positive for Plasmodium falciparum by either a conventional or novel highly sensitive rapid diagnostic test. Seropositivity to the early transcribed membrane protein 5 antigen 1 represented recent exposure to P. falciparum. Clusters were identified using SaTScan. Associations among individual, household, and environmental risk factors for malaria, recent exposure, and living in spatial clusters of these outcomes were evaluated. Malaria infection was detected in 161 individuals (median age: 15 years). Weighted malaria prevalence was low (0.56%; 95% CI: 0.45-0.70%). Serological evidence of recent exposure was detected in 1,134 individuals. Bed net use, household wealth, and elevation were protective, whereas being febrile, over age 5 years, and living in either households with rudimentary wall material or farther from the road increased the odds of malaria. Two predominant overlapping spatial clusters of infection and recent exposure were identified. Individual, household, and environmental risk factors are associated with the odds of individual risk and recent exposure in Artibonite; spatial clusters are primarily associated with household-level risk factors. Findings from serology testing can further strengthen the targeting of interventions.

BMC Health Services Research, 2023

Critical Public Health, 2023

Reproductive Health, 2022

Additional file 2. Codes.

Additional file 1. Interviews and focus groups guides.

Additional file 1. Â Interview guide for key informant interviews.

BMC Health Services Research, 2020

BMC Public Health, 2020

Emerging Infectious Diseases, 2020

Thèse de doctorat (Ph. D.) en santé publique

Context. In Burkina Faso, malaria causes approximately 25,000 deaths every year in children under... more Context. In Burkina Faso, malaria causes approximately 25,000 deaths every year in children under five. In 2010, national health authorities introduced case management of malaria by community health workers (CHWs) as a way to increase prompt access to effective treatments. While this strategy’s efficacy has been demonstrated in controlled
studies, very few studies evaluated its effectiveness under real-world and nation-wide conditions of implementation.
Objective. The overarching aim of this thesis is to evaluate the effects of the Burkinabè program on treatment-seeking practices in febrile children. The specific objectives are: (1) to examine CHWs’ perceptions and investigate the contextual factors likely to affect their performance; (2) to estimate the use of CHWs in febrile children and its determinants; (3) to evalauate changes in treatment-seeking practices induced by the introduction of a concomitant intervention – the removal of user fees at health centres.
Methods. The study was conducted in two similar health districts, Kaya and Zorgho. The evaluation design integrates quantitative and qualitative components. Interviews were carried out with all CHWs in the study area (N=27). Surveys were repeated every year from 2011 to 2013 in 3002 randomly selected households. Treatment-seeking practices of all children with a recent sickness episode (N2011=707; N2012=787; N2013=831) were examined.
Results. Results show that the use of CHWs is really low in comparison to previous controlled studies. Feasibility issues in urban areas and barriers to implementation of the community case management of malaria programme were identified. Moreover, its effectiveness in rural areas was challenged by the removal of user fees at health centres.
Conclusion. In Burkina Faso, community case management of malaria faces serious challenges of feasibility and implentation. These challenges compromise the programme’s potential to reduce child morbidity and mortality. The lack of integration between the programme and local concomitant interventions can generate unpredicted adverse effects.

Des idées reçues en santé mondiale, 2015

Les agents de santé communautaires ont pour mission d’améliorer la santé de la population dans le... more Les agents de santé communautaires ont pour mission d’améliorer la santé de la population dans leur village. Ils partagent deux caractéristiques essentielles : (1) ils proviennent du village où ils opèrent et (2) ils reçoivent une formation ad hoc de courte durée, de quelques jours à quelques semaines tout au plus. Les ASC sont souvent considérés comme le prolongement du système de santé dans les villages, même si, dans la plupart des cas, ils ne font pas partie de la fonction publique, ils ne reçoivent pas de salaire officiel et leurs actes ne sont pas réglementés.

La santé communautaire dans tous ses états, 2016

« Tendance lourde » disent souvent les experts en sondage et autres spécialistes du marketing. Da... more « Tendance lourde » disent souvent les experts en sondage et autres spécialistes du marketing. Dans le domaine de la santé publique, au sens large du terme, il nous semble déceler depuis plusieurs années une évaporation, non seulement du terme de santé communautaire, mais plus simplement de celui de communauté. Dans ce texte qui n’a pas d’autres prétentions que de partager une réflexion, on ne reviendra pas sur les définitions conceptuelles ou théoriques de la communauté, ou de leur implication pour les interventions, des auteurs plus qualifiés que nous, en ont fait l’analyse depuis longtemps (Saillant, 2004 ; Vibert, 2006 ; Vibert et autres, 2012). On tentera plus modestement d’évoquer que la santé communautaire, ou plus largement la place de la communauté en santé publique, reste, au pire en déclin, et au mieux, encore à la marge du courant dominant d’une santé publique technocratique. Pour ce faire, on prendra deux exemples tirés de contextes que nous connaissons relativement bien et au sein desquels nous sommes impliqués, soit l’enseignement à l’Université de Montréal et la recherche en Afrique de l’Ouest. On évoquera donc ici la santé publique et la santé mondiale, mettant de côté les débats sur leur différentiation avec la santé communautaire et la promotion de la santé que nous avons évoquée ailleurs (Ridde, 2007 ; Ridde, 2013), mais nous y reviendrons.

4th Global Symposium on Health Systems Research

2017 Annual Meeting of the ASTMH

2016 Annual Meeting of the ASTMH

3rd Global Symposium on Health Systems Research