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Papers by Moussa Sarr

Frontiers in Public Health

Behavior change communication (BCC) strategies have the potential to improve infant feeding and n... more Behavior change communication (BCC) strategies have the potential to improve infant feeding and nutrition outcomes among infants and young children in low- and middle-income countries. More recently, there has been a shift toward the adoption of mHealth interventions—the use of mobile phones to transmit health-related information or direct care—to promote recommended BCC strategies among the caregivers of infants and young children. In Senegal, most infants and young children are not fed according to recommended practices leading to a high prevalence of undernutrition and micronutrient deficiencies. The aims of this cluster randomized control trial, using an effectiveness-implementation (type 1) hybrid design, were to: (1) determine the impact of an mHealth IYCF intervention on IYCF practices and nutrition outcomes; and (2) examine the implementation, costs, and opportunities for scaling up the mHealth messaging intervention. The trial was conducted in three regions in Senegal (Thie...

BMJ open, Apr 1, 2024

Objectives Community health workers are essential to front-line health outreach throughout low-in... more Objectives Community health workers are essential to front-line health outreach throughout low-income and middle-income countries, including programming for early childhood immunisation. Understanding how community health workers are engaged for successful early childhood vaccination among countries who showed success in immunisation coverage would support evidence-based policy guidance across contexts. Design We employed a multiple case study design using qualitative research methods. Setting We conducted research in Nepal, Senegal and Zambia. Participants We conducted 207 interviews and 71 focus group discussions with 678 participants at the national, regional, district, health facility and community levels of the health systems of Nepal, Senegal and Zambia, from October 2019 to April 2021. We used thematic analysis to investigate contributing factors of community health worker programming that supported early childhood immunisation within each country and across contexts. Results Implementation of vaccination programming relied principally on the (1) organisation, (2) motivation and (3) trust of community health workers. Organisation was accomplished by expanding cadres of community health workers to carry out their roles and responsibilities related to vaccination. Motivation was supported by intrinsic and extrinsic incentives. Trust was expressed by communities due to community health worker respect and value placed on their work. Conclusion Improvements in immunisation coverage was facilitated by community health worker organisation, motivation and trust. With the continued projection of health worker shortages, especially in low-income countries, community health workers bridged the equity gap in access to vaccination services by enabling wider reach to underserved populations. Although improvements in vaccination programming were seen in all three countries-including government commitment to addressing human resource deficits, training and remuneration; workload, inconsistency in compensation, training duration and scope, and supervision remain major challenges to immunisation programming. Health decision-makers should consider organisation, motivation and trust of community health workers to improve the implementation of immunisation programming. ⇒ This study involved different stakeholders in immunisation programming from the national, regional, health facility and community level, thus, gaining diverse perspectives and insights on immunisation. ⇒ The research team was multidisciplinary, and our team ensured involvement of all stakeholders in the design, implementation and the dissemination of this project. ⇒ The research tools focused on the factors that drove catalytic change and did not focus on interventions or policies that were unsuccessful. ⇒ The understanding of historical events using qualitative research methods was challenging; interviewees focused on current experiences rather than discussions on historical factors. ⇒ COVID-19 pandemic impacted data collection as the stakeholders shifted focus to COVID-19 response and participants prioritised their safety over data collection.

BMJ Open, Apr 1, 2022

Exemplars in vaccine delivery protocol: a case-study-based identification and evaluation of criti... more Exemplars in vaccine delivery protocol: a case-study-based identification and evaluation of critical factors in achieving high and sustained childhood immunisation coverage in selected low-income and lower-middle-income countries. BMJ Open 2022;12:e058321.

medRxiv (Cold Spring Harbor Laboratory), Mar 7, 2023

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Journal of AIDS and HIV Research, May 31, 2011

A better understanding of the significance and determinants of loss of follow-up and key potentia... more A better understanding of the significance and determinants of loss of follow-up and key potential related outcome measures, such as death and missed study visit would assist program evaluation and provide basis for future interventions. Senegal has one of Africa's lowest HIV/AIDS infection rate, less than 1%. But vulnerable groups such as sex workers have higher HIV prevalence. Currently, HIV infection among legal sex workers in Dakar has risen to 27.1%, compared to 1% 20 years ago, (Fact sheet, 2004). The prostitution in Senegal has been regulated since 1969. Sex workers register at public health clinics like ours, where they receive photo identity cards and make monthly visits for medical checkups. However, many operate outside the system. We estimate that more than 80% of Senegal sex workers do not register. In a retrospective cohort analysis, loss of follow-rates and death were assessed among HIV infected female sex workers receiving antiretroviral drugs at the "Institute d'Hygiene Social" (IHS) of Dakar, Senegal. Records of 74 HIV infected female sex workers receiving antiretroviral treatment, and followed at the IHS from April 2001 to August 2008 were reviewed. Overall, 15 patients (20.3%) died and 42 (57%) were lost during an average follow-up period of 26 months (SD = 18.9). The mean age of patients was 46.6 years old (SD = 7.8) and the mean CD4 count at entry was 215 (SD = 68.6). Using Cox Regression models, we did not find a significant relationship between age, ethnicity, CD4 count at entry or HIV-1 vs. HIV-2 type and loss of follow-up. These findings indicate the need to obtain better longitudinal follow-up data for optimal assessment of the reasons for loss-of follow up among HIV infected female sex workers receiving ARV in Senegal.

Annals of Epidemiology, Sep 1, 2009

American Journal of Epidemiology, 2007

Nature Communications

Monitoring subnational healthcare quality is important for identifying and addressing geographic ... more Monitoring subnational healthcare quality is important for identifying and addressing geographic inequities. Yet, health facility surveys are rarely powered to support the generation of estimates at more local levels. With this study, we propose an analytical approach for estimating both temporal and subnational patterns of healthcare quality indicators from health facility survey data. This method uses random effects to account for differences between survey instruments; space-time processes to leverage correlations in space and time; and covariates to incorporate auxiliary information. We applied this method for three countries in which at least four health facility surveys had been conducted since 1999 – Kenya, Senegal, and Tanzania – and estimated measures of sick-child care quality per WHO Service Availability and Readiness Assessment (SARA) guidelines at programmatic subnational level, between 1999 and 2020. Model performance metrics indicated good out-of-sample predictive val...

IntroductionCommunity health workers are essential to frontline health outreach throughout low- a... more IntroductionCommunity health workers are essential to frontline health outreach throughout low- and middle-income countries, including programming for early childhood immunization. The World Health Organization estimates a projected shortage of 18 million health workers by 2030. Understanding how community health workers are engaged for successful early childhood vaccination among countries who showed success in immunization coverage would support evidence-based policy guidance across contexts. To that end, we identified factors of community health worker programs that contributed to improved vaccination coverage in Nepal, Senegal, and Zambia.MethodsWe conducted interviews and focus group discussions at the national, regional, district, health facility, and community levels of the health systems of Nepal, Senegal, and Zambia, and used thematic analysis to investigate contributing factors of community health worker programming that supported early childhood immunization within each c...

Having a geolocated list of all facilities in a country – a “master facility list” (MFL) – can pr... more Having a geolocated list of all facilities in a country – a “master facility list” (MFL) – can provide critical inputs for health program planning and implementation. To the best of our knowledge, Senegal has never had a centralized MFL, though many data sources currently exist within the broader Senegalese data landscape that could be leveraged and consolidated into a single database – a critical first step toward building a full MFL. We collated 12,965 facility observations from 16 separate datasets and lists in Senegal, and applied matching algorithms, manual checking and revisions as needed, and verification processes to identify unique facilities and triangulate corresponding GPS coordinates. Our resulting consolidated facility list has a total of 4,685 facilities, with 2,423 having at least one set of GPS coordinates. Developing approaches to leverage existing data toward future MFL establishment can help bridge data demands and inform more targeted approaches for completing a...

Tropical Medicine & International Health, 2020

ObjectivesScaling up of point‐of‐care testing (POCT) for early infant diagnosis of HIV (EID) coul... more ObjectivesScaling up of point‐of‐care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost‐effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems.MethodsWe modelled a quality assurance system‐raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1‐year impact and cost‐effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false‐positive diagnoses.ResultsThe modell...

IntroductionThe fundamental components of a vaccine delivery system are well-documented, but robu... more IntroductionThe fundamental components of a vaccine delivery system are well-documented, but robust evidence is needed onhowthe related processes and implementation strategies - including the facilitators and barriers-contribute to improvements in childhood vaccination coverage. The purpose of this study was to identify critical facilitators and barriers to the implementation of common interventions across three countries that have dramatically increased coverage of early childhood vaccination over the past 20 years, and to qualify common or divergent themes in their success.MethodsWe conducted 277 key informant interviews and focus group discussions with public health leaders at the regional, district, and local levels and community members in Nepal, Senegal, and Zambia to identify intervention activities and the facilitators and barriers to implementation. We used thematic analysis grounded in the Consolidated Framework for Implementation Research (CFIR) to identify immunization p...

Vaccine: X, 2023

Background: The essential components of a vaccine delivery system are well-documented, but robust... more Background: The essential components of a vaccine delivery system are well-documented, but robust evidence is lacking on how policies and implementation strategies are operationalized to drive catalytic improvements in coverage. To address this gap, we identified success factors that supported improvements in routine immunization coverage in Senegal, especially from 2000 to 2019. Methods: We identified Senegal as an exemplar in the delivery of childhood vaccines through analysis of DTP1 and DTP3 coverage data. Through interviews and focus group discussions at the national, regional, district, health facility, and community-level, we investigated factors that contributed to high and sustained vaccination coverage. We conducted a thematic analysis through application of implementation science frameworks to determine critical success factors. We triangulated these findings with quantitative analyses using publicly available data. Results: The following success factors emerged: 1) Strong political will and prioritization of resources for immunization programming supported urgent allocation of funding and supplies; 2) Collaboration between the Ministry of Health and Social Action and external partners fostered innovation, capacity building, and efficiency; 3) Improved surveillance, monitoring, and evaluation allowed for timely and evidence-based decision making; 4) Community ownership of vaccine service delivery supported tailored programming and response to local needs; and 5) Community health workers spearheaded vaccine promotion and demand generation for vaccines. Conclusion: The vaccination program in Senegal was supported by evidence-based decision making at the national-level, alignment of priorities between governmental entities and external partners, and strong community engagement initiatives that fostered local ownership of vaccine delivery and uptake. High routine immunization coverage was likely driven by prioritization of immunization programming, improved surveillance systems, a mature and reliable community health worker program, and tailored strategies for addressing geographical, social, and cultural barriers.

Monitoring healthcare quality at a subnational resolution is key to identify and resolve geograph... more Monitoring healthcare quality at a subnational resolution is key to identify and resolve geographic inequities and ensure that no sub-population is left behind. Yet, health facility surveys are typically not powered to report reliable estimates at a subnational scale.In this study, we present a framework to fill this gap and jointly analyse publicly available facility survey data, allowing exploration of temporal trends and subnational disparities in healthcare quality metrics. Specifically, our Bayesian hierarchical model includes random effects to account for differences between survey instruments; space-time processes to leverage correlations in space and time; and covariates to incorporate auxiliary information. We apply this framework to Kenya, Senegal, and Tanzania - three countries with at least four rounds of standardized facility surveys each – and estimate the readiness and process quality of sick-child care over time and across subnational areas.These estimates of readine...

medRxiv (Cold Spring Harbor Laboratory), Apr 28, 2022

IntroductionIncreases in global childhood vaccine delivery have led to decreases in morbidity fro... more IntroductionIncreases in global childhood vaccine delivery have led to decreases in morbidity from vaccine-preventable diseases. However, these improvements in vaccination have been heterogeneous, with some countries demonstrating greater levels of change and sustainability. Understanding what these high-performing countries have done differently and how their decision-making processes will support targeted improvements in childhood vaccine delivery.Methods and analysisWe studied three countries - Nepal, Senegal, Zambia - with exemplary improvements in coverage between 2000-2018 as part of the Exemplars in Global Health Program. We apply established implementation science frameworks to understand the “how” and “why” underlying improvements in vaccine delivery and coverage. Through mixed methods research we will identify drivers of catalytic change in vaccine coverage and the decision-making process supporting these interventions and activities. Methods include quantitative analysis ...

BMJ Global Health, 2021

How has COVID-19 impacted the delivery of routine immunizations? What steps has your country take... more How has COVID-19 impacted the delivery of routine immunizations? What steps has your country taken to mitigate these challenges? BACKGROUND The COVID-19 pandemic has substantially affected routine immunization services in countries around the world. To minimize the negative effects of these disruptions, countries are working to maintain or resume key immunization services. Our hope is to learn the strategies and steps that individual countries are taking, so that these best practices can be shared more broadly.

MMWR. Morbidity and Mortality Weekly Report, Nov 29, 2019

Journal of Adolescent Health, 2001

BACKGROUNDThe essential components of a vaccine delivery system are well-documented, but robust e... more BACKGROUNDThe essential components of a vaccine delivery system are well-documented, but robust evidence is lacking on how policies and implementation strategies are operationalized to drive catalytic improvements in coverage. To address this gap, we identified success factors that supported improvements in routine immunization coverage in Senegal, especially from 2000 to 2019.METHODSWe identified Senegal as an exemplar in the delivery of childhood vaccines through analysis of DTP1 and DTP3 coverage data. Through interviews and focus group discussions at the national, regional, district, health facility, and community-level, we investigated factors that contributed to high and sustained vaccination coverage. We conducted a thematic analysis through application of implementation science frameworks to determine critical success factors. We triangulated these findings with quantitative analyses using publicly available data.RESULTSThe following success factors emerged: 1) Strong politi...