Cystic Echinococcosis: An Impact Assessment of Prevention Programs in Endemic Developing Countries in Africa, Central Asia, and South America

Table 10

Appraisal summary of Article Meeting Inclusion Criteria [15].

Population:	(i) WHO Mongolia Office; (ii) Mongolian government sectors; (iii) Local hospitals; (iv) Veterinary institutes; (v) Laboratories; (vi) Two Cystic Echinococcosis (CE) patients
Sample size:	(i) 29 private and public stakeholders
Program outputs:	Chinese Central Communist Party (CCP). National Health Committee implemented the National Control Program on Major Parasitic Diseases (2006–2015): (i) Subsidized surgeries for CE patients from 2007; (ii) November 2015 State Council created a multi-stakeholder network of 30 agencies: the National Health Commission; the United Front Work Department of the Communist Party of China (CPC) Central Committee; the Central Comprehensive Management Office; the National Development and Reform Commission; and the Ministry of Education; (iii) March 2017: 10 Chinese government departments formed a Steering Working Group in the Tibet Autonomous Region, Sichuan Tibetan Area; Yushu and Guoluo Prefecture in Qinghai Province; Multiple CCP ministries and commissions implemented an integrated national plan for major parasitic disease control (2016–2020): (i) Dog and livestock management; (ii) Public health education; (iii) Human patient treatment and surveillance; The Ministry of Health, Mongolia (2017): (i) Issued “Technical Guidelines for Zoonotic Disease” Prevention and Control, which encompassed specific guidelines for CE
Study design:	Qualitative case study
Program outcome and impact:	March 2018 qualitative field research: (i) Focus group discussions and in-depth interviews conducted by Chinese public health practitioners; (ii) Participants expressed opinions on China-Mongolia collaboration and discussed program themes: challenges, funding gaps, training, medical diagnostic methods, and presence of field controls
Main findings:	Secondary findings Mongolia: (i) Focused on treatment versus preventative dog management, which resulted in underreporting and under diagnosis; (ii) Issues with Mongolian program implementation and coordination due to multiple stakeholders: The Ministry of Health, hospitals, zoonotic health centers, and veterinary departments; Primary qualitative research (interview responses,): (i) 79.3% not aware of the national plan for infectious disease control; (ii) 44.8% stated limited funding was a challenge for control; (iii) Two participants claimed that the government and international agencies’ research funding reduced monetary constraints; (iv) 58.6% concluded that there are no CE field control efforts; (v) 75.9% received no training associated with CE in the last 5 years (e.g., respondents from the WHO Mongolia Office, Mongolian government sectors, local hospitals, veterinary institutes, and laboratories); (vi) Two clinical doctors stated diagnosis was based upon experience vs. following WHO-Informal Working Group on Echinococcosis (IWGE) ultrasound cyst staging; Proposed challenges and solutions: (i) 8 proposed more government engagement; (ii) 10 identified low public awareness; (iii) 17 identified insufficient capacity; (iv) 22 proposed establishing a national strategy, which encompassed routine disease surveillance and technical support from China; Group discussions: (i) Limited nationwide disease surveillance and associated distribution mapping; (ii) Poor management of stray dogs; (iii) Inadequate diagnostic tools for humans and dogs; (iv) Praziquantel and albendazole viewed as an obstruction to control; (v) High drug costs; Recommendations: (i) Mongolia led, China supported, bilateral cooperation. China prepares formal documents and aids in developing technical guidelines and standards; (ii) China-Mongolia cross sector collaboration (e.g., disciplines: medicine, veterinary, parasitology, and epidemiology) and government departments (e.g., public health, quarantine, and animal health) to share technology, technical and project management skills, information, and resources; (iii) Integrating CE control with other dog transmitted, neglected zoonoses (e.g., rabies), to improve efficiency and reduce costs; (iv) Cross-sectional population survey to create a disease baseline; (v) Dog management: de-worming and registration; (vi) Financial support; (vii) Public health education; (viii) Strengthen existing surveillance systems; (ix) Increase physical and economic access to affordable drugs
Limitations:	(i) No clear research question; (ii) Only sampled participants from Mongolia; (iii) Research bias: no information on the types of survey, focus group or interview questions (e.g., open ended or closed); number of participants in each focus group; ethics statement; or how surveys were delivered (e.g., verbal, written, and online); (iv) Unequal respondent demographics: no survey, interview, or focus group representation of health organizations, apart from the WHO Mongolia office. Only two CE patient participants; (v) Research bias: authors work within research centers, government bodies, and/or for the WHO, which funds control programs; (vi) Some results are not readily comparable, due to context specific nature of case study designs