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Table 1 Linkage between different outcomes related to different control measures to be integrated within the primary health care system, at the health centre (HC) level

From: Integration of schistosomiasis control activities within the primary health care system: a critical review

Outcomes Household level Community level Health centre level
Proximal outcomesa
 Diagnosis and treatment (HC-based)d Improved health care-seeking at HC Community ownership/community participation to improve the disease related situation directly and/or via health committee; referral of suspicious cases to the HC for early diagnosis and treatment (D/T) Staff ownership; early detection of positive cases; treatment of all positive cases; referral of complicated cases
 Health educatione Early recognition of signs and symptoms; improved health care-seeking at HC Community ownership/community participation to improve the disease related situation directly and/or via health committee; early recognition of suspicious cases; referral of suspicious cases to the HC for early D/T Staff ownership; early detection of positive cases; treatment of all non-complicated cases; referral of complicated cases
 Snail controle Community ownership/community participation to improve the disease related situation (by regular contribution to the mollusciciding activities) directly and/or via health committee; improved environment Reduction of snails in water used by people (by mollusciciding activities); improved environment (by regular mollusciciding activities);
 Clean water supply and sanitatione Community ownership/community participation to improve the disease-related situation by behaviour change (avoiding contact and defecating/urinating in/near water, use of latrines) and direct contribution to the construction activities; improved environment Staff ownership; improved environment
Intermediate outcomesb Improved knowledge, attitude and practice; improved coverage in D/T; and improved access to health care (i.e. availability and financial accessibility) Improved knowledge, attitude and practice; improved coverage in D/T; and improved access to health care (i.e. availability and financial accessibility) Improved knowledge, attitude and practice; improved coverage in D/T; and improved access to health care (i.e. availability and financial accessibility)
Distal outcomesc Reduction in schistosomiasis prevalence; reduction in schistosomiasis incidence; and reduction in schistosomiasis-related mortality Reduction in schistosomiasis prevalence; reduction in schistosomiasis incidence; and reduction in schistosomiasis-related mortality Reduction in schistosomiasis prevalence; reduction in schistosomiasis incidence; and reduction in schistosomiasis-related mortality
  1. aProximal outcomes are different according to the control measure considered and the levels
  2. bIntermediate outcomes are identical, regardless of the control measure considered and the levels. They are all common consequence/result of different proximal outcomes, which interact with each other, in synergistic way
  3. cDistal outcomes are identical, regardless of the control measure considered and the levels. They constitute common consequences/results of different intermediate outcomes, that interact with each other, in synergistic way. They constitute the health impact of an intervention (programme activities)
  4. dDiagnosis and treatment (HC-based) is a prerequisite control measure at the health centre level, for the integration of any other control measure
  5. eHealth education, Snail control and Clean water supply and sanitation are different control measures to be integrated within the primary health care system, especially at the health centre