Implementation and Utilization of Security Assistance: A Multi-Country Analysis

DTIC Science & Technology

2015-09-01

related to this procurement (The Hague, 2012). The purchase of surplus Leopard battle tanks and other vehicles from Germany in 2012 confirmed a new... related programs NATO North Atlantic Treaty Organization NESA Near East South Asia OCO overseas contingency operations P&A price and...countries. B. RESEARCH QUESTIONS This project addresses several questions related to the implementation and use of security assistance programs. The

Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

PubMed

Morisaki, N; Ganchimeg, T; Ota, E; Vogel, J P; Souza, J P; Mori, R; Gülmezoglu, A M

2014-03-01

To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. Descriptive analysis and effect estimates using multilevel logistic regression. Coverage of antibiotic prophylaxis for caesarean section. A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey; 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-eclampsia/eclampsia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study.

PubMed

Ganchimeg, T; Ota, E; Morisaki, N; Laopaiboon, M; Lumbiganon, P; Zhang, J; Yamdamsuren, B; Temmerman, M; Say, L; Tunçalp, Ö; Vogel, J P; Souza, J P; Mori, R

2014-03-01

To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health. Twenty-nine countries in Africa, Latin America, Asia and the Middle East. Women admitted for delivery in 359 health facilities during 2-4 months between 2010 and 2011. Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. Risk of adverse pregnancy outcomes among adolescent mothers. A total of 124 446 mothers aged ≤24 years and their infants were analysed. Compared with mothers aged 20-24 years, adolescent mothers aged 10-19 years had higher risks of eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra-hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 26-34 weeks was significantly lower among adolescent mothers. Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Taking innovative vector control interventions in urban Latin America to scale: lessons learnt from multi-country implementation research.

PubMed

Quintero, Juliana; García-Betancourt, Tatiana; Caprara, Andrea; Basso, Cesar; Garcia da Rosa, Elsa; Manrique-Saide, Pablo; Coelho, Giovanini; Sánchez-Tejeda, Gustavo; Dzul-Manzanilla, Felipe; García, Diego Alejandro; Carrasquilla, Gabriel; Alfonso-Sierra, Eduardo; Monteiro Vasconcelos Motta, Cyntia; Sommerfeld, Johannes; Kroeger, Axel

2017-09-01

Prior to the current public health emergency following the emergence of chikungunya and Zika Virus Disease in the Americas during 2014 and 2015, multi-country research investigated between 2011 and 2013 the efficacy of novel Aedes aegypti intervention packages through cluster randomised controlled trials in four Latin-American cities: Fortaleza (Brazil); Girardot (Colombia), Acapulco (Mexico) and Salto (Uruguay). Results from the trials led to a scaling up effort of the interventions at city levels. Scaling up refers to deliberate efforts to increase the impact of successfully tested health interventions to benefit more people and foster policy and program development in a sustainable way. The different scenarios represent examples for  a 'vertical approach' and a 'horizontal approach'. This paper presents the analysis of a preliminary process evaluation of the scaling up efforts in the mentioned cites, with a focus on challenges and enabling factors encountered by the research teams, analysing the main social, political, administrative, financial and acceptance factors.

Experiences from a pilot study on how to conduct a qualitative multi-country research project regarding use of antibiotics in Southeast Europe.

PubMed

Kaae, Susanne; Sporrong, Sofia Kälvemark; Traulsen, Janine Morgall; Wallach Kildemoes, Helle; Nørgaard, Lotte Stig; Jakupi, Arianit; Raka, Denis; Gürpinar, Emre Umut; Alkan, Ali; Hoxha, Iris; Malaj, Admir; Cantarero, Lourdes Arevalo

2016-01-01

In 2014, a qualitative multi-country research project was launched to study the reasons behind the high use of antibiotics in regions of Southeast Europe by using previously untrained national interviewers (who were engaged in other antibiotic microbial resistance-related investigations) to conduct qualitative interviews with local patients, physicians and pharmacists. Little knowledge exists about how to implement qualitative multi-country research collaborations involving previously untrained local data collectors. The aim of this paper was therefore to contribute to the knowledge regarding how to conduct these types of research projects by evaluating a pilot study of the project. Local data collectors conducted the study according to a developed protocol and evaluated the study with the responsible researcher-team from University of Copenhagen. The pilot study focused on 'local ownership', 'research quality' and 'feasibility' with regard to successful implementation and evaluation. The evaluation was achieved by interpreting 'Skype' and 'face to face' meetings and email correspondence by applying 'critical common sense'. Local data collectors achieved a sense of joint ownership. Overall, the protocol worked well. Several minor challenges pertaining to research quality and feasibility were identified, in particular obtaining narratives when conducting interviews and recruiting patients for the study. Furthermore, local data collectors found it difficult to allocate sufficient time to the project. Solutions were discussed and added to the protocol. Despite the challenges, it was possible to achieve an acceptable scientific level of research when conducting qualitative multi-country research collaboration under the given circumstances. Specific recommendations to achieve this are provided by the authors.

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study

PubMed Central

Anderson, Peter; O'Donnell, Amy; Kaner, Eileen; Gual, Antoni; Schulte, Bernd; Pérez Gómez, Augusto; de Vries, Hein; Natera Rey, Guillermina; Rehm, Jürgen

2017-01-01

Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1 st December 2017. PMID:29188013

Implementing large-scale programmes to optimise the health workforce in low- and middle-income settings: a multicountry case study synthesis.

PubMed

Gopinathan, Unni; Lewin, Simon; Glenton, Claire

2014-12-01

To identify factors affecting the implementation of large-scale programmes to optimise the health workforce in low- and middle-income countries. We conducted a multicountry case study synthesis. Eligible programmes were identified through consultation with experts and using Internet searches. Programmes were selected purposively to match the inclusion criteria. Programme documents were gathered via Google Scholar and PubMed and from key informants. The SURE Framework - a comprehensive list of factors that may influence the implementation of health system interventions - was used to organise the data. Thematic analysis was used to identify the key issues that emerged from the case studies. Programmes from Brazil, Ethiopia, India, Iran, Malawi, Venezuela and Zimbabwe were selected. Key system-level factors affecting the implementation of the programmes were related to health worker training and continuing education, management and programme support structures, the organisation and delivery of services, community participation, and the sociopolitical environment. Existing weaknesses in health systems may undermine the implementation of large-scale programmes to optimise the health workforce. Changes in the roles and responsibilities of cadres may also, in turn, impact the health system throughout. © 2014 John Wiley & Sons Ltd.

Tuberculosis and latent tuberculous infection screening of migrants in Europe: comparative analysis of policies, surveillance systems and results.

PubMed

Kunst, H; Burman, M; Arnesen, T M; Fiebig, L; Hergens, M-P; Kalkouni, O; Klinkenberg, E; Orcau, À; Soini, H; Sotgiu, G; Zenner, D; de Vries, G

2017-08-01

Migration patterns into and within Europe have changed over the last decade. In 2015, European Union (EU) countries received over 1.2 million asylum requests, more than double the number registered in the previous year. This review compares the published literature on policies for tuberculosis (TB) and latent tuberculous infection (LTBI) screening in EU and European Free Trade Association (EFTA) countries with the existing TB/LTBI screening programmes for migrants in 11 EU/EFTA countries based on a survey of policy and surveillance systems. In addition, we provide a systematic review of the literature on the yield of screening migrants for active TB and LTBI in Europe. Published studies provide limited information about screening coverage and the yield of screening evaluations in EU/EFTA countries. Furthermore, countries use different screening strategies and settings, and different definitions for coverage and yield of screening for active TB and LTBI. We recommend harmonising case definitions, reporting standards and policies for TB/LTBI screening. To achieve TB elimination targets, a European platform for multi-country data collection and analysis, sharing of countries' policies and practices, and harmonisation of migrant screening strategies is needed.

Effects of planned, mistimed and unwanted pregnancies on the use of prenatal health services in sub-Saharan Africa: a multicountry analysis of Demographic and Health Survey data.

PubMed

Amo-Adjei, Joshua; Anamaale Tuoyire, Derek

2016-12-01

We analysed the extent of planned, mistimed and unwanted pregnancies and how they predict optimal use of prenatal (timing and number of antenatal) care services in 30 African countries. We pooled data from Demographic and Health Surveys conducted in 30 African countries between 2006 and 2015. We described the extent of mistimed and unwanted pregnancies and further used mixed effects logistic and Poisson regression estimation techniques to examine the impacts of planned, mistimed and unwanted pregnancies on the use of prenatal health services. In total, 73.65% of pregnancies in all countries were planned. Mistimed pregnancy ranged from 7.43% in Burkina Faso to 41.33% in Namibia. Unwanted pregnancies were most common in Swaziland (39.54%) and least common in Niger (0.74%). Timely (first trimester) initiation of ANC was 37% overall in all countries; the multicountry average number of ANC visits was optimal [4.1; 95% CI: 4.1-4.2] but with notable disparities between countries. Overall, mistimed and unwanted pregnancies were strongly associated with late ANC attendance and fewer visits women made in the pooled analysis. Unintended pregnancies are critical risks to achieving improved maternal health in respect of early and optimal ANC coverage for women in Africa. Programmes targeted at advancing coverage of ANC in Africa need to deploy contextually appropriate mechanisms to prevent unintended pregnancies. © 2016 John Wiley & Sons Ltd.

Institutional frameworks for management of epizoonotic emergencies in six countries in the Eastern Africa region: a situational analysis.

PubMed

Bazeyo, W; Mayega, Roy W; Nabukenya, I; Keyyu, J; Mamuya, S; Tabu, S J; Senna, L; Mohammad, M; Rugigana, E; Alingi, A; Mapatano, M; Kiguli, J; Orach, C G; Burnham, G; Killewo, J

2013-06-01

The Eastern Africa region is a hot-spot for epidemics of emerging zoonotic diseases ('epizoonotics'). However, the region's capacity for response to epidemics of zoonotic origin has not been documented. This paper presents a multi-country situational analysis on the institutional frameworks for management of zoonotic epidemics in the Eastern Africa region. A multi-country assessment of 6 country teams was conducted (Uganda, Kenya, Tanzania, Ethiopia, DRC and Rwanda). It involved a review of records and interviews with key informants from agencies with a stake in the management of zoonotic and disasters in general in the respective countries. Qualitative data were analyzed for key emerging themes. There are many socio-cultural risk factors to epidemic prone zoonotic diseases in the region. Countries have varying levels of preparedness for zoonotic emergencies. All 6 countries have a framework for disaster management. However, technical response to epidemics is managed by the line sectors, with limited Inter-sectoral collaboration. Some sectors were disproportionately more prepared than others. Surveillance systems are mostly passive and inadequate for early detection. All 6 countries have built reasonable capacity to respond to avian influenza, but not other zoonotic emergencies. Most countries lack personnel at the operational levels, and veterinary public health services are ill-facilitated. There is need to strengthen veterinary public health services at all levels, but with a 'one health' approach. There is also need to establish 'risk-based surveillance' hot spots for zoonotic epidemics and to build community resilience 'epizoonotic' diseases.

The Efficacy of Guanxinning Injection in Treating Angina Pectoris: Systematic Review and Meta-Analysis of Randomized Controlled Trials

PubMed Central

Jia, Yongliang; Leung, Siu-wai; Lee, Ming-Yuen; Cui, Guozhen; Huang, Xiaohui; Pan, Fongha

2013-01-01

Objective. The randomized controlled trials (RCTs) on Guanxinning injection (GXN) in treating angina pectoris were published only in Chinese and have not been systematically reviewed. This study aims to provide a PRISMA-compliant and internationally accessible systematic review to evaluate the efficacy of GXN in treating angina pectoris. Methods. The RCTs were included according to prespecified eligibility criteria. Meta-analysis was performed to evaluate the symptomatic (SYMPTOMS) and electrocardiographic (ECG) improvements after treatment. Odds ratios (ORs) were used to measure effect sizes. Subgroup analysis, sensitivity analysis, and metaregression were conducted to evaluate the robustness of the results. Results. Sixty-five RCTs published between 2002 and 2012 with 6064 participants were included. Overall ORs comparing GXN with other drugs were 3.32 (95% CI: [2.72, 4.04]) in SYMPTOMS and 2.59 (95% CI: [2.14, 3.15]) in ECG. Subgroup analysis, sensitivity analysis, and metaregression found no statistically significant dependence of overall ORs upon specific study characteristics. Conclusion. This meta-analysis of eligible RCTs provides evidence that GXN is effective in treating angina pectoris. This evidence warrants further RCTs of higher quality, longer follow-up periods, larger sample sizes, and multicentres/multicountries for more extensive subgroup, sensitivity, and metaregression analyses. PMID:23634167

Comparative analysis of core genome MLST and SNP typing within a European Salmonella serovar Enteritidis outbreak.

PubMed

Pearce, Madison E; Alikhan, Nabil-Fareed; Dallman, Timothy J; Zhou, Zhemin; Grant, Kathie; Maiden, Martin C J

2018-06-02

Multi-country outbreaks of foodborne bacterial disease present challenges in their detection, tracking, and notification. As food is increasingly distributed across borders, such outbreaks are becoming more common. This increases the need for high-resolution, accessible, and replicable isolate typing schemes. Here we evaluate a core genome multilocus typing (cgMLST) scheme for the high-resolution reproducible typing of Salmonella enterica (S. enterica) isolates, by its application to a large European outbreak of S. enterica serovar Enteritidis. This outbreak had been extensively characterised using single nucleotide polymorphism (SNP)-based approaches. The cgMLST analysis was congruent with the original SNP-based analysis, the epidemiological data, and whole genome MLST (wgMLST) analysis. Combination of the cgMLST and epidemiological data confirmed that the genetic diversity among the isolates predated the outbreak, and was likely present at the infection source. There was consequently no link between country of isolation and genetic diversity, but the cgMLST clusters were congruent with date of isolation. Furthermore, comparison with publicly available Enteritidis isolate data demonstrated that the cgMLST scheme presented is highly scalable, enabling outbreaks to be contextualised within the Salmonella genus. The cgMLST scheme is therefore shown to be a standardised and scalable typing method, which allows Salmonella outbreaks to be analysed and compared across laboratories and jurisdictions. Copyright © 2018. Published by Elsevier B.V.

The European Union Joint Procurement Agreement for cross-border health threats: what is the potential for this new mechanism of health system collaboration?

PubMed

Azzopardi-Muscat, Natasha; Schroder-Bäck, Peter; Brand, Helmut

2017-01-01

The Joint Procurement Agreement (JPA) is an innovative instrument for multi-country procurement of medical countermeasures against cross-border health threats. This paper aims to assess its potential performance. A literature review was conducted to identify key features of successful joint procurement programmes. Documentary analysis and a key informants' interview were carried out to analyse the European Union (EU) JPA. Ownership, equity, transparency, stable central financing, standardisation, flexibility and gradual development were identified as important prerequisites for successful establishment of multi-country joint procurement programmes in the literature while security of supply, favourable prices, reduction of operational costs and administrative burden and creation of professional expert networks were identified as desirable outcomes. The EU JPA appears to fulfil the criteria of ownership, transparency, equity, flexibility and gradual development. Standardisation is only partly fulfilled and central EU level financing is not provided. Security of supply is an important outcome for all EU Member States (MS). Price savings, reduction in administrative burden and creation of professional networks may be particularly attractive for the smaller MS. The JPA has the potential to increase health system collaboration and efficiency at EU level provided that the incentives for sustained commitment of larger MS are sufficiently attractive.

Maternal and congenital syphilis in selected Latin America and Caribbean countries: a multi-country analysis using data from the Perinatal Information System.

PubMed

Serruya, Suzanne J; Duran, Pablo; Martinez, Gerardo; Romero, Mario; Caffe, Sonja; Alonso, Monica; Silveira, Mariangela F

2015-04-01

Background Maternal syphilis has an important impact on reproductive health. In 2010, World Health Organization (WHO)/Pan American Health Organization (PAHO) member countries approved the Strategy and Plan of Action for Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in the Americas by 2015. This paper aims to describe epidemiological and programmatic characteristics related to maternal and congenital syphilis in selected countries of Latin America and Caribbean for the period 2010-12. The report is based on a multi-country, quantitative and qualitative analysis from data collected from several sources, representing a compilation of country reports from nine countries as part of the 2012 mid-term evaluation of the Strategy. Data was collected based on standardised procedures at country level. Results are variable among countries. All countries have a strategic national plan to eliminate congenital syphilis, with some distinct characteristics for each country. Protocols and guidelines for the management and treatment of maternal and congenital syphilis in all countries were updated between 2011 and 2013. A high rate of missing information for all countries for some indicators was noticed. The main limitation of the analyses is the huge amount of missing data. Countries must continue to be supported to build capacity for collecting high-quality data on intervention coverage and inequities, and to use it as a basis for decisions about how best to reach women and children with interventions. A high level political commitment is necessary to put into practice the Regional Initiative to Eliminate Congenital Syphilis, with the support of Health Ministries.

Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

PubMed

Lumbiganon, P; Laopaiboon, M; Intarut, N; Vogel, J P; Souza, J P; Gülmezoglu, A M; Mori, R

2014-03-01

To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. A total of 314 623 pregnant women admitted to the participating facilities. We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission. Amongst 314 623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589/2822; 95% CI 20.1-21.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio, aOR, 7.0; 95% CI 6.6-7.4), severe maternal outcomes (aOR 27.9; 95% CI 24.7-31.6), and perinatal mortality (aOR 3.8; 95% CI 3.5-4.1). Indirect causes were responsible for about one-fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

PubMed Central

2011-01-01

Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs). Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs) within 13 European Countries. General Practitioners (GPs) recruited consecutive patients with an acute cough. GPs completed a case report form (CRF) and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i) selecting, setting up and maintaining PCNs; ii) designing local context-appropriate data collection tools and efficient data management systems; and iii) gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i) appointing key individuals (National Network Facilitator and Coordinator) with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii) rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii) providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos, celebrating achievements, incorporating social events and prizes within meetings, and providing a framework for exploitation of local data. Conclusions Many challenges associated with multi-country primary care research can be overcome by engendering strong, effective communication, commitment and involvement of all local researchers. The practical solutions identified and the lessons learned in implementing the GRACE-01 study may assist in establishing other international primary care clinical research platforms. Trial registration ClinicalTrials.gov Identifier: NCT00353951 PMID:21794112

Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

PubMed

Vogel, J P; Souza, J P; Mori, R; Morisaki, N; Lumbiganon, P; Laopaiboon, M; Ortiz-Panozo, E; Hernandez, B; Pérez-Cuevas, R; Roy, M; Mittal, S; Cecatti, J G; Tunçalp, Ö; Gülmezoglu, A M

2014-03-01

We aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS). A total of 359 participating facilities in 29 countries. A total of 308 392 singleton deliveries. We reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions). Fresh and macerated LFDs (defined as stillbirths ≥ 1000 g and/or ≥28 weeks of gestation) and ENDs. The LFD rate was 17.7 per 1000 births; 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns; 67.1% occurred by day 3 of life. Maternal complications were present in 22.9, 27.7, and 21.2% [corrected] of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-eclampsia, eclampsia, and severe anaemia. Preventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Decomposing the gap in missed opportunities for vaccination between poor and non-poor in sub-Saharan Africa: A Multicountry Analyses.

PubMed

Ndwandwe, Duduzile; Uthman, Olalekan A; Adamu, Abdu A; Sambala, Evanson Z; Wiyeh, Alison B; Olukade, Tawa; Bishwajit, Ghose; Yaya, Sanni; Okwo-Bele, Jean-Marie; Wiysonge, Charles S

2018-04-24

Understanding the gaps in missed opportunities for vaccination (MOV) in sub-Saharan Africa would inform interventions for improving immunisation coverage to achieving universal childhood immunisation. We aimed to conduct a multicountry analyses to decompose the gap in MOV between poor and non-poor in SSA. We used cross-sectional data from 35 Demographic and Health Surveys in SSA conducted between 2007 and 2016. Descriptive statistics used to understand the gap in MOV between the urban poor and non-poor, and across the selected covariates. Out of the 35 countries included in this analysis, 19 countries showed pro-poor inequality, 5 showed pro-non-poor inequality and remaining 11 countries showed no statistically significant inequality. Among the countries with statistically significant pro-illiterate inequality, the risk difference ranged from 4.2% in DR Congo to 20.1% in Kenya. Important factors responsible for the inequality varied across countries. In Madagascar, the largest contributors to inequality in MOV were media access, number of under-five children, and maternal education. However, in Liberia media access narrowed inequality in MOV between poor and non-poor households. The findings indicate that in most SSA countries, children belonging to poor households are most likely to have MOV and that socio-economic inequality in is determined not only by health system functions, but also by factors beyond the scope of health authorities and care delivery system. The findings suggest the need for addressing social determinants of health.

Patterns of authorship on community health workers in low-and-middle-income countries: an analysis of publications (2012–2016)

PubMed Central

Maleka, Nelisiwe

2018-01-01

Introduction Studies of authorship provide a barometer of local research capacity and ownership of research, considered key to defining appropriate research priorities, developing contextualised responses to health problems and ensuring that research informs policy and practice. This paper reports on an analysis of patterns of research authorship of the now substantial literature on community health workers (CHWs) in low-and-middle-income countries (LMICs) for the 5-year period: 2012–2016. Methods A search of five databases identified a total of 649 indexed publications reporting on CHWs in LMICs and meeting the inclusion criteria. The country, region and income classification of studies, affiliations (country, organisation) of lead (first) and last authors, proportions of all authors locally affiliated, programme area (eg, maternal child health) and funding source were extracted. Results The 649 papers reported experiences from 51 countries, 55% from middle-income countries (MICs) and 32% from low-income countries (LICs), with the remaining 13% multicountry studies. Overall, 47% and 54% of all the papers had a high-income country (HIC) lead and last author, respectively. Authorship followed three patterns: (1) a concentrated HIC pattern, with US-based authors numerically dominating LIC-based and multicountry studies; (2) an MIC pattern of autonomy, with a handful of countries—India, South Africa and Brazil, in particular—leading >70% of their CHW publications and (3) a pattern of unevenness among LICs in their lead authorship of publications varying from 14% (Malawi) to 54% (Uganda). Region, programme area and funding source were all associated with the distribution of authorship across country income categories. Conclusion The findings in this analysis mirror closely that of other authorship studies in global health. Collectively these provide a common message—that investments in global health programmes in the Millennium Development Goal era may have benefited health but not necessarily capacity for knowledge generation in LMICs. PMID:29765777

Patterns of authorship on community health workers in low-and-middle-income countries: an analysis of publications (2012-2016).

PubMed

Schneider, Helen; Maleka, Nelisiwe

2018-01-01

Studies of authorship provide a barometer of local research capacity and ownership of research, considered key to defining appropriate research priorities, developing contextualised responses to health problems and ensuring that research informs policy and practice. This paper reports on an analysis of patterns of research authorship of the now substantial literature on community health workers (CHWs) in low-and-middle-income countries (LMICs) for the 5-year period: 2012-2016. A search of five databases identified a total of 649 indexed publications reporting on CHWs in LMICs and meeting the inclusion criteria. The country, region and income classification of studies, affiliations (country, organisation) of lead (first) and last authors, proportions of all authors locally affiliated, programme area (eg, maternal child health) and funding source were extracted. The 649 papers reported experiences from 51 countries, 55% from middle-income countries (MICs) and 32% from low-income countries (LICs), with the remaining 13% multicountry studies. Overall, 47% and 54% of all the papers had a high-income country (HIC) lead and last author, respectively. Authorship followed three patterns: (1) a concentrated HIC pattern, with US-based authors numerically dominating LIC-based and multicountry studies; (2) an MIC pattern of autonomy, with a handful of countries-India, South Africa and Brazil, in particular-leading >70% of their CHW publications and (3) a pattern of unevenness among LICs in their lead authorship of publications varying from 14% (Malawi) to 54% (Uganda). Region, programme area and funding source were all associated with the distribution of authorship across country income categories. The findings in this analysis mirror closely that of other authorship studies in global health. Collectively these provide a common message-that investments in global health programmes in the Millennium Development Goal era may have benefited health but not necessarily capacity for knowledge generation in LMICs.

Women's Autonomy and Attitudes toward Condom Use: A Multicountry Analysis.

PubMed

Sharma, Bonita B; Small, Eusebius; Mengo, Cecilia; Ude, Paula

2017-01-01

Autonomy gives women the ability to negotiate safe sex and make decisions on their health. This study explores the gender stratification framework to understand the intertwined nature of HIV and women's autonomy using the nationally representative Demographic Health Survey. It examines women's autonomy and attitudes toward condom use for prevention of HIV/AIDS in four culturally diverse countries. Findings from the logistic regression indicate that labor force participation, individual autonomy, and decision making significantly increased the odds of always using a condom during sex in all countries. Promoting prevention policies highlighting women's autonomy may contribute in reducing the spread of HIV infection.

Aligning the PRME: How Study Abroad Nurtures Responsible Leadership

ERIC Educational Resources Information Center

Sroufe, Robert; Sivasubramaniam, Nagaraj; Ramos, Diane; Saiia, David

2015-01-01

Productive relationships between business schools and corporate organizations provide fertile ground for bringing business leaders, faculty, students, and community partners face-to-face with contemporaries abroad to foster development of responsible global leadership competencies. While well-orchestrated multicountry collaboration offers unique…

Is the 2000 CDC growth reference appropriate for developing countries?

PubMed

Roberfroid, Dominique; Lerude, Marie-Paule; Pérez-Cueto, Armando; Kolsteren, Patrick

2006-04-01

In 2000, the Centers for Disease Control and Prevention (CDC) produced a revised growth reference. This has already been used in different settings outside the USA. Using data obtained during a nutritional survey in Madagascar, we compare results produced by using both the 2000 CDC and the 1978 National Center for Health Statistics (NCHS)/World Health Organization (WHO) growth references. We show that changing the reference has an important impact on nutritional diagnosis. In particular, the prevalence of wasting is greatly increased. This could generate substantial operational and clinical difficulties. We recommend continued use of the 1978 NCHS/WHO reference until release of the new WHO multi-country growth charts.

Strong smoker interest in 'setting an example to children' by quitting: national survey data.

PubMed

Thomson, George; Wilson, Nick; Weerasekera, Deepa; Edwards, Richard

2011-02-01

To further explore smoker views on reasons to quit. As part of the multi-country ITC Project, a national sample of 1,376 New Zealand adult (18+ years) smokers was surveyed in 2007/08. This sample included boosted sampling of Māori, Pacific and Asian New Zealanders. 'Setting an example to children' was given as 'very much' a reason to quit by 51%, compared to 45% giving personal health concerns. However, the 'very much' and 'somewhat' responses (combined) were greater for personal health (81%) than 'setting an example to children' (74%). Price was the third ranked reason (67%). In a multivariate analysis, women were significantly more likely to state that 'setting an example to children' was 'very much' or 'somewhat' a reason to quit; as were Māori, or Pacific compared to European; and those suffering financial stress. The relatively high importance of 'example to children' as a reason to quit is an unusual finding, and may have arisen as a result of social marketing campaigns encouraging cessation to protect families in New Zealand. The policy implications could include a need for a greater emphasis on social reasons (e.g. 'example to children'), in pack warnings, and in social marketing for smoking cessation. © 2011 The Authors. ANZJPH © 2010 Public Health Association of Australia.

Food composition database development for between country comparisons.

PubMed

Merchant, Anwar T; Dehghan, Mahshid

2006-01-19

Nutritional assessment by diet analysis is a two-stepped process consisting of evaluation of food consumption, and conversion of food into nutrient intake by using a food composition database, which lists the mean nutritional values for a given food portion. Most reports in the literature focus on minimizing errors in estimation of food consumption but the selection of a specific food composition table used in nutrient estimation is also a source of errors. We are conducting a large prospective study internationally and need to compare diet, assessed by food frequency questionnaires, in a comparable manner between different countries. We have prepared a multi-country food composition database for nutrient estimation in all the countries participating in our study. The nutrient database is primarily based on the USDA food composition database, modified appropriately with reference to local food composition tables, and supplemented with recipes of locally eaten mixed dishes. By doing so we have ensured that the units of measurement, method of selection of foods for testing, and assays used for nutrient estimation are consistent and as current as possible, and yet have taken into account some local variations. Using this common metric for nutrient assessment will reduce differential errors in nutrient estimation and improve the validity of between-country comparisons.

Equity trends in ownership of insecticide-treated nets in 19 sub-Saharan African countries.

PubMed

Taylor, Cameron; Florey, Lia; Ye, Yazoume

2017-05-01

To examine the change in equity of insecticide-treated net (ITN) ownership among 19 malaria-endemic countries in sub-Saharan Africa before and after the launch of the Cover The Bed Net Gap initiative. To assess change in equity in ownership of at least one ITN by households from different wealth quintiles, we used data from Demographic and Health Surveys and Malaria Indicator Surveys. We assigned surveys conducted before the launch (2003-2008) as baseline surveys and surveys conducted between 2009-2014 as endpoint surveys. We did country-level and pooled multicountry analyses. Pooled analyses based on malaria transmission risk, were done by dividing geographical zones into either low- and intermediate-risk or high-risk. To assess changes in equity, we calculated the Lorenz concentration curve and concentration index (C-index). Out of the 19 countries we assessed, 13 countries showed improved equity between baseline and endpoint surveys and two countries showed no changes. Four countries displayed worsened equity, two favouring the poorer households and two favouring the richer. The multicountry pooled analysis showed an improvement in equity (baseline survey C-index: 0.11; 95% confidence interval, CI: 0.10 to 0.11; and endpoint survey C-index: 0.00; 95% CI: -0.01 to 0.00). Similar trends were seen in both low- and intermediate-risk and high-risk zones. The mass ITN distribution campaigns to increase coverage, linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of ITN ownership across sub-Saharan Africa with significant reduction in inequity among wealth quintiles.

Determinants of Underemployment of Young Adults: A Multi-Country Study.

ERIC Educational Resources Information Center

Ruiz-Quintanilla, S. Antonio; Claes, Rita

1996-01-01

Data from the international Work Socialization of Youth project (1988-90) were analyzed for office technology workers and machine operators in six European countries. Organizational and societal factors had greater influence on part-time/temporary employment than did job search strategies, gender, or age. (SK)

Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients.

PubMed

van Anholt, R D; Sobotka, L; Meijer, E P; Heyman, H; Groen, H W; Topinková, E; van Leen, M; Schols, J M G A

2010-09-01

We investigated the potential of a high-protein, arginine- and micronutrient-enriched oral nutritional supplement (ONS) to improve healing of pressure ulcers in non-malnourished patients who would usually not be considered for extra nutritional support. Forty-three non-malnourished subjects with stage III or IV pressure ulcers were included in a multicountry, randomized, controlled, double-blind, parallel group trial. They were offered 200 mL of the specific ONS or a non-caloric control product three times per day, in addition to their regular diet and standard wound care, for a maximum of 8 wk. Results were compared with repeated-measures mixed models (RMMM), analysis of variance, or Fisher's exact tests for categorical parameters. Supplementation with the specific ONS accelerated pressure ulcer healing, indicated by a significantly different decrease in ulcer size compared with the control, over the period of 8 wk (P

ARTIFICIAL NEURAL NETWORKS DETECTION OF VIRAL PRESENCE IN SHELLFISH: RESULTS OF A MULTI-COUNTRY COLLABORATION. (R829784)

EPA Science Inventory

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

The Multiplier Effect: The Case for Multi-School, Global Education Programs

ERIC Educational Resources Information Center

Dugan, Rik; Nink, Matt

2010-01-01

Multi-school and multi-country programs greatly enhance leadership development and global awareness in students and teachers, while creating better problem solvers, stronger relationships, and wider community impact than any single-school program. That's why Global Youth Leadership Institute (GYLI) and National Association of Independent Schools…

A Multicountry Study of Cross-Cultural Differences in Psychological Wellness of Adolescents

ERIC Educational Resources Information Center

Asamsama, Octaviana Hemmy; Huang, Leesa; Nelson, R. Brett; Chen, Cin-Ru; Huang, Lily; Kwon, Kyongboon; Kodama, Naoko

2014-01-01

Relative to positive psychology, a focus on increasing psychological well-being has been recently supported. Positive psychology is the study of influences and processes that contribute to the successful and optimal functioning of individuals. Nurturing and encouraging wellness competencies creates a buffer against mental illness and fosters…

Cost-effectiveness of duloxetine: the Stress Urinary Incontinence Treatment (SUIT) study.

PubMed

Mihaylova, Borislava; Pitman, Richard; Tincello, Douglas; van der Vaart, Huub; Tunn, Ralf; Timlin, Louise; Quail, Deborah; Johns, Adam; Sculpher, Mark

2010-08-01

To assess the cost-effectiveness of duloxetine compared with conservative therapy in women with stress urinary incontinence (SUI). Cost and outcome data were taken from the Stress Urinary Incontinence Treatment (SUIT) study, a 12-month, prospective, observational, naturalistic, multicenter, multicountry study. Costs were assessed in UK pound and outcomes in quality adjusted life years using responses to the EuroQol (EQ-5D); numbers of urine leaks were also estimated. Potential selection bias was countered using multivariate regression and propensity score analysis. Duloxetine alone, duloxetine in combination with conservative treatment, and conservative treatment alone were associated with roughly two fewer leaks per week compared with no treatment. Duloxetine alone and with conservative treatment for SUI were associated with incremental quality-adjusted life-years (QALYs) of about 0.03 over a year compared with no treatment or with conservative treatment alone. Conservative treatment alone did not show an effect on QALYs. None of the interventions appeared to have marked impacts on costs over a year. Depending on the form of matching, duloxetine either dominated or had an incremental cost-effectiveness ratio (ICER) below pound900 per QALY gained compared with no treatment and with conservative treatment alone. Duloxetine plus conservative therapy had an ICER below pound5500 compared with no treatment or conservative treatment alone. Duloxetine compared with duloxetine plus conservative therapy showed similar outcomes but an additional cost for the combined intervention. Although the limitations of the use of SUIT's observational data for this purpose need to be acknowledged, the study suggests that initiating duloxetine therapy in SUI is a cost-effective treatment alternative.

Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions.

PubMed

Tran, Viet-Thi; Barnes, Caroline; Montori, Victor M; Falissard, Bruno; Ravaud, Philippe

2015-05-14

Management strategies for patients with chronic conditions are becoming increasingly complex, which may result in a burden of treatment for patients. To develop a Minimally Disruptive Medicine designed to reduce the burden of treatment, clinicians need to understand which healthcare tasks and aggravating factors may be responsible for this burden. The objective of the present study was to describe and classify the components of the burden of treatment for patients with chronic conditions from the patient's perspective. We performed a multi-country qualitative study using an online survey and a purposive sampling strategy to select English-, French-, and Spanish-speaking participants with different chronic conditions. Participants were recruited by physicians, patients' associations, advertisement on social media, and 'snowballing'. The answers were analyzed by i) manual content analysis with a grounded theory approach, coded by two researchers, and ii) automatic textual analysis by Reinert's method. Between 2013 and 2014, 1,053 participants from 34 different countries completed the online survey using 408,625 words. Results from both analyses were synthesized in a taxonomy of the burden of treatment, which described i) the tasks imposed on patients by their diseases and by their healthcare system (e.g., medication management, lifestyle changes, follow-up, etc.); ii) the structural (e.g., access to healthcare resources, coordination between care providers), personal, situational, and financial factors that aggravated the burden of treatment; and iii) patient-reported consequences of the burden (e.g., poor adherence to treatments, financial burden, impact on professional, family, and social life, etc.). Our findings may not be applicable to patients with chronic conditions who differ from those who responded to our survey. Our taxonomy of the burden of treatment, provided by patients with chronic conditions from different countries and settings, supports the development of tools to ascertain the burden of treatment and highlights potential targets for interventions to minimize it.

Genderedness of Bar Drinking Culture and Alcohol-Related Harms: A Multi-Country Study

ERIC Educational Resources Information Center

Roberts, Sarah C. M.; Bond, Jason; Korcha, Rachael; Greenfield, Thomas K.

2013-01-01

This study explores whether associations between consuming alcohol in bars and alcohol-related harms are consistent across countries and whether country-level characteristics modify associations. We hypothesized that genderedness of bar drinking modifies associations, such that odds of harms associated with bar drinking increase more rapidly in…

Gender and Management in HEIs: Changing Organisational and Management Structures

ERIC Educational Resources Information Center

Ozkanli, Ozlem; Machado, Maria de Lourdes; White, Kate; O'Connor, Pat; Riordan, Sarah; Neale, Jenny

2009-01-01

This paper reports on the second phase of a multi-country study examining cross cultural perspectives of gender and management in Higher Education Institutions (HEIs). It examines the broader labour market context and legislative frameworks for higher education in each country and then analyses the literature on women in university management. The…

The "Trans" in Transnational-Translingual: Rhetorical and Linguistic Flexibility as New Norms

ERIC Educational Resources Information Center

Donahue, Christiane

2016-01-01

In this article, Christine Donahue describes how her experiences as a scholar, a member of multi-country European research projects, university research laboratories, and as an invited professor in multiple institutions, have transformed her life and her approach to writing research. Donahue notes that human instinct when encountering the new, the…

Financing Higher Education: A Myriad of Problems, A Myriad of Solutions. Issue Brief

ERIC Educational Resources Information Center

Lkhamsuren, Munkh-Erdene; Dromina-Voloc, Nataliya; Kimmie, Riedwaan

2009-01-01

This paper uses a multicountry perspective spanning four countries--the United States, Mongolia, South Africa, and Ukraine--to highlight a number of strategies and challenges related to the creation and implementation of suitable higher education finance polices. It draws attention to the financial imperatives that affect higher education in the…

Building multi-country collaboration on watershed ...

EPA Pesticide Factsheets

Community-based watershed resilience programs that bridge public health and environmental outcomes often require cross-boundary, multi-country collaboration. The CRESSIDA project, led by the Regional Environmental Center for Central and Eastern Europe (REC) and supported by the US Environmental Protection Agency (EPA), forwards a resilience-focused approach for Western Balkan communities in the Drini and Drina river watersheds with the goal of safeguarding public health and the environment. The initial phases of this project give a contextualized example of how to advance resilience-driven environmental health goals in Western Balkan communities, and experience within the region has garnered several theme areas that require focus in order to promote a holistic watershed management program. In this paper, using CRESSIDA as a case study, we show (1) how watershed projects designed with resilience-driven environmental health goals can work in context, (2) provide data surrounding contextualized problems with resilience and suggest tools and strategies for the implementation of projects to address these problems, and (3) explore how cross-boundary foci are central to the success of these approaches in watersheds that comprise several countries. Published in the journal, Reviews on Environmental Health.

Event-based surveillance of food- and waterborne diseases in Europe: urgent inquiries (outbreak alerts) during 2008 to 2013.

PubMed

Gossner, C M; de Jong, B; Hoebe, C J; Coulombier, D

2015-06-25

During 2008 to 2013, 215 outbreak alerts, also known as 'urgent inquiries' (UI), for food- and waterborne diseases were launched in Europe, the majority of them (135; 63%) being related to salmonellosis. For 110 (51%) UI, a potential food vehicle of infection was identified, with vegetables being the most reported category (34;31%). A total of 28% (n = 60) of the outbreaks reported had an international dimension, involving at least two countries (mean: 4; standard deviation: 2; range:2–14). Participating countries posted 2,343 messages(initial posts and replies, excluding updates), with a median of 11 messages per urgent inquiry (range:1–28). Of 60 multicountry UI, 50 involved between two and four countries. The UI allowed early detection of multicountry outbreaks, facilitated the identification of the suspected vehicles and consequently contributed to the timely implementation of control measures. The introduction of an epidemic intelligence information system platform in 2010 has strengthened the role of the Food- and Waterborne Diseases and Zoonoses network in facilitating timely exchange of information between public health authorities of the participating countries.

Management information systems in maternal and child health/family planning programs: a multi-country analysis.

PubMed

Keller, A

1991-01-01

A diagnosis was conducted of management information systems (MIS) for maternal and child health and family planning programs in 27 African, 5 Asian, and 8 Latin American and Caribbean countries. The diagnosis covered the collection and use of information on physical infrastructure, human resources, equipment/supplies, services provided, coverage attained, and program quality and impact. It was found that many programs do not produce certain basic input and output indicators and that even among those that do, information is too infrequently brought to bear on management decision-making. Constraints under which the MIS operate in these countries are identified, and some rudimentary calculations of what would be required to improve MIS functioning are made.

Community economic status and intimate partner violence against women in bangladesh: compositional or contextual effects?

PubMed

VanderEnde, Kristin E; Sibley, Lynn M; Cheong, Yuk Fai; Naved, Ruchira Tabassum; Yount, Kathryn M

2015-06-01

In this research, we used a multi-level contextual-effects analysis to disentangle the household- and community-level associations between income and intimate partner violence (IPV) against women in Bangladesh. Our analyses of data from 2,668 women interviewed as part of the World Health Organization (WHO) multi-country study on women's health and domestic violence against women showed that household income was negatively associated with women's risk of experiencing IPV. Controlling for residence in a low-income household, living in a low-income community was not associated with women's risk of experiencing IPV. These results support a household-level, not community-level, relationship between income and IPV in Bangladesh. © The Author(s) 2015.

Equity trends in ownership of insecticide-treated nets in 19 sub-Saharan African countries

PubMed Central

Florey, Lia; Ye, Yazoume

2017-01-01

Abstract Objective To examine the change in equity of insecticide-treated net (ITN) ownership among 19 malaria-endemic countries in sub-Saharan Africa before and after the launch of the Cover The Bed Net Gap initiative. Methods To assess change in equity in ownership of at least one ITN by households from different wealth quintiles, we used data from Demographic and Health Surveys and Malaria Indicator Surveys. We assigned surveys conducted before the launch (2003–2008) as baseline surveys and surveys conducted between 2009–2014 as endpoint surveys. We did country-level and pooled multicountry analyses. Pooled analyses based on malaria transmission risk, were done by dividing geographical zones into either low- and intermediate-risk or high-risk. To assess changes in equity, we calculated the Lorenz concentration curve and concentration index (C-index). Findings Out of the 19 countries we assessed, 13 countries showed improved equity between baseline and endpoint surveys and two countries showed no changes. Four countries displayed worsened equity, two favouring the poorer households and two favouring the richer. The multicountry pooled analysis showed an improvement in equity (baseline survey C-index: 0.11; 95% confidence interval, CI: 0.10 to 0.11; and endpoint survey C-index: 0.00; 95% CI: −0.01 to 0.00). Similar trends were seen in both low- and intermediate-risk and high-risk zones. Conclusion The mass ITN distribution campaigns to increase coverage, linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of ITN ownership across sub-Saharan Africa with significant reduction in inequity among wealth quintiles. PMID:28479633

Lessons learned from health sector reform: a four-country comparison.

PubMed

Talukder, Md Noorunnabi; Rob, Ubaidur; Mahabub-Ul-Anwar, Md

Various reforms have been undertaken to improve the functioning of health systems in developing countries, but there is limited comparative analysis of reform initiatives. This article discusses health sector reform experiences of four developing countries and identifies the lessons learned. The article is based on the review of background papers on Bangladesh, Pakistan, Indonesia, and Tanzania prepared as part of a multi-country study on health sector reform. Findings suggest that decentralization works effectively while implementing primary and secondary health programs. Decentralization of power and authority to local authorities requires strengthening and supporting these units. Along with the public sector, the private sector plays an effective role in institutional and human resources development as well as in improving service delivery. Community participation facilitates recruitment and development of field workers, facility improvement, and service delivery. For providing financial protection to the poor, there is a need to review user fees and develop affordable health insurance with an exemption mechanism. There is no uniform health sector reform approach; therefore, the experiences of other countries will help countries undertake appropriate reforms. Here, it is important to examine the context and determine the reform measures that constitute the best means in terms of equity, efficiency, and sustainability.

Public Library Websites as Electronic Branches: A Multi-Country Quantitative Evaluation

ERIC Educational Resources Information Center

Velasquez, Diane L.; Evans, Nina

2018-01-01

Introduction: This paper describes the findings of a study of 1517 public library Websites in Australia, Canada, and the United States over a period of four years. These Websites are referred to as 'electronic branches' of the libraries, thereby extending the definition of physical library branches into the digital realm. The purpose of the…

Knowing and Doing Vocational Education and Training Reform: Evidence, Learning and the Policy Process

ERIC Educational Resources Information Center

McGrath, Simon; Lugg, Rosemary

2012-01-01

Much of VET policy internationally draws on a toolkit that has been seriously questioned for its logic, international relevance and effectiveness by considerable amounts of academic research. Reflecting primarily on our experiences of leading a complex, multi-country policy study, we develop an account that seeks to explore ways in which the…

A Conceptualization of Entrepreneurial Curiosity and Construct Development: A Multi-Country Empirical Validation

ERIC Educational Resources Information Center

Jeraj, Mitja; Antoncic, Bostjan

2013-01-01

The purpose of this article was to fill a gap in the literature regarding the conceptualization and measurement of entrepreneurial curiosity. Although research in other fields suggest that different types of curiosity exist, no conceptualization research has yet been done in the field of entrepreneurial curiosity. This research aimed to develop a…

Dental students' perceived sources of stress: a multi-country study.

PubMed

Polychronopoulou, Argy; Divaris, Kimon

2009-05-01

The aim of this study was to identify dental students' self-reported sources of stress and to explore the role of specific curricular and institutional differences in the variation of perceived stressors among dental students in Greece, Ireland, Slovenia, Sweden, Spain, and Croatia. A thirty-item modified version of the Dental Environment Stress (DES) questionnaire was administered to all undergraduate students enrolled at six European dental schools selected to reflect geographical, curricular, and professional environment diversity: Athens, Greece; Dublin, Ireland; Ljubljana, Slovenia; Malmö, Sweden; Santiago de Compostela, Spain; and Zagreb, Croatia. Participation varied from 93 percent in Athens to 65 percent in Dublin. A total of 1,492 questionnaires were available for analysis. Univariate analysis and multivariate modelling were used for data analysis. Performance pressure, workload, and self-efficacy beliefs constituted the students' main concerns. In the univariate analysis, student responses differed by country: Swedish students provided the lowestst scores in five out of six DES factors, Spanish students were the most concerned about "clinical training" and "performance pressure," whereas Greek students were the most concerned about "patient treatment." Multivariate modelling revealed that problem-based learning (PBL) was inversely associated with perceived stress for "self-efficacy beliefs" OR (95% CI): 0.66 (0.52, 0.84), "workload" OR (95% CI): 0.58 (0.41, 0.80); and "clinical training" OR (95% CI): 0.69 (0.50, 0.95) when compared to traditional curricula. Students' perceived stressors differed greatly among the six institutions and were associated with both individual (gender, study level) and educational/institutional (curriculum type, class size, educational costs) parameters.

"Swim or Sink": State of Induction in the Deployment of Early Career Academics into Teaching at Makerere University

ERIC Educational Resources Information Center

Ssempebwa, Jude; Teferra, Damtew; Bakkabulindi, Fred Edward K.

2016-01-01

Conducted as part of a multi-country study of the teaching-related experiences and expectations of early career academics (ECAs) in Africa, this study investigated the major influences on the teaching practice of ECAs at Makerere University; the mechanisms by which these academics learn to teach; the teaching-related challenges they experience;…

College Major and the Gender Earnings Gap: A Multi-Country Examination of Postgraduate Labour Market Outcomes

ERIC Educational Resources Information Center

Garcia-Aracil, Adela

2008-01-01

This paper explores the effects of degree choice on the distribution of occupational benefits in terms of income, and their contribution to the gender earnings gap, among young European higher education graduates. The results reveal that the field of study, which is the result of a personal choice, appears to influence the distribution of…

Why Are Teachers Absent? Probing Service Delivery in Peruvian Primary Schools

ERIC Educational Resources Information Center

Alcazar, Lorena; Rogers, F. Halsey; Chaudhury, Nazmul; Hammer, Jeffrey; Kremer, Michael; Muralidharan, Karthik

2006-01-01

A high rate of absence of teachers from their posts is a serious obstacle to delivery of education in many developing countries, but hard evidence on the problem has been scarce. This study, carried out as part of a new multi-country survey project, is the first systematic investigation in Peru into the extent and causes of teachers' absence from…

Multi-Country, Cross-National Comparison of Youth Suicide Ideation: Findings from Global School-Based Health Surveys

ERIC Educational Resources Information Center

Page, Randy M.; Saumweber, Jacqueline; Hall, P. Cougar; Crookston, Benjamin T.; West, Joshua H.

2013-01-01

This study describes the prevalence of suicide ideation in 109 Global School-based Health Surveys (GSHS) conducted from 2003-2010 representing 49 different countries and 266,694 school-attending students aged 13-15 years primarily living in developing areas of the World. Prevalence of suicide ideation varied widely among and between countries,…

Organisational Barriers for Women in Senior Management: A Comparison of Turkish and New Zealand Universities

ERIC Educational Resources Information Center

Neale, Jenny; Ozkanli, Ozlem

2010-01-01

This paper reports on the second phase of a multi-country study examining cross-cultural perspectives of gender and management in universities. The first phase of this research with eight countries found that the representation of women was consistently low, especially at Rector/Vice Chancellor level. In the second phase interviews were conducted…

[The unfinished agenda for child survival: what role for the integrated management of childhood illness?].

PubMed

Lambrechts, T; Gamatié, Y; Aboubaker, S

2005-01-01

The endorsement by the United Nations General Assembly of the Millennium Development Goals (MDG) and the growing acknowledgment by the international community that child survival is an unfinished agenda created a new momentum for rapid scaling up of effective child health interventions. In this review, the authors discuss the environment in which child health programs are being implemented and the potential role of the integrated management of childhood illness (IMCI) strategy in country efforts to achieve the MDGs. The discussion is based on the conclusions of a multi-country analytic review of the IMCI strategy conducted jointly by DFID, UNICEF, USAID, and WHO as well as the results of another multi-country evaluation coordinated by the WHO on IMCI costs, effectiveness, and impact. The article concludes on the need to increase child health investments and on the potential importance of IMCI in improving child survival. However, the MDGs may not be reached if IMCI is not implemented in conjunction with other strategies to reduce mortality during the first days of life and to strengthen the health system. The authors also stress the need to increase research on mechanisms to scale up delivery of existing public health interventions.

Creating opportunities through mentorship, parental involvement, and safe spaces (COMPASS) program: multi-country study protocol to protect girls from violence in humanitarian settings.

PubMed

Falb, Kathryn L; Tanner, Sophie; Ward, Leora; Erksine, Dorcas; Noble, Eva; Assazenew, Asham; Bakomere, Theresita; Graybill, Elizabeth; Lowry, Carmen; Mallinga, Pamela; Neiman, Amy; Poulton, Catherine; Robinette, Katie; Sommer, Marni; Stark, Lindsay

2016-03-05

Violence against adolescent girls in humanitarian settings is of urgent concern given their additional vulnerabilities to violence and unique health and well-being needs that have largely been overlooked by the humanitarian community. In order to understand what works to prevent violence against adolescent girls, a multi-component curriculum-based safe spaces program (Creating Opportunities through Mentorship, Parental involvement and Safe Spaces - COMPASS) will be implemented and evaluated. The objectives of this multi-country study are to understand the feasibility, acceptability and effectiveness of COMPASS programming to prevent violence against adolescent girls in diverse humanitarian settings. Two wait-listed cluster-randomized controlled trials are being implemented in conflict-affected communities in eastern Democratic Republic of Congo (N = 886 girls aged 10-14 years) and in refugee camps in western Ethiopia (N = 919 girls aged 13-19 years). The intervention consists of structured facilitated sessions delivered in safe spaces by young female mentors, caregiver discussion groups, capacity-building activities with service providers, and community engagement. In Ethiopia, the research centers on the overall impact of COMPASS compared to a wait-list group. In DRC, the research objective is to understand the incremental effectiveness of the caregiver component in addition to the other COMPASS activities as compared to a wait-list group. The primary outcome is change in sexual violence. Secondary outcomes include decreased physical and emotional abuse, reduced early marriage, improved gender norms, and positive interpersonal relationships, among others. Qualitative methodologies seek to understand girls' perceptions of safety within their communities, key challenges they face, and to identify potential pathways of change. These trials will add much needed evidence for the humanitarian community to meet the unique needs of adolescent girls and to promote their safety and well-being, as well as contributing to how multi-component empowerment programming for adolescent girls could be adapted across humanitarian settings. Clinical Trials NCT02384642 (Registered: 2/24/15) & NCT02506543 (Registered: 7/19/15).

Measles immunity gaps and the progress towards elimination: a multi-country modelling analysis.

PubMed

Trentini, Filippo; Poletti, Piero; Merler, Stefano; Melegaro, Alessia

2017-10-01

The persistent circulation of measles in both low-income and high-income countries requires a better characterisation of present epidemiological trends and existing immunity gaps across different sociodemographic settings. Serological surveys, which provide direct measures of population protection against the infection, are underexploited and often supply fragmentary estimates of population immunity. This study aims to investigate how measles immunity has changed over time across different socioeconomic settings, as a result of demographic changes and past immunisation policies. For this multi-country modelling analysis, we developed a transmission model to simulate measles circulation during the past 65 years in nine countries with distinct demographic and vaccination histories. The model was calibrated on historical serological data and used to estimate the reduction of disease burden as a result of vaccination and present age-specific residual susceptibility. Our model shows that estimated residual susceptibility to measles ranges from 3% in the UK to more than 10% in Kenya and Ethiopia. In high-income countries, such as Italy, Singapore, and South Korea, where routine first-dose administration produced more than 90% of immunised individuals, only about 20% of susceptible individuals are younger than 5 years. We also observed that the reduction in fertility that has occurred during the past decades in high-income countries has contributed to almost half of the reduction in measles incidence. In low-income countries, where fertility is high, the population is younger and routine vaccination has been suboptimum. Susceptible individuals are concentrated in early childhood, with about 60% of susceptible individuals in Ethiopia younger than 10 years. In these countries, Supplementary Immunization Activities (SIAs) were responsible for more than 25% of immunised individuals (up to 45% in Ethiopia), mitigating the consequences of suboptimum routine vaccination coverage. Future vaccination strategies in high-fertility countries should focus on increasing childhood immunisation rates, either by raising first-dose coverage or by making erratic SIAs more frequent and regular. Immunisation campaigns targeting adolescents and adults are required in low-fertility countries, where the susceptibility in these age groups will otherwise sustain measles circulation. European Research Council. Copyright © 2017 Elsevier Ltd. All rights reserved.

Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: a retrospective analysis.

PubMed

Cordova-Pozo, Kathya; Hoopes, Andrea J; Cordova, Freddy; Vega, Bernardo; Segura, Zoyla; Hagens, Arnold

2018-02-08

Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains: communication with parents, partners and peers; access to SRH information; access to SRH services; and use of contraception. When the project ended, the outcome evaluation showed limited impact with concerns about accuracy of monitoring and attrition of participants. We reviewed and analyzed a series of CERCA documents and related data sources. Key findings from these documents were organized within an RBM framework (planning, monitoring, and impact evaluation) to understand how CERCA methodology and performance might have reaped improved results. Strengths and weaknesses were identified in all three elements of the RBM framework. In Planning, the proposed Theory of Change (ToC) differed from that which was carried out in the intervention package. Each country implemented a different intervention package without articulated assumptions on how the activities of intervention would bring about change. In Monitoring, the project oversight was mainly based on administrative and financial requirements rather than monitoring fidelity and quality of intervention activities. In Impact Evaluation, the original CERCA evaluation assessed intervention effects among adolescents, without identifying success and failure factors related to the outcomes, the nature of the outcomes, or cost-effectiveness of interventions. This analysis showed that multi-country projects are complex, entail risks in execution and require robust project management. RBM can be a useful tool to ensure a systematic approach at different phases within a multi-country setting.

Multi-Country Experience in Delivering a Joint Course on Software Engineering--Numerical Results

ERIC Educational Resources Information Center

Budimac, Zoran; Putnik, Zoran; Ivanovic, Mirjana; Bothe, Klaus; Zdravkova, Katerina; Jakimovski, Boro

2014-01-01

A joint course, created as a result of a project under the auspices of the "Stability Pact of South-Eastern Europe" and DAAD, has been conducted in several Balkan countries: in Novi Sad, Serbia, for the last six years in several different forms, in Skopje, FYR of Macedonia, for two years, for several types of students, and in Tirana,…

How have Global Health Initiatives impacted on health equity?

PubMed

Hanefeld, Johanna

2008-01-01

This review examines the impact of Global Health Initiatives (GHIs) on health equity, focusing on low- and middle-income countries. It is a summary of a literature review commissioned by the WHO Commission on the Social Determinants of Health. GHIs have emerged during the past decade as a mechanism in development assistance for health. The review focuses on three GHIs, the US President's Emergency Plan For AIDS Relief (PEPFAR), the World Bank's Multi-country AIDS Programme (MAP) and the Global Fund to Fight AIDS, TB and Malaria. All three have leveraged significant amounts of funding for their focal diseases - together these three GHIs provide an estimated two-thirds of external resources going to HIV/AIDS. This paper examines their impact on gender equity. An analysis of these Initiatives finds that they have a significant impact on health equity, including gender equity, through their processes of programme formulation and implementation, and through the activities they fund and implement, including through their impact on health systems and human resources. However, GHIs have so far paid insufficient attention to health inequities. While increasingly acknowledging equity, including gender equity, as a concern, Initiatives have so far failed to adequately translate this into programmes that address drivers of health inequity, including gender inequities. The review highlights the comparative advantage of individual GHIs, which point to an increased need for, and continued difficulties in, harmonisation of activities at country level. On the basis of this comparative analysis, key recommendations are made. They include a call for equity-sensitive targets, the collection of gender-disaggregated data, the use of policy-making processes for empowerment, programmes that explicitly address causes of health inequity and impact assessments of interventions' effect on social inequities.

Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial.

PubMed

Hosseinipour, Mina C; Bisson, Gregory P; Miyahara, Sachiko; Sun, Xin; Moses, Agnes; Riviere, Cynthia; Kirui, Fredrick K; Badal-Faesen, Sharlaa; Lagat, David; Nyirenda, Mulinda; Naidoo, Kogieleum; Hakim, James; Mugyenyi, Peter; Henostroza, German; Leger, Paul D; Lama, Javier R; Mohapi, Lerato; Alave, Jorge; Mave, Vidya; Veloso, Valdilea G; Pillay, Sandy; Kumarasamy, Nagalingeswaran; Bao, Jing; Hogg, Evelyn; Jones, Lynne; Zolopa, Andrew; Kumwenda, Johnstone; Gupta, Amita

2016-03-19

Mortality within the first 6 months after initiating antiretroviral therapy is common in resource-limited settings and is often due to tuberculosis in patients with advanced HIV disease. Isoniazid preventive therapy is recommended in HIV-positive adults, but subclinical tuberculosis can be difficult to diagnose. We aimed to assess whether empirical tuberculosis treatment would reduce early mortality compared with isoniazid preventive therapy in high-burden settings. We did a multicountry open-label randomised clinical trial comparing empirical tuberculosis therapy with isoniazid preventive therapy in HIV-positive outpatients initiating antiretroviral therapy with CD4 cell counts of less than 50 cells per μL. Participants were recruited from 18 outpatient research clinics in ten countries (Malawi, South Africa, Haiti, Kenya, Zambia, India, Brazil, Zimbabwe, Peru, and Uganda). Individuals were screened for tuberculosis using a symptom screen, locally available diagnostics, and the GeneXpert MTB/RIF assay when available before inclusion. Study candidates with confirmed or suspected tuberculosis were excluded. Inclusion criteria were liver function tests 2·5 times the upper limit of normal or less, a creatinine clearance of at least 30 mL/min, and a Karnofsky score of at least 30. Participants were randomly assigned (1:1) to either the empirical group (antiretroviral therapy and empirical tuberculosis therapy) or the isoniazid preventive therapy group (antiretroviral therapy and isoniazid preventive therapy). The primary endpoint was survival (death or unknown status) at 24 weeks after randomisation assessed in the intention-to-treat population. Kaplan-Meier estimates of the primary endpoint across groups were compared by the z-test. All participants were included in the safety analysis of antiretroviral therapy and tuberculosis treatment. This trial is registered with ClinicalTrials.gov, number NCT01380080. Between Oct 31, 2011, and June 9, 2014, we enrolled 850 participants. Of these, we randomly assigned 424 to receive empirical tuberculosis therapy and 426 to the isoniazid preventive therapy group. The median CD4 cell count at baseline was 18 cells per μL (IQR 9-32). At week 24, 22 (5%) participants from each group died or were of unknown status (95% CI 3·5-7·8) for empirical group and for isoniazid preventive therapy (95% CI 3·4-7·8); absolute risk difference of -0·06% (95% CI -3·05 to 2·94). Grade 3 or 4 signs or symptoms occurred in 50 (12%) participants in the empirical group and 46 (11%) participants in the isoniazid preventive therapy group. Grade 3 or 4 laboratory abnormalities occurred in 99 (23%) participants in the empirical group and 97 (23%) participants in the isoniazid preventive therapy group. Empirical tuberculosis therapy did not reduce mortality at 24 weeks compared with isoniazid preventive therapy in outpatient adults with advanced HIV disease initiating antiretroviral therapy. The low mortality rate of the trial supports implementation of systematic tuberculosis screening and isoniazid preventive therapy in outpatients with advanced HIV disease. National Institutes of Allergy and Infectious Diseases through the AIDS Clinical Trials Group. Copyright © 2016 Elsevier Ltd. All rights reserved.

Multi-Country Evaluation of the Sensitivity and Specificity of Two Commercially-Available NS1 ELISA Assays for Dengue Diagnosis

PubMed Central

Guzman, Maria G.; Jaenisch, Thomas; Gaczkowski, Roger; Ty Hang, Vo Thi; Sekaran, Shamala Devi; Kroeger, Axel; Vazquez, Susana; Ruiz, Didye; Martinez, Eric; Mercado, Juan C.; Balmaseda, Angel; Harris, Eva; Dimano, Efren; Leano, Prisca Susan A.; Yoksan, Sutee; Villegas, Elci; Benduzu, Herminia; Villalobos, Iris; Farrar, Jeremy; Simmons, Cameron P.

2010-01-01

Background Early diagnosis of dengue can assist patient triage and management and prevent unnecessary treatments and interventions. Commercially available assays that detect the dengue virus protein NS1 in the plasma/serum of patients offers the possibility of early and rapid diagnosis. Methodology/Principal Findings The sensitivity and specificity of the Pan-E Dengue Early ELISA and the Platelia™ Dengue NS1 Ag assays were compared against a reference diagnosis in 1385 patients in 6 countries in Asia and the Americas. Platelia was more sensitive (66%) than Pan-E (52%) in confirmed dengue cases. Sensitivity varied by geographic region, with both assays generally being more sensitive in patients from SE Asia than the Americas. Both kits were more sensitive for specimens collected within the first few days of illness onset relative to later time points. Pan-E and Platelia were both 100% specific in febrile patients without evidence of acute dengue. In patients with other confirmed diagnoses and healthy blood donors, Platelia was more specific (100%) than Pan-E (90%). For Platelia, when either the NS1 test or the IgM test on the acute sample was positive, the sensitivity versus the reference result was 82% in samples collected in the first four days of fever. NS1 sensitivity was not associated to disease severity (DF or DHF) in the Platelia test, whereas a trend for higher sensitivity in DHF cases was seen in the Pan-E test (however combined with lower overall sensitivity). Conclusions/Significance Collectively, this multi-country study suggests that the best performing NS1 assay (Platelia) had moderate sensitivity (median 64%, range 34–76%) and high specificity (100%) for the diagnosis of dengue. The poor sensitivity of the evaluated assays in some geographical regions suggests further assessments are needed. The combination of NS1 and IgM detection in samples collected in the first few days of fever increased the overall dengue diagnostic sensitivity. PMID:20824173

Patient level cost of diabetes self-management education programmes: an international evaluation

PubMed Central

Doyle, Gerardine; O'Donnell, Shane; Quigley, Etáin; Cullen, Kate; Gibney, Sarah; Levin-Zamir, Diane; Ganahl, Kristin; Müller, Gabriele; Muller, Ingrid; Maindal, Helle Terkildsen; Chang, Wushou Peter; Van Den Broucke, Stephan

2017-01-01

Objectives The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Setting Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Participants Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary and secondary measures Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. Results We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. Conclusions This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME. PMID:28583913

A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study.

PubMed

Souza, J P; Betran, A P; Dumont, A; de Mucio, B; Gibbs Pickens, C M; Deneux-Tharaux, C; Ortiz-Panozo, E; Sullivan, E; Ota, E; Togoobaatar, G; Carroli, G; Knight, H; Zhang, J; Cecatti, J G; Vogel, J P; Jayaratne, K; Leal, M C; Gissler, M; Morisaki, N; Lack, N; Oladapo, O T; Tunçalp, Ö; Lumbiganon, P; Mori, R; Quintana, S; Costa Passos, A D; Marcolin, A C; Zongo, A; Blondel, B; Hernández, B; Hogue, C J; Prunet, C; Landman, C; Ochir, C; Cuesta, C; Pileggi-Castro, C; Walker, D; Alves, D; Abalos, E; Moises, Ecd; Vieira, E M; Duarte, G; Perdona, G; Gurol-Urganci, I; Takahiko, K; Moscovici, L; Campodonico, L; Oliveira-Ciabati, L; Laopaiboon, M; Danansuriya, M; Nakamura-Pereira, M; Costa, M L; Torloni, M R; Kramer, M R; Borges, P; Olkhanud, P B; Pérez-Cuevas, R; Agampodi, S B; Mittal, S; Serruya, S; Bataglia, V; Li, Z; Temmerman, M; Gülmezoglu, A M

2016-02-01

To generate a global reference for caesarean section (CS) rates at health facilities. Cross-sectional study. Health facilities from 43 countries. Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10,045,875 women giving birth from 43 countries for model testing. We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. © 2015 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Patient level cost of diabetes self-management education programmes: an international evaluation.

PubMed

Doyle, Gerardine; O'Donnell, Shane; Quigley, Etáin; Cullen, Kate; Gibney, Sarah; Levin-Zamir, Diane; Ganahl, Kristin; Müller, Gabriele; Muller, Ingrid; Maindal, Helle Terkildsen; Chang, Wushou Peter; Van Den Broucke, Stephan

2017-06-04

The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Pregnancy intendedness and the association with physical, sexual and emotional abuse - a European multi-country cross-sectional study.

PubMed

Lukasse, Mirjam; Laanpere, Made; Karro, Helle; Kristjansdottir, Hildur; Schroll, Anne-Mette; Van Parys, An-Sofie; Wangel, Anne-Marie; Schei, Berit

2015-05-26

Unintended pregnancies are common and when not resulting in a termination of pregnancy may lead to unintended childbirth. Unintended pregnancies are associated with increased health risks, also for women for whom pregnancy continues to childbirth. Our objective was to present the prevalence of unintended pregnancy in six European countries among pregnant women attending routine antenatal care, and to investigate the association with a history of physical, sexual and emotional abuse. A prospective cross-sectional study, of 7102 pregnant women who filled out a questionnaire during pregnancy as part of a multi-country cohort study (Bidens) with the participating countries: Belgium, Iceland, Denmark, Estonia, Norway and Sweden. A validated instrument, the Norvold Abuse Questionnaire (NorAq) consisting of 10 descriptive questions measured abuse. Pregnancy intendedness was assessed using a single question asking women if this pregnancy was planned. Cross-tabulation, Chi-square tests and binary logistic regression analysis were used. Approximately one-fifth (19.2 %) of all women reported their current pregnancy to be unintended. Women with an unintended pregnancy were significantly younger, had less education, suffered economic hardship, had a different ethnic background from the regional majority and more frequently were not living with their partner. The prevalence of an unintended pregnancy among women reporting any lifetime abuse was 24.5 %, and 38.5 % among women reporting recent abuse. Women with a history of any lifetime abuse had significantly higher odds of unintended pregnancy, also after adjusting for confounding factors, AOR for any lifetime abuse 1.41 (95 % CI 1.23-1.60) and for recent abuse AOR 2.03 (95 % CI 1.54-2.68). Women who have experienced any lifetime abuse are significantly more likely to have an unintended pregnancy. This is particularly true for women reporting recent abuse, suggesting that women living in a violent relationship have less control over their fertility.

Eco-bio-social research on dengue in Asia: a multicountry study on ecosystem and community-based approaches for the control of dengue vectors in urban and peri-urban Asia.

PubMed

Sommerfeld, Johannes; Kroeger, Axel

2012-12-01

This article provides an overview of methods and cross-site insights of a 5-year research and capacity building initiative conducted between 2006 and 2011 in six countries of South Asia (India, Sri Lanka) and South-East Asia (Indonesia, Myanmar, Philippines, Thailand).The initiative managed an interdisciplinary investigation of ecological, biological, and social (i.e., eco-bio-social) dimensions of dengue in urban and peri-urban areas, and developed community-based interventions aimed at reducing dengue vector breeding and viral transmission. The multicountry study comprised interdisciplinary research groups from six leading Asian research institutions. The groups conducted a detailed situation analysis to identify and characterize local eco-bio-social conditions, and formed a community-of-practice for EcoHealth research where group partners disseminated results and collaboratively developed site-specific intervention tools for vector-borne diseases. In sites where water containers produced more than 70% of Aedes pupae, interventions ranged from mechanical lid covers for containers to biological control. Where small discarded containers presented the main problem, groups experimented with solid waste management, composting and recycling schemes. Many intervention tools were locally produced and all tools were implemented through community partnership strategies. All sites developed socially and culturally appropriate health education materials. The study also mobilised and empowered women's, students' and community groups and at several sites organized new volunteer groups for environmental health. The initiative's programmes showed significant impact on vector densities in some sites. Other sites showed varying effect - partially attributable to the 'contamination' of control groups - yet led to significant outcomes at the community level where local groups united around broad interests in environmental hygiene and sanitation. The programme's findings are relevant for defining efficient, effective and ecologically sound vector control interventions based on local evidence and in accordance with WHO's strategy for integrated vector management.

Eco-bio-social research on dengue in Asia: a multicountry study on ecosystem and community-based approaches for the control of dengue vectors in urban and peri-urban Asia

PubMed Central

Sommerfeld, Johannes; Kroeger, Axel

2012-01-01

This article provides an overview of methods and cross-site insights of a 5-year research and capacity building initiative conducted between 2006 and 2011 in six countries of South Asia (India, Sri Lanka) and South-East Asia (Indonesia, Myanmar, Philippines, Thailand).The initiative managed an interdisciplinary investigation of ecological, biological, and social (i.e., eco-bio-social) dimensions of dengue in urban and peri-urban areas, and developed community-based interventions aimed at reducing dengue vector breeding and viral transmission. The multicountry study comprised interdisciplinary research groups from six leading Asian research institutions. The groups conducted a detailed situation analysis to identify and characterize local eco-bio-social conditions, and formed a community-of-practice for EcoHealth research where group partners disseminated results and collaboratively developed site-specific intervention tools for vector-borne diseases. In sites where water containers produced more than 70% of Aedes pupae, interventions ranged from mechanical lid covers for containers to biological control. Where small discarded containers presented the main problem, groups experimented with solid waste management, composting and recycling schemes. Many intervention tools were locally produced and all tools were implemented through community partnership strategies. All sites developed socially and culturally appropriate health education materials. The study also mobilised and empowered women’s, students’ and community groups and at several sites organized new volunteer groups for environmental health. The initiative’s programmes showed significant impact on vector densities in some sites. Other sites showed varying effect — partially attributable to the ‘contamination’ of control groups — yet led to significant outcomes at the community level where local groups united around broad interests in environmental hygiene and sanitation. The programme’s findings are relevant for defining efficient, effective and ecologically sound vector control interventions based on local evidence and in accordance with WHO’s strategy for integrated vector management. PMID:23318234

Costs and financing of routine immunization: Approach and selected findings of a multi-country study (EPIC).

PubMed

Brenzel, Logan; Young, Darwin; Walker, Damian G

2015-05-07

Few detailed facility-based costing studies of routine immunization (RI) programs have been conducted in recent years, with planners, managers and donors relying on older information or data from planning tools. To fill gaps and improve quality of information, a multi-country study on costing and financing of routine immunization and new vaccines (EPIC) was conducted in Benin, Ghana, Honduras, Moldova, Uganda and Zambia. This paper provides the rationale for the launch of the EPIC study, as well as outlines methods used in a Common Approach on facility sampling, data collection, cost and financial flow estimation for both the routine program and new vaccine introduction. Costing relied on an ingredients-based approach from a government perspective. Estimating incremental economic costs of new vaccine introduction in contexts with excess capacity are highlighted. The use of more disaggregated System of Health Accounts (SHA) coding to evaluate financial flows is presented. The EPIC studies resulted in a sample of 319 primary health care facilities, with 65% of facilities in rural areas. The EPIC studies found wide variation in total and unit costs within each country, as well as between countries. Costs increased with level of scale and socio-economic status of the country. Governments are financing an increasing share of total RI financing. This study provides a wealth of high quality information on total and unit costs and financing for RI, and demonstrates the value of in-depth facility approaches. The paper discusses the lessons learned from using a standardized approach, as well as proposes further areas of methodology development. The paper discusses how results can be used for resource mobilization and allocation, improved efficiency of services at the country level, and to inform policies at the global level. Efforts at routinizing cost analysis to support sustainability efforts would be beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

Draft Genome Sequences of 510 Listeria monocytogenes Strains from Food Isolates and Human Listeriosis Cases from Northern Italy.

PubMed

Lomonaco, Sara; Gallina, Silvia; Filipello, Virginia; Sanchez Leon, Maria; Kastanis, George John; Allard, Marc; Brown, Eric; Amato, Ettore; Pontello, Mirella; Decastelli, Lucia

2018-01-18

Listeriosis outbreaks are frequently multistate/multicountry outbreaks, underlining the importance of molecular typing data for several diverse and well-characterized isolates. Large-scale whole-genome sequencing studies on Listeria monocytogenes isolates from non-U.S. locations have been limited. Herein, we describe the draft genome sequences of 510 L. monocytogenes isolates from northern Italy from different sources.

Forestry Training Manual for Africa Region U.S. Peace Corps. Training for Development. Peace Corps Information Collection & Exchange Training Manual No. T-14.

ERIC Educational Resources Information Center

Mahaffey, George; And Others

This manual is a state-side forestry teaching guide, complete with exercises, for the training of prospective Peace Corps volunteers who will serve in various African countries. The modular format lends itself to both single-country and multicountry forestry training. The first part of the guide contains instructions to the trainer on conducting…

Re-evaluation of a 2014 multi-country European outbreak of Salmonella Enteritidis phage type 14b using recent epidemiological and molecular data

PubMed Central

Hörmansdorfer, Stefan; Messelhäußer, Ute; Rampp, Albert; Schönberger, Katharina; Dallman, Tim; Allerberger, Franz; Kornschober, Christian; Sing, Andreas; Wallner, Peter; Zapf, Andreas

2017-01-01

A European multi-country outbreak of Salmonella Enteritidis phage type (PT) 14b occurred from March to November 2014 associated with the consumption of eggs. The outbreak involved more than 400 human cases from France, Luxembourg, Austria and the United Kingdom. In 2016–2017, it has been re-evaluated combining recent epidemiological results with latest molecular data. The outbreak was traced back to one large Bavarian egg producer with four distinct premises, three located in Bavaria, one in the Czech Republic. The outbreak isolates of S. Enteritidis PT 14b were grouped into three closely related clades by whole genome sequencing. Two of these clades could be referred to two Bavarian premises of the egg producer on the basis of epidemiological and molecular data, while epidemiological data presumably linked the third clade to another premises of the egg producer. Interestingly and in contrast to the situation in other European countries where several outbreaks were documented, all notified 91 laboratory-confirmed cases of S. Enteritidis PT 14b from Bavaria were sporadic, singular cases not belonging to any epidemiological outbreaks. In conclusion, as demonstrated here, the resolution of food-related outbreaks with such a high discriminatory power is rare in outbreak investigation. PMID:29258650

Re-evaluation of a 2014 multi-country European outbreak of Salmonella Enteritidis phage type 14b using recent epidemiological and molecular data.

PubMed

Hörmansdorfer, Stefan; Messelhäußer, Ute; Rampp, Albert; Schönberger, Katharina; Dallman, Tim; Allerberger, Franz; Kornschober, Christian; Sing, Andreas; Wallner, Peter; Zapf, Andreas

2017-12-01

A European multi-country outbreak of Salmonella Enteritidis phage type (PT) 14b occurred from March to November 2014 associated with the consumption of eggs. The outbreak involved more than 400 human cases from France, Luxembourg, Austria and the United Kingdom. In 2016-2017, it has been re-evaluated combining recent epidemiological results with latest molecular data. The outbreak was traced back to one large Bavarian egg producer with four distinct premises, three located in Bavaria, one in the Czech Republic. The outbreak isolates of S. Enteritidis PT 14b were grouped into three closely related clades by whole genome sequencing. Two of these clades could be referred to two Bavarian premises of the egg producer on the basis of epidemiological and molecular data, while epidemiological data presumably linked the third clade to another premises of the egg producer. Interestingly and in contrast to the situation in other European countries where several outbreaks were documented, all notified 91 laboratory-confirmed cases of S. Enteritidis PT 14b from Bavaria were sporadic, singular cases not belonging to any epidemiological outbreaks. In conclusion, as demonstrated here, the resolution of food-related outbreaks with such a high discriminatory power is rare in outbreak investigation.

Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness.

PubMed

Bryce, Jennifer; Victora, Cesar G; Habicht, Jean-Pierre; Black, Robert E; Scherpbier, Robert W

2005-12-01

To summarize the expectations held by World Health Organization programme personnel about how the introduction of the Integrated Management of Childhood Illness (IMCI) strategy would lead to improvements in child health and nutrition, to compare these expectations with what was learned from the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE-IMCI), and to discuss the implications of these findings for child survival policies and programmes. The MCE-IMCI study designs were based on an impact model developed in 1999-2000 to define how IMCI would be implemented at country level and below, and the outcomes and impact it would have on child health and survival. MCE-IMCI studies included: feasibility assessments documenting IMCI implementation in 12 countries (1999-2001); in-depth studies using compatible designs in Bangladesh, Brazil, Peru, Tanzania and Uganda; and cross-site analyses addressing the effectiveness of specific subsets of IMCI activities. The IMCI strategy was successfully introduced in the great majority of countries with moderate to high levels of child mortality in the period from 1996 to 2001. Seven years of country-based evaluation, however, indicates that some of the basic expectations underlying the development of IMCI were not met. Four of the five countries (the exception is Tanzania) had difficulties in expanding the strategy at national level while maintaining adequate intervention quality. Technical guidelines on delivering interventions at family and community levels were slow to appear, and in their absence countries stalled in their efforts to increase population coverage with essential interventions related to care-seeking, nutrition, and correct care of the sick child at home. The full weight of health system limitations on IMCI implementation was not appreciated at the outset, and only now is it clear that solutions to larger problems in political commitment, human resources, financing, integrated or at least coordinated programme management, and effective decentralization are essential underpinnings of successful efforts to reduce child mortality. This analysis highlights the need for a shift if child survival efforts are to be successful. Delivery systems that rely solely on government health facilities must be expanded to include the full range of potential channels in a setting and strong community-based approaches. The focus on process within child health programmes must change to include greater accountability for intervention coverage at population level. Global strategies that expect countries to make massive adaptations must be complemented by country-level implementation guidelines that begin with local epidemiology and rely on tools developed for specific epidemiological profiles.

Wheat forecast economics effect study. [value of improved information on crop inventories, production, imports and exports

NASA Technical Reports Server (NTRS)

Mehra, R. K.; Rouhani, R.; Jones, S.; Schick, I.

1980-01-01

A model to assess the value of improved information regarding the inventories, productions, exports, and imports of crop on a worldwide basis is discussed. A previously proposed model is interpreted in a stochastic control setting and the underlying assumptions of the model are revealed. In solving the stochastic optimization problem, the Markov programming approach is much more powerful and exact as compared to the dynamic programming-simulation approach of the original model. The convergence of a dual variable Markov programming algorithm is shown to be fast and efficient. A computer program for the general model of multicountry-multiperiod is developed. As an example, the case of one country-two periods is treated and the results are presented in detail. A comparison with the original model results reveals certain interesting aspects of the algorithms and the dependence of the value of information on the incremental cost function.

The association between female genital fistula symptoms and gender-based violence: A multicountry secondary analysis of household survey data.

PubMed

Mallick, Lindsay; Tripathi, Vandana

2018-01-01

The Demographic and Health Surveys (DHS), which include standardised questions on female genital fistula symptoms, provide a unique opportunity to evaluate the epidemiology of fistula. This study sought to examine associations between self-reported fistula symptoms and experience of gender-based violence (GBV) among women interviewed in DHS surveys. This study used data from thirteen DHS surveys with standardised fistula and domestic violence modules. Data from the most recent survey in each country were pooled, weighting each survey equally. Multivariable logistic regressions controlled for maternal and demographic factors. Prevalence of fistula symptoms in this sample of 95 625 women ranges from 0.3% to 1.8% by country. The majority of women reporting fistula symptoms (56%) have ever experienced physical violence, and more than one-quarter have ever experienced sexual violence (27%), compared with 38% and 13% among women with no symptoms, respectively. Similarly, 16% of women with fistula symptoms report recently experiencing sexual violence-twice the percentage among women not reporting symptoms (8%). Women whose first experience of sexual violence was from a non-partner have almost four times the odds of reporting fistula symptoms compared with women who never experienced sexual violence. These associations indicate a need to investigate temporal and causal relationships between violence and fistula. The increased risk of physical and sexual violence among women with fistula symptoms suggests that fistula programmes should incorporate GBV into provider training and services. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Noncommunicable Disease Risk Factors and Mobile Phones: A Proposed Research Agenda

PubMed Central

Wosu, Adaeze C; Gibson, Dustin G; Labrique, Alain B; Ali, Joseph; Pariyo, George W

2017-01-01

Noncommunicable diseases (NCDs) account for two-thirds of all deaths globally, with 75% of these occurring in low- and middle-income countries (LMICs). Many LMICs seek cost-effective methods to obtain timely and quality NCD risk factor data that could inform resource allocation, policy development, and assist evaluation of NCD trends over time. Over the last decade, there has been a proliferation of mobile phone ownership and access in LMICs, which, if properly harnessed, has great potential to support risk factor data collection. As a supplement to traditional face-to-face surveys, the ubiquity of phone ownership has made large proportions of most populations reachable through cellular networks. However, critical gaps remain in understanding the ways by which mobile phone surveys (MPS) could aid in collection of NCD data in LMICs. Specifically, limited information exists on the optimization of these surveys with regard to incentives and structure, comparative effectiveness of different MPS modalities, and key ethical, legal, and societal issues (ELSI) in the development, conduct, and analysis of these surveys in LMIC settings. We propose a research agenda that could address important knowledge gaps in optimizing MPS for the collection of NCD risk factor data in LMICs and provide an example of a multicountry project where elements of that agenda aim to be integrated over the next two years. PMID:28476722

Business cycle impacts on substance use of adolescents: A multi-country analysis.

PubMed

Paling, Thomas; Vall Castello, Judit

2017-11-01

Populations respond to changes in the economic climate in a variety of ways. The recent 'Great Recession' has brought attention to the vulnerability of many economies around the world to changes in non-domestic macroeconomic fluctuations. However, empirical evidence on the responses of adolescents' substance consumption behaviour when the economy deteriorates is very scarce. Thus, the focus of this paper is to analyse the substance consumption patterns displayed by adolescents in response to changes in macroeconomic conditions in a large number of countries. Our results show that beer and wine consumption vary counter-cyclically (a 1pp increase in the unemployment rate increases the probability of drinking beer (wine) by 3% (5.5%)) while adolescent smoking prevalence varies pro-cyclically (a 1pp increase in the unemployment rate decreases the probability of being a current smoker by 3.8%). More importantly, we find that the probability of ever being drunk increases by 1.3% for a 1pp increase in the unemployment rate. Further to this, substantial heterogeneous effects from the aggregate-level results were found when analysing a variety of demographic and geographic dimensions. In light of the existing empirical evidence which outlines that early substance initiators demonstrate worse neurological deficits and suffer stronger labour market penalties (compared to later initiators or abstainers) these findings can aid policy makers in reducing these lasting adverse outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

How firms set prices for medical materials: a multi-country study.

PubMed

Ide, Hiroo; Mollahaliloglu, Salih

2009-09-01

This study presents a comparison of medical material prices, discusses why differences exist, and examines methods for comparing prices. Market prices for drug-eluting stents (DES), non-drug-eluting stents (non-DES), and percutaneous transluminal coronary angioplasty (PTCA) catheters were collected from five countries: the United States, Japan, Korea, Turkey, and Thailand. To compare prices, three adjustment methods were used: currency exchange rates, purchasing power parity (PPP), and gross domestic product (GDP) per capita. The ratios of medical material prices compared with those in the United States were higher in Japan (from 1.4 for DES to 5.0 for PTCA catheters) and Korea (from 1.2 for DES to 4.0 for PTCA catheters), and lower in Turkey (from 0.8 for non-DES to 1.4 for DES) and Thailand (from 0.5 for non-DES to 1.3 for PTCA catheters). The PPP-adjusted ratios changed slightly for Japan, Korea, and Turkey. When the prices were adjusted by GDP per capita, the ratios were much higher. Comparing prices using currency exchange rates or PPP is applicable only between countries with stable economic relations; adjustment by GDP per capita reflects the actual burden. Further study is needed to fully elucidate the factors influencing the global medical material market.

Can role models boost entrepreneurial attitudes?

PubMed Central

Fellnhofer, Katharina; Puumalainen, Kaisu

2017-01-01

This multi-country study used role models to boost perceptions of entrepreneurial feasibility and desirability. The results of a structural equation model based on a sample comprising 426 individuals who were primarily from Austria, Finland and Greece revealed a significant positive influence on perceived entrepreneurial desirability and feasibility. These findings support the argument for embedding entrepreneurial role models in entrepreneurship education courses to promote entrepreneurial activities. This direction is not only relevant for the academic community but also essential for nascent entrepreneurs, policymakers and society at large. PMID:28458611

Can role models boost entrepreneurial attitudes?

PubMed

Fellnhofer, Katharina; Puumalainen, Kaisu

2017-01-01

This multi-country study used role models to boost perceptions of entrepreneurial feasibility and desirability. The results of a structural equation model based on a sample comprising 426 individuals who were primarily from Austria, Finland and Greece revealed a significant positive influence on perceived entrepreneurial desirability and feasibility. These findings support the argument for embedding entrepreneurial role models in entrepreneurship education courses to promote entrepreneurial activities. This direction is not only relevant for the academic community but also essential for nascent entrepreneurs, policymakers and society at large.

The effect of souvenaid on functional brain network organisation in patients with mild Alzheimer's disease: a randomised controlled study.

PubMed

de Waal, Hanneke; Stam, Cornelis J; Lansbergen, Marieke M; Wieggers, Rico L; Kamphuis, Patrick J G H; Scheltens, Philip; Maestú, Fernando; van Straaten, Elisabeth C W

2014-01-01

Synaptic loss is a major hallmark of Alzheimer's disease (AD). Disturbed organisation of large-scale functional brain networks in AD might reflect synaptic loss and disrupted neuronal communication. The medical food Souvenaid, containing the specific nutrient combination Fortasyn Connect, is designed to enhance synapse formation and function and has been shown to improve memory performance in patients with mild AD in two randomised controlled trials. To explore the effect of Souvenaid compared to control product on brain activity-based networks, as a derivative of underlying synaptic function, in patients with mild AD. A 24-week randomised, controlled, double-blind, parallel-group, multi-country study. 179 drug-naïve mild AD patients who participated in the Souvenir II study. Patients were randomised 1∶1 to receive Souvenaid or an iso-caloric control product once daily for 24 weeks. In a secondary analysis of the Souvenir II study, electroencephalography (EEG) brain networks were constructed and graph theory was used to quantify complex brain structure. Local brain network connectivity (normalised clustering coefficient gamma) and global network integration (normalised characteristic path length lambda) were compared between study groups, and related to memory performance. THE NETWORK MEASURES IN THE BETA BAND WERE SIGNIFICANTLY DIFFERENT BETWEEN GROUPS: they decreased in the control group, but remained relatively unchanged in the active group. No consistent relationship was found between these network measures and memory performance. The current results suggest that Souvenaid preserves the organisation of brain networks in patients with mild AD within 24 weeks, hypothetically counteracting the progressive network disruption over time in AD. The results strengthen the hypothesis that Souvenaid affects synaptic integrity and function. Secondly, we conclude that advanced EEG analysis, using the mathematical framework of graph theory, is useful and feasible for assessing the effects of interventions. Dutch Trial Register NTR1975.

The Effect of Souvenaid on Functional Brain Network Organisation in Patients with Mild Alzheimer’s Disease: A Randomised Controlled Study

PubMed Central

de Waal, Hanneke; Stam, Cornelis J.; Lansbergen, Marieke M.; Wieggers, Rico L.; Kamphuis, Patrick J. G. H.; Scheltens, Philip; Maestú, Fernando; van Straaten, Elisabeth C. W.

2014-01-01

Background Synaptic loss is a major hallmark of Alzheimer’s disease (AD). Disturbed organisation of large-scale functional brain networks in AD might reflect synaptic loss and disrupted neuronal communication. The medical food Souvenaid, containing the specific nutrient combination Fortasyn Connect, is designed to enhance synapse formation and function and has been shown to improve memory performance in patients with mild AD in two randomised controlled trials. Objective To explore the effect of Souvenaid compared to control product on brain activity-based networks, as a derivative of underlying synaptic function, in patients with mild AD. Design A 24-week randomised, controlled, double-blind, parallel-group, multi-country study. Participants 179 drug-naïve mild AD patients who participated in the Souvenir II study. Intervention Patients were randomised 1∶1 to receive Souvenaid or an iso-caloric control product once daily for 24 weeks. Outcome In a secondary analysis of the Souvenir II study, electroencephalography (EEG) brain networks were constructed and graph theory was used to quantify complex brain structure. Local brain network connectivity (normalised clustering coefficient gamma) and global network integration (normalised characteristic path length lambda) were compared between study groups, and related to memory performance. Results The network measures in the beta band were significantly different between groups: they decreased in the control group, but remained relatively unchanged in the active group. No consistent relationship was found between these network measures and memory performance. Conclusions The current results suggest that Souvenaid preserves the organisation of brain networks in patients with mild AD within 24 weeks, hypothetically counteracting the progressive network disruption over time in AD. The results strengthen the hypothesis that Souvenaid affects synaptic integrity and function. Secondly, we conclude that advanced EEG analysis, using the mathematical framework of graph theory, is useful and feasible for assessing the effects of interventions. Trial registration Dutch Trial Register NTR1975. PMID:24475144

Attributing foodborne salmonellosis in humans to animal reservoirs in the European Union using a multi-country stochastic model.

PubMed

DE Knegt, L V; Pires, S M; Hald, T

2015-04-01

A Bayesian modelling approach comparing the occurrence of Salmonella serovars in animals and humans was used to attribute salmonellosis cases to broilers, turkeys, pigs, laying hens, travel and outbreaks in 24 European Union countries. Salmonella data for animals and humans, covering the period from 2007 to 2009, were mainly obtained from studies and reports published by the European Food Safety Authority. Availability of food sources for consumption was derived from trade and production data from the European Statistical Office. Results showed layers as the most important reservoir of human salmonellosis in Europe, with 42·4% (7 903 000 cases, 95% credibility interval 4 181 000-14 510 000) of cases, 95·9% of which was caused by S. Enteritidis. In Finland and Sweden, most cases were travel-related, while in most other countries the main sources were related to the laying hen or pig reservoir, highlighting differences in the epidemiology of Salmonella, surveillance focus and eating habits across the European Union.

Association Among Father Involvement, Partner Violence, and Paternal Health: UN Multi-Country Cross-Sectional Study on Men and Violence.

PubMed

Chan, Ko Ling; Emery, Clifton R; Fulu, Emma; Tolman, Richard M; Ip, Patrick

2017-05-01

The influence of father involvement on intimate partner violence (IPV) and men's health is poorly understood. This study aimed to investigate the prevalence of six aspects of father involvement in delivery and child care, and to explore their individual associations with IPV against women and paternal health in an Asia-Pacific context. This study analyzed data from the 2011-2012 UN Multi-Country Cross-Sectional Study on Men and Violence, which surveyed >10,000 men from Bangladesh, Cambodia, China, Indonesia, Papua New Guinea, and Sri Lanka. Multivariate regression analyses were conducted in 2016 to examine the associations among father involvement, IPV, and paternal health. The sample comprised 6,184 men (aged 18-49 years) who had at least one child. The prevalence ranged from 40.0% to 62.9% across different aspects of father involvement. Presence at prenatal visits, taking paternity leave, and helping children with homework were associated with a reduced likelihood of IPV against women (all p<0.05). When possible confounding factors were adjusted for, father involvement accounted for 2% of the variance of men's perceived health, 4% of depression, and 2% of life satisfaction (all p<0.05). Father involvement may be beneficial in reducing IPV and improving paternal health. More family-friendly policies should be adopted by policymakers to promote father involvement throughout pregnancy to improve family well-being and child development. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control.

PubMed

Biesma, Regien G; Brugha, Ruairí; Harmer, Andrew; Walsh, Aisling; Spicer, Neil; Walt, Gill

2009-07-01

This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries' national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions.

Genderedness of bar drinking culture and alcohol-related harms: A multi-country study

PubMed Central

Roberts, Sarah C. M.; Bond, Jason; Korcha, Rachael; Greenfield, Thomas K.

2012-01-01

This study explores whether associations between consuming alcohol in bars and alcohol-related harms are consistent across countries and whether country-level characteristics modify associations. We hypothesized that genderedness of bar drinking modifies associations, such that odds of harms associated with bar drinking increase more rapidly in predominantly male bar-drinking countries. Multilevel analysis was used to analyze survey data from 21 countries representing five continents from Gender, Alcohol, and Culture: An International Study (GENACIS). Bar frequency was positively associated with harms overall. Relationships between bar frequency and harms varied across country. Genderedness modified associations between bar frequency and odds of fights, marriage/relationship harms, and work harms. Findings were significant only for men. Contrary to our hypothesis, odds of harms associated with bar drinking increased less rapidly in countries where bar drinking is predominantly male. This suggests predominantly male bar drinking cultures may be protective for males who more frequently drink in bars. PMID:23710158

The association between exposure to point-of-sale anti-smoking warnings and smokers’ interest in quitting and quit attempts: Findings from the International Tobacco Control Four Country Survey

PubMed Central

Li, Lin; Borland, Ron; Yong, Hua-Hie; Hitchman, Sara C.; Wakefield, Melanie A.; Kasza, Karin A.; Fong, Geoffrey T.

2011-01-01

Aims This study aimed to examine the associations between reported exposure to anti-smoking warnings at the point-of-sale (POS) and smokers’ interest in quitting and their subsequent quit attempts by comparing reactions in Australia where warnings are prominent to smokers in other countries. Design A prospective multi-country cohort design was employed. Setting Australia, Canada, the UK and the US. Participants 21,613 adult smokers who completed at least one of the seven waves (2002-2008) of the International Tobacco Control Four Country Survey were included in the analysis. Measurements Reported exposure to POS anti-smoking warnings and smokers’ interest in quitting at the same wave and quit attempts over the following year. Findings Compared to smokers in Canada, the UK and the US, Australian smokers reported higher levels of awareness of POS anti-smoking warnings, and this difference was consistent over the study period. Over waves in Australia (but not in the other three countries) there was a significantly positive association between reported exposure to POS anti-smoking warnings and interest in quitting (adjusted odds ratio = 1.139, 95% CI 1.039~1.249, p<0.01) and prospective quit attempts (adjusted odds ratio = 1.216, 95% CI 1.114~1.327, p<0.001) when controlling for demographics, smoking characteristics, overall salience of anti-smoking information, and awareness of anti-smoking material from channels other than POS. Conclusions Point-of-sale health warnings about tobacco are more prominent in Australia than US, UK or Canada and appear to act as a prompt to quitting. PMID:21954921

The Effects of Biocompatible Compared with Standard Peritoneal Dialysis Solutions on Peritonitis Microbiology, Treatment, and Outcomes: the balANZ Trial

PubMed Central

Johnson, David W.; Brown, Fiona G.; Clarke, Margaret; Boudville, Neil; Elias, Tony J.; Foo, Marjorie W.Y.; Jones, Bernard; Kulkarni, Hemant; Langham, Robyn; Ranganathan, Dwarakanathan; Schollum, John; Suranyi, Michael G.; Tan, Seng H.; Voss, David

2012-01-01

♦ Background: A multicenter, multi-country randomized controlled trial (the balANZ study) recently reported that peritonitis rates significantly improved with the use of neutral-pH peritoneal dialysis (PD) solutions low in glucose degradation products (“biocompatible”) compared with standard solutions. The present paper reports a secondary outcome analysis of the balANZ trial with respect to peritonitis microbiology, treatment, and outcomes. ♦ Methods: Adult incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years. ♦ Results: The safety population analysis for peritonitis included 91 patients in each group. The unadjusted geometric mean peritonitis rates in those groups were 0.30 [95% confidence interval (CI): 0.22 to 0.41] episodes per patient-year for the biocompatible group and 0.49 (95% CI: 0.39 to 0.62) episodes per patient-year for the control group [incidence rate ratio (IRR): 0.61; 95% CI: 0.41 to 0.90; p = 0.01]. When specific causative organisms were examined, the rates of culture-negative, gram-positive, gram-negative, and polymicrobial peritonitis episodes were not significantly different between the biocompatible and control groups, although the biocompatible group did experience a significantly lower rate of non-pseudomonal gram-negative peritonitis (IRR: 0.41; 95% CI: 0.18 to 0.92; p = 0.03). Initial empiric antibiotic regimens were comparable between the groups. Biocompatible fluid use did not significantly reduce the risk of peritonitis-associated hospitalization (adjusted odds ratio: 0.80; 95% CI: 0.48 to 1.34), but did result in a shorter median duration of peritonitis-associated hospitalization (6 days vs 11 days, p = 0.05). Peritonitis severity was more likely to be rated as mild in the biocompatible group (37% vs 10%, p = 0.001). Overall peritonitis-associated technique failures and peritonitis-related deaths were comparable in the two groups. ♦ Conclusions: Biocompatible PD fluid use was associated with a broad reduction in gram-positive, gram-negative, and culture-negative peritonitis that reached statistical significance for non-pseudomonal gram-negative organisms. Peritonitis hospitalization duration was shorter, and peritonitis severity was more commonly rated as mild in patients receiving biocompatible PD fluids, although other peritonitis outcomes were comparable between the groups. PMID:22991015

A collaborative approach to investigating the risk of thrombocytopenic purpura after measles-mumps-rubella vaccination in England and Denmark.

PubMed

Andrews, Nick; Stowe, Julia; Miller, Elizabeth; Svanström, Henrik; Johansen, Kari; Bonhoeffer, Jan; Hviid, Anders

2012-04-19

The assessment of rare adverse events following vaccination may not be possible within a single country due to an insufficiently large denominator population. In 2008 a European consortium (VAESCO) was funded to perform collaborative vaccine safety studies. To help assess the feasibility of multi-country collaboration England and Denmark, who have established vaccine safety research infrastructures, undertook to work to a common protocol and share results and data to estimate the risk of a known true adverse event, thrombocytopenic purpura (TP) following measles-mumps-rubella (MMR) vaccination. TP is a known rare reaction to MMR and therefore provided an opportunity to assess whether two countries would produce similar results when working collaboratively. Despite some initial problems with ensuring data were comparable, the two countries gave very similar estimates of the relative incidence in the 6 weeks after vaccination and a pooled relative incidence estimate of 2.13 (95% confidence interval 1.55-2.94) and attributable risk of 1 in 50,000 doses. Both countries used hospital admissions for TP and the analysis was performed using the self controlled case series method which is particularly suited to collaborative studies because of its implicit control for individual level confounding. The study therefore shows the potential for vaccine safety collaborations across Europe to detect true associations through use of common protocols and sharing of results or data. Copyright © 2011 Brighton Collaboration. Published by Elsevier Ltd.. All rights reserved.

Attitudes and usage of denture adhesives by complete denture wearers: a survey in Greece and the Netherlands.

PubMed

Polyzois, Gregory L; de Baat, Cees

2012-06-01

To explore whether there are differences in usage of and attitudes towards denture adhesives among patients in two countries. There are no multi-country surveys concerning usage of and attitudes towards denture adhesives from complete denture wearers. The survey took place in Greece and the Netherlands with a sample of 284 and 165 consecutive complete denture wearers, respectively, by using a 9-item prepared questionnaire. Statistical analysis relied on chi-square test at α = 0.05. In this survey, 26 and 20% of Greek and Dutch patients, respectively, had tried denture adhesive, but only 27% of them in Greece as well as in the Netherlands currently used it; 49% of the Greek and 45% of the Dutch participants rated the overall performance of adhesives as good. Between the two populations, no differences were identified in a majority of the research variables, except where 27% of Greeks answered that they did not know the existence of denture adhesives compared to none of the Dutch patients and when 90% of the Dutch contrary to 70% of Greeks reported that they did not need denture adhesives as they could manage their dentures well. The usage of and attitudes towards denture adhesives between the Greek and Dutch sample were similar with only two exceptions concerning the knowledge of existence and the need of using denture adhesives. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

PubMed

Vogel, Joshua P; Souza, João Paulo; Gülmezoglu, A Metin; Mori, Rintaro; Lumbiganon, Pisake; Qureshi, Zahida; Carroli, Guillermo; Laopaiboon, Malinee; Fawole, Bukola; Ganchimeg, Togoobaatar; Zhang, Jun; Torloni, Maria Regina; Bohren, Meghan; Temmerman, Marleen

2014-11-22

Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries. WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks' gestation and we excluded births that occurred outside a facility or quicker than 3 h after arrival. We calculated use of antenatal corticosteroids in women who gave birth between 26 and 34 weeks' gestation, when antenatal corticosteroids are known to be most beneficial. We also calculated use in women at 22-25 weeks' and 34-36 weeks' gestation. We assessed tocolytic drug use, with and without antenatal corticosteroids, in spontaneous, uncomplicated preterm deliveries at 26-34 weeks' gestation. Of 303,842 recorded deliveries after 22 weeks' gestation, 17,705 (6%) were preterm. 3900 (52%) of 7547 women who gave birth at 26-34 weeks' gestation, 94 (19%) of 497 women who gave birth at 22-25 weeks' gestation, and 2276 (24%) of 9661 women who gave birth at 35-36 weeks' gestation received antenatal corticosteroids. Rates of antenatal corticosteroid use varied between countries (median 54%, range 16-91%; IQR 30-68%). Of 4677 women who were potentially eligible for tocolysis drugs, 1276 (27%) were treated with bed rest or hydration and 2248 (48%) received no treatment. β-agonists alone (n=346, 7%) were the most frequently used tocolytic drug. Only 848 (18%) of potentially eligible women received both a tocolytic drug and antenatal corticosteroids. Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice. UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects. Copyright © 2014 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.

Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa

PubMed Central

Peltzer, Karl; Williams, Jennifer Stewart; Kowal, Paul; Negin, Joel; Snodgrass, James Josh; Yawson, Alfred; Minicuci, Nadia; Thiele, Liz; Phaswana-Mafuya, Nancy; Biritwum, Richard Berko; Naidoo, Nirmala; Chatterji, Somnath

2014-01-01

Background and objective The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries. Design Secondary analysis of data from the World Health Organization’s Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use. Results In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions. Conclusions This study provides a basis for further investigation of country-specific responses to UHC. PMID:25363363

Estimating regional centile curves from mixed data sources and countries.

PubMed

van Buuren, Stef; Hayes, Daniel J; Stasinopoulos, D Mikis; Rigby, Robert A; ter Kuile, Feiko O; Terlouw, Dianne J

2009-10-15

Regional or national growth distributions can provide vital information on the health status of populations. In most resource poor countries, however, the required anthropometric data from purpose-designed growth surveys are not readily available. We propose a practical method for estimating regional (multi-country) age-conditional weight distributions based on existing survey data from different countries. We developed a two-step method by which one is able to model data with widely different age ranges and sample sizes. The method produces references both at the country level and at the regional (multi-country) level. The first step models country-specific centile curves by Box-Cox t and Box-Cox power exponential distributions implemented in generalized additive model for location, scale and shape through a common model. Individual countries may vary in location and spread. The second step defines the regional reference from a finite mixture of the country distributions, weighted by population size. To demonstrate the method we fitted the weight-for-age distribution of 12 countries in South East Asia and the Western Pacific, based on 273 270 observations. We modeled both the raw body weight and the corresponding Z score, and obtained a good fit between the final models and the original data for both solutions. We briefly discuss an application of the generated regional references to obtain appropriate, region specific, age-based dosing regimens of drugs used in the tropics. The method is an affordable and efficient strategy to estimate regional growth distributions where the standard costly alternatives are not an option. Copyright (c) 2009 John Wiley & Sons, Ltd.

The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control

PubMed Central

Biesma, Regien G; Brugha, Ruairí; Harmer, Andrew; Walsh, Aisling; Spicer, Neil; Walt, Gill

2009-01-01

This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries’ national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions. PMID:19491291

School staff perpetration of physical violence against students in Uganda: a multilevel analysis of risk factors

PubMed Central

Merrill, Katherine G; Knight, Louise; Glynn, Judith R; Allen, Elizabeth; Naker, Dipak; Devries, Karen M

2017-01-01

Objective To conduct a multilevel analysis of risk factors for physical violence perpetration by school staff against Ugandan students. Design Multilevel logistic regression analysis of cross-sectional survey data from 499 staff and 828 caregivers of students at 38 primary schools, collected in 2012 and 2014 during the Good Schools Study. Setting Luwero District, Uganda. Main outcome measure Past-week use of physical violence by school staff against students was measured using the International Society for the Prevention of Child Abuse and Neglect ‘Child Abuse Screening Tool- Child International’ and the WHO Multi-Country Study on Women’s Health and Domestic Violence against Women. Results Of 499 staff, 215 (43%) reported perpetration of physical violence against students in the past week. Individual risk factors associated with physical violence perpetration included being a teacher versus another type of staff member (p<0.001), approving of physical discipline practices (p<0.001), having children (p<0.01), being age 30–39 years (p<0.05), using physical violence against non-students (p<0.05) and being a victim of intimate partner violence (IPV) (p<0.05). We observed weak evidence (p=0.06) that male staff members who had been a victim of IPV showed higher odds of violence perpetration compared with male staff who had not been a victim of IPV. No evidence was observed for school- or community-level risk factors. Conclusions Physical violence perpetration from school staff is widespread, and interventions are needed to address this issue. Staff who have been victims of violence and who use violence against people other than students may benefit from additional interventions. Researchers should further investigate how school and community contexts influence staff’s physical violence usage, given a lack of associations observed in this study. PMID:28821514

School staff perpetration of physical violence against students in Uganda: a multilevel analysis of risk factors.

PubMed

Merrill, Katherine G; Knight, Louise; Glynn, Judith R; Allen, Elizabeth; Naker, Dipak; Devries, Karen M

2017-08-18

To conduct a multilevel analysis of risk factors for physical violence perpetration by school staff against Ugandan students. Multilevel logistic regression analysis of cross-sectional survey data from 499 staff and 828 caregivers of students at 38 primary schools, collected in 2012 and 2014 during the Good Schools Study. Luwero District, Uganda. Past-week use of physical violence by school staff against students was measured using the International Society for the Prevention of Child Abuse and Neglect 'Child Abuse Screening Tool- Child International' and the WHO Multi-Country Study on Women's Health and Domestic Violence against Women. Of 499 staff, 215 (43%) reported perpetration of physical violence against students in the past week. Individual risk factors associated with physical violence perpetration included being a teacher versus another type of staff member (p<0.001), approving of physical discipline practices (p<0.001), having children (p<0.01), being age 30-39 years (p<0.05), using physical violence against non-students (p<0.05) and being a victim of intimate partner violence (IPV) (p<0.05). We observed weak evidence (p=0.06) that male staff members who had been a victim of IPV showed higher odds of violence perpetration compared with male staff who had not been a victim of IPV. No evidence was observed for school- or community-level risk factors. Physical violence perpetration from school staff is widespread, and interventions are needed to address this issue. Staff who have been victims of violence and who use violence against people other than students may benefit from additional interventions. Researchers should further investigate how school and community contexts influence staff's physical violence usage, given a lack of associations observed in this study. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Efficacy, Safety and Cost of Insecticide Treated Wall Lining, Insecticide Treated Bed Nets and Indoor Wall Wash with Lime for Visceral Leishmaniasis Vector Control in the Indian Sub-continent: A Multi-country Cluster Randomized Controlled Trial

PubMed Central

Das, Pradeep; Ghosh, Debashis; Priyanka, Jyoti; Matlashewski, Greg; Kroeger, Axel; Upfill-Brown, Alexander

2016-01-01

Background We investigated the efficacy, safety and cost of lime wash of household walls plus treatment of sand fly breeding places with bleach (i.e. environmental management or EM), insecticide impregnated durable wall lining (DWL), and bed net impregnation with slow release insecticide (ITN) for sand fly control in the Indian sub-continent. Methods This multi-country cluster randomized controlled trial had 24 clusters in each three sites with eight clusters per high, medium or low sand fly density stratum. Every cluster included 45–50 households. Five households from each cluster were randomly selected for entomological measurements including sand fly density and mortality at one, three, nine and twelve months post intervention. Household interviews were conducted for socioeconomic information and intervention acceptability assessment. Cost for each intervention was calculated. There was a control group without intervention. Findings Sand fly mortality [mean and 95%CI] ranged from 84% (81%-87%) at one month to 74% (71%-78%) at 12 months for DWL, 75% (71%-79%) at one month to 49% (43%-55%) at twelve months for ITN, and 44% (34%-53%) at one month to 22% (14%-29%) at twelve months for EM. Adjusted intervention effect on sand fly density measured by incidence rate ratio ranged from 0.28 (0.23–0.34) at one month to 0.62 (0.51–0.75) at 12 months for DWL; 0.72 (0.62–0.85) at one month to 1.02 (0.86–1.22) at 12 months for ITN; and 0.89 (0.76–1.03) at one months to 1.49 (1.26–1.74) at 12 months for EM. Household acceptance of EM was 74% compared to 94% for both DWL and ITN. Operational cost per household in USD was about 5, 8, and 2 for EM, DWL and ITN, respectively. Minimal adverse reactions were reported for EM and ITN while 36% of households with DWL reported transient itching. Interpretation DWL is the most effective, durable and acceptable control method followed by ITN. The Visceral Leishmaniasis (VL) Elimination Program in the Indian sub-continent should consider DWL and ITN for sand fly control in addition to IRS. PMID:27533097

Diagnosis of neglected tropical diseases among patients with persistent digestive disorders (diarrhoea and/or abdominal pain ≥14 days): Pierrea multi-country, prospective, non-experimental case-control study.

PubMed

Polman, Katja; Becker, Sören L; Alirol, Emilie; Bhatta, Nisha K; Bhattarai, Narayan R; Bottieau, Emmanuel; Bratschi, Martin W; Burza, Sakib; Coulibaly, Jean T; Doumbia, Mama N; Horié, Ninon S; Jacobs, Jan; Khanal, Basudha; Landouré, Aly; Mahendradhata, Yodi; Meheus, Filip; Mertens, Pascal; Meyanti, Fransiska; Murhandarwati, Elsa H; N'Goran, Eliézer K; Peeling, Rosanna W; Ravinetto, Raffaella; Rijal, Suman; Sacko, Moussa; Saye, Rénion; Schneeberger, Pierre H H; Schurmans, Céline; Silué, Kigbafori D; Thobari, Jarir A; Traoré, Mamadou S; van Lieshout, Lisette; van Loen, Harry; Verdonck, Kristien; von Müller, Lutz; Yansouni, Cédric P; Yao, Joel A; Yao, Patrick K; Yap, Peiling; Boelaert, Marleen; Chappuis, François; Utzinger, Jürg

2015-08-18

Diarrhoea still accounts for considerable mortality and morbidity worldwide. The highest burden is concentrated in tropical areas where populations lack access to clean water, adequate sanitation and hygiene. In contrast to acute diarrhoea (<14 days), the spectrum of pathogens that may give rise to persistent diarrhoea (≥14 days) and persistent abdominal pain is poorly understood. It is conceivable that pathogens causing neglected tropical diseases play a major role, but few studies investigated this issue. Clinical management and diagnostic work-up of persistent digestive disorders in the tropics therefore remain inadequate. Hence, important aspects regarding the pathogenesis, epidemiology, clinical symptomatology and treatment options for patients presenting with persistent diarrhoea and persistent abdominal pain should be investigated in multi-centric clinical studies. This multi-country, prospective, non-experimental case-control study will assess persistent diarrhoea (≥14 days; in individuals aged ≥1 year) and persistent abdominal pain (≥14 days; in children/adolescents aged 1-18 years) in up to 2000 symptomatic patients and 2000 matched controls. Subjects from Côte d'Ivoire, Indonesia, Mali and Nepal will be clinically examined and interviewed using a detailed case report form. Additionally, each participant will provide a stool sample that will be examined using a suite of diagnostic methods (i.e., microscopic techniques, rapid diagnostic tests, stool culture and polymerase chain reaction) for the presence of bacterial and parasitic pathogens. Treatment will be offered to all infected participants and the clinical treatment response will be recorded. Data obtained will be utilised to develop patient-centred clinical algorithms that will be validated in primary health care centres in the four study countries in subsequent studies. Our research will deepen the understanding of the importance of persistent diarrhoea and related digestive disorders in the tropics. A diversity of intestinal pathogens will be assessed for potential associations with persistent diarrhoea and persistent abdominal pain. Different diagnostic methods will be compared, clinical symptoms investigated and diagnosis-treatment algorithms developed for validation in selected primary health care centres. The findings from this study will improve differential diagnosis and evidence-based clinical management of digestive syndromes in the tropics. ClinicalTrials.gov; identifier: NCT02105714 .

Social and ecological synergy: local rulemaking, forest livelihoods, and biodiversity conservation.

PubMed

Persha, Lauren; Agrawal, Arun; Chhatre, Ashwini

2011-03-25

Causal pathways to achieve social and ecological benefits from forests are unclear, because there are few systematic multicountry empirical analyses that identify important factors and their complex relationships with social and ecological outcomes. This study examines biodiversity conservation and forest-based livelihood outcomes using a data set on 84 sites from six countries in East Africa and South Asia. We find both positive and negative relationships, leading to joint wins, losses, and trade-offs depending on specific contextual factors; participation in forest governance institutions by local forest users is strongly associated with jointly positive outcomes for forests in our study.

Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries.

PubMed

Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

2016-08-02

The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with the quality of and access to health care services. The study focuses on six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). We use data on past experience with health care use collected in 2010 through uniform national surveys in these countries. Based on these data, we carry out a multi-country analysis to investigate factors associated with the satisfaction of health care users in the six countries. The results indicate that about 10-14 % of the service users are not satisfied with the quality of, or access to health care services they used in the preceding year. However, significant differences across countries and services are observed, e.g. the highest level of dissatisfaction with access to outpatient services (16.4 %) is observed among patients in Lithuania, while in Poland, the level of dissatisfaction with quality of outpatient and inpatient services are much lower than dissatisfaction with access. The study also analyses the association of users' satisfaction with factors such as making informal payments, inability to pay and relative importance of service attributes stated by the service users. These multi-country findings provide evidence for health policy making in the Central and Eastern European countries. Although the average rates of satisfactions per country are relatively high, the results suggest that there is ample room for improvements. Specifically, many service-users still report dissatisfaction especially those who pay informally and those unable to pay. The high shares of informal payments and inability of users to deal with the health expenditures lead to doubts about the fairness of the health care provision in Central and Eastern Europe. There is an urgent need for policy makers in the region to not only acknowledge but also to effectively address this key problem.

Differences on Primary Care Labor Perceptions in Medical Students from 11 Latin American Countries

PubMed Central

Mayta-Tristán, Percy; Montenegro-Idrogo, Juan José; Mejia, Christian R.; Abudinén A., Gabriel; Azucas-Peralta, Rita; Barrezueta-Fernandez, Jorge; Cerna-Urrutia, Luis; DaSilva-DeAbreu, Adrián; Mondragón-Cardona, Alvaro; Moya, Geovanna; Valverde-Solano, Christian D.; Theodorus-Villar, Rhanniel; Vizárraga-León, Maribel

2016-01-01

Background The shortage in Latin-American Primary Care (PC) workforce may be due to negative perceptions about it. These perceptions might be probably influenced by particular features of health systems and academic environments, thus varying between countries. Methods Observational, analytic and cross-sectional multicountry study that evaluated 9,561 first and fifth-year medical students from 63 medical schools of 11 Latin American countries through a survey. Perceptions on PC work was evaluated through a previously validated scale. Tertiles of the scores were created in order to compare the different countries. Crude and adjusted prevalence ratios were calculated using simple and multiple Poisson regression with robust variance. Results Approximately 53% of subjects were female; mean age was 20.4±2.9 years; 35.5% were fifth-year students. Statistically significant differences were found between the study subjects’ country, using Peru as reference. Students from Chile, Colombia, Mexico and Paraguay perceived PC work more positively, while those from Ecuador showed a less favorable position. No differences were found among perceptions of Bolivian, Salvadoran, Honduran and Venezuelan students when compared to their Peruvian peers. Conclusions Perceptions of PC among medical students from Latin America vary according to country. Considering such differences can be of major importance for potential local specific interventions. PMID:27414643

Social capital and self-reported general and mental health in nine Former Soviet Union countries.

PubMed

Goryakin, Yevgeniy; Suhrcke, Marc; Rocco, Lorenzo; Roberts, Bayard; McKee, Martin

2014-01-01

Social capital has been proposed as a potentially important contributor to health, yet most of the existing research tends to ignore the challenge of assessing causality in this relationship. We deal with this issue by employing various instrumental variable estimation techniques. We apply the analysis to a set of nine former Soviet countries, using a unique multi-country household survey specifically designed for this region. Our results confirm that there appears to be a causal association running from several dimensions of individual social capital to general and mental health. Individual trust appears to be more strongly related to general health, while social isolation- to mental health. In addition, social support and trust seem to be more important determinants of health than the social capital dimensions that facilitate solidarity and collective action. Our findings are remarkably robust to a range of different specifications, including the use of instrumental variables. Certain interaction effects are also found: for instance, untrusting people who live in communities with higher aggregate level of trust are even less likely to experience good health than untrusting people living in the reference communities.

The research agenda for improving health policy, systems performance, and service delivery for tuberculosis control: a WHO perspective.

PubMed Central

Nunn, Paul; Harries, Anthony; Godfrey-Faussett, Peter; Gupta, Raj; Maher, Dermot; Raviglione, Mario

2002-01-01

The development of WHO's DOTS strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation and improvement of operational research in this area. From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multicountry projects that were also concerned with health policy and the needs of health systems. The results are now being put into practice by national TB control programmes. In 1998 an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multidrug resistance. An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article. We discuss the prerequisites for success, the shortcomings of this WHO- supported programme, and future challenges and needs. PMID:12132005

Infant feeding practices and prevalence of obesity in eight European countries - the IDEFICS study.

PubMed

Hunsberger, Monica; Lanfer, Anne; Reeske, Anna; Veidebaum, Toomas; Russo, Paola; Hadjigeorgiou, Charalampos; Moreno, Luis A; Molnar, Dénes; De Henauw, Stefaan; Lissner, Lauren; Eiben, Gabriele

2013-02-01

To assess the association between exclusive breast-feeding and childhood overweight. Cross-sectional data are from the baseline survey of the longitudinal cohort study IDEFICS. Exclusive rather than partial breast-feeding is the focus of the study due to the theoretical relationship between exclusive breast-feeding and development of dietary self-regulation. Children's measured heights and weights were used to calculate weight status, while waist-to-height ratio (WtHR) and skinfold measures were examined as alternative indicators of adiposity and fat patterning. Examination centres in eight European countries (Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain). The analysis included 14 726 children aged 2-9 years for whom early feeding practices were reported by parents in standardized questionnaires. After controlling for education, income and other potential confounders, breast-feeding exclusively for 4-6 months was protective of overweight (including obesity) when compared with children never exclusively breast-fed (OR = 0·73; 95 % CI 0·63, 0·85) across all measures of overweight. Exclusively breast-feeding for 6 months offered slightly more protection than for 4 and 5 months combined (OR = 0·71; 95 % CI 0·58, 0·85). The associations could not be explained by socio-economic characteristics or maternal overweight. This multi-country investigation indicated that exclusive breast-feeding for 4-6 months may confer protection against overweight in addition to other known benefits. There was no demonstrated benefit of exclusive breast-feeding for more than 6 months or combination feeding for any duration across all measures of overweight examined.

Boundary work for sustainable development: Natural resource management at the Consultative Group on International Agricultural Research (CGIAR).

PubMed

Clark, William C; Tomich, Thomas P; van Noordwijk, Meine; Guston, David; Catacutan, Delia; Dickson, Nancy M; McNie, Elizabeth

2016-04-26

Previous research on the determinants of effectiveness in knowledge systems seeking to support sustainable development has highlighted the importance of "boundary work" through which research communities organize their relations with new science, other sources of knowledge, and the worlds of action and policymaking. A growing body of scholarship postulates specific attributes of boundary work that promote used and useful research. These propositions, however, are largely based on the experience of a few industrialized countries. We report here on an effort to evaluate their relevance for efforts to harness science in support of sustainability in the developing world. We carried out a multicountry comparative analysis of natural resource management programs conducted under the auspices of the Consultative Group on International Agricultural Research. We discovered six distinctive kinds of boundary work contributing to the successes of those programs-a greater variety than has been documented in previous studies. We argue that these different kinds of boundary work can be understood as a dual response to the different uses for which the results of specific research programs are intended, and the different sources of knowledge drawn on by those programs. We show that these distinctive kinds of boundary work require distinctive strategies to organize them effectively. Especially important are arrangements regarding participation of stakeholders, accountability in governance, and the use of "boundary objects." We conclude that improving the ability of research programs to produce useful knowledge for sustainable development will require both greater and differentiated support for multiple forms of boundary work.

Boundary work for sustainable development: Natural resource management at the Consultative Group on International Agricultural Research (CGIAR)

PubMed Central

Clark, William C.; Tomich, Thomas P.; van Noordwijk, Meine; Guston, David; Catacutan, Delia; Dickson, Nancy M.; McNie, Elizabeth

2016-01-01

Previous research on the determinants of effectiveness in knowledge systems seeking to support sustainable development has highlighted the importance of “boundary work” through which research communities organize their relations with new science, other sources of knowledge, and the worlds of action and policymaking. A growing body of scholarship postulates specific attributes of boundary work that promote used and useful research. These propositions, however, are largely based on the experience of a few industrialized countries. We report here on an effort to evaluate their relevance for efforts to harness science in support of sustainability in the developing world. We carried out a multicountry comparative analysis of natural resource management programs conducted under the auspices of the Consultative Group on International Agricultural Research. We discovered six distinctive kinds of boundary work contributing to the successes of those programs—a greater variety than has been documented in previous studies. We argue that these different kinds of boundary work can be understood as a dual response to the different uses for which the results of specific research programs are intended, and the different sources of knowledge drawn on by those programs. We show that these distinctive kinds of boundary work require distinctive strategies to organize them effectively. Especially important are arrangements regarding participation of stakeholders, accountability in governance, and the use of “boundary objects.” We conclude that improving the ability of research programs to produce useful knowledge for sustainable development will require both greater and differentiated support for multiple forms of boundary work. PMID:21844351

Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer – disparities in outcomes (ABC‐DO) study

PubMed Central

Zietsman, Annelle; Galukande, Moses; Anele, Angelica; Adisa, Charles; Parham, Groesbeck; Pinder, Leeya; Cubasch, Herbert; Joffe, Maureen; Kidaaga, Frederick; Lukande, Robert; Offiah, Awa U.; Egejuru, Ralph O.; Shibemba, Aaron; Schuz, Joachim; Anderson, Benjamin O.; dos Santos Silva, Isabel; McCormack, Valerie

2017-01-01

Breast cancer (BC) survival rates in sub‐Saharan Africa (SSA) are low in part due to advanced stage at diagnosis. As one component of a study of the entire journey of SSA women with BC, we aimed to identify shared and setting‐specific drivers of advanced stage BC. Women newly diagnosed in the multicountry African Breast Cancer–Disparities in Outcomes (ABC‐DO) study completed a baseline interview and their stage information was extracted from medical records. Ordinal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for advanced stage (I, II, III, IV) in relation to individual woman‐level, referral and biological factors. A total of 1795 women were included from Nigeria, Uganda, Zambia, and the multiracial populations of Namibia and South Africa, 1091 of whom (61%) were stage III/IV. Stage was lower in women with greater BC knowledge (OR 0.77 (95% CI: 0.70, 0.85) per point on a 6 point scale). More advanced stage was associated with being black (4.00 (2.79, 5.74)), having attended

Toward a multi-country monitoring system of reproductive health in the context of endocrine disrupting chemical exposure.

PubMed

Le Moal, Joëlle; Sharpe, Richard M; Jϕrgensen, Niels; Levine, Hagai; Jurewicz, Joanna; Mendiola, Jaime; Swan, Shanna H; Virtanen, Helena; Christin-Maître, Sophie; Cordier, Sylvaine; Toppari, Jorma; Hanke, Wojciech

2016-02-01

Worrying trends regarding human reproductive endpoints (e.g. semen quality, reproductive cancers) have been reported and there is growing circumstantial evidence for a possible causal link between these trends and exposure to endocrine disrupting chemicals (EDCs). However, there is a striking lack of human data to fill the current knowledge gaps. To answer the crucial questions raised on human reproductive health, there is an urgent need for a reproductive surveillance system to be shared across countries. A multidisciplinary network named HUman Reproductive health and Global ENvironment Network (HURGENT) was created aiming at designing a European monitoring system for reproductive health indicators. Collaborative work allowed setting up the available knowledge to design such a system. Furthermore we conducted an overview of 23 potential indicators, based upon a weight of evidence (WoE) approach according to their potential relation with EDC exposure. The framework and purposes of the surveillance system are settled as well as the approach to select suitable reproductive indicators. The indicators found with the highest scores according to the WoE approach are prostate and breast cancer incidence, sex ratio, endometriosis and uterine fibroid incidence, indicators related to the testicular dysgenesis syndrome, precocious puberty incidence and reproductive hormone levels. Not only sentinel health endpoints, but also diseases with high burdens in public health are highlighted as prior indicators in the context of EDC exposure. Our work can serve as a basis to construct, as soon as possible, the first multi-country reproductive monitoring system. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Multi-country retrospective observational study of the management and outcomes of patients with Type 2 diabetes during Ramadan in 2010 (CREED).

PubMed

Babineaux, S M; Toaima, D; Boye, K S; Zagar, A; Tahbaz, A; Jabbar, A; Hassanein, M

2015-06-01

To describe the characteristics and management of patients with diabetes who chose to fast during Ramadan in 2010. This was a multi-country, retrospective, observational study, supplemented with physician and patient questionnaires, with data captured before, during and after Ramadan. A total of 508 physicians in 13 countries enrolled 3777 patients and a total of 3394 evaluable cases were analysed. We report on the subset of patients with Type 2 diabetes, which included 3250 patients (95.8%). Oral anti-hyperglycaemic therapy was the predominant pre-Ramadan therapy for most patients (76.6%). The treatment regimen was modified before Ramadan for 39.3% of all patients (34.9% for patients on oral drugs alone, 47.1% for patients on injectable drugs alone). Almost all physicians (96.2%) reported providing fasting-specific advice to patients and 62.6% report using guidelines or recommendations for the management of diabetes during Ramadan. In all, 64% of patients reported fasting everyday of Ramadan and 94.2% fasted for at least 15 days. Physicians have increasingly adopted multiple approaches to the management of fasting during Ramadan, including the adoption of international and/or national guidelines, providing fasting-specific advice and adjusting treatment regimens, such that patients are able to fast for a greater number of days without acute complications. Additional research is needed to explore physician and patient beliefs and practices to inform the evidence-based management of diabetes while fasting, both during and outside of Ramadan, and to identify and address barriers to the universal uptake of techniques to facilitate that management. © 2015 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women's health and domestic violence

PubMed Central

2011-01-01

Background Intimate partner violence (IPV) against women is a global public health and human rights concern. Despite a growing body of research into risk factors for IPV, methodological differences limit the extent to which comparisons can be made between studies. We used data from ten countries included in the WHO Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites, in order to inform the design of IPV prevention programs. Methods Standardised population-based household surveys were done between 2000 and 2003. One woman aged 15-49 years was randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. We performed multivariate logistic regression to identify predictors of physical and/or sexual partner violence within the past 12 months. Results Despite wide variations in the prevalence of IPV, many factors affected IPV risk similarly across sites. Secondary education, high SES, and formal marriage offered protection, while alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood, increased the risk of IPV. The strength of the association was greatest when both the woman and her partner had the risk factor. Conclusions IPV prevention programs should increase focus on transforming gender norms and attitudes, addressing childhood abuse, and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention. PMID:21324186

A Multi-country Study of the Household Willingness-to-Pay for Dengue Vaccines: Household Surveys in Vietnam, Thailand, and Colombia

PubMed Central

Lee, Jung-Seok

2015-01-01

Background The rise in dengue fever cases and the absence of dengue vaccines will likely cause governments to consider various types of effective means for controlling the disease. Given strong public interests in potential dengue vaccines, it is essential to understand the private economic benefits of dengue vaccines for accelerated introduction of vaccines into the public sector program and private markets of high-risk countries. Methodology/Principal Findings A contingent valuation study for a hypothetical dengue vaccine was administered to 400 households in a multi-country setting: Vietnam, Thailand, and Colombia. All respondents received a description of the hypothetical dengue vaccine scenarios of 70% or 95% effectiveness for 10 or 30 years with a three dose series. Five price points were determined after pilot tests in order to reflect different local situations such as household income levels and general perceptions towards dengue fever. We adopted either Poisson or negative binomial regression models to calculate average willingness-to-pay (WTP), as well as median WTP. We found that there is a significant demand for dengue vaccines. The parametric median WTP is $26.4 ($8.8 per dose) in Vietnam, $70.3 ($23.4 per dose) in Thailand, and $23 ($7.7 per dose) in Colombia. Our study also suggests that respondents place more value on vaccinating young children than school age children and adults. Conclusions/Significance Knowing that dengue vaccines are not yet available, our study provides critical information to both public and private sectors. The study results can be used to ensure broad coverage with an affordable price and incorporated into cost benefit analyses, which can inform prioritization of alternative health interventions at the national level. PMID:26030922

A Multi-country Study of the Household Willingness-to-Pay for Dengue Vaccines: Household Surveys in Vietnam, Thailand, and Colombia.

PubMed

Lee, Jung-Seok; Mogasale, Vittal; Lim, Jacqueline K; Carabali, Mabel; Sirivichayakul, Chukiat; Anh, Dang Duc; Lee, Kang-Sung; Thiem, Vu Dinh; Limkittikul, Kriengsak; Tho, Le Huu; Velez, Ivan D; Osorio, Jorge E; Chanthavanich, Pornthep; da Silva, Luiz J; Maskery, Brian A

2015-01-01

The rise in dengue fever cases and the absence of dengue vaccines will likely cause governments to consider various types of effective means for controlling the disease. Given strong public interests in potential dengue vaccines, it is essential to understand the private economic benefits of dengue vaccines for accelerated introduction of vaccines into the public sector program and private markets of high-risk countries. A contingent valuation study for a hypothetical dengue vaccine was administered to 400 households in a multi-country setting: Vietnam, Thailand, and Colombia. All respondents received a description of the hypothetical dengue vaccine scenarios of 70% or 95% effectiveness for 10 or 30 years with a three dose series. Five price points were determined after pilot tests in order to reflect different local situations such as household income levels and general perceptions towards dengue fever. We adopted either Poisson or negative binomial regression models to calculate average willingness-to-pay (WTP), as well as median WTP. We found that there is a significant demand for dengue vaccines. The parametric median WTP is $26.4 ($8.8 per dose) in Vietnam, $70.3 ($23.4 per dose) in Thailand, and $23 ($7.7 per dose) in Colombia. Our study also suggests that respondents place more value on vaccinating young children than school age children and adults. Knowing that dengue vaccines are not yet available, our study provides critical information to both public and private sectors. The study results can be used to ensure broad coverage with an affordable price and incorporated into cost benefit analyses, which can inform prioritization of alternative health interventions at the national level.

Authorship in paediatric research conducted in low- and middle-income countries: parity or parasitism?

PubMed

Rees, Chris A; Lukolyo, Heather; Keating, Elizabeth M; Dearden, Kirk A; Luboga, Samuel A; Schutze, Gordon E; Kazembe, Peter N

2017-11-01

Interest in global health has increased greatly in the past two decades. Concomitantly, the number and complexity of research partnerships between high-income (HIC) and low- and middle-income countries (LMICs) has grown. We aimed to determine whether there is authorship parity (equitable representation and author order) or parasitism (no authors from study countries) in paediatric research conducted in LMICs. We reviewed all articles published from 2006 to 2015 in the four paediatric journals with the highest Eigenfactor scores. We limited our review to articles from LMICs and abstracted information on author affiliation and order, funding source and study design. We calculated Student's t-tests and chi-square using Fisher's exact test with Monte Carlo estimates. There were 24 169 articles published during the study period, and 1243 met inclusion criteria. Of those, 95.9% (n = 1,192) included at least one author affiliated with a LMIC. Among multicountry studies (n = 165), 40.4% did not include authors from every LMIC involved. Of the 9876 authors, most were affiliated with institutions from upper-middle-income countries (41.7%) and HICs (32.7%), with far fewer affiliated with lower middle-income (15.5%) and low-income countries (5.4%) (P < 0.001). In articles from low-income countries, first and last authors from HICs were more common than authors with low-income country affiliations (P < 0.001). Authorship parasitism was rare overall but common in multicountry studies. In studies conducted in low-income countries, HIC authors more commonly occupied first and last author positions than authors from the study countries. Where LMIC authors make substantial contributions, researchers should strive for authorship parity. © 2017 John Wiley & Sons Ltd.

Improving antimicrobial use among health workers in first-level facilities: results from the multi-country evaluation of the Integrated Management of Childhood Illness strategy.

PubMed Central

Gouws, Eleanor; Bryce, Jennifer; Habicht, Jean-Pierre; Amaral, João; Pariyo, George; Schellenberg, Joanna Armstrong; Fontaine, Olivier

2004-01-01

OBJECTIVE: The objective of this study was to assess the effect of Integrated Management of Childhood Illness (IMCI) case management training on the use of antimicrobial drugs among health-care workers treating young children at first-level facilities. Antimicrobial drugs are an essential child-survival intervention. Ensuring that children younger than five who need these drugs receive them promptly and correctly can save their lives. Prescribing these drugs only when necessary and ensuring that those who receive them complete the full course can slow the development of antimicrobial resistance. METHODS: Data collected through observation-based surveys in randomly selected first-level health facilities in Brazil, Uganda and the United Republic of Tanzania were statistically analysed. The surveys were carried out as part of the multi-country evaluation of IMCI effectiveness, cost and impact (MCE). FINDINGS: Results from three MCE sites show that children receiving care from health workers trained in IMCI are significantly more likely to receive correct prescriptions for antimicrobial drugs than those receiving care from workers not trained in IMCI.They are also more likely to receive the first dose of the drug before leaving the health facility, to have their caregiver advised how to administer the drug, and to have caregivers who are able to describe correctly how to give the drug at home as they leave the health facility. CONCLUSIONS: IMCI case management training is an effective intervention to improve the rational use of antimicrobial drugs for sick children visiting first-level health facilities in low-income and middle-income countries. PMID:15508195

A situational analysis of priority disaster hazards in Uganda: findings from a hazard and vulnerability analysis.

PubMed

Mayega, R W; Wafula, M R; Musenero, M; Omale, A; Kiguli, J; Orach, G C; Kabagambe, G; Bazeyo, W

2013-06-01

Most countries in sub-Saharan Africa have not conducted a disaster risk analysis. Hazards and vulnerability analyses provide vital information that can be used for development of risk reduction and disaster response plans. The purpose of this study was to rank disaster hazards for Uganda, as a basis for identifying the priority hazards to guide disaster management planning. The study as conducted in Uganda, as part of a multi-country assessment. A hazard, vulnerability and capacity analysis was conducted in a focus group discussion of 7 experts representing key stakeholder agencies in disaster management in Uganda. A simple ranking method was used to rank the probability of occurance of 11 top hazards, their potential impact and the level vulnerability of people and infrastructure. In-terms of likelihood of occurance and potential impact, the top ranked disaster hazards in Uganda are: 1) Epidemics of infectious diseases, 2) Drought/famine, 3) Conflict and environmental degradation in that order. In terms of vulnerability, the top priority hazards to which people and infrastructure were vulnerable were: 1) Conflicts, 2) Epidemics, 3) Drought/famine and, 4) Environmental degradation in that order. Poverty, gender, lack of information, and lack of resilience measures were some of the factors promoting vulnerability to disasters. As Uganda develops a disaster risk reduction and response plan, it ought to prioritize epidemics of infectious diseases, drought/famine, conflics and environmental degradation as the priority disaster hazards.

Building Cross-Country Networks for Laboratory Capacity and Improvement.

PubMed

Schneidman, Miriam; Matu, Martin; Nkengasong, John; Githui, Willie; Kalyesubula-Kibuuka, Simeon; Silva, Kelly Araujo

2018-03-01

Laboratory networks are vital to well-functioning public health systems and disease control efforts. Cross-country laboratory networks play a critical role in supporting epidemiologic surveillance, accelerating disease outbreak response, and tracking drug resistance. The East Africa Public Health Laboratory Network was established to bolster diagnostic and disease surveillance capacity. The network supports the introduction of regional quality standards; facilitates the rollout and evaluation of new diagnostic tools; and serves as a platform for training, research, and knowledge sharing. Participating facilities benefitted from state-of-the art investments, capacity building, and mentorship; conducted multicountry research studies; and contributed to disease outbreak response. Copyright © 2017 Elsevier Inc. All rights reserved.

National Systems of Innovation and Technological Differentiation:. a Multi-Country Model

NASA Astrophysics Data System (ADS)

Ribeiro, Leonardo C.; Ruiz, Ricardo M.; Albuquerque, Eduardo M.; Bernardes, Américo T.

Science and technology have a fundamental role in the economic development. Although this statement is generally well accepted, the internal mechanisms which are responsible for these interactions are not clear. In the last decade, dealing with this problem, many models have been proposed. In this paper, we introduce a model that creates an artificial world economy that is a network of countries. Each country has its own national system of innovation and the interactions between countries are given by functions that connect the competitiveness of their prices and their technological capabilities. Starting from different configurations, the artificial world economy self-organizes itself and creates a hierarchies of countries.

Alternatives to the use of antimicrobial agents in pig production: A multi-country expert-ranking of perceived effectiveness, feasibility and return on investment.

PubMed

Postma, Merel; Stärk, Katharina D C; Sjölund, Marie; Backhans, Annette; Beilage, Elisabeth Grosse; Lösken, Svenja; Belloc, Catherine; Collineau, Lucie; Iten, Denise; Visschers, Vivianne; Nielsen, Elisabeth O; Dewulf, Jeroen

2015-03-01

Nineteen alternatives to antimicrobial agents were ranked on perceived effectiveness, feasibility and return on investment (ROI) from 0 (not effective, not feasible, no ROI) to 10 (fully effective, completely feasible, maximum ROI) by 111 pig health experts from Belgium, Denmark, France, Germany, Sweden and Switzerland. The top 5 measures in terms of perceived effectiveness were (1) improved internal biosecurity, (2) improved external biosecurity, (3) improved climate/environmental conditions, (4) high health/Specific Pathogen Free/disease eradication and (5) increased vaccination. The top 5 measures in terms of perceived feasibility were (1) increased vaccination, (2) increased use of anti-inflammatory products, (3) improved water quality, (4) feed quality/optimization and (5) use of zinc/metals. The top 5 measures in terms of perceived ROI were (1) improved internal biosecurity, (2) zinc/metals, (3) diagnostics/action plan, (4) feed quality/optimization and (5) climate/environmental improvements. Univariate linear regression showed that veterinary practitioners rank internal biosecurity, vaccination, use of zinc/metals, feed quality optimization and climate/environmental on average highest, while researchers and professors focused more on increased use of diagnostics and action plans. Financial incentives/penalties ranked low in all countries. Belgian respondents ranked feed quality significantly lower compared to the German respondents while reduction of stocking density was ranked higher in Belgium compared to Denmark. Categorical Principal Component Analysis applied to the average ranking supported the finding that veterinary practitioners had a preference for more practical, common and already known alternatives. The results showed that improvements in biosecurity, increased use of vaccination, use of zinc/metals, feed quality improvement and regular diagnostic testing combined with a clear action plan were perceived to be the most promising alternatives to antimicrobials in industrial pig production based on combined effectiveness, feasibility and ROI. Copyright © 2015 Elsevier B.V. All rights reserved.

Pathways between childhood trauma, intimate partner violence, and harsh parenting: findings from the UN Multi-country Study on Men and Violence in Asia and the Pacific.

PubMed

Fulu, Emma; Miedema, Stephanie; Roselli, Tim; McCook, Sarah; Chan, Ko Ling; Haardörfer, Regine; Jewkes, Rachel

2017-05-01

Although childhood trauma and violence against women are global public health issues, few population-based data from low-income and middle-income countries exist about the links between them. We present data from the UN Multi-country Study on Men and Violence in Asia and the Pacific, exploring the pathways between different forms of childhood trauma and violence against women. In this multicountry study, we interviewed multistage representative samples of men and women, aged 18-49 years, in Asia and the Pacific, using standardised population-based household surveys. Men were interviewed in six countries, and women in four. Respondents were asked questions about their perpetration or experience of intimate partner violence or non-partner sexual violence, childhood trauma, and harsh parenting (smacking their children as a form of discipline). We used maximum likelihood multivariate logit models to explore associations between childhood trauma and violence against women, and fitted path models to explore associations between experience and perpetration of child maltreatment. Between Jan 1, 2011, and Dec 1, 2012, 10 178 men and 3106 women completed interviews in this study, with between 815 and 1812 men per site and 477 and 1103 women per site. The proportion of men who experienced any childhood trauma varied between 59% (n=478, 95% CI 54·0-63·3; Indonesia rural site) and 92% (n=791, 89·4-93·8; Bougainville, Papua New Guinea). For women, the results ranged from 44% (n=272, 37·7-50·8; Sri Lanka) to 84% (n=725, 80·7-86·8; Bougainville, Papua New Guinea). For men, all forms of childhood trauma were associated with all forms of intimate partner violence perpetration. For women, all forms of childhood trauma were associated with physical intimate partner violence, and both physical and sexual intimate partner violence. There were significant, often gendered, pathways between men's and women's perpetration and experiences of childhood trauma, physical intimate partner violence, harsh parenting, and other factors. The data point to both a co-occurrence and a cycle of abuse, with childhood trauma leading to violence against women and further child maltreatment, which in turn increases the risk of experience or perpetration of violence during adulthood. Efforts to prevent both forms of violence would benefit from a meaningful integrated approach. Interventions should promote positive parenting, address inequality and the normalisation of violence across the life course, and transform men's power over women and children. Partners for Prevention. National studies were funded by the UN Population Fund in Bangladesh and China, UN Women in Cambodia and Indonesia, UN Develoment Programme in Papua New Guinea, and CARE in Sri Lanka. Copyright © 2017 The Authors. Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.

HIV Spending as a Share of Total Health Expenditure: An Analysis of Regional Variation in a Multi-Country Study

PubMed Central

Amico, Peter; Aran, Christian; Avila, Carlos

2010-01-01

Background HIV has devastated numerous countries in sub-Saharan Africa and is a dominant health force in many other parts of the world. Its undeniable importance is reflected in the establishment of Millennium Development Goal No. 6. Unprecedented amounts of funding have been committed and disbursed over the past two decades. Many have argued that this enormous influx of funding has been detrimental to building stronger health systems in recipient countries. This paper examines the funding share for HIV measured against the total funding for health. Methodology/Principal Findings A descriptive analysis of HIV and health expenditures in 2007 from 65 countries was conducted. Comparable data from individual countries was used by applying a consistent definition for HIV expenditures and total health expenditures from NHAs to align them with National AIDS Assessment Reports. In 2007, the total public and international expenditure in LMICs for HIV was 1.6 percent of the total spending on health, while the share in SSA was 19.4 percent. HIV prevalence was six-fold higher in SSA than the next highest region and it is the only region whose share of HIV spending exceeded the burden of HIV DALYs. Conclusions/Significance The share of HIV spending across the 65 countries was quite moderate considering that the estimated share of deaths attributable to HIV stood at 3.8 percent and DALYs at 4.4 percent. Several high spending countries are using a large share of their total health spending for HIV health, but these countries are the exception rather than representative of the average SSA country. There is wide variation between regions, but the burden of disease also varies significantly. The percentage of HIV spending is a useful indicator for better understanding health care resources and their allocation patterns. PMID:20885986

Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis.

PubMed

McKinnon, Britt; Harper, Sam; Kaufman, Jay S; Bergevin, Yves

2014-03-01

Neonatal mortality rates (NMRs) in countries of low and middle income have been only slowly decreasing; coverage of essential maternal and newborn health services needs to increase, particularly for disadvantaged populations. Our aim was to produce comparable estimates of changes in socioeconomic inequalities in NMR in the past two decades across these countries. We used data from Demographic and Health Surveys (DHS) for countries in which a survey was done in 2008 or later and one about 10 years previously. We measured absolute inequalities with the slope index of inequality and relative inequalities with the relative index of inequality. We used an asset-based wealth index and maternal education as measures of socioeconomic position and summarised inequality estimates for all included countries with random-effects meta-analysis. 24 low-income and middle-income countries were eligible for inclusion. In most countries, absolute and relative wealth-related and educational inequalities in NMR decreased between survey 1 and survey 2. In five countries (Cameroon, Nigeria, Malawi, Mozambique, and Uganda), the difference in NMR between the top and bottom of the wealth distribution was reduced by more than two neonatal deaths per 1000 livebirths per year. By contrast, wealth-related inequality increased by more than 1·5 neonatal deaths per 1000 livebirths per year in Ethiopia and Cambodia. Patterns of change in absolute and relative educational inequalities in NMR were similar to those of wealth-related NMR inequalities, although the size of educational inequalities tended to be slightly larger. Socioeconomic inequality in NMR seems to have decreased in the past two decades in most countries of low and middle income. However, a substantial survival advantage remains for babies born into wealthier households with a high educational level, which should be considered in global efforts to further reduce NMR. Canadian Institutes of Health Research. Copyright © 2014 McKinnon et al. Open Access article distributed under the terms of CC BY. Published by .. All rights reserved.

The efficacy of different models of smoke-free laws in reducing exposure to second-hand smoke: a multi-country comparison.

PubMed

Ward, Mark; Currie, Laura M; Kabir, Zubair; Clancy, Luke

2013-05-01

Exposure to second-hand tobacco smoke is a serious public health concern and while all EU Member States have enacted some form of regulation aimed at limiting exposure, the scope of these regulations vary widely and many countries have failed to enact comprehensive legislation creating smoke-free workplaces and indoor public places. To gauge the effectiveness of different smoke-free models we compared fine particles from second-hand smoke in hospitality venues before and after the implementation of smoking bans in France, Greece, Ireland, Italy, Portugal, Turkey, and Scotland. Data on PM2.5 fine particle concentration levels were recorded in 338 hospitality venues across these countries before and after the implementation of smoke-free legislation. Changes in mean PM2.5 concentrations during the period from pre- to post-legislation were then compared across countries. While a reduction in PM2.5 was observed in all countries, those who had enacted and enforced more fully comprehensive smoke-free legislation experienced the greatest reduction in second-hand tobacco smoke. Comprehensive smoke-free laws are more effective than partial laws in reducing exposure to second-hand tobacco smoke. Also, any law, regardless of scope must be actively enforced in order to have the desired impact. There is continued need for surveillance of smoke-free efforts in all countries. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Elder Abuse in the Iberian Peninsula and Bolivia: A Multicountry Comparative Study.

PubMed

Carmona-Torres, Juan Manuel; Carvalhal, Rosa; Gálvez-Rioja, Ruth Mary; Ruiz-Gandara, África; Goergen, Thomas; Rodríguez-Borrego, Mª Aurora

2017-06-01

The objective of this study is to determine the prevalence of abuse of vulnerable older persons in the family and community environment in the following regions-Spain (Andalusia-Córdoba), Portugal (Azores), and Bolivia (Santa Cruz de la Sierra)-and to identify risk factors and delineate a profile of abused older persons. For this, a descriptive cross-sectional study was conducted. The sample consisted of people in the age group 65 years plus living in the catchment areas of health centers. The following were used as instruments to collect data: the medical record of the patients of relevant health centers, Mini-Mental State Examination (MMSE), daily activities autonomy test, adaptability, partnership, growth, affection, and resolve (APGAR) familiar test, The Elder Abuse Suspicion Index (EASI) and the Social Work Evaluation Form. Multivariable logistic regression was performed to identify factors associated with abuse. Suspected abuse was identified in 6.9% of the elderly who participated in the study in Spain, 39% in Bolivia, and 24.5% in Azores. In all areas, studied psychological abuse was the most common type of abuse. In conclusion, although the prevalence of abuse to older people in the family and community environment differs in the areas studied, it is present in all countries and the data are comparable with other developing and European countries. The profile of the abused older persons appears to be similar in all countries.

Physical activity and asthma: A longitudinal and multi-country study.

PubMed

Russell, Melissa A; Janson, Christer; Real, Francisco Gómez; Johannessen, Ane; Waatevik, Marie; Benediktsdóttir, Bryndis; Holm, Mathias; Lindberg, Eva; Schlünssen, Vivi; Raza, Wasif; Dharmage, Shyamali C; Svanes, Cecilie

2017-11-01

To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis. The Respiratory Health in Northern Europe (RHINE) is a population-based postal questionnaire cohort study. Physical activity, height and weight were self-reported in Bergen, Norway, at RHINE II (1999-2001) and all centres at RHINE III (2010-2012). A longitudinal analysis of Bergen data investigated the association of baseline physical activity with follow-up asthma, incident asthma and symptoms, using logistic and zero-inflated Poisson regression (n = 1782). A cross-sectional analysis of all RHINE III centres investigated the association of physical activity with concurrent asthma and symptoms (n = 13,542) using mixed-effects models. Body mass index (BMI) was categorised (<20, 20-24.99, 25-29.99, 30+ kg/m 2 ) and physical activity grouped by amount and frequency of lighter (no sweating/heavy breathing) and vigorous (sweating/heavy breathing) activity. In the Bergen longitudinal analysis, undertaking light activity 3+ times/week at baseline was associated with less follow-up asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories. These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI.

Socioeconomic Inequality in Disability Among Adults: A Multicountry Study Using the World Health Survey

PubMed Central

Hosseinpoor, Ahmad R.; Stewart Williams, Jennifer A.; Gautam, Jeny; Posarac, Aleksandra; Officer, Alana; Verdes, Emese; Kostanjsek, Nenad

2013-01-01

Objectives. We compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups. Methods. Data on 218 737 respondents participating in the World Health Survey 2002–2004 were analyzed. A composite disability score (0–100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality. Results. Median age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries. Conclusions. Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need. PMID:23678901

Snowfall less sensitive to warming in Karakoram than in Himalayas due to a unique seasonal cycle

USGS Publications Warehouse

Kapnick, Sarah B.; Delworth, Thomas L.; Ashfaq, Moetasim; Malyshev, Sergey; Milly, Paul C.D.

2014-01-01

The high mountains of Asia, including the Karakoram, Himalayas and Tibetan Plateau, combine to form a region of perplexing hydroclimate changes. Glaciers have exhibited mass stability or even expansion in the Karakoram region1, 2, 3, contrasting with glacial mass loss across the nearby Himalayas and Tibetan Plateau1, 4, a pattern that has been termed the Karakoram anomaly. However, the remote location, complex terrain and multi-country fabric of high-mountain Asia have made it difficult to maintain longer-term monitoring systems of the meteorological components that may have influenced glacial change. Here we compare a set of high-resolution climate model simulations from 1861 to 2100 with the latest available observations to focus on the distinct seasonal cycles and resulting climate change signatures of Asia’s high-mountain ranges. We find that the Karakoram seasonal cycle is dominated by non-monsoonal winter precipitation, which uniquely protects it from reductions in annual snowfall under climate warming over the twenty-first century. The simulations show that climate change signals are detectable only with long and continuous records, and at specific elevations. Our findings suggest a meteorological mechanism for regional differences in the glacier response to climate warming.

Socioeconomic inequality in disability among adults: a multicountry study using the World Health Survey.

PubMed

Hosseinpoor, Ahmad R; Stewart Williams, Jennifer A; Gautam, Jeny; Posarac, Aleksandra; Officer, Alana; Verdes, Emese; Kostanjsek, Nenad; Chatterji, Somnath

2013-07-01

We compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups. Data on 218,737 respondents participating in the World Health Survey 2002-2004 were analyzed. A composite disability score (0-100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality. Median age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries. Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need.

Limits and opportunities to community health worker empowerment: A multi-country comparative study.

PubMed

Kane, Sumit; Kok, Maryse; Ormel, Hermen; Otiso, Lilian; Sidat, Mohsin; Namakhoma, Ireen; Nasir, Sudirman; Gemechu, Daniel; Rashid, Sabina; Taegtmeyer, Miriam; Theobald, Sally; de Koning, Korrie

2016-09-01

In LMICs, Community Health Workers (CHW) increasingly play health promotion related roles involving 'Empowerment of communities'. To be able to empower the communities they serve, we argue, it is essential that CHWs themselves be, and feel, empowered. We present here a critique of how diverse national CHW programs affect CHW's empowerment experience. We present an analysis of findings from a systematic review of literature on CHW programs in LMICs and 6 country case studies (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique). Lee & Koh's analytical framework (4 dimensions of empowerment: meaningfulness, competence, self-determination and impact), is used. CHW programs empower CHWs by providing CHWs, access to privileged medical knowledge, linking CHWs to the formal health system, and providing them an opportunity to do meaningful and impactful work. However, these empowering influences are constantly frustrated by - the sense of lack/absence of control over one's work environment, and the feelings of being unsupported, unappreciated, and undervalued. CHWs expressed feelings of powerlessness, and frustrations about how organisational processual and relational arrangements hindered them from achieving the desired impact. While increasingly the onus is on CHWs and CHW programs to solve the problem of health access, attention should be given to the experiences of CHWs themselves. CHW programs need to move beyond an instrumentalist approach to CHWs, and take a developmental and empowerment perspective when engaging with CHWs. CHW programs should systematically identify disempowering organisational arrangements and take steps to remedy these. Doing so will not only improve CHW performance, it will pave the way for CHWs to meet their potential as agents of social change, beyond perhaps their role as health promoters. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Development and Validation of a Cross-Country Hospital Patient Quality of Care Assessment Tool in Europe.

PubMed

Villiers-Tuthill, Amanda; Doulougeri, Karolina; McGee, Hannah; Montgomery, Anthony; Panagopoulou, Efharis; Morgan, Karen

2017-12-01

Patient perceptions of quality of care (QoC) are directly linked with patient safety and clinical effectiveness. We need patient-designed QoC instruments that work across languages and countries to optimise studies across systems in this area. Few QoC measurement tools exist that assess all aspects of QoC from the patient perspective. This paper describes the development and validation of a comprehensive measure to assess patient perceptions of QoC that incorporates technical and interpersonal aspects of care and is grounded in the established Institute of Medicine (IOM) QoC framework. We conducted a multi-country cross-sectional study. Following a literature review and patient focus groups, an expert panel generated questionnaire items. Following a pilot study, item numbers were reduced. The final questionnaire consisted of three sections: demographics, perceived QoC and one open-ended question. Data was collected from patients (n = 531) discharged from hospitals across seven countries in South East Europe (languages: Turkish, Greek, Portuguese, Romanian, Croatian, Macedonian and Bulgarian). Reliability and validity of the measure were assessed. Confirmatory factor analysis was used to compare various factor models of patient-perceived QoC. Good model fit was demonstrated for a two-factor model: communication and interpersonal care, and hospital facilities. The ORCAB (Improving quality and safety in the hospital: The link between organisational culture, burnout and quality of care) Patient QoC questionnaire has been collaboratively and exhaustively developed between healthcare professionals and patients. It enables patient QoC data to be assessed in the context of the IOM pillars of quality, considering both technical and interpersonal dimensions of care. It represents an important first step in including the patient perspective.

Newborn survival in Malawi: a decade of change and future implications.

PubMed

Zimba, Evelyn; Kinney, Mary V; Kachale, Fannie; Waltensperger, Karen Z; Blencowe, Hannah; Colbourn, Tim; George, Joby; Mwansambo, Charles; Joshua, Martias; Chanza, Harriet; Nyasulu, Dorothy; Mlava, Grace; Gamache, Nathalie; Kazembe, Abigail; Lawn, Joy E

2012-07-01

Malawi is one of two low-income sub-Saharan African countries on track to meet the Millennium Development Goal (MDG 4) for child survival despite high fertility and HIV and low health worker density. With neonatal deaths becoming an increasing proportion of under-five deaths, addressing newborn survival is critical for achieving MDG 4. We examine change for newborn survival in the decade 2000-10, analysing mortality and coverage indicators whilst considering other contextual factors. We assess national and donor funding, as well as policy and programme change for newborn survival using standard analyses and tools being applied as part of a multi-country analysis. Compared with the 1990s, progress towards MDG 4 and 5 accelerated considerably from 2000 to 2010. Malawi's neonatal mortality rate (NMR) reduced slower than annual reductions in mortality for children 1-59 months and maternal mortality (NMR reduced 3.5% annually). Yet, the NMR reduced at greater pace than the regional and global averages. A significant increase in facility births and other health system changes, including increased human resources, likely contributed to this decline. High level attention for maternal health and associated comprehensive policy change has provided a platform for a small group of technical and programme experts to link in high impact interventions for newborn survival. The initial entry point for newborn care in Malawi was mainly through facility initiatives, such as Kangaroo Mother Care. This transitioned to an integrated and comprehensive approach at community and facility level through the Community-Based Maternal and Newborn Care package, now being implemented in 17 of 28 districts. Addressing quality gaps, especially for care at birth in facilities, and including newborn interventions in child health programmes, will be critical to the future agenda of newborn survival in Malawi.

Where Do Poor Women in Developing Countries Give Birth? A Multi-Country Analysis of Demographic and Health Survey Data

PubMed Central

Montagu, Dominic; Yamey, Gavin; Visconti, Adam; Harding, April; Yoong, Joanne

2011-01-01

Background In 2008, over 300,000 women died during pregnancy or childbirth, mostly in poor countries. While there are proven interventions to make childbirth safer, there is uncertainty about the best way to deliver these at large scale. In particular, there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate, we examined delivery location and attendance and the reasons women report for giving birth at home. Methodology/Principal Findings We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA), where death rates are highest, we conducted a subsample analysis of motivations for giving birth at home. In SSA, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA, 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA, 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA); 40% in the wealthiest quintile were unattended, while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility, while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed “not necessary” by a household decision maker. Among the poorest women, “not necessary” was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended. Conclusions In developing countries, most poor women deliver at home. This suggests that, at least in the near term, efforts to reduce maternal deaths should prioritize community-based interventions aimed at making home births safer. PMID:21386886

Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data.

PubMed

Montagu, Dominic; Yamey, Gavin; Visconti, Adam; Harding, April; Yoong, Joanne

2011-02-28

In 2008, over 300,000 women died during pregnancy or childbirth, mostly in poor countries. While there are proven interventions to make childbirth safer, there is uncertainty about the best way to deliver these at large scale. In particular, there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate, we examined delivery location and attendance and the reasons women report for giving birth at home. We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA), where death rates are highest, we conducted a subsample analysis of motivations for giving birth at home. In SSA, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA, 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA, 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA); 40% in the wealthiest quintile were unattended, while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility, while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed "not necessary" by a household decision maker. Among the poorest women, "not necessary" was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended. In developing countries, most poor women deliver at home. This suggests that, at least in the near term, efforts to reduce maternal deaths should prioritize community-based interventions aimed at making home births safer.

Impact of vaccination against Haemophilus influenzae type b with and without a booster dose on meningitis in four South American countries.

PubMed

Garcia, Salvador; Lagos, Rosanna; Muñoz, Alma; Picón, Teresa; Rosa, Raquel; Alfonso, Adriana; Abriata, Graciela; Gentile, Angela; Romanin, Viviana; Regueira, Mabel; Chiavetta, Laura; Agudelo, Clara Inés; Castañeda, Elizabeth; De la Hoz, Fernando; Higuera, Ana Betty; Arce, Patricia; Cohen, Adam L; Verani, Jennifer; Zuber, Patrick; Gabastou, Jean-Marc; Pastor, Desiree; Flannery, Brendan; Andrus, Jon

2012-01-05

To inform World Health Organization recommendations regarding use of Haemophilus influenzae type b (Hib) vaccines in national immunization programs, a multi-country evaluation of trends in Hib meningitis incidence and prevalence of nasopharyngeal Hib carriage was conducted in four South American countries using either a primary, three-dose immunization schedule without a booster dose or with a booster dose in the second year of life. Surveillance data suggest that high coverage of Hib conjugate vaccine sustained low incidence of Hib meningitis and low prevalence of Hib carriage whether or not a booster dose was used. Copyright © 2011 Elsevier Ltd. All rights reserved.

Analysis Of End-Of-Life Care, Out-Of-Pocket Spending, And Place Of Death In 16 European Countries And Israel.

PubMed

Orlovic, Martina; Marti, Joachim; Mossialos, Elias

2017-07-01

In Europe the aging of the population will pose considerable challenges to providing high-quality end-of-life care. The complexity of providing care and the large spectrum of actors involved make it difficult to understand the care pathways and how these are influenced by financial and institutional factors. We examined a large, multicountry data set with waves of data from the period 2006-13 to determine the differences in health care usage, out-of-pocket spending, and place of death in sixteen European countries and Israel. Our results reveal the importance of the funding mechanisms of long-term care. They also illuminate the effect of patients' characteristics on end-of-life care pathways. We found that in countries where public financing and organization of long-term care are particularly strong, patients at the end of life are more likely to have reduced hospitalizations and a higher share of out-of-hospital deaths. Understanding end-of-life care patterns is crucial to developing policies to address the urgent public health priority that this aspect of health care presents. Project HOPE—The People-to-People Health Foundation, Inc.

Differential effects of dietary diversity and maternal characteristics on linear growth of children aged 6-59 months in sub-Saharan Africa: a multi-country analysis.

PubMed

Amugsi, Dickson A; Dimbuene, Zacharie T; Kimani-Murage, Elizabeth W; Mberu, Blessing; Ezeh, Alex C

2017-04-01

To investigate the differential effects of dietary diversity (DD) and maternal characteristics on child linear growth at different points of the conditional distribution of height-for-age Z-score (HAZ) in sub-Saharan Africa. Secondary analysis of data from nationally representative cross-sectional samples of singleton children aged 0-59 months, born to mothers aged 15-49 years. The outcome variable was child HAZ. Quantile regression was used to perform the multivariate analysis. The most recent Demographic and Health Surveys from Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC). The present analysis was restricted to children aged 6-59 months (n 31 604). DD was associated positively with HAZ in the first four quantiles (5th, 10th, 25th and 50th) and the highest quantile (90th) in Nigeria. The largest effect occurred at the very bottom (5th quantile) and the very top (90th quantile) of the conditional HAZ distribution. In DRC, DD was significantly and positively associated with HAZ in the two lower quantiles (5th, 10th). The largest effects of maternal education occurred at the lower end of the conditional HAZ distribution in Ghana, Nigeria and DRC. Maternal BMI and height also had positive effects on HAZ at different points of the conditional distribution of HAZ. Our analysis shows that the association between DD and maternal factors and HAZ differs along the conditional HAZ distribution. Intervention measures need to take into account the heterogeneous effect of the determinants of child nutritional status along the different percentiles of the HAZ distribution.

The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study.

PubMed

Vandenberghe, G; Bloemenkamp, K; Berlage, S; Colmorn, L; Deneux-Tharaux, C; Gissler, M; Knight, M; Langhoff-Roos, J; Lindqvist, P G; Oberaigner, W; Van Roosmalen, J; Zwart, J; Roelens, K

2018-05-04

International comparison of complete uterine rupture. Descriptive multi-country population-based study. International. International Network of Obstetric Survey Systems (INOSS). We merged individual data, collected prospectively in nine population-based studies, of women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes. Prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section (CS) and trial of labour after CS (TOLAC). Severe maternal and perinatal morbidity and mortality. We identified 864 complete uterine ruptures in 2 625 017 deliveries. Overall prevalence was 3.3 (95% CI 3.1-3.5) per 10 000 deliveries, 22 (95% CI 21-24) in women with and 0.6 (95% CI 0.5-0.7) in women without previous CS. Prevalence in women with previous CS was negatively correlated with previous CS rate (ρ = -0.917) and positively correlated with TOLAC rate of the background population (ρ = 0.600). Uterine rupture resulted in peripartum hysterectomy in 87 of 864 women (10%, 95% CI 8-12%) and in a perinatal death in 116 of 874 infants (13.3%, 95% CI 11.2-15.7) whose mother had uterine rupture. Overall rate of neonatal asphyxia was 28% in neonates who survived. Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.) TWEETABLE ABSTRACT: Prevalence of complete uterine rupture is higher in countries with low previous CS and high TOLAC rates. © 2018 Royal College of Obstetricians and Gynaecologists.

Age-related prevalence and met need for correctable and uncorrectable near vision impairment in a multi-country study.

PubMed

He, Mingguang; Abdou, Amza; Ellwein, Leon B; Naidoo, Kovin S; Sapkota, Yuddha D; Thulasiraj, R D; Varma, Rohit; Zhao, Jialiang; Kocur, Ivo; Congdon, Nathan G

2014-01-01

To estimate the prevalence, potential determinants, and proportion of met need for near vision impairment (NVI) correctable with refraction approximately 2 years after initial examination of a multi-country cohort. Population-based, prospective cohort study. People aged ≥35 years examined at baseline in semi-rural (Shunyi) and urban (Guangzhou) sites in China; rural sites in Nepal (Kaski), India (Madurai), and Niger (Dosso); a semi-urban site (Durban) in South Africa; and an urban site (Los Angeles) in the United States. Near visual acuity (NVA) with and without current near correction was measured at 40 cm using a logarithm of the minimum angle of resolution near vision tumbling E chart. Participants with uncorrected binocular NVA ≤20/40 were tested with plus sphere lenses to obtain best-corrected binocular NVA. Prevalence of total NVI (defined as uncorrected NVA ≤20/40) and NVI correctable and uncorrectable to >20/40, and current spectacle wearing among those with bilateral NVA ≤20/63 improving to >20/40 with near correction (met need). Among 13 671 baseline participants, 10 533 (77.2%) attended the follow-up examination. The prevalence of correctable NVI increased with age from 35 to 50-60 years and then decreased at all sites. Multiple logistic regression modeling suggested that correctable NVI was not associated with gender at any site, whereas more educated persons aged >54 years were associated with a higher prevalence of correctable NVI in Nepal and India. Although near vision spectacles were provided free at baseline, wear among those who could benefit was <40% at all but 2 centers (Guangzhou and Los Angeles). Prevalence of correctable NVI is greatest among persons of working age, and rates of correction are low in many settings, suggesting that strategies targeting the workplace may be needed. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Prevalence of Amblyopia in School-Aged Children and Variations by Age, Gender, and Ethnicity in a Multi-Country Refractive Error Study.

PubMed

Xiao, Ou; Morgan, Ian G; Ellwein, Leon B; He, Mingguang

2015-09-01

To estimate the age-, gender-, and ethnicity-specific prevalence of amblyopia in children aged 5 to 15 years using data from the multi-country Refractive Error Study in Children (RESC). Population-based, cross-sectional study. Among 46 260 children aged 5 to 15 years who were enumerated from 8 sites in the RESC study, 39 551 had a detailed ocular examination and a reliable visual acuity (VA) measurement in 1 or both eyes. Information on ethnicity was available for 39 321 of these participants. This study focused on findings from the 39 321 children. The examination included VA measurements, evaluation of ocular alignment and refractive error under cycloplegia, and examination of the external eye, anterior segment, media, and fundus. The proportion of children aged 5 to 15 years with amblyopia in different ethnic cohorts. Amblyopia was defined as best-corrected visual acuity (BCVA) of ≤20/40 in either eye, with tropia, anisometropia (≥2 spherical equivalent diopters [D]), or hyperopia (≥+6 spherical equivalent D), after excluding children with fundus or anterior segment abnormalities. The overall prevalence of amblyopia was 0.74% (95% confidence interval, 0.64-0.83) with significant (P < 0.001) variation across ethnic groups: 1.43% in Hispanic, 0.93% in Chinese, 0.62% in Indian, 0.52% in Malay, 0.35% in Nepali, and 0.28% in African children. Amblyopia was not associated with age or gender. The most common cause of amblyopia was anisometropia. In this study, the prevalence of amblyopia varied with ethnicity and was highest in Hispanic children and lowest in African children. Most cases were unilateral and developed before the age of 5 years. The impact of changes of definitions on prevalence estimates is discussed. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women's health and domestic violence against women.

PubMed

Devries, Karen; Watts, Charlotte; Yoshihama, Mieko; Kiss, Ligia; Schraiber, Lilia Blima; Deyessa, Negussie; Heise, Lori; Durand, Julia; Mbwambo, Jessie; Jansen, Henrica; Berhane, Yemane; Ellsberg, Mary; Garcia-Moreno, Claudia

2011-07-01

Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women's health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000-2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15-49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city); lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25-50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour. Copyright © 2011 Elsevier Ltd. All rights reserved.

Multicountry Prospective Clinical Evaluation of Two Enzyme-Linked Immunosorbent Assays and Two Rapid Diagnostic Tests for Diagnosing Dengue Fever

PubMed Central

Dauner, Allison L.; Valks, Andrea; Forshey, Brett M.; Long, Kanya C.; Thaisomboonsuk, Butsaya; Sierra, Gloria; Picos, Victor; Talmage, Sara; Morrison, Amy C.; Halsey, Eric S.; Comach, Guillermo; Yasuda, Chadwick; Loeffelholz, Michael; Jarman, Richard G.; Fernandez, Stefan; An, Ung Sam; Kochel, Tadeusz J.; Jasper, Louis E.; Wu, Shuenn-Jue L.

2015-01-01

We evaluated four dengue diagnostic devices from Alere, including the SD Bioline Dengue Duo (nonstructural [NS] 1 Ag and IgG/IgM), the Panbio Dengue Duo Cassette (IgM/IgG) rapid diagnostic tests (RDTs), and the Panbio dengue IgM and IgG capture enzyme-linked immunosorbent assays (ELISAs) in a prospective, controlled, multicenter study in Peru, Venezuela, Cambodia, and the United States, using samples from 1,021 febrile individuals. Archived, well-characterized samples from an additional 135 febrile individuals from Thailand were also used. Reference testing was performed on all samples using an algorithm involving virus isolation, in-house IgM and IgG capture ELISAs, and plaque reduction neutralization tests (PRNT) to determine the infection status of the individual. The primary endpoints were the clinical sensitivities and specificities of these devices. The SD Bioline Dengue Duo had an overall sensitivity of 87.3% (95% confidence interval [CI], 84.1 to 90.2%) and specificity of 86.8% (95% CI, 83.9 to 89.3%) during the first 14 days post-symptom onset (p.s.o.). The Panbio Dengue Duo Cassette demonstrated a sensitivity of 92.1% (87.8 to 95.2%) and specificity of 62.2% (54.5 to 69.5%) during days 4 to 14 p.s.o. The Panbio IgM capture ELISA had a sensitivity of 87.6% (82.7 to 91.4%) and specificity of 88.1% (82.2 to 92.6%) during days 4 to 14 p.s.o. Finally, the Panbio IgG capture ELISA had a sensitivity of 69.6% (62.1 to 76.4%) and a specificity of 88.4% (82.6 to 92.8%) during days 4 to 14 p.s.o. for identification of secondary dengue infections. This multicountry prospective study resulted in reliable real-world performance data that will facilitate data-driven laboratory test choices for managing patient care during dengue outbreaks. PMID:25588659

Fever case management at private health facilities and private pharmacies on the Kenyan coast: analysis of data from two rounds of client exit interviews and mystery client visits.

PubMed

Poyer, Stephen; Musuva, Anne; Njoki, Nancy; Okara, Robi; Cutherell, Andrea; Sievers, Dana; Lussiana, Cristina; Memusi, Dorothy; Kiptui, Rebecca; Ejersa, Waqo; Dolan, Stephanie; Charman, Nicole

2018-03-13

Private sector availability and use of malaria rapid diagnostic tests (RDTs) lags behind the public sector in Kenya. Increasing channels through which quality malaria diagnostic services are available can improve access to testing and help meet the target of universal diagnostic testing. Registered pharmacies are currently not permitted to perform blood tests, and evidence of whether malaria RDTs can be used by non-laboratory private providers in line with the national malaria control guidelines is required to inform ongoing policy discussions in Kenya. Two rounds of descriptive cross-sectional exit interviews and mystery client surveys were conducted at private health facilities and registered pharmacies in 2014 and 2015, 6 and 18 months into a multi-country project to prime the private sector market for the introduction of RDTs. Data were collected on reported RDT use, medicines received and prescribed, and case management of malaria test-negative mystery clients. Analysis compared outcomes at facilities and pharmacies independently for the two survey rounds. Across two rounds, 534 and 633 clients (including patients) from 130 and 120 outlets were interviewed, and 214 and 250 mystery client visits were completed. Reported testing by any malaria diagnostic test was higher in private health facilities than registered pharmacies in both rounds (2014: 85.6% vs. 60.8%, p < 0.001; 2015: 85.3% vs. 56.3%, p < 0.001). In registered pharmacies, testing by RDT was 52.1% in 2014 and 56.3% in 2015. At least 75% of test-positive patients received artemisinin-based combination therapy (ACT) in both rounds, with no significant difference between outlet types in either round. Provision of any anti-malarial for test-negative patients ranged from 0 to 13.9% across outlet types and rounds. In 2015, mystery clients received the correct (negative) diagnosis and did not receive an anti-malarial in 75.5% of visits to private health facilities and in 78.4% of visits to registered pharmacies. Non-laboratory staff working in registered pharmacies in Kenya can follow national guidelines for diagnosis with RDTs when provided with the same level of training and supervision as private health facility staff. Performance and compliance to treatment recommendations are comparable to diagnostic testing outcomes recorded in private health facilities.

Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis.

PubMed

Daru, Jahnavi; Zamora, Javier; Fernández-Félix, Borja M; Vogel, Joshua; Oladapo, Olufemi T; Morisaki, Naho; Tunçalp, Özge; Torloni, Maria Regina; Mittal, Suneeta; Jayaratne, Kapila; Lumbiganon, Pisake; Togoobaatar, Ganchimeg; Thangaratinam, Shakila; Khan, Khalid S

2018-05-01

Anaemia affects as many as half of all pregnant women in low-income and middle-income countries, but the burden of disease and associated maternal mortality are not robustly quantified. We aimed to assess the association between severe anaemia and maternal death with data from the WHO Multicountry Survey on maternal and newborn health. We used multilevel and propensity score regression analyses to establish the relation between severe anaemia and maternal death in 359 health facilities in 29 countries across Latin America, Africa, the Western Pacific, eastern Mediterranean, and southeast Asia. Severe anaemia was defined as antenatal or postnatal haemoglobin concentrations of less than 70 g/L in a blood sample obtained before death. Maternal death was defined as death any time after admission until the seventh day post partum or discharge. In regression analyses, we adjusted for post-partum haemorrhage, general anaesthesia, admission to intensive care, sepsis, pre-eclampsia or eclampsia, thrombocytopenia, shock, massive transfusion, severe oliguria, failure to form clots, and severe acidosis as confounding variables. These variables were used to develop the propensity score. 312 281 women admitted in labour or with ectopic pregnancies were included in the adjusted multilevel logistic analysis, and 12 470 were included in the propensity score regression analysis. The adjusted odds ratio for maternal death in women with severe anaemia compared with those without severe anaemia was 2·36 (95% CI 1·60-3·48). In the propensity score analysis, severe anaemia was also associated with maternal death (adjusted odds ratio 1·86 [95% CI 1·39-2·49]). Prevention and treatment of anaemia during pregnancy and post partum should remain a global public health and research priority. Barts and the London Charity. Copyright This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Global regulatory developments for clinical stem cell research: diversification and challenges to collaborations.

PubMed

Rosemann, Achim; Bortz, Gabriela; Vasen, Federico; Sleeboom-Faulkner, Margaret

2016-10-01

In this article, we explore regulatory developments in stem cell medicine in seven jurisdictions: Japan, China, India, Argentina, Brazil, the USA and the EU. We will show that the research methods, ethical standards and approval procedures for the market use of clinical stem cell interventions are undergoing an important process of global diversification. We will discuss the implications of this process for international harmonization and the conduct of multicountry clinical research collaborations. It will become clear that the increasing heterogeneity of research standards and regulations in the stem cell field presents a significant challenge to international clinical trial partnerships, especially with countries that diverge from the regulatory models that have been developed in the USA and the EU.

A loophole in international quarantine procedures disclosed during the SARS crisis.

PubMed

Lee, Chi-Wei; Tsai, Yen-Shuo; Wong, Tai-Wai; Lau, Chor-Chiu

2006-01-01

This study describes a loophole in the international quarantine system during the recent Asian severe acute respiratory syndrome (SARS) outbreak. Specifically, that of travelers disguising symptoms of respiratory tract infection at international airports, in order to board aircraft to return to their home countries-notwithstanding the infection risks this involves to others. High medical fees for treatment to non-residents in epidemic areas were found to be the main cause for this behaviour. This phenomenon revealed a loophole in the control mechanisms of international quarantine procedures, letting travelers carrying a highly contagious virus slip by undetected and causing possible multi-country outbreaks of communicable diseases. Clinical evidence collected from medical records at medical centers can highlight this oversight.

Health providers' opinions on provider-client relations: results of a multi-country study to test Health Workers for Change.

PubMed

Fonn, S; Mtonga, A S; Nkoloma, H C; Bantebya Kyomuhendo, G; daSilva, L; Kazilimani, E; Davis, S; Dia, R

2001-09-01

A multi-centre study in four African countries was undertaken to test the acceptability and effectiveness of Health Workers for Change, a methodology to explore provider-client relations within a gender-sensitive context. This intervention addresses the interpersonal component of quality of care. The methodology, consisting of six workshops, was implemented by research teams in Zambia, Senegal, Mozambique and Uganda. It was found to be acceptable within in a range of cultural and primary health care settings. The workshops allowed difficult issues such as prejudice and bribery to be discussed openly, fostered problem solving and the development of practical plans to address problems that could strengthen district health systems.

The drivers of facility-based immunization performance and costs. An application to Moldova.

PubMed

Maceira, Daniel; Goguadze, Ketevan; Gotsadze, George

2015-05-07

This paper identifies factors that affect the cost and performance of the routine immunization program in Moldova through an analysis of facility-based data collected as part of a multi-country costing and financing study of routine immunization (EPIC). A nationally representative sample of health care facilities (50) was selected through multi-stage, stratified random sampling. Data on inputs, unit prices and facility outputs were collected during October 3rd 2012-January 14th 2013 using a pre-tested structured questionnaire. Ordinary least square (OLS) regression analysis was performed to determine factors affecting facility outputs (number of doses administered and fully immunized children) and explaining variation in total facility costs. The study found that the number of working hours, vaccine wastage rates, and whether or not a doctor worked at a facility (among other factors) were positively and significantly associated with output levels. In addition, the level of output, price of inputs and share of the population with university education were significantly associated with higher facility costs. A 1% increase in fully immunized child would increase total cost by 0.7%. Few costing studies of primary health care services in developing countries evaluate the drivers of performance and cost. This exercise attempted to fill this knowledge gap and helped to identify organizational and managerial factors at a primary care district and national level that could be addressed by improved program management aimed at improved performance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Utilization of HIV-related services from the private health sector: A multi-country analysis.

PubMed

Wang, Wenjuan; Sulzbach, Sara; De, Susna

2011-01-01

Increasing the participation of the private health sector in the AIDS response could help to achieve universal access to comprehensive HIV prevention, treatment, care and support. Yet little is known about the extent to which the private health sector is delivering HIV-related services. This study uses data from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) from 12 countries in Africa, Asia and Latin America and the Caribbean to explore use of HIV testing and STI care from the private for-profit sector, and its association with household wealth status. The analysis indicates that the private for-profit health sector is active in HIV-related service delivery, although the level of participation varies by region and country. From 3 to 45 percent of women and 6 to 42 percent of men reported the private for-profit sector as their source of the most recent HIV testing. While in some countries, use of the private for-profit health sector for HIV testing and STI care increases with wealth, in others the relationship is not clear, as there are no significant differences in using private for-profit HIV-related services between the rich and the poor. We conclude that as the global AIDS response evolves from emergency relief to sustained country programs, broader consideration of the role of the private for-profit health sector may be warranted. Copyright © 2010 Elsevier Ltd. All rights reserved.

What are the preferred characteristics of a service robot for the elderly? A multi-country focus group study with older adults and caregivers.

PubMed

Bedaf, Sandra; Marti, Patrizia; De Witte, Luc

2017-11-10

This multi-perspective study focuses on how a service robot for the elderly should behave when interacting with potential users. An existing service robot and a scenario were used as a concrete case, which was discussed and analyzed during focus group sessions with older adults (n = 38), informal caregivers (n = 24), and professional caregivers (n = 35) in the Netherlands, France, and the United Kingdom. A total of seven topics-privacy, task execution, environment, appearance, behavior, visitors, and communication-were explored. The results showed that some of the characteristics mentioned were unique to a user group, but several were cross-cutting. Overall, potential users expected the service robot to be customizable in order to match the users' needs and preferences. Also, high expectations concerning its functioning and behavior were expressed, which sometimes could even be compared to the qualities of a human being. This emphasizes the complexity of service robot development for older adults, and highlights the need for a personalized and flexible solution. One size does not fit all, and specific attention should be paid to the development of the robot's social behavior and skills beyond a mere functional support for the person.

A Multi-Country Study of Harms to Children Because of Others’ Drinking

PubMed Central

Laslett, Anne-Marie; Rankin, Georgia; Waleewong, Orratai; Callinan, Sarah; Hoang, Hanh T. M.; Florenzano, Ramon; Hettige, Siri; Obot, Isidore; Siengsounthone, Latsamy; Ibanga, Akanidomo; Hope, Ann; Landberg, Jonas; Vu, Hanh T. M.; Thamarangsi, Thaksaphon; Rekve, Dag; Room, Robin

2017-01-01

Objective: This study aims to ascertain and compare the prevalence and correlates of alcohol-related harms to children cross-nationally. Method: National and regional sample surveys of randomly selected households included 7,848 carers (4,223 women) from eight countries (Australia, Chile, Ireland, Lao People’s Democratic Republic [PDR], Nigeria, Sri Lanka, Thailand, and Vietnam). Country response rates ranged from 35% to 99%. Face-to-face or telephone surveys asking about harm from others’ drinking to children ages 0–17 years were conducted, including four specific harms: that because of others’ drinking in the past year children had been (a) physically hurt, (b) verbally abused, (c) exposed to domestic violence, or (d) left unsupervised. Results: The prevalence of alcohol-related harms to children varied from a low of 4% in Lao PDR to 14% in Vietnam. Alcohol-related harms to children were reported by a substantial minority of families in most countries, with only Lao PDR and Nigeria reporting significantly lower levels of harm. Alcohol-related harms to children were dispersed sociodemographically and were concentrated in families with heavy drinkers. Conclusions: Family-level drinking patterns were consistently identified as correlates of harm to children because of others’ drinking, whereas sociodemographic factors showed few obvious correlations. PMID:28317499

The role of meat in the expression of rheumatoid arthritis.

PubMed

Grant, W B

2000-11-01

Rheumatoid arthritis (RA) is characterized by inflammation of the synovial tissues in the joints. A number of papers related to dietary components that are associated with this inflammation are reviewed. In addition, the ecological approach is used to study the links between diet and RA. Multi-country data for prevalence of RA for females from eight and fifteen countries were compared statistically with components of national dietary supply. Fat from meat and offal for the period 2 years before the prevalence data was found to have the highest statistical association with the prevalence of RA (r(2) 0.877, P<0.001 for eight countries). The statistical correlations for meat and offal were almost as high as those for their fat. Similar correlations were found for temporal changes in indices of effects of RA in several European countries between 1968 and 1978 as more meat was added to the national diets, although the correlations were higher for meat than for fat. It is hypothesized that meat and offal may be a major factor contributing to the inflammation in RA. In the present short review, the author examines some of the data that associate meat consumption with RA and the possible factors, e.g. fat, Fe and nitrite, which may contribute to the inflammation.

Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: a multicountry observational study from the Africa Liver Cancer Consortium.

PubMed

Yang, Ju Dong; Mohamed, Essa A; Aziz, Ashraf O Abdel; Shousha, Hend I; Hashem, Mohamed B; Nabeel, Mohamed M; Abdelmaksoud, Ahmed H; Elbaz, Tamer M; Afihene, Mary Y; Duduyemi, Babatunde M; Ayawin, Joshua P; Gyedu, Adam; Lohouès-Kouacou, Marie-Jeanne; Ndam, Antonin W Ndjitoyap; Moustafa, Ehab F; Hassany, Sahar M; Moussa, Abdelmajeed M; Ugiagbe, Rose A; Omuemu, Casimir E; Anthony, Richard; Palmer, Dennis; Nyanga, Albert F; Malu, Abraham O; Obekpa, Solomon; Abdo, Abdelmounem E; Siddig, Awatif I; Mudawi, Hatim M Y; Okonkwo, Uchenna; Kooffreh-Ada, Mbang; Awuku, Yaw A; Nartey, Yvonne A; Abbew, Elizabeth T; Awuku, Nana A; Otegbayo, Jesse A; Akande, Kolawole O; Desalegn, Hailemichael M; Omonisi, Abidemi E; Ajayi, Akande O; Okeke, Edith N; Duguru, Mary J; Davwar, Pantong M; Okorie, Michael C; Mustapha, Shettima; Debes, Jose D; Ocama, Ponsiano; Lesi, Olufunmilayo A; Odeghe, Emuobor; Bello, Ruth; Onyekwere, Charles; Ekere, Francis; Igetei, Rufina; Mah'moud, Mitchell A; Addissie, Benyam; Ali, Hawa M; Gores, Gregory J; Topazian, Mark D; Roberts, Lewis R

2017-02-01

Hepatocellular carcinoma is a leading cause of cancer-related death in Africa, but there is still no comprehensive description of the current status of its epidemiology in Africa. We therefore initiated an African hepatocellular carcinoma consortium aiming to describe the clinical presentation, management, and outcomes of patients with hepatocellular carcinoma in Africa. We did a multicentre, multicountry, retrospective observational cohort study, inviting investigators from the African Network for Gastrointestinal and Liver Diseases to participate in the consortium to develop hepatocellular carcinoma research databases and biospecimen repositories. Participating institutions were from Cameroon, Egypt, Ethiopia, Ghana, Ivory Coast, Nigeria, Sudan, Tanzania, and Uganda. Clinical information-demographic characteristics, cause of disease, liver-related blood tests, tumour characteristics, treatments, last follow-up date, and survival status-for patients diagnosed with hepatocellular carcinoma between Aug 1, 2006, and April 1, 2016, were extracted from medical records by participating investigators. Because patients from Egypt showed differences in characteristics compared with patients from the other countries, we divided patients into two groups for analysis; Egypt versus other African countries. We undertook a multifactorial analysis using the Cox proportional hazards model to identify factors affecting survival (assessed from the time of diagnosis to last known follow-up or death). We obtained information for 2566 patients at 21 tertiary referral centres (two in Egypt, nine in Nigeria, four in Ghana, and one each in the Ivory Coast, Cameroon, Sudan, Ethiopia, Tanzania, and Uganda). 1251 patients were from Egypt and 1315 were from the other African countries (491 from Ghana, 363 from Nigeria, 277 from Ivory Coast, 59 from Cameroon, 51 from Sudan, 33 from Ethiopia, 21 from Tanzania, and 20 from Uganda). The median age at which hepatocellular carcinoma was diagnosed significantly later in Egypt than the other African countries (58 years [IQR 53-63] vs 46 years [36-58]; p<0·0001). Hepatitis C virus was the leading cause of hepatocellular carcinoma in Egypt (1054 [84%] of 1251 patients), and hepatitis B virus was the leading cause in the other African countries (597 [55%] of 1082 patients). Substantially fewer patients received treatment specifically for hepatocellular carcinoma in the other African countries than in Egypt (43 [3%] of 1315 vs 956 [76%] of 1251; p<0·0001). Among patients with survival information (605 [48%] of 1251 in Egypt and 583 [44%] of 1315 in other African countries), median survival was shorter in the other African countries than in Egypt (2·5 months [95% CI 2·0-3·1] vs 10·9 months [9·6-12·0]; p<0·0001). Factors independently associated with poor survival were: being from an African countries other than Egypt (hazard ratio [HR] 1·59 [95% CI 1·13-2·20]; p=0·01), hepatic encephalopathy (2·81 [1·72-4·42]; p=0·0004), diameter of the largest tumour (1·07 per cm increase [1·04-1·11]; p<0·0001), log α-fetoprotein (1·10 per unit increase [1·02-1·20]; p=0·0188), Eastern Cooperative Oncology Group performance status 3-4 (2·92 [2·13-3·93]; p<0·0001) and no treatment (1·79 [1·44-2·22]; p<0·0001). Characteristics of hepatocellular carcinoma differ between Egypt and other African countries. The proportion of patients receiving specific treatment in other African countries was low and their outcomes were extremely poor. Urgent efforts are needed to develop health policy strategies to decrease the burden of hepatocellular carcinoma in Africa. None. Copyright © 2017 Elsevier Ltd. All rights reserved.

Macro- and micro-level predictors of age categorization: results from the European Social Survey.

PubMed

Ayalon, Liat; Doron, Israel; Bodner, Ehud; Inbar, Noit

2014-03-01

This study evaluated macro- and micro-level variables associated with individuals' perception of the ending of youth, the beginning of old age, and the length of the middle age period. The European Social Survey is a biennial multi-country, cross-sectional survey. Our analysis is based on the fourth wave, which included a rotating module on ageism. The source sample consisted of 28 countries and a total of 54,988 respondents. Whereas macro-level variability accounted for 14 % of the variance associated with the perception of the ending of youth, only 5.7 % of the variance associated with the perception of the beginning of old age was accounted for by macro-level variability. Almost 10 % of the variance associated with the perception of the middle age period was associated with macro-level variability. Different patterns of macro- and micro-level correlates emerged for the ending of youth, beginning of old age, and the period of middle age. Overall, results demonstrate that individual differences in the perception of the ending of youth, the beginning of old age, and the length of the middle age period are more pronounced than contextual differences. Results also suggest that individuals' mental maps regarding the timing of these events are not necessarily concordant.

The Determinants of Reported Personal and Household Hygiene Behaviour: A Multi-Country Study

PubMed Central

Aunger, Robert; Greenland, Katie; Ploubidis, George; Schmidt, Wolf; Oxford, John; Curtis, Valerie

2016-01-01

A substantial proportion of the total infectious disease burden world-wide is due to person-to-person spread of pathogens within households. A questionnaire-based survey on the determinants of hand-washing with soap and cleaning of household surfaces was conducted in at least 1000 households in each of twelve countries across the world (N = 12,239). A structural equation model of hygiene behaviour and its consequences derived from theory was then estimated on this dataset for both behaviours, using a maximum likelihood procedure. The analysis showed that the frequency of handwashing with soap is significantly related to how automatically it is performed, and whether or not someone is busy, or tired. Surface cleaning was strongly linked to possessing a cleaning routine, the perception that one is living in a dirty environment and that others are doing the behaviour, whether one has a strong sense of contamination, as well as a felt need to keep one’s surroundings tidy. Being concerned with good manners is also linked to the performance of both behaviours. This study is the first to identify the role of manners, orderliness and routine on hygiene behaviours globally. Such findings should prove helpful in designing programs to improve domestic hygiene practices. PMID:27541259

Context matters: a multicountry analysis of individual- and neighbourhood-level factors associated with women's sanitation use in sub-Saharan Africa.

PubMed

Winter, Samantha; Dreibelbis, Robert; Barchi, Francis

2018-02-01

To identify cross-national trends in factors associated with women's sanitation use in sub-Saharan Africa. Using data from Demographic and Health Surveys conducted in 14 SSA countries between 2008 and 2014, we modelled women's sanitation use in relation to various individual- and neighbourhood-level factors. Substantial variation exists between countries in the strength and direction of factors associated with sanitation use. Particularly significant associations across the region included access to different water sources, years of education, family size, age, living in a female-headed household, being married and wealth. Neighbourhood-level poverty, ethnic diversity and urbanisation were important factors in a majority of countries. International development goals for sanitation are frequently framed in terms of availability, implicitly suggesting that if facilities are accessible, they will be used. A more nuanced view that takes into account not only the existence of facilities but also the factors influencing their use is needed to understand the dynamics of women's sanitation use in the region. Policies focused on availability may not yield the desired public health benefits from improved sanitation in sub-Saharan Africa. Context-relevant factors must be addressed concurrently to achieve sanitation development goals. © 2017 John Wiley & Sons Ltd.

The Determinants of Reported Personal and Household Hygiene Behaviour: A Multi-Country Study.

PubMed

Aunger, Robert; Greenland, Katie; Ploubidis, George; Schmidt, Wolf; Oxford, John; Curtis, Valerie

2016-01-01

A substantial proportion of the total infectious disease burden world-wide is due to person-to-person spread of pathogens within households. A questionnaire-based survey on the determinants of hand-washing with soap and cleaning of household surfaces was conducted in at least 1000 households in each of twelve countries across the world (N = 12,239). A structural equation model of hygiene behaviour and its consequences derived from theory was then estimated on this dataset for both behaviours, using a maximum likelihood procedure. The analysis showed that the frequency of handwashing with soap is significantly related to how automatically it is performed, and whether or not someone is busy, or tired. Surface cleaning was strongly linked to possessing a cleaning routine, the perception that one is living in a dirty environment and that others are doing the behaviour, whether one has a strong sense of contamination, as well as a felt need to keep one's surroundings tidy. Being concerned with good manners is also linked to the performance of both behaviours. This study is the first to identify the role of manners, orderliness and routine on hygiene behaviours globally. Such findings should prove helpful in designing programs to improve domestic hygiene practices.

Compliance With Referral Advice After Treatment With Prereferral Rectal Artesunate: A Study in 3 Sub-Saharan African Countries.

PubMed

Siribié, Mohamadou; Ajayi, IkeOluwapo O; Nsungwa-Sabiiti, Jesca; Sanou, Armande K; Jegede, Ayodele S; Afonne, Chinenye; Falade, Catherine O; Gomes, Melba

2016-12-15

 Children aged <5 years were enrolled in a large study in 3 countries of sub-Saharan Africa because they had danger signs preventing them from being able to take oral medications. We examined compliance and factors associated with compliance with referral advice for those who were treated with rectal artesunate.  Patient demographic data, speed of accessing treatment after danger signs were recognized, clinical symptoms, malaria microscopy, treatment-seeking behavior, and compliance with referral advice were obtained from case record forms of 179 children treated with prereferral rectal artesunate in a multicountry study. We held focus group discussions and key informant interviews with parents, community health workers (CHWs), and facility staff to understand the factors that deterred or facilitated compliance with referral advice.  There was a very high level of compliance (90%) among patients treated with prereferral rectal artesunate. Age, symptoms at baseline (prostration, impaired consciousness, convulsions, coma), and malaria status were not related to referral compliance in the analysis.  Teaching CHWs to diagnose and treat young children with prereferral rectal artesunate is feasible in remote communities of Africa, and high compliance with referral advice can be achieved. © 2016 World Health Organization; licensee Oxford Journals.

Self-reported medical, medication and laboratory error in eight countries: risk factors for chronically ill adults.

PubMed

Scobie, Andrea

2011-04-01

To identify risk factors associated with self-reported medical, medication and laboratory error in eight countries. The Commonwealth Fund's 2008 International Health Policy Survey of chronically ill patients in eight countries. None. A multi-country telephone survey was conducted between 3 March and 30 May 2008 with patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK and the USA who self-reported being chronically ill. A bivariate analysis was performed to determine significant explanatory variables of medical, medication and laboratory error (P < 0.01) for inclusion in a binary logistic regression model. The final regression model included eight risk factors for self-reported error: age 65 and under, education level of some college or less, presence of two or more chronic conditions, high prescription drug use (four+ drugs), four or more doctors seen within 2 years, a care coordination problem, poor doctor-patient communication and use of an emergency department. Risk factors with the greatest ability to predict experiencing an error encompassed issues with coordination of care and provider knowledge of a patient's medical history. The identification of these risk factors could help policymakers and organizations to proactively reduce the likelihood of error through greater examination of system- and organization-level practices.

Social determinants of sex differences in disability among older adults: a multi-country decomposition analysis using the World Health Survey.

PubMed

Hosseinpoor, Ahmad Reza; Williams, Jennifer Stewart; Jann, Ben; Kowal, Paul; Officer, Alana; Posarac, Aleksandra; Chatterji, Somnath

2012-09-08

Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women. World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into "disabled" vs. "not disabled". We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the "explained" part that arises because of differences between males and females in terms of age and social and economic characteristics, and an "unexplained" part attributed to the differential effects of these characteristics. Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants. There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.

The Relative Impacts of Disease on Health Status and Capability Wellbeing: A Multi-Country Study

PubMed Central

Mitchell, Paul Mark; Al-Janabi, Hareth; Richardson, Jeff; Iezzi, Angelo; Coast, Joanna

2015-01-01

Background Evaluations of the impact of interventions for resource allocation purposes commonly focus on health status. There is, however, also concern about broader impacts on wellbeing and, increasingly, on a person's capability. This study aims to compare the impact on health status and capability of seven major health conditions, and highlight differences in treatment priorities when outcomes are measured by capability as opposed to health status. Methods The study was a cross-sectional four country survey (n = 6650) of eight population groups: seven disease groups with: arthritis, asthma, cancer, depression, diabetes, hearing loss, and heart disease and one health population ‘comparator’ group. Two simple self-complete questionnaires were used to measure health status (EQ-5D-5L) and capability (ICECAP-A). Individuals were classified by illness severity using condition-specific questionnaires. Effect sizes were used to estimate: (i) the difference in health status and capability for those with conditions, relative to a healthy population; and (ii) the impact of the severity of the condition on health status and capability within each disease group. Findings 5248 individuals were included in the analysis. Individuals with depression have the greatest mean reduction in both health (effect size, 1.26) and capability (1.22) compared to the healthy population. The effect sizes for capability for depression are much greater than for all other conditions, which is not the case for health. For example, the arthritis group effect size for health (1.24) is also high and similar to that of depression, whereas for the same arthritis group, the effect size for capability is much lower than that for depression (0.55). In terms of severity within disease groups, individuals categorised as 'mild' have similar capability levels to the healthy population (effect sizes <0.2, excluding depression) but lower health status than the healthy population (≥0.4). Conclusion Significant differences exist in the relative effect sizes across diseases when measured by health status and capability. In terms of treating morbidity, a shift in focus from health gain to capability gain would increase funding priorities for patients with depression specifically and severe illnesses more generally. PMID:26630131

Elevated blood pressure and household solid fuel use in premenopausal women: Analysis of 12 Demographic and Health Surveys (DHS) from 10 countries.

PubMed

Arku, Raphael E; Ezzati, Majid; Baumgartner, Jill; Fink, Günther; Zhou, Bin; Hystad, Perry; Brauer, Michael

2018-01-01

Approximately three billion people are exposed to household air pollution (HAP) from solid fuel cookstoves. Studies from single settings have linked HAP with elevated blood pressure (BP), but no evidence exists from multi-country analyses. Using nationally representative and internationally comparable data, we examined the association between solid fuel use and BP in 77,605 largely premenopausal women (aged 15-49) from ten resource-poor countries. We obtained data on systolic and diastolic BP, self-reported primary cooking fuel, health and socio-demographic characteristics from 12 Demographic and Health Surveys conducted in Albania, Armenia, Azerbaijan, Bangladesh, Benin, Ghana, Kyrgyzstan, Lesotho, Namibia, and Peru. We estimated associations between history of fuel use [solid fuel (coal or biomass) versus clean fuel (electricity or gas)] with systolic and diastolic BP and hypertension using a meta-analytical approach. Overall, the country-level mean systolic and diastolic BP were 117 (range: 111-127) and 74 (71-83) mmHg, respectively. The country-level mean age of the women was 30.8 years (range: 28.4-32.9). The prevalence of solid fuel use was 46.0% (range: 4.1-95.8). In adjusted, pooled analyses, primary use of solid fuel was associated with 0.58mmHg higher systolic BP (95% CI: 0.23, 0.93) as compared to primary use of clean fuel. The pooled estimates for diastolic BP and pulse pressure were also positive, but the confidence intervals contained zero. The pooled odds of hypertension was [OR = 1.07 (95% CI: 0.99, 1.16)], an effect that was driven by rural participants for whom solid fuel use was associated with a 16% greater odds of hypertension [OR = 1.16 (95% CI: 1.01, 1.35)]. Cooking with solid fuels was associated with small increases in BP and odds of hypertension. Use of cleaner fuels like gas or electricity may reduce cardiovascular risk in developing countries, particularly among rural residents. Copyright © 2017 Elsevier Inc. All rights reserved.

Chagas disease: current epidemiological trends after the interruption of vectorial and transfusional transmission in the Southern Cone countries.

PubMed

Moncayo, Alvaro

2003-07-01

Chagas disease, named after Carlos Chagas who first described it in 1909, exists only on the American Continent. It is caused by a parasite, Trypanosoma cruzi, transmitted to humans by blood-sucking triatomine bugs and by blood transfusion. Chagas disease has two successive phases, acute and chronic. The acute phase lasts 6 to 8 weeks. After several years of starting the chronic phase, 20% to 35% of the infected individuals, depending on the geographical area will develop irreversible lesions of the autonomous nervous system in the heart, esophagus, colon and the peripheral nervous system. Data on the prevalence and distribution of Chagas disease improved in quality during the 1980's as a result of the demographically representative cross-sectional studies carried out in countries where accurate information was not available. A group of experts met in Bras lia in 1979 and devised standard protocols to carry out countrywide prevalence studies on human T. cruzi infection and triatomine house infestation. Thanks to a coordinated multi-country program in the Southern Cone countries the transmission of Chagas disease by vectors and by blood transfusion has been interrupted in Uruguay in1997, in Chile in 1999, and in 8 of the 12 endemic states of Brazil in 2000 and so the incidence of new infections by T. cruzi in the whole continent has decreased by 70%. Similar control multi-country initiatives have been launched in the Andean countries and in Central America and rapid progress has been recorded to ensure the interruption of the transmission of Chagas disease by 2005 as requested by a Resolution of the World Health Assembly approved in 1998. The cost-benefit analysis of the investments of the vector control program in Brazil indicate that there are savings of US$17 in medical care and disabilities for each dollar spent on prevention, showing that the program is a health investment with good return. Since the inception in 1979 of the Steering Committee on Chagas Disease of the Special Program for Research and Training in Tropical Diseases of the World Health Organization (TDR), the objective was set to promote and finance research aimed at the development of new methods and tools to control this disease. The well known research institutions in Latin America were the key elements of a world wide network of laboratories that received - on a competitive basis - financial support for projects in line with the priorities established. It is presented the time line of the different milestones that were answering successively and logically the outstanding scientific questions identified by the Scientific Working Group in 1978 and that influenced the development and industrial production of practical solutions for diagnosis of the infection and disease control.

Socio-economic determinants of HIV testing and counselling: a comparative study in four African countries.

PubMed

Obermeyer, Carla Makhlouf; Neuman, Melissa; Hardon, Anita; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Cherutich, Peter; Namakhoma, Ireen

2013-09-01

Research indicates that individuals tested for HIV have higher socio-economic status than those not tested, but less is known about how socio-economic status is associated with modes of testing. We compared individuals tested through provider-initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested. Cross-sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi-country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio-economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand-alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother-to-child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses. Higher socio-economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio-economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested. Provider-initiated modes of testing make testing accessible to individuals from lower socio-economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio-economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent. © 2013 John Wiley & Sons Ltd.

Does participation in a weight control program also improve clinical and functional outcomes for Chinese patients with schizophrenia treated with olanzapine?

PubMed Central

Montgomery, William; Treuer, Tamas; Ye, Wenyu; Xue, Hai Bo; Wu, Sheng Hu; Liu, Li; Kadziola, Zbigniew; Stensland, Michael D; Ascher-Svanum, Haya

2014-01-01

Objectives This study examined whether participation in a weight control program (WCP) by patients with schizophrenia treated with olanzapine was also associated with improvements in clinical and functional outcomes. Methods A post-hoc analysis was conducted using data from the Chinese subgroup (n=330) of a multi-country, 6-month, prospective, observational study of outpatients with schizophrenia who initiated or switched to oral olanzapine. At study entry and monthly visits, participants were assessed with the Clinical Global Impression of Severity, and measures of patient insight, social activities, and work impairment. The primary comparison was between the 153 patients who participated in a WCP at study entry (n=93) or during the study (n=60) and the 177 patients who did not participate in a weight control program (non-WCP). Mixed Models for Repeated Measures with baseline covariates were used to compare outcomes over time. Kaplan–Meier survival analysis was used to assess time to response. Results Participants had a mean age of 29.0 years and 29.3 years, and 51.0% and 57.6% were female for WCP and non-WCP groups, respectively. Average initiated daily dose for olanzapine was 9.5±5.4 mg. WCP participants gained less weight than non-participants (3.9 kg vs 4.9 kg, P=0.03) and showed statistically significant better clinical and functional outcomes: greater improvement in illness severity (−2.8 vs −2.1, P<0.001), higher treatment response rates (94.1% vs 80.9%, P<0.001), shorter time to response (P<0.001), and greater improvement in patients’ insight (P<0.001). Patients who enrolled in a WCP during the study had greater initial weight gain than those who enrolled at baseline (P<0.05), but similar total weight gain. Conclusion Participation in a WCP may not only lower the risk of clinically significant weight gain in olanzapine-treated patients, but may also be associated with additional clinical and functional benefits. PMID:25031537

Changing hearts and minds: Results from a multi-country gender and sexual diversity training.

PubMed

Poteat, Tonia; Park, Chulwoo; Solares, Diego; Williams, John K; Wolf, R Cameron; Metheny, Noah; Vazzano, Andrea; Dent, Juan; Gibbs, Ashley; Nonyane, Bareng Aletta Sanny; Toiv, Nora

2017-01-01

Engaging key populations, including gender and sexual minorities, is essential to meeting global targets for reducing new HIV infections and improving the HIV continuum of care. Negative attitudes toward gender and sexual minorities serve as a barrier to political will and effective programming for HIV health services. The President's Emergency Plan for AIDS Relief (PEPFAR), established in 2003, provided Gender and Sexual Diversity Trainings for 2,825 participants including PEPFAR staff and program implementers, U.S. government staff, and local stakeholders in 38 countries. The outcomes of these one-day trainings were evaluated among a subset of participants using a mixed methods pre- and post-training study design. Findings suggest that sustainable decreases in negative attitudes toward gender and sexual minorities are achievable with a one-day training.

Is Child Labor a Barrier to School Enrollment in Low- and Middle-Income Countries?

PubMed Central

Putnick, Diane L.; Bornstein, Marc H.

2015-01-01

Achieving universal primary education is one of the Millennium Development Goals. In low- and middle-income developing countries (LMIC), child labor may be a barrier. Few multi-country, controlled studies of the relations between different kinds of child labor and schooling are available. This study employs 186,795 families with 7- to 14-year-old children in 30 LMIC to explore relations of children’s work outside the home, family work, and household chores with school enrollment. Significant negative relations emerged between each form of child labor and school enrollment, but relations were more consistent for family work and household chores than work outside the home. All relations were moderated by country and sometimes by gender. These differentiated findings have nuanced policy implications. PMID:26034342

The relationship between the Maria da Penha Law and intimate partner violence in two Brazilian states.

PubMed

Gattegno, Mariana V; Wilkins, Jasmine D; Evans, Dabney P

2016-11-17

Globally, inequality between men and women manifests in a variety of ways. In particular, gender inequality increases the risk of perpetration of violence against women (VAW), especially intimate partner violence (IPV), by males. The World Health Organization (WHO) estimates that 35 % of women have experienced physical, psychological and/or sexual IPV at least once in their lives, making IPV unacceptably common. In 2006, the Maria da Penha Law on Domestic and Family Violence, became the first federal law to regulate VAW and punish perpetrators in Brazil. This study examines the relationship between Brazilian VAW legislation and male perpetration of VAW by comparing reported prevalence of IPV before and after the enactment of the Maria da Penha Law. To assess changes in magnitude of IPV before and after the law, we used data from the 2013 Brazilian National Health Survey; we replicated the analyses conducted for the WHO Multi-Country Study on Women's Health and Domestic Violence Against Women-whose data were collected before the passage of the Maria da Penha Law. We compare findings from the two studies. Our analyses show an increase in the reported prevalence of physical violence, and a decrease in the reported prevalence of sexual and psychological violence. The increase may result from an actual increase in physical violence, increased awareness and reporting of physical violence, or a combination of both factors. Additionally, our analysis revealed that in the urban setting of São Paulo, physical violence was more likely to be severe and occur in the home; meanwhile, in the rural state of Pernambuco, physical violence was more likely to be moderate in nature and occur in public. The Maria da Penha Law increased attention and resources for VAW response and prevention; however, its true impact remains unmeasured. Our data suggest a need for regular, systematic collection of comparable population-based data to accurately estimate the true prevalence of IPV in Brazil. Furthermore, such data may inform policy and program planning to address specific needs across diverse settings including rural and urban communities. If routinely collected over time, such data can be used to develop policies and programs that address all forms of IPV, as well as evidence-based programs that address the social and cultural norms that support other forms of VAW and gender inequality.

Effectiveness of Non-nucleoside Reverse-Transcriptase Inhibitor-Based Antiretroviral Therapy in Women Previously Exposed to a Single Intrapartum Dose of Nevirapine: A Multi-country, Prospective Cohort Study

PubMed Central

Stringer, Jeffrey S. A.; McConnell, Michelle S.; Kiarie, James; Bolu, Omotayo; Anekthananon, Thanomsak; Jariyasethpong, Tavatchai; Potter, Dara; Mutsotso, Winnie; Borkowf, Craig B.; Mbori-Ngacha, Dorothy; Muiruri, Peter; Ong'ech, John Odero; Zulu, Isaac; Njobvu, Lungowe; Jetsawang, Bongkoch; Pathak, Sonal; Bulterys, Marc; Shaffer, Nathan; Weidle, Paul J.

2010-01-01

Background Intrapartum and neonatal single-dose nevirapine (NVP) reduces the risk of mother-to-child HIV transmission but also induces viral resistance to non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. This drug resistance largely fades over time. We hypothesized that women with a prior single-dose NVP exposure would have no more than a 10% higher cumulative prevalence of failure of their NNRTI-containing antiretroviral therapy (ART) over the first 48 wk of therapy than would women without a prior exposure. Methods and Findings We enrolled 355 NVP-exposed and 523 NVP-unexposed women at two sites in Zambia, one site in Kenya, and two sites in Thailand into a prospective, non-inferiority cohort study and followed them for 48 wk on ART. Those who died, discontinued NNRTI-containing ART, or had a plasma viral load ≥400 copies/ml at either the 24 wk or 48 wk study visits and confirmed on repeat testing were characterized as having failed therapy. Overall, 114 of 355 NVP-exposed women (32.1%) and 132 of 523 NVP-unexposed women (25.2%) met criteria for treatment failure. The difference in failure rates between the exposure groups was 6.9% (95% confidence interval [CI] 0.8%–13.0%). The failure rates of women stratified by our predefined exposure interval categories were as follows: 47 of 116 women in whom less than 6 mo elapsed between exposure and starting ART failed therapy (40%; p<0.001 compared to unexposed women); 25 of 67 women in whom 7–12 mo elapsed between exposure and starting ART failed therapy (37%; p = 0.04 compared to unexposed women); and 42 of 172 women in whom more than 12 mo elapsed between exposure and starting ART failed therapy (24%; p = 0.82 compared to unexposed women). Locally weighted regression analysis also indicated a clear inverse relationship between virologic failure and the exposure interval. Conclusions Prior exposure to single-dose NVP was associated with an increased risk of treatment failure; however, this risk seems largely confined to women with a more recent exposure. Women requiring ART within 12 mo of NVP exposure should not be prescribed an NNRTI-containing regimen as first-line therapy. Please see later in the article for the Editors' Summary PMID:20169113

Development of a web-based application and multicountry analysis framework for assessing interdicted infections and cost-utility of screening donated blood for HIV, HCV and HBV.

PubMed

Custer, B; Janssen, M P; Hubben, G; Vermeulen, M; van Hulst, M

2017-08-01

Most countries test donations for HIV, HCV and HBV using serology with or without nucleic acid testing (NAT). Cost-utility analyses provide information on the relative value of different screening options. The aim of this project was to develop an open access risk assessment and cost-utility analysis web-tool for assessing HIV, HCV and HBV screening options (http://www.isbtweb.org/working-parties/transfusion-transmitted-infectious-diseases/). An analysis for six countries (Brazil, Ghana, the Netherlands, South Africa, Thailand and USA) was conducted. Four strategies; (1) antibody assays (Abs) for HIV and HCV + HBsAg, (2) antibody assays that include antigens for HIV and HCV (Combo) + HBsAg, (3) NAT in minipools of variable size (MP NAT) and (4) individual donation (ID) NAT can be evaluated using the tool. Country-specific data on donors, donation testing results, recipient outcomes and costs are entered using the online interface. Results obtained include the number infections interdicted using each screening options, and the (incremental and average) cost-utility of the options. In each of the six countries evaluated, the use of antibody assays is cost effective or even cost saving. NAT has varying cost-utility depending on the setting, and where adopted, the incremental cost-utility exceeds any previously defined or proposed threshold in each country. The web-tool allows an assessment of infectious units interdicted and value for money of different testing strategies. Regardless of gross national income (GNI) per capita, countries appear willing to dedicate healthcare resources to blood supply safety in excess of that for other sectors of health care. © 2017 International Society of Blood Transfusion.

The International Alcohol Control (IAC) study-evaluating the impact of alcohol policies.

PubMed

Casswell, Sally; Meier, Petra; MacKintosh, Anne M; Brown, Abraham; Hastings, Gerard; Thamarangsi, Thaksaphon; Chaiyasong, Surasak; Chun, Sungsoo; Huckle, Taisia; Wall, Martin; You, Ru Q

2012-08-01

This paper describes a new multicountry collaborative project to assess the impact of alcohol control policy. Longitudinal surveys of drinkers in a number of participating countries and analysis of the policy context allow for the assessment of change over time within countries and comparison between countries. The design of the study is modeled on the International Tobacco Control study and aims to assess the impact of alcohol policies in different cultural contexts on policy-related behaviors and alcohol consumption. A survey instrument and protocol for policy analysis have been developed by the initial participating countries: England, Scotland, Thailand, South Korea, and New Zealand. The first round of data collection is scheduled for 2011-2012. The survey instrument (International Alcohol Control [IAC] survey) measures key policy relevant behaviors: place and time of purchase, amounts purchased and price paid; ease of access to alcohol purchase; alcohol marketing measures; social supply; perceptions of alcohol affordability and availability and salience of price; perceptions of enforcement; people's experiences with specific alcohol restrictions; support for policy and consumption (typical quantity, frequency using beverage and location-specific measures). The Policy Analysis Protocol (PoLAP) assesses relevant aspects of the policy environment including regulation and implementation. It has proved feasible to design instruments to collect detailed data on behaviors relevant to alcohol policy change and to assess the policy environment in different cultural settings. In a policy arena in which the interest groups and stakeholders have different perceptions of appropriate policy responses to alcohol-related harm, a robust methodology to assess the impact of policy will contribute to the debate. Copyright © 2012 by the Research Society on Alcoholism.

Preliminary Development of the Food Allergy Coping and Emotions Questionnaires for Children, Adolescents, and Young People: Qualitative Analysis of Data on IgE-Mediated Food Allergy from Five Countries.

PubMed

DunnGalvin, Audrey; Polloni, Laura; Le Bovidge, Jennifer; Muraro, Antonella; Greenhawt, Matthew; Taylor, Steve; Baumert, Joseph; Burks, Wesley; Trace, Anna; DunnGalvin, Gillian; Forristal, Lisa; McGrath, Laura; White, Jennifer; Vasquez, Marta; Allen, Katrina; Sheikh, Aziz; Hourihane, Jonathan; Tang, Mimi L K

We have previously developed a food allergy-specific developmental model, that explained emotions and coping styles, among children aged 6 to 15years in Ireland. The objective of this study was to investigate the usefulness of the developmental model in a large multicountry data set, including any mediators of coping style, and to use the findings to generate an item pool that will form the basis for 3 age-appropriate self-report questionnaires to measure coping and emotions. We conducted deductive thematic analysis on secondary data from interviews with 274 participants aged 6 to 23 years, and 119 parents from Australia, Ireland, Italy, the UK, and the USA. Analysis was undertaken across the entire data set. The Food Allergy Coping and Emotions (FACE) model has 5 major themes: (1) experiences and emotions, (2) search for normality, (3) management and coping, (4) "external mediators," and (5) "internal mediators" (between emotions and coping). These themes were present across countries, but differed according to age. Early-life experiences provide the foundation for later cognitions and behaviors. The expanded FACE developmental model is useful in explaining emotions and coping styles across different age groups and countries. These data will also be used to generate an age-specific bank of items for the development of 3 (age-specific self-report, and parent proxy) questionnaires to assess emotions and coping in food allergy. Findings provide insight into how particular styles of coping develop and vary from patient to patient and may also guide clinician-patient communication and the development of individualized management strategies. Copyright © 2018. Published by Elsevier Inc.

‘Side effects’ are ‘central effects’ that challenge retention in HIV treatment programmes in six sub-Saharan African countries: a multicountry qualitative study

PubMed Central

McLean, Estelle; Ddaaki, William; Odongo, Fred; Bukenya, Dominic; Wamoyi, Joyce; Bonnington, Oliver; Seeley, Janet; Zaba, Basia; Wringe, Alison

2017-01-01

Objectives To explore the bodily and relational experience of taking antiretroviral therapy (ART) and the subsequent effect on retention in HIV care in six sub-Saharan African countries. Methods In-depth interviews were conducted with 130 people living with HIV (PLHIV) who had initiated ART, 38 PLHIV who were lost to follow-up and 53 healthcare workers (HCWs) in Kenya, Uganda, Tanzania, Malawi, Zimbabwe and South Africa. PLHIV were purposely selected to include a range of HIV treatment histories. Deductive and inductive analysis was guided by aspects of practice theory; retention in HIV care following ART initiation was the practice of interest. Results PLHIV who were engaged in HIV care took ART every day, attended clinic appointments and ate as well as possible. For PLHIV, biomedical markers acted as reassurance for their positive treatment progression. However, many described ART side effects ranging from dizziness to conditions severe enough to prevent them from leaving home or caring for themselves or others. In all settings, the primary concern of HCW was ensuring patients achieved viral suppression, with management of side effects seen as a lower priority. Where PLHIV tolerated side effects, they were deemed the lesser of two evils compared with their pre-ART illnesses. Participants who reported feeling well prior to starting ART were often less able to tolerate side effects, and in many cases these events triggered their disengagement from HIV care. Conclusions Retention in ART care is rarely an outcome of rational decision-making, but the consequence of bodily and relational experiences. Initiatives to improve retention should consider how bodily experiences of PLHIV relate to the rest of their lives and how this can be respected and supported by service providers to subsequently improve retention in care. PMID:28736390

Overview, methods and results of multi-country community-based maternal and newborn care economic analysis.

PubMed

Daviaud, Emmanuelle; Owen, Helen; Pitt, Catherine; Kerber, Kate; Bianchi Jassir, Fiorella; Barger, Diana; Manzi, Fatuma; Ekipara-Kiracho, Elizabeth; Greco, Giulia; Waiswa, Peter; Lawn, Joy E

2017-10-01

Home visits for pregnancy and postnatal care were endorsed by the WHO and partners as a complementary strategy to facility-based care to reduce newborn and maternal mortality. This article aims to synthesise findings and implications from the economic analyses of community-based maternal and newborn care (CBMNC) evaluations in seven countries. The evaluations included five cluster randomized trials (Ethiopia, Ghana, South Africa, Tanzania, Uganda) and programmatic before/after assessments (Bolivia, Malawi). The economic analyses were undertaken using a standardized, comparable methodology the 'Cost of Integrated Newborn Care' Tool, developed by the South African Medical Research Council, with Saving Newborn Lives and a network of African economists. The main driver of costs is the number of community health workers (CHWs), determined by their time availability, as fixed costs per CHW (equipment, training, salary/stipend, supervision and management), independent from the level of activity (number of mothers visited) represented over 96% of economic and financial costs in five of the countries. Unpaid volunteers are not necessarily a cheap option. An integrated programme with multi-purpose paid workers usually has lower costs per visit but requires innovative management, including supervision to ensure that coverage, or quality of care are not compromised since these workers have many other responsibilities apart from maternal and newborn health. If CHWs reach 95% of pregnant women in a standardized 100 000 population, the additional financial cost in all cases would be under USD1 per capita. In five of the six countries, the programme would be highly cost-effective (cost per DALY averted < GDP/capita) by WHO threshold even if they only achieved a reduction of 1 neonatal death per 1000 live births. These results contribute useful information for implementation planning and sustainability of CBMNC programmes. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Newborn survival in Nepal: a decade of change and future implications.

PubMed

Pradhan, Y V; Upreti, Shyam Raj; Pratap K C, Naresh; K C, Ashish; Khadka, Neena; Syed, Uzma; Kinney, Mary V; Adhikari, Ramesh Kant; Shrestha, Parashu Ram; Thapa, Kusum; Bhandari, Amit; Grear, Kristina; Guenther, Tanya; Wall, Stephen N

2012-07-01

Nepal is on target to meet the Millennium Development Goals for maternal and child health despite high levels of poverty, poor infrastructure, difficult terrain and recent conflict. Each year, nearly 35,000 Nepali children die before their fifth birthday, with almost two-thirds of these deaths occurring in the first month of life, the neonatal period. As part of a multi-country analysis, we examined changes for newborn survival between 2000 and 2010 in terms of mortality, coverage and health system indicators as well as national and donor funding. Over the decade, Nepal's neonatal mortality rate reduced by 3.6% per year, which is faster than the regional average (2.0%) but slower than national annual progress for mortality of children aged 1-59 months (7.7%) and maternal mortality (7.5%). A dramatic reduction in the total fertility rate, improvements in female education and increasing change in skilled birth attendance, as well as increased coverage of community-based child health interventions, are likely to have contributed to these mortality declines. Political commitment and support for newborn survival has been generated through strategic use of global and national data and effective partnerships using primarily a selective newborn-focused approach for advocacy and planning. Nepal was the first low-income country to have a national newborn strategy, influencing similar strategies in other countries. The Community-Based Newborn Care Package is delivered through the nationally available Female Community Health Volunteers and was piloted in 10 of 75 districts, with plans to increase to 35 districts in mid-2013. Innovation and scale up, especially of community-based packages, and public health interventions and commodities appear to move relatively rapidly in Nepal compared with some other countries. Much remains to be done to achieve high rates of effective coverage of community care, and especially to improve the quality of facility-based care given the rapid shift to births in facilities.

Methodologic approach for the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

PubMed Central

Aaron, Grant J; Varadhan, Ravi

2017-01-01

Background: The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project is a multiagency and multicountry collaboration that was formed to improve micronutrient assessment and to better characterize anemia. Objectives: The aims of the project were to 1) identify factors associated with inflammation, 2) assess the relations between inflammation, malaria infection, and biomarkers of iron and vitamin A status and compare adjustment approaches, and 3) assess risk factors for anemia in preschool children (PSC) and women of reproductive age (WRA). Design: The BRINDA database inclusion criteria included surveys that 1) were conducted after 2004, 2) had target groups of PSC, WRA, or both, and 3) used a similar laboratory methodology for the measurement of ≥1 biomarker of iron [ferritin or soluble transferrin receptor or vitamin A status (retinol-binding protein or retinol)] and ≥1 biomarker of inflammation (α-1-acid glycoprotein or C-reactive protein). Individual data sets were standardized and merged into a BRINDA database comprising 16 nationally and regionally representative surveys from 14 countries. Collectively, the database covered all 6 WHO geographic regions and contained ∼30,000 PSC and 27,000 WRA. Data were analyzed individually and combined with the use of a meta-analysis. Results: The methods that were used to standardize the BRINDA database and the analytic approaches used to address the project’s research questions are presented in this article. Three approaches to adjust micronutrient biomarker concentrations in the presence of inflammation and malaria infection are presented, along with an anemia conceptual framework that guided the BRINDA project’s anemia analyses. Conclusions: The BRINDA project refines approaches to interpret iron and vitamin A biomarker values in settings of inflammation and malaria infection and suggests the use of a new regression approach as well as proposes an anemia framework to which real-world data can be applied. Findings can inform guidelines and strategies to prevent and control micronutrient deficiencies and anemia globally. PMID:28615254

Newborn survival in Uganda: a decade of change and future implications.

PubMed

Mbonye, Anthony K; Sentongo, Miriam; Mukasa, Gelasius K; Byaruhanga, Romano; Sentumbwe-Mugisa, Olive; Waiswa, Peter; Naamala Sengendo, Hanifah; Aliganyira, Patrick; Nakakeeto, Margaret; Lawn, Joy E; Kerber, Kate

2012-07-01

Each year in Uganda 141 000 children die before reaching their fifth birthday; 26% of these children die in their first month of life. In a setting of persistently high fertility rates, a crisis in human resources for health and a recent history of civil unrest, Uganda has prioritized Millennium Development Goals 4 and 5 for child and maternal survival. As part of a multi-country analysis we examined change for newborn survival over the past decade through mortality and health system coverage indicators as well as national and donor funding for health, and policy and programme change. Between 2000 and 2010 Uganda's neonatal mortality rate reduced by 2.2% per year, which is greater than the regional average rate of decline but slower than national reductions in maternal mortality and under-five mortality after the neonatal period. While existing population-based data are insufficient to measure national changes in coverage and quality of services, national attention for maternal and child health has been clear and authorized from the highest levels. Attention and policy change for newborn health is comparatively recent. This recognized gap has led to a specific focus on newborn health through a national Newborn Steering Committee, which has been given a mandate from the Ministry of Health to advise on newborn survival issues since 2006. This multi-disciplinary and inter-agency network of stakeholders has been able to preside over a number of important policy changes at the level of facility care, education and training, community-based service delivery through Village Health Teams and changes to essential drugs and commodities. The committee's comprehensive reach has enabled rapid policy change and increased attention to newborn survival in a relatively short space of time. Translating this favourable policy environment into district-level implementation and high quality services is now the priority.

Leveraging ongoing research to evaluate the health impacts of South Africa's salt reduction strategy: a prospective nested cohort within the WHO-SAGE multicountry, longitudinal study

PubMed Central

Charlton, Karen; Menyanu, Elias; Biritwum, Richard Berko; Naidoo, Nirmala; Pieterse, Chiné; Madurai, Savathree (Lorna); Baumgartner, Jeannine; Asare, George A; Thiele, Elizabeth; Schutte, Aletta E; Kowal, Paul

2016-01-01

Introduction Attempting to curb the rising epidemic of hypertension, South Africa implemented legislation in June 2016 mandating maximum sodium levels in a range of manufactured foods that contribute significantly to population salt intake. This natural experiment, comparing two African countries with and without salt legislation, will provide timely information on the impact of legislative approaches addressing the food supply to improve blood pressure in African populations. This article outlines the design of this ongoing prospective nested cohort study. Methods and analysis Baseline sodium intake was assessed in a nested cohort of the WHO Study on global AGEing and adult health (WHO-SAGE) wave 2 (2014–2015), a multinational longitudinal study on the health and well-being of adults and the ageing process. The South African cohort consisted of randomly selected households (n=4030) across the country. Spot and 24-hour urine samples are collected in a random subsample (n=1200) and sodium, potassium, creatinine and iodine analysed. Salt behaviour and sociodemographic data are captured using face-to-face interviews, alongside blood pressure and anthropometric measures. Ghana, the selected control country with no formal salt policy, provided a nested subsample (n=1200) contributing spot and 24-hour urine samples from the SAGE Ghana cohort (n=5000). Follow-up interviews and urine collection (wave 3) in both countries will take place in 2017 (postlegislation) to assess change in population-level sodium intake and blood pressure. Ethics and dissemination SAGE was approved by the WHO Ethics Review Committee (reference number RPC149) with local approval from the North-West University Human Research Ethics Committee and University of the Witwatersrand Human Research Ethics Committee (South Africa), and University of Ghana Medical School Ethics and Protocol Review Committee (Ghana). The results of the study will be published in peer-reviewed international journals, presented at national and international conferences, and summarised as research and policy briefs. PMID:27903563

Comparative analysis of prevalence of intimate partner violence against women in military and civilian communities in Abuja, Nigeria.

PubMed

Chimah, Carol Uzoamaka; Adogu, Prosper Obunikem Uche; Odeyemi, Kofoworola; Ilika, Amobi Linus

2015-01-01

Intimate partner violence (IPV) occurs across the world, in various cultures, and affects people across societies irrespective of economic status or gender. Most data on IPV before World Health Organization multicountry study (WHOMCS) usually came from sources other than the military. Result of this study will contribute to the existing body of knowledge and may serve as a baseline for future studies in military populations. This study compares the prevalence of the different types of IPV against women in military and civilian communities in Abuja, Nigeria. Using a multistage sampling technique, 260 women who had intimate male partners were selected from military and civilian communities of Abuja. Collected data on personal characteristics and different types of IPV experienced were analyzed to demonstrate comparison of the association between the different forms of IPV and the respondents' sociodemographic and partner characteristics in the two study populations using percentages and χ-square statistics, and P-value was assumed to be significant at ≤0.05. The prevalence of the four major types of IPV was higher among the military respondents than among civilians: controlling behavior, 37.1% versus 29.1%; emotional/psychological abuse, 42.4% versus 13.4%; physical abuse, 19.7% versus 5.9%, and sexual abuse, 9.2% versus 8.8%. Significantly more respondents from the military population (59 [45.4%]) compared to civilians (21 [19.4%]) were prevented by their partners from seeing their friends (P=0.000). The situation is reversed with regard to permission to seek health care for self, with civilians reporting a significantly higher prevalence (35 [32.4%]) than did military respondents (20 [15.4%]) (P=0.002). The military respondents were clearly at a higher risk of experiencing all the variants of emotional violence than the civilians (P=0.00). The commonest form of physical violence against women was "being slapped or having something thrown at them, that could hurt", which was markedly higher in the military (43 [33.1%]) than in the civilian population (10 [9.3%]), (P<0.05). IPV is a significant public health problem in Abuja, and the military population is clearly at a higher risk of experiencing all forms of IPV compared to the civilian population. The military should encourage and finance research on effect of military operations and posttraumatic stress disorders on family relationships with a view of developing evidence-based treatment models for military personnel.

Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis

PubMed Central

Clarke, Philip M.; Glasziou, Paul; Patel, Anushka; Chalmers, John; Woodward, Mark; Harrap, Stephen B.; Salomon, Joshua A.

2010-01-01

Background Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries. Methods and Findings Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$), which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%–96% across regions) and lowest for nephropathy (15%–26%). The average numbers of days in hospital given at least one admission were greatest for stroke (17–32 d across region) and heart failure (16–31 d) and lowest for nephropathy (12–23 d). Considering regional differences, probabilities of hospitalization were lowest in Asia and highest in Established Market Economies; on the other hand, lengths of stay were highest in Asia and lowest in Established Market Economies. Overall estimated annual hospital costs for patients with none of the specified events or event histories ranged from Int$76 in Asia to Int$296 in Established Market Economies. All complications included in this analysis led to significant increases in hospital costs; coronary events, cerebrovascular events, and heart failure were the most costly, at more than Int$1,800, Int$3,000, and Int$4,000 in Asia, Eastern Europe, and Established Market Economies, respectively. Conclusions Major complications of diabetes significantly increase hospital use and costs across various settings and are likely to impose a high economic burden on health care systems. Please see later in the article for the Editors' Summary PMID:20186272

Changing hearts and minds: Results from a multi-country gender and sexual diversity training

PubMed Central

Park, Chulwoo; Solares, Diego; Williams, John K.; Wolf, R. Cameron; Metheny, Noah; Vazzano, Andrea; Dent, Juan; Gibbs, Ashley; Nonyane, Bareng Aletta Sanny; Toiv, Nora

2017-01-01

Engaging key populations, including gender and sexual minorities, is essential to meeting global targets for reducing new HIV infections and improving the HIV continuum of care. Negative attitudes toward gender and sexual minorities serve as a barrier to political will and effective programming for HIV health services. The President’s Emergency Plan for AIDS Relief (PEPFAR), established in 2003, provided Gender and Sexual Diversity Trainings for 2,825 participants including PEPFAR staff and program implementers, U.S. government staff, and local stakeholders in 38 countries. The outcomes of these one-day trainings were evaluated among a subset of participants using a mixed methods pre- and post-training study design. Findings suggest that sustainable decreases in negative attitudes toward gender and sexual minorities are achievable with a one-day training. PMID:28926568

The integral inventory for depression, a new, self-rated clinimetric instrument for the emotional and painful dimensions in major depressive disorder.

PubMed

Dueñas, Héctor; Lara, Carmen; Walton, Richard J; Granger, Renee E; Dossenbach, Martin; Raskin, Joel

2011-09-01

To assess the reliability and validity of the Integral Inventory for Depression (IID) scale using post hoc analyses of data from a multi-country study (ClinicalTrials.gov: NCT00561509) of patients with major depressive disorder (MDD). Patients (N = 1629) completed the IID (comprising two separate dimensions for emotional and physically painful symptoms; maximum score of 65) and a reference scale (16-item Quick Inventory of Depressive Symptomatology Self-Report) at baseline and at follow-up (8 and 24 weeks). Physicians rated MDD symptoms using the Clinical Global Impressions of Severity scale at each visit. Inter-item correlation, internal consistency, external validity, factor structure, and exploratory analysis of an optimal severity cut-off point were assessed. The IID displayed two distinct dimensions (i.e. painful and emotional) with little item redundancy and good internal consistency (Cronbach's α > 0.83 at each visit). The IID displayed good external validity (Pearson's correlations coefficients >0.60 at each visit) and statistically significant agreement (McNemar's test; P < 0.001 at follow-up) with the reference scale. Results suggest that a cut-off score of ≤24 had adequate precision (>80%) to identify patients with and without moderate MDD. Results suggest that the IID may be a reliable and valid tool for assessing emotional and painful symptoms of MDD.

Community influences on modern contraceptive use among young women in low and middle-income countries: a cross-sectional multi-country analysis.

PubMed

Mutumba, Massy; Wekesa, Eliud; Stephenson, Rob

2018-04-02

Despite investment in family planning programs and education, unmet need for family planning remains high among young women (aged 15-24) in low and middle-income countries, increasing the risk for unwanted pregnancies and adverse social and reproductive health outcomes. There is a dearth of cross-national research that identifies the differential impact of community level factors among youth in low and middle-income countries (LMICs), which is imperative for the design of structural level interventions aimed at increasing family planning use. Grounded in the socio-ecological framework, this paper utilizes Demographic and Health Survey (DHS) from 52 LMICs to examine the influence of community level reproductive, gender, fertility, literacy and economic indicators on modern contraceptive use among female youth. Analyses are conducted using multi-level logistic regressions with random community-level effects. Our findings highlight the positive influence of community level education attainment and negative influence of gender and fertility related norms on young women's contraceptive use. Additionally, increased exposure to mass media did not positively influence young women's uptake of modern contraceptive methods. Taken together, findings indicate that young women's contraceptive decision-making is greatly shaped by their social contexts. The commonalities and regional variations in community level influences provide support for both structural level interventions and tailored regional approaches to family planning interventions.

Urban Household Characteristics and Dietary Diversity: An Analysis of Food Security in Accra, Ghana.

PubMed

Codjoe, Samuel Nii Ardey; Okutu, David; Abu, Mumuni

2016-06-01

The world's population is increasingly becoming urbanized. If the current urban growth rate is to continue, new and unprecedented challenges for food security will be inevitable. Dietary diversity has been used to ascertain food security status albeit at the multicountry and country levels. Thus, household-level studies in urban settings, particularly in sub-Sahara African, are few. Yet, it is imperative that assessments of food security are undertaken particularly in urban settings, due to the projected fast rate of urbanization and the challenges of attaining food security. To examine household characteristics and dietary diversity. The study uses data from 452 households from the second round of the Regional Institute for Population Studies (RIPS) EDULINK urban poverty and health study. Bivariate and multivariate analyses are undertaken. Mean dietary diversity for all households is 6.8. Vegetables have the highest diversity, followed by cereal-based and grain products. Household characteristics that have statistically significant associations with dietary diversity include sex and level of education of household head, household wealth quintile, and source of food. There is high dietary diversity in the study communities of Accra but low consumption of foods rich in micronutrient, such as fruits and milk/dairy products. The study brings to fore issues related to resource-disadvantaged entities of the urban system, namely, females, poor households, and the non-educated who have food insecurity problems. © The Author(s) 2016.

Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.

PubMed

Fulu, Emma; Jewkes, Rachel; Roselli, Tim; Garcia-Moreno, Claudia

2013-10-01

Male perpetration of intimate partner violence (IPV) is under-researched. In this Article, we present data for the prevalence of, and factors associated with, male perpetration of IPV from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. We aimed to estimate the prevalence of perpetration of partner violence, identify factors associated with perpetration of different forms of violence, and inform prevention strategies. We undertook standardised population-based household surveys with a multistage representative sample of men aged 18-49 years in nine sites in Bangladesh, China, Cambodia, Indonesia, Sri Lanka, and Papua New Guinea between January, 2011, and December, 2012. We built multinomial regression models of factors associated with lifetime violence perpetration: physical IPV, sexual IPV, both physical and sexual IPV, multiple emotional or economic IPV versus none, and calculated population-attributable fractions. In the analysis, we considered factors related to social characteristics, gender attitudes and relationship practices, victimisation history, psychological factors, substance misuse, and participation in violence outside the home. 10,178 men completed interviews in our study (between 815 and 1812 per site). The response rate was higher than 82·5% in all sites except for urban Bangladesh (73·2%) and Sri Lanka (58·7%). The prevalence of physical or sexual IPV perpetration, or both, varied by site, between 25·4% (190/746; rural Indonesia) and 80·0% (572/714; Bougainville, Papua New Guinea). When multiple emotional or economic abuse was included, the prevalence of IPV perpetration ranged from 39·3% (409/1040; Sri Lanka) to 87·3% (623/714; Bougainville, Papua New Guinea). Factors associated with IPV perpetration varied by country and type of violence. On the basis of population-attributable fractions, we show factors related to gender and relationship practices to be most important, followed by experiences of childhood trauma, alcohol misuse and depression, low education, poverty, and involvement in gangs and fights with weapons. Perpetration of IPV by men is highly prevalent in the general population in the sites studied. Prevention of IPV is crucial, and interventions should address gender socialisation and power relations, abuse in childhood, mental health issues, and poverty. Interventions should be tailored to respond to the specific patterns of violence in various contexts. Physical and sexual partner violence might need to be addressed in different ways. Partners for Prevention--a UN Development Programme, UN Population Fund, UN Women, and UN Volunteers regional joint programme for gender-based violence prevention in Asia and the Pacific; UN Population Fund Bangladesh and China; UN Women Cambodia and Indonesia; UN Development Programme in Papua New Guinea and Pacific Centre; and the Governments of Australia, the UK, Norway, and Sweden. Copyright © 2013 Fulu et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.

Prevalence of pain reporting and associated health outcomes across emerging markets and developed countries.

PubMed

Goren, Amir; Mould-Quevedo, Joaquín; daCosta DiBonaventura, Marco

2014-11-01

The current study represents the first broad, multi-country, population-based survey of pain, assessing the association between pain and health outcomes, plus comparing the burden of pain across emerging and developed countries. Data from the 2011/2012 National Health and Wellness Surveys were used. Respondents reporting pain (neuropathic pain, fibromyalgia, back pain, surgery pain, and/or arthritis pain) vs no pain in emerging (Brazil, China, Russia) vs developed (European Union, Japan, United States) countries were compared on sociodemographic characteristics and measures of quality of life (SF-12v2 and SF-36v2), work productivity and activity impairment, and health care resource use. Respondents included 128,821 without pain and 29,848 with pain in developed countries, and 37,244 without pain and 4,789 with pain in emerging countries. Pain reporting and treatment rates were lower in China (6.2% and 28.3%, respectively) and Japan (4.4% and 26.3%, respectively) than in other countries (≥ 14.3% and 35.8%, respectively). Significant impairments in quality of life, productivity, and resource use were associated with pain across all health outcomes in both developed and emerging countries, with some productivity and physical health status impairments greater with pain in developed countries, whereas mental health status impairment and resource use were greater with pain in emerging countries. Pain was associated with burden across all study outcomes in all regions. Yet, differences emerged in the degree of impairment, pain reporting, diagnosis, treatment rates, and characteristics of patients between emerging and developed nations, thus helping guide a broader understanding of this highly prevalent condition globally. Wiley Periodicals, Inc.

Who's afraid of national laws? Pesticide corporations use trade negotiations to avoid bans and undercut public health protections in Central America.

PubMed

Rosenthal, Erika

2005-01-01

The agrochemical industry is using trade agreements to block proposed bans on pesticides identified as the worst occupational health hazards by a multi-country illness surveillance program in Central America. Through privileged access to closed-door negotiations, industry inserted deregulatory mechanisms, including a regional pesticide registry that invalidates national laws, investors' rights protection, and increased intellectual property protections, into the draft Central American Customs Union and the Central American Free Trade Agreement. These agreements undermine health-based national pesticide registration requirements; weaken health ministries' role in pesticide control; block marketing of cheaper, less toxic pesticides; and have a chilling effect on future pesticide regulatory activity. So long as corporations have privileged access to the trade negotiations and civil society is excluded, the resulting agreements will benefit special interests at the expense of public health.

Pathos & Ethos: Emotions and Willingness to Pay for Tobacco Products

PubMed Central

Chakravarti, Amitav; Ortoleva, Pietro; Gaskell, George; Ivchenko, Andriy; Lupiáñez-Villanueva, Francisco; Mureddu, Francesco; Rudisill, Caroline

2015-01-01

In this article we use data from a multi-country Randomized Control Trial study on the effect of anti-tobacco pictorial warnings on an individual’s emotions and behavior. By exploiting the exogenous variations of images as an instrument, we are able to identify the effect of emotional responses. We use a range of outcome variables, from cognitive (risk perception and depth of processing) to behavioural (willingness to buy and willingness to pay). Our findings suggest that the odds of buying a tobacco product can be reduced by 80% if the negative affect elicited by the images increases by one standard deviation. More importantly from a public policy perspective, not all emotions behave alike, as eliciting shame, anger, or distress proves more effective in reducing smoking than fear and disgust. JEL Classification C26, C99, D03, I18 PsycINFO classification 2360; 3920 PMID:26485272

Literacy and life skills education for vulnerable youth: What policy makers can do

NASA Astrophysics Data System (ADS)

Bernhardt, Anna Caroline; Yorozu, Rika; Medel-Añonuevo, Carolyn

2014-04-01

In countries with a high concentration of youth with low literacy levels, the policy and programming task related to education and training is particularly daunting. This note briefly presents policies and practices which have been put in place to provide vulnerable youth with literacy and life skills education. It is based on a multi-country research study undertaken by the UNESCO Institute for Lifelong Learning (UIL) in cooperation with the Department of Foreign Affairs, Trade and Development Canada (DFATD Canada; previously Canadian International Development Agency, CIDA), and on subsequent policy dialogue forums with policy makers, practitioners, researchers and youth representatives held in Africa, the Arab region and Asia. Built on this review of existing policies and their implementation, this note provides lessons for innovative practices and suggests six concrete ways to address the needs of vulnerable youth through literacy and life skills education.

Integrated Multilevel Surveillance of the World's Infecting Microbes and Their Resistance to Antimicrobial Agents

PubMed Central

O'Brien, Thomas F.; Stelling, John

2011-01-01

Summary: Microbial surveillance systems have varied in their source of support; type of laboratory reporting (patient care or reference); inclusiveness of reports filed; extent of microbial typing; whether single hospital, multihospital, or multicountry; proportion of total medical centers participating; and types, levels, integration across levels, and automation of analyses performed. These surveillance systems variably support the diagnosis and treatment of patients, local or regional infection control, local or national policies and guidelines, laboratory capacity building, sentinel surveillance, and patient safety. Overall, however, only a small fraction of available data are under any surveillance, and very few data are fully integrated and analyzed. Advancing informatics and genomics can make microbial surveillance far more efficient and effective at preventing infections and improving their outcomes. The world's microbiology laboratories should upload their reports each day to programs that detect events, trends, and epidemics in communities, hospitals, countries, and the world. PMID:21482726

Associations between Mode of HIV Testing and Consent, Confidentiality, and Referral: A Comparative Analysis in Four African Countries

PubMed Central

Obermeyer, Carla Makhlouf; Neuman, Melissa; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Cherutich, Peter; Namakhoma, Ireen; Hardon, Anita

2012-01-01

Background Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regarding consent, confidentiality, and referral vary depending on whether testing is provided through voluntary counseling and testing (VCT) or provider-initiated testing. Methods and Findings The MATCH (Multi-Country African Testing and Counseling for HIV) study was carried out in Burkina Faso, Kenya, Malawi, and Uganda. Surveys were conducted at selected facilities. We defined eight outcome measures related to pre- and post-test counseling, consent, confidentiality, satisfactory interactions with providers, and (for HIV-positive respondents) referral for care. These were compared across three types of facilities: integrated facilities, where testing is provided along with medical care; stand-alone VCT facilities; and prevention of mother-to-child transmission (PMTCT) facilities, where testing is part of PMTCT services. Tests of bivariate associations and modified Poisson regression were used to assess significance and estimate the unadjusted and adjusted associations between modes of testing and outcome measures. In total, 2,116 respondents tested in 2007 or later reported on their testing experience. High percentages of clients across countries and modes of testing reported receiving recommended services and being satisfied. In the unadjusted analyses, integrated testers were less likely to meet with a counselor before testing (83% compared with 95% of VCT testers; p<0.001), but those who had a pre-test meeting were more likely to have completed consent procedures (89% compared with 83% among VCT testers; p<0.001) and pre-test counseling (78% compared with 73% among VCT testers; p = 0.015). Both integrated and PMTCT testers were more likely to receive complete post-test counseling than were VCT testers (59% among both PMTCT and integrated testers compared with 36% among VCT testers; p<0.001). Adjusted analyses by country show few significant differences by mode of testing: only lower satisfaction among integrated testers in Burkina Faso and Uganda, and lower frequency of referral among PMTCT testers in Malawi. Adjusted analyses of pooled data across countries show a higher likelihood of pre-test meeting for those testing at VCT facilities (adjusted prevalence ratio: 1.22, 95% CI: 1.07–1.38) and higher satisfaction for stand-alone VCT facilities (adjusted prevalence ratio: 1.15; 95% CI: 1.06–1.25), compared to integrated testing, but no other associations were statistically significant. Conclusions Overall, in this study most respondents reported favorable outcomes for consent, confidentiality, and referral. Provider-initiated ways of delivering testing and counseling do not appear to be associated with less favorable outcomes for clients than traditional, client-initiated VCT, suggesting that testing can be scaled up through multiple modes without detriment to clients' rights. Please see later in the article for the Editors' Summary PMID:23109914

Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.

PubMed

Obermeyer, Carla Makhlouf; Neuman, Melissa; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Cherutich, Peter; Namakhoma, Ireen; Hardon, Anita

2012-01-01

Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regarding consent, confidentiality, and referral vary depending on whether testing is provided through voluntary counseling and testing (VCT) or provider-initiated testing. The MATCH (Multi-Country African Testing and Counseling for HIV) study was carried out in Burkina Faso, Kenya, Malawi, and Uganda. Surveys were conducted at selected facilities. We defined eight outcome measures related to pre- and post-test counseling, consent, confidentiality, satisfactory interactions with providers, and (for HIV-positive respondents) referral for care. These were compared across three types of facilities: integrated facilities, where testing is provided along with medical care; stand-alone VCT facilities; and prevention of mother-to-child transmission (PMTCT) facilities, where testing is part of PMTCT services. Tests of bivariate associations and modified Poisson regression were used to assess significance and estimate the unadjusted and adjusted associations between modes of testing and outcome measures. In total, 2,116 respondents tested in 2007 or later reported on their testing experience. High percentages of clients across countries and modes of testing reported receiving recommended services and being satisfied. In the unadjusted analyses, integrated testers were less likely to meet with a counselor before testing (83% compared with 95% of VCT testers; p<0.001), but those who had a pre-test meeting were more likely to have completed consent procedures (89% compared with 83% among VCT testers; p<0.001) and pre-test counseling (78% compared with 73% among VCT testers; p = 0.015). Both integrated and PMTCT testers were more likely to receive complete post-test counseling than were VCT testers (59% among both PMTCT and integrated testers compared with 36% among VCT testers; p<0.001). Adjusted analyses by country show few significant differences by mode of testing: only lower satisfaction among integrated testers in Burkina Faso and Uganda, and lower frequency of referral among PMTCT testers in Malawi. Adjusted analyses of pooled data across countries show a higher likelihood of pre-test meeting for those testing at VCT facilities (adjusted prevalence ratio: 1.22, 95% CI: 1.07-1.38) and higher satisfaction for stand-alone VCT facilities (adjusted prevalence ratio: 1.15; 95% CI: 1.06-1.25), compared to integrated testing, but no other associations were statistically significant. Overall, in this study most respondents reported favorable outcomes for consent, confidentiality, and referral. Provider-initiated ways of delivering testing and counseling do not appear to be associated with less favorable outcomes for clients than traditional, client-initiated VCT, suggesting that testing can be scaled up through multiple modes without detriment to clients' rights. Please see later in the article for the Editors' Summary.

Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect.

PubMed

Matendo, Richard; Engmann, Cyril; Ditekemena, John; Gado, Justin; Tshefu, Antoinette; Kinoshita, Rinko; McClure, Elizabeth M; Moore, Janet; Wallace, Dennis; Carlo, Waldemar A; Wright, Linda L; Bose, Carl

2011-08-04

In many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant. In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity. Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training. The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC) using two established programs. This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC) program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP). The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training. More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96), which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality. NRP training had no demonstrable effect on early neonatal mortality. Training DRC birth attendants using the ENC program reduces perinatal mortality. However, a period of utilization and re-enforcement of training may be necessary before a decline in mortality occurs. ENC training has the potential to be a low cost, high impact intervention in developing countries. This trial has been registered at http://www.clinicaltrials.gov (identifier NCT00136708).

Social determinants of sex differences in disability among older adults: a multi-country decomposition analysis using the World Health Survey

PubMed Central

2012-01-01

Introduction Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women. Methods World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into “disabled” vs. “not disabled”. We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the “explained” part that arises because of differences between males and females in terms of age and social and economic characteristics, and an “unexplained” part attributed to the differential effects of these characteristics. Results Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants. Conclusions There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women. PMID:22958712

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: first results of ETAC. Early Treatment of the Atopic Child.

PubMed

1998-08-01

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (> or = 30 kU/l) or specific IgE (> or = 0.35 kUA/l) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.

Health care seeking behaviours in pregnancy in rural Sindh, Pakistan: a qualitative study.

PubMed

Qureshi, Rahat Najam; Sheikh, Sana; Khowaja, Asif Raza; Hoodbhoy, Zahra; Zaidi, Shujaat; Sawchuck, Diane; Vidler, Marianne; Bhutta, Zulfiqar A; von Dadeslzen, Peter

2016-06-08

Pakistan has alarmingly high numbers of maternal mortality along with suboptimal care-seeking behaviour. It is essential to identify the barriers and facilitators that women and families encounter, when deciding to seek maternal care services. This study aimed to understand health-seeking patterns of pregnant women in rural Sindh, Pakistan. A qualitative study was undertaken in rural Sindh, Pakistan as part of a large multi-country study in 2012. Thirty three focus group discussions and 26 in-depth interviews were conducted with mothers [n = 173], male decision-makers [n = 64], Lady Health Workers [n = 64], Lady Health Supervisors [n = 10], Women Medical Officers [n = 9] and Traditional Birth Attendants [n = 7] in the study communities. A set of a priori themes regarding care-seeking during pregnancy and its complications as well as additional themes as they emerged from the data were used for analysis. Qualitative analysis was done using NVivo version 10. Women stated they usually visited health facilities if they experienced pregnancy complications or danger signs, such as heavy bleeding or headache. Findings revealed the importance of husbands and mothers-in-law as decision makers regarding health care utilization. Participants expressed that poor availability of transport, financial constraints and the unavailability of chaperones were important barriers to seeking care. In addition, private facilities were often preferred due to the perceived superior quality of services. Maternal care utilization was influenced by social, economic and cultural factors in rural Pakistani communities. The perceived poor quality care at public hospitals was a significant barrier for many women in accessing health services. If maternal lives are to be saved, policy makers need to develop processes to overcome these barriers and ensure easily accessible high-quality care for women in rural communities. NCT01911494.

Multi-country analysis of the effects of diarrhoea on childhood stunting

PubMed Central

Checkley, William; Buckley, Gillian; Gilman, Robert H; Assis, Ana MO; Guerrant, Richard L; Morris, Saul S; Mølbak, Kåre; Valentiner-Branth, Palle; Lanata, Claudio F; Black, Robert E

2008-01-01

Diarrhoea is an important cause of death and illness among children in developing countries; however, it remains controversial as to whether diarrhoea leads to stunting. We conducted a pooled analysis of nine studies that collected daily diarrhoea morbidity and longitudinal anthropometry to determine the effects of the longitudinal history of diarrhoea prior to 24 months on stunting at age 24 months. Data covered a 20-year period and five countries. We used logistic regression to model the effect of diarrhoea on stunting. The prevalence of stunting at age 24 months varied by study (range 21–90%), as did the longitudinal history of diarrhoea prior to 24 months (incidence range 3.6–13.4 episodes per child-year, prevalence range 2.4–16.3%). The effect of diarrhoea on stunting, however, was similar across studies. The odds of stunting at age 24 months increased multiplicatively with each diarrhoeal episode and with each day of diarrhoea before 24 months (all P < 0.001). The adjusted odds of stunting increased by 1.13 for every five episodes (95% CI 1.07–1.19), and by 1.16 for every 5% unit increase in longitudinal prevalence (95% CI 1.07–1.25). In this assembled sample of 24-month-old children, the proportion of stunting attributed to ≥5 diarrhoeal episodes before 24 months was 25% (95% CI 8–38%) and that attributed to being ill with diarrhoea for ≥2% of the time before 24 months was 18% (95% CI 1–31%). These observations are consistent with the hypothesis that a higher cumulative burden of diarrhoea increases the risk of stunting. PMID:18567626

Multi-country analysis of treatment costs for HIV/AIDS (MATCH): facility-level ART unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia.

PubMed

Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

2014-01-01

Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. In 2010-2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2-8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77-95% alive and on treatment). This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation.

Economic policy and the double burden of malnutrition: cross-national longitudinal analysis of minimum wage and women's underweight and obesity.

PubMed

Conklin, Annalijn I; Ponce, Ninez A; Crespi, Catherine M; Frank, John; Nandi, Arijit; Heymann, Jody

2018-04-01

To examine changes in minimum wage associated with changes in women's weight status. Longitudinal study of legislated minimum wage levels (per month, purchasing power parity-adjusted, 2011 constant US dollar values) linked to anthropometric and sociodemographic data from multiple Demographic and Health Surveys (2000-2014). Separate multilevel models estimated associations of a $10 increase in monthly minimum wage with the rate of change in underweight and obesity, conditioning on individual and country confounders. Post-estimation analysis computed predicted mean probabilities of being underweight or obese associated with higher levels of minimum wage at study start and end. Twenty-four low-income countries. Adult non-pregnant women (n 150 796). Higher minimum wages were associated (OR; 95 % CI) with reduced underweight in women (0·986; 0·977, 0·995); a decrease that accelerated over time (P-interaction=0·025). Increasing minimum wage was associated with higher obesity (1·019; 1·008, 1·030), but did not alter the rate of increase in obesity prevalence (P-interaction=0·8). A $10 rise in monthly minimum wage was associated (prevalence difference; 95 % CI) with an average decrease of about 0·14 percentage points (-0·14; -0·23, -0·05) for underweight and an increase of about 0·1 percentage points (0·12; 0·04, 0·20) for obesity. The present longitudinal multi-country study showed that a $10 rise in monthly minimum wage significantly accelerated the decline in women's underweight prevalence, but had no association with the pace of growth in obesity prevalence. Thus, modest rises in minimum wage may be beneficial for addressing the protracted underweight problem in poor countries, especially South Asia and parts of Africa.

Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa

PubMed Central

Blaauw, Duane; Ditlopo, Prudence; Maseko, Fresier; Chirwa, Maureen; Mwisongo, Aziza; Bidwell, Posy; Thomas, Steve; Normand, Charles

2013-01-01

Background Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies. Objective The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Methods We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave. Results There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (χ2=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (χ2=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave. Conclusions We have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less standardised and more targeted HRH strategies than has been practised to date. PMID:23364090

Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities.

PubMed

Cailhol, Johann; Craveiro, Isabel; Madede, Tavares; Makoa, Elsie; Mathole, Thubelihle; Parsons, Ann Neo; Van Leemput, Luc; Biesma, Regien; Brugha, Ruairi; Chilundo, Baltazar; Lehmann, Uta; Dussault, Gilles; Van Damme, Wim; Sanders, David

2013-10-25

Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries' responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.

Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities

PubMed Central

2013-01-01

Background Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. Methods A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. Results In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Conclusion Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries. PMID:24160182

Inequity in costs of seeking sexual and reproductive health services in India and Kenya.

PubMed

Haghparast-Bidgoli, Hassan; Pulkki-Brännström, Anni-Maria; Lafort, Yves; Beksinska, Mags; Rambally, Letitia; Roy, Anuradha; Reza-Paul, Sushena; Ombidi, Wilkister; Gichangi, Peter; Skordis-Worrall, Jolene

2015-09-15

This study aims to assess inequity in expenditure on sexual and reproductive health (SRH) services in India and Kenya. In addition, this analysis aims to measure the extent to which payments are catastrophic and to explore coping mechanisms used to finance health spending. Data for this study were collected as a part of the situational analysis for the "Diagonal Interventions to Fast Forward Enhanced Reproductive Health" (DIFFER) project, a multi-country project with fieldwork sites in three African sites; Mombasa (Kenya), Durban (South Africa) and Tete (Mozambique), and Mysore in India. Information on access to SRH services, the direct costs of seeking care and a range of socio-economic variables were obtained through structured exit interviews with female SRH service users in Mysore (India) and Mombasa (Kenya) (n = 250). The costs of seeking care were analysed by household income quintile (as a measure of socio-economic status). The Kakwani index and quintile ratios are used as measures of inequitable spending. Catastrophic spending on SRH services was calculated using the threshold of 10% of total household income. The results showed that spending on SRH services was highly regressive in both sites, with lower income households spending a higher percentage of their income on seeking care, compared to households with a higher income. Spending on SRH as a percentage of household income ranged from 0.02 to 6.2% and 0.03-7.5% in India and Kenya, respectively. There was a statistically significant difference in the proportion of spending on SRH services across income quintiles in both settings. In India, the poorest households spent two times, and in Kenya ten times, more on seeking care than the least poor households. The most common coping mechanisms in India and Kenya were "receiving [money] from partner or household members" (69%) and "using own savings or regular income" (44%), respectively. Highly regressive spending on SRH services highlights the heavier burden borne by the poorest when seeking care in resource-constrained settings such as India and Kenya. The large proportion of service users, particularly in India, relying on money received from family members to finance care seeking suggests that access would be more difficult for those with weak social ties, small social networks or weak bargaining positions within the family - although this requires further study.

More than just talk: the framing of transactional sex and its implications for vulnerability to HIV in Lesotho, Madagascar and South Africa

PubMed Central

2011-01-01

Background 'Transactional sex' was regarded by the mid-1990s as an important determinant of HIV transmission, particularly in sub-Saharan Africa. Little attention has been paid to what the terms used to denote transactional sex suggest about how it is understood. This study provides a nuanced set of descriptions of the meaning of transactional sex in three settings. Furthermore, we discuss how discourses around transactional sex suggest linkages to processes of globalization and hold implications for vulnerability to HIV. Methods The analysis in this article is based on three case studies conducted as part of a multi-country research project that investigated linkages between economic globalization and HIV. In this analysis, we contextualize and contrast the 'talk' about transactional sex through the following research methods in three study sites: descriptions revealed through semi-structured interviews with garment workers in Lesotho; focus groups with young women and men in Antananarivo, Madagascar; and focus groups and in-depth interviews with young women and men in Mbekweni, South Africa. Results Participants' talk about transactional sex reveals two themes: (1) 'The politics of differentiation' reflects how participants used language to demarcate identities, and distance themselves from contextually-based marginalized identities; and (2) 'Gender, agency and power' describes how participants frame gendered-power within the context of transactional sex practices, and reflects on the limitations to women's power as sexual agents in these exchanges. Talk about transactional sex in our study settings supports the assertion that emerging transactional sexual practices are linked with processes of globalization tied to consumerism. Conclusions By focusing on 'talk' about transactional sex, we locate definitions of transactional sex, and how terms used to describe transactional sex are morally framed for people within their local context. We take advantage of an opportunity to comparatively explore such talk across three different study sites, and contribute to a better understanding of both emerging sexual practices and their implications for HIV vulnerability. Our work underlines that transactional sex needs to be reflected as it is perceived: something very different from, but of at least equal concern to, formal sex work in the efforts to curb HIV transmission. PMID:21961516

Water-energy nexus in the Sava River Basin: energy security in a transboundary perspective

NASA Astrophysics Data System (ADS)

Ramos, Eunice; Howells, Mark

2016-04-01

Resource management policies are frequently designed and planned to target specific needs of particular sectors, without taking into account the interests of other sectors who share the same resources. In a climate of resource depletion, population growth, increase in energy demand and climate change awareness, it is of great importance to promote the assessment of intersectoral linkages and, by doing so, understand their effects and implications. This need is further augmented when common use of resources might not be solely relevant at national level, but also when the distribution of resources spans over different nations. This paper focuses on the study of the energy systems of five south eastern European countries, which share the Sava River Basin (SRB), using a water-food(agriculture)-energy nexus approach. In the case of the electricity generation sector, the use of water is essential for the integrity of the energy systems, as the electricity production in the riparian countries relies on two major technology types dependent on water resources: hydro and thermal power plants. For example, in 2012, an average of 37% of the electricity production in the SRB countries was generated by hydropower and 61% in thermal power plants. Focusing on the SRB, in terms of existing installed capacities, the basin accommodates close to a tenth of all hydropower capacity while providing water for cooling to 42% of the net capacity of thermal power currently in operation in the basin. This energy-oriented nexus study explores the dependency on the basin's water resources of the energy systems in the region for the period between 2015 and 2030. To do so, a multi-country electricity model was developed to provide a quantification ground to the analysis, using the open-source software modelling tool OSeMOSYS. Three main areas are subject to analysis: first, the impact of energy efficiency and renewable energy strategies in the electricity generation mix; secondly, the potential impacts of climate change under a moderate climate change projection scenario; and finally, deriving from the latter point, the cumulative impact of an increase in water demand in the agriculture sector, for irrigation. Additionally, electricity trade dynamics are compared across the different scenarios under scrutiny, as an effort to investigate the response of the regional energy systems in simulated trade conditions.

Transcultural adaptation and validation of Hindi version of Quebec Back Pain Disability Scale.

PubMed

Zaidi, Sahar; Verma, Shalini; Moiz, Jamal Ali; Hussain, Mohammed E

2017-08-07

To transculturally adapt the Quebec Back Pain Disability Scale for Hindi-speaking population and examine its psychometric properties in patients with low back pain. The Quebec Back Pain Disability Scale was translated and cross-culturally adapted into Hindi following international guidelines. Hindi version of the scale was completed by 120 patients with low back pain and 60 healthy controls. Patients with low back pain were also administered the Hindi-Roland Morris Disability Questionnaire and Visual Analog Scale. Psychometric evaluation included test-retest reliability, convergent and discriminative validity. Exploratory factor analysis was carried out to determine the factor structure. The factorial analysis revealed a four-factor solution (bending/carrying, ambulation/reach, prolonged postures and rest). Convergent validity was confirmed by high correlation of Hindi Quebec Back Pain Disability Scale to the Hindi version of Roland Morris Disability Questionnaire (r = 0.77 and p < 0.001) as well as Visual Analog Scale (r = 0.682 and p < 0.001) scores. Discriminative validity was established by significantly different scores for patients with low back pain and the healthy controls (35.36 ± 18.6 vs. 9.13 ± 6.08 and p < 0.001). The translated version of the scale showed remarkable internal consistency (Cronbach α = 0.98) and the intraclass correlation coefficient of test-retest reliability was excellent (ICC 2,1 =0.96). MDC 95 and SEM scores obtained were 10.28 and 3.71, respectively. The Hindi version of Quebec Back Pain Disability Scale has good test-retest reliability, discriminative and convergent validity and is appropriate for clinical and research use in Hindi-speaking low back pain patients. Implications for rehabilitation Linguistically and culturally adapted questionnaires help researchers make adequate inferences about instruments measuring health and quality of life. The translated version would serve as a valid research tool allowing comparability of data across cultures thus, providing opportunities for large multicenter, multicountry trials. A Hindi Quebec Back Pain Disability Scale version will help to improve the quality and efficacy of assessment of low back pain by developing in patients, a better understanding of the items which can be easily correlated with the activities of daily living.

The ACTwatch project: methods to describe anti-malarial markets in seven countries.

PubMed

Shewchuk, Tanya; O'Connell, Kathryn A; Goodman, Catherine; Hanson, Kara; Chapman, Steven; Chavasse, Desmond

2011-10-31

Policy makers, governments and donors are faced with an information gap when considering ways to improve access to artemisinin-based combination therapy (ACT) and malaria diagnostics including rapid diagnostic tests (RDTs). To help address some of these gaps, a five-year multi-country research project called ACTwatch was launched. The project is designed to provide a comprehensive picture of the anti-malarial market to inform national and international anti-malarial drug policy decision-making. The project is being conducted in seven malaria-endemic countries: Benin, Cambodia, the Democratic Republic of Congo, Madagascar, Nigeria, Uganda and Zambia from 2008 to 2012.ACTwatch measures which anti-malarials are available, where they are available and at what price and who they are used by. These indicators are measured over time and across countries through three study components: outlet surveys, supply chain studies and household surveys. Nationally representative outlet surveys examine the market share of different anti-malarials passing through public facilities and private retail outlets. Supply chain research provides a picture of the supply chain serving drug outlets, and measures mark-ups at each supply chain level. On the demand side, nationally representative household surveys capture treatment seeking patterns and use of anti-malarial drugs, as well as respondent knowledge of anti-malarials. The research project provides findings on both the demand and supply side determinants of anti-malarial access. There are four key features of ACTwatch. First is the overlap of the three study components where nationally representative data are collected over similar periods, using a common sampling approach. A second feature is the number and diversity of countries that are studied which allows for cross-country comparisons. Another distinguishing feature is its ability to measure trends over time. Finally, the project aims to disseminate findings widely for decision-making. ACTwatch is a unique multi-country research project that threads together anti-malarial supply and consumer behaviour to provide an evidence base to policy makers that can help determine where interventions may positively impact access to and use of quality-assured ACT and RDTs. Because of its ability to detect change over time, it is well suited to monitor the effects of policy or intervention developments in a country.

The ACTwatch project: methods to describe anti-malarial markets in seven countries

PubMed Central

2011-01-01

Background Policy makers, governments and donors are faced with an information gap when considering ways to improve access to artemisinin-based combination therapy (ACT) and malaria diagnostics including rapid diagnostic tests (RDTs). To help address some of these gaps, a five-year multi-country research project called ACTwatch was launched. The project is designed to provide a comprehensive picture of the anti-malarial market to inform national and international anti-malarial drug policy decision-making. Methods The project is being conducted in seven malaria-endemic countries: Benin, Cambodia, the Democratic Republic of Congo, Madagascar, Nigeria, Uganda and Zambia from 2008 to 2012. ACTwatch measures which anti-malarials are available, where they are available and at what price and who they are used by. These indicators are measured over time and across countries through three study components: outlet surveys, supply chain studies and household surveys. Nationally representative outlet surveys examine the market share of different anti-malarials passing through public facilities and private retail outlets. Supply chain research provides a picture of the supply chain serving drug outlets, and measures mark-ups at each supply chain level. On the demand side, nationally representative household surveys capture treatment seeking patterns and use of anti-malarial drugs, as well as respondent knowledge of anti-malarials. Discussion The research project provides findings on both the demand and supply side determinants of anti-malarial access. There are four key features of ACTwatch. First is the overlap of the three study components where nationally representative data are collected over similar periods, using a common sampling approach. A second feature is the number and diversity of countries that are studied which allows for cross-country comparisons. Another distinguishing feature is its ability to measure trends over time. Finally, the project aims to disseminate findings widely for decision-making. Conclusions ACTwatch is a unique multi-country research project that threads together anti-malarial supply and consumer behaviour to provide an evidence base to policy makers that can help determine where interventions may positively impact access to and use of quality-assured ACT and RDTs. Because of its ability to detect change over time, it is well suited to monitor the effects of policy or intervention developments in a country. PMID:22039780

Calf-Level Factors Associated with Bovine Neonatal Pancytopenia – A Multi-Country Case-Control Study

PubMed Central

Jones, Bryony A.; Sauter-Louis, Carola; Henning, Joerg; Stoll, Alexander; Nielen, Mirjam; Van Schaik, Gerdien; Smolenaars, Anja; Schouten, Matthijs; den Uijl, Ingrid; Fourichon, Christine; Guatteo, Raphael; Madouasse, Aurélien; Nusinovici, Simon; Deprez, Piet; De Vliegher, Sarne; Laureyns, Jozef; Booth, Richard; Cardwell, Jackie M.; Pfeiffer, Dirk U.

2013-01-01

Bovine neonatal pancytopenia (BNP), a high fatality condition causing haemorrhages in calves aged less than 4 weeks, was first reported in 2007 in Germany and subsequently observed at low incidence in other European countries and New Zealand. A multi-country matched case-control study was conducted in 2011 to identify calf-level risk factors for BNP. 405 BNP cases were recruited from 330 farms in Belgium, France, Germany and the Netherlands by laboratory confirmation of farmer-reported cases. Up to four calves of similar age from the same farm were selected as controls (1154 calves). Risk factor data were collected by questionnaire. Multivariable modelling using conditional logistic regression indicated that PregSure®BVD (PregSure, Pfizer Animal Health) vaccination of the dam was strongly associated with BNP cases (adjusted matched Odds Ratio - amOR 17.8 first lactation dams; 95% confidence interval – ci 2.4, 134.4; p = 0.005), and second or more lactation PregSure-vaccinated dams were more likely to have a case than first lactation vaccinated dams (amOR 2.2 second lactation; ci 1.1, 4.3; p = 0.024; amOR 5.3 third or more lactation; ci 2.9, 9.8; p = <0.001). Feeding colostrum from other cows was strongly associated with BNP if the dam was not PregSure-vaccinated (amOR 30.5; ci 2.1, 440.5; p = 0.012), but the effect was less if the dam was PregSure-vaccinated (amOR 2.1; ci 1.1, 4.0; p = 0.024). Feeding exclusively dam’s milk was a higher risk than other types of milk (amOR 3.4; ci 1.6, 7.5; p = 0.002). The population attributable fractions were 0.84 (ci 0.68, 0.92) for PregSure vaccination, 0.13 (ci 0.06, 0.19) for feeding other cows’ colostrum, and 0.15 (ci 0.08, 0.22) for feeding dam’s milk. No other calf-level factors were identified, suggesting that there are other important factors that are outside the scope of this study, such as genetics, which explain why BNP develops in some PregSure-colostrum-exposed calves but not in others. PMID:24312485

Using Multicountry Ecological and Observational Studies to Determine Dietary Risk Factors for Alzheimer's Disease.

PubMed

Grant, William B

2016-07-01

Rates of Alzheimer's disease (AD) are rising worldwide. The most important risk factors seem to be linked to diet. For example, when Japan made the nutrition transition from the traditional Japanese diet to the Western diet, AD rates rose from 1% in 1985 to 7% in 2008. Foods protective against AD include fruits, vegetables, grains, low-fat dairy products, legumes, and fish, whereas risk factors include meat, sweets, and high-fat dairy products. The evidence comes from ecological and observational studies as well as investigations of the mechanisms whereby dietary factors affect risk. The mechanisms linking dietary risk factors to AD are fairly well known and include increased oxidative stress from metal ions such as copper as well as from advanced glycation end products associated with high-temperature cooking, increased homocysteine concentrations, and cholesterol and its effects on amyloid beta, insulin resistance, and obesity. Lower 25-hydroxyvitamin D concentrations also are associated with increased risk of AD. In addition to reviewing the journal literature, a new ecological study was conducted using AD prevalence from 10 countries (Brazil, Chile, Cuba, Egypt, India, Mongolia, Nigeria, Republic of Korea, Sri Lanka, and the United States) along with dietary supply data 5, 10, and 15 years before the prevalence data. Dietary supply of meat or animal products less milk 5 years before AD prevalence had the highest correlations with AD prevalence in this study. Thus, reducing meat consumption could significantly reduce the risk of AD as well as of several cancers, diabetes mellitus type 2, stroke, and, likely, chronic kidney disease. • Single-country ecological data can be used to find links between diet and AD because the national diet changes, such as during the nutrition transition to a Western diet. • Multicountry ecological studies can be used to find links between dietary factors and risk of AD. • Prospective observational studies are useful in linking dietary components and patterns to risk of AD. • The most important dietary link to AD appears to be meat consumption, with eggs and high-fat dairy also contributing. • Diets high in grains, fruits, vegetables, and fish are associated with reduced risk of AD, but these factors cannot counter the effects of meat, eggs, and high-fat dairy. • Higher vitamin D status is associated with reduced risk of AD.

Pain and alcohol consumption among older adults: findings from the World Health Organization Study on global AGEing and adult health, Wave 1.

PubMed

Ahangari, Alebtekin; Stewart Williams, Jennifer; Myléus, Anna

2016-10-01

To investigate cross-sectional associations between self-reported recent pain and alcohol use/abstinence, and previous-day pain and previous-week alcohol consumption in adults aged 50 + in six low- and middle-income countries (LMICs). The WHO Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010) in China, Ghana, India, Mexico, Russia and South Africa is the data source. Prevalence of alcohol use/abstinence is reported by previous-day and previous-month pain. Multinomial logistic regressions (crude and adjusted for sex and country) tested associations between recent pain and alcohol use in the pooled multicountry sample. Across the six SAGE countries, about one-third of respondents reported alcohol use, being highest in Russia (74%) and lowest in India (16%). Holding the effects of sex and country constant, compared with abstainers, people with previous-day pain were more likely to be previous-day or other users. With regard to the quantity and frequency of alcohol use, people with previous-day pain were more likely to be non-heavy drinkers. Overall, we found that, in this population of older adults in six LMICs, recent pain was associated with moderate use of alcohol, although there were differences between countries. The findings provide a platform for country-specific research to better understand bi-directional associations between pain and alcohol in older adults. © 2016 John Wiley & Sons Ltd.

Characterizing performance improvement in primary care systems in Mesoamerica: A realist evaluation protocol.

PubMed

Munar, Wolfgang; Wahid, Syed S; Curry, Leslie

2018-01-03

Background . Improving performance of primary care systems in low- and middle-income countries (LMICs) may be a necessary condition for achievement of universal health coverage in the age of Sustainable Development Goals. The Salud Mesoamerica Initiative (SMI), a large-scale, multi-country program that uses supply-side financial incentives directed at the central-level of governments, and continuous, external evaluation of public, health sector performance to induce improvements in primary care performance in eight LMICs. This study protocol seeks to explain whether and how these interventions generate program effects in El Salvador and Honduras. Methods . This study presents the protocol for a study that uses a realist evaluation approach to develop a preliminary program theory that hypothesizes the interactions between context, interventions and the mechanisms that trigger outcomes. The program theory was completed through a scoping review of relevant empirical, peer-reviewed and grey literature; a sense-making workshop with program stakeholders; and content analysis of key SMI documents. The study will use a multiple case-study design with embedded units with contrasting cases. We define as a case the two primary care systems of Honduras and El Salvador, each with different context characteristics. Data will be collected through in-depth interviews with program actors and stakeholders, documentary review, and non-participatory observation. Data analysis will use inductive and deductive approaches to identify causal patterns organized as 'context, mechanism, outcome' configurations. The findings will be triangulated with existing secondary, qualitative and quantitative data sources, and contrasted against relevant theoretical literature. The study will end with a refined program theory. Findings will be published following the guidelines generated by the Realist and Meta-narrative Evidence Syntheses study (RAMESES II). This study will be performed contemporaneously with SMI's mid-term stage of implementation. Of the methods described, the preliminary program theory has been completed. Data collection, analysis and synthesis remain to be completed.

Underutilisation of routinely collected data in the HIV programme in Zambia: a review of quantitatively analysed peer-reviewed articles.

PubMed

Munthali, Tendai; Musonda, Patrick; Mee, Paul; Gumede, Sehlulekile; Schaap, Ab; Mwinga, Alwyn; Phiri, Caroline; Kapata, Nathan; Michelo, Charles; Todd, Jim

2017-06-13

The extent to which routinely collected HIV data from Zambia has been used in peer-reviewed published articles remains unexplored. This paper is an analysis of peer-reviewed articles that utilised routinely collected HIV data from Zambia within six programme areas from 2004 to 2014. Articles on HIV, published in English, listed in the Directory of open access journals, African Journals Online, Google scholar, and PubMed were reviewed. Only articles from peer-reviewed journals, that utilised routinely collected data and included quantitative data analysis methods were included. Multi-country studies involving Zambia and another country, where the specific results for Zambia were not reported, as well as clinical trials and intervention studies that did not take place under routine care conditions were excluded, although community trials which referred patients to the routine clinics were included. Independent extraction was conducted using a predesigned data collection form. Pooled analysis was not possible due to diversity in topics reviewed. A total of 69 articles were extracted for review. Of these, 7 were excluded. From the 62 articles reviewed, 39 focused on HIV treatment and retention in care, 15 addressed prevention of mother-to-child transmission, 4 assessed social behavioural change, and 4 reported on voluntary counselling and testing. In our search, no articles were found on condom programming or voluntary male medical circumcision. The most common outcome measures reported were CD4+ count, clinical failure or mortality. The population analysed was children in 13 articles, women in 16 articles, and both adult men and women in 33 articles. During the 10 year period of review, only 62 articles were published analysing routinely collected HIV data in Zambia. Serious consideration needs to be made to maximise the utility of routinely collected data, and to benefit from the funds and efforts to collect these data. This could be achieved with government support of operational research and publication of findings based on routinely collected Zambian HIV data.

Characterizing performance improvement in primary care systems in Mesoamerica: A realist evaluation protocol

PubMed Central

Munar, Wolfgang; Wahid, Syed S.; Curry, Leslie

2018-01-01

Background. Improving performance of primary care systems in low- and middle-income countries (LMICs) may be a necessary condition for achievement of universal health coverage in the age of Sustainable Development Goals. The Salud Mesoamerica Initiative (SMI), a large-scale, multi-country program that uses supply-side financial incentives directed at the central-level of governments, and continuous, external evaluation of public, health sector performance to induce improvements in primary care performance in eight LMICs. This study protocol seeks to explain whether and how these interventions generate program effects in El Salvador and Honduras. Methods. This study presents the protocol for a study that uses a realist evaluation approach to develop a preliminary program theory that hypothesizes the interactions between context, interventions and the mechanisms that trigger outcomes. The program theory was completed through a scoping review of relevant empirical, peer-reviewed and grey literature; a sense-making workshop with program stakeholders; and content analysis of key SMI documents. The study will use a multiple case-study design with embedded units with contrasting cases. We define as a case the two primary care systems of Honduras and El Salvador, each with different context characteristics. Data will be collected through in-depth interviews with program actors and stakeholders, documentary review, and non-participatory observation. Data analysis will use inductive and deductive approaches to identify causal patterns organized as ‘context, mechanism, outcome’ configurations. The findings will be triangulated with existing secondary, qualitative and quantitative data sources, and contrasted against relevant theoretical literature. The study will end with a refined program theory. Findings will be published following the guidelines generated by the Realist and Meta-narrative Evidence Syntheses study (RAMESES II). This study will be performed contemporaneously with SMI’s mid-term stage of implementation. Of the methods described, the preliminary program theory has been completed. Data collection, analysis and synthesis remain to be completed. PMID:29431181

Key Role of Sequencing to Trace Hepatitis A Viruses Circulating in Italy During a Large Multi-Country European Foodborne Outbreak in 2013

PubMed Central

Bruni, Roberto; Taffon, Stefania; Equestre, Michele; Chionne, Paola; Madonna, Elisabetta; Rizzo, Caterina; Tosti, Maria Elena; Alfonsi, Valeria; Ricotta, Lara; De Medici, Dario; Di Pasquale, Simona; Scavia, Gaia; Pavoni, Enrico; Losio, Marina Nadia; Romanò, Luisa; Zanetti, Alessandro Remo; Morea, Anna; Pacenti, Monia; Palù, Giorgio; Capobianchi, Maria Rosaria; Chironna, Maria; Pompa, Maria Grazia; Ciccaglione, Anna Rita

2016-01-01

Background Foodborne Hepatitis A Virus (HAV) outbreaks are being recognized as an emerging public health problem in industrialized countries. In 2013 three foodborne HAV outbreaks occurred in Europe and one in USA. During the largest of the three European outbreaks, most cases occurred in Italy (>1,200 cases as of March 31, 2014). A national Task Force was established at the beginning of the outbreak by the Ministry of Health. Mixed frozen berries were early demonstrated to be the source of infection by the identity of viral sequences in patients and in food. In the present study the molecular characterization of HAV isolates from 355 Italian cases is reported. Methods Molecular characterization was carried out by PCR/sequencing (VP1/2A region), comparison with reference strains and phylogenetic analysis. Results A unique strain was responsible for most characterized cases (235/355, 66.1%). Molecular data had a key role in tracing this outbreak, allowing 110 out of the 235 outbreak cases (46.8%) to be recognized in absence of any other link. The data also showed background circulation of further unrelated strains, both autochthonous and travel related, whose sequence comparison highlighted minor outbreaks and small clusters, most of them unrecognized on the basis of epidemiological data. Phylogenetic analysis showed most isolates from travel related cases clustering with reference strains originating from the same geographical area of travel. Conclusions In conclusion, the study documents, in a real outbreak context, the crucial role of molecular analysis in investigating an old but re-emerging pathogen. Improving the molecular knowledge of HAV strains, both autochthonous and circulating in countries from which potentially contaminated foods are imported, will become increasingly important to control outbreaks by supporting trace back activities, aiming to identify the geographical source(s) of contaminated food, as well as public health interventions. PMID:26901877

Key Role of Sequencing to Trace Hepatitis A Viruses Circulating in Italy During a Large Multi-Country European Foodborne Outbreak in 2013.

PubMed

Bruni, Roberto; Taffon, Stefania; Equestre, Michele; Chionne, Paola; Madonna, Elisabetta; Rizzo, Caterina; Tosti, Maria Elena; Alfonsi, Valeria; Ricotta, Lara; De Medici, Dario; Di Pasquale, Simona; Scavia, Gaia; Pavoni, Enrico; Losio, Marina Nadia; Romanò, Luisa; Zanetti, Alessandro Remo; Morea, Anna; Pacenti, Monia; Palù, Giorgio; Capobianchi, Maria Rosaria; Chironna, Maria; Pompa, Maria Grazia; Ciccaglione, Anna Rita

2016-01-01

Foodborne Hepatitis A Virus (HAV) outbreaks are being recognized as an emerging public health problem in industrialized countries. In 2013 three foodborne HAV outbreaks occurred in Europe and one in USA. During the largest of the three European outbreaks, most cases occurred in Italy (>1,200 cases as of March 31, 2014). A national Task Force was established at the beginning of the outbreak by the Ministry of Health. Mixed frozen berries were early demonstrated to be the source of infection by the identity of viral sequences in patients and in food. In the present study the molecular characterization of HAV isolates from 355 Italian cases is reported. Molecular characterization was carried out by PCR/sequencing (VP1/2A region), comparison with reference strains and phylogenetic analysis. A unique strain was responsible for most characterized cases (235/355, 66.1%). Molecular data had a key role in tracing this outbreak, allowing 110 out of the 235 outbreak cases (46.8%) to be recognized in absence of any other link. The data also showed background circulation of further unrelated strains, both autochthonous and travel related, whose sequence comparison highlighted minor outbreaks and small clusters, most of them unrecognized on the basis of epidemiological data. Phylogenetic analysis showed most isolates from travel related cases clustering with reference strains originating from the same geographical area of travel. In conclusion, the study documents, in a real outbreak context, the crucial role of molecular analysis in investigating an old but re-emerging pathogen. Improving the molecular knowledge of HAV strains, both autochthonous and circulating in countries from which potentially contaminated foods are imported, will become increasingly important to control outbreaks by supporting trace back activities, aiming to identify the geographical source(s) of contaminated food, as well as public health interventions.

Is Exposure to Animal Feces Harmful to Child Nutrition and Health Outcomes? A Multicountry Observational Analysis.

PubMed

Headey, Derek; Nguyen, Phuong; Kim, Sunny; Rawat, Rahul; Ruel, Marie; Menon, Purnima

2017-04-01

AbstractIt has recently been hypothesized that exposure to livestock constitutes a significant risk factor for diarrhea and environmental enteric disorder in young children, which may significantly contribute to undernutrition. To date, though, very little research has documented the extent of exposure to animal feces and whether this exposure is associated with child anthropometry in large samples and diverse settings. This study investigates these issues using data from the Alive and Thrive study conducted in rural areas of Ethiopia, Bangladesh, and Vietnam. These surveys used spot-checks to collect data on proxies of hygiene behaviors such as the cleanliness of mothers, young children, and the homestead environment, including the presence of animal feces. Animal feces were visible in 38-42% of household compounds across the three countries and were positively associated with household livestock ownership and negatively associated with maternal and child cleanliness. One-sided tests from multivariate least squares models for children 6-24 months of age indicate that the presence of animal feces is significantly and negatively associated with child height-for-age z scores in Ethiopia (β = -0.22), Bangladesh (β = -0.13), and in a pooled sample (β = -0.11), but not in Vietnam. There is also suggestive evidence that animal feces may be positively associated with diarrhea symptoms in Bangladesh. The results in this article, therefore, contribute to a growing body of evidence suggesting that animal ownership may pose a significant risk to child nutrition and health outcomes in developing countries.

Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis

PubMed Central

Ugaz, Jorge I; Chatterji, Minki; Gribble, James N; Banke, Kathryn

2016-01-01

Abstract As programs continue to expand access to family planning information, services, and products, it is critical that these efforts be undertaken with an equity lens, ensuring that regardless of socioeconomic status, all women and couples can use the method that meets their needs. This study explores the relationship between household wealth and the use of long-acting and permanent methods (LAPMs) versus short-acting methods of contraception among modern method users, using multivariate analyses based on Demographic Health Survey data from 30 developing countries conducted between 2006 and 2013. Overall, and controlling for relevant individual and household characteristics including age, number of living children, education, and urban/rural residence, we found that wealthier women were more likely than poorer women to use LAPMs instead of short-acting methods: 20 of the 30 countries showed a positive and statistically significant association between wealth and LAPM use. For 10 of those countries, however, LAPM use was significantly higher only for the top (1 or 2) wealthiest quintiles. Eight countries showed no broad pattern of association, while in 2 countries—Bangladesh and India—poorer women were more likely to use LAPMs than wealthier women. The positive association between wealth and LAPM use was found most consistently in the Latin American and the Caribbean countries in our sample. These findings can help program implementers respond better to women’s needs for modern contraception, especially in reaching women from lower- and middle-income households. PMID:27016543

Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis.

PubMed

Ugaz, Jorge I; Chatterji, Minki; Gribble, James N; Banke, Kathryn

2016-03-01

As programs continue to expand access to family planning information, services, and products, it is critical that these efforts be undertaken with an equity lens, ensuring that regardless of socioeconomic status, all women and couples can use the method that meets their needs. This study explores the relationship between household wealth and the use of long-acting and permanent methods (LAPMs) versus short-acting methods of contraception among modern method users, using multivariate analyses based on Demographic Health Survey data from 30 developing countries conducted between 2006 and 2013. Overall, and controlling for relevant individual and household characteristics including age, number of living children, education, and urban/rural residence, we found that wealthier women were more likely than poorer women to use LAPMs instead of short-acting methods: 20 of the 30 countries showed a positive and statistically significant association between wealth and LAPM use. For 10 of those countries, however, LAPM use was significantly higher only for the top (1 or 2) wealthiest quintiles. Eight countries showed no broad pattern of association, while in 2 countries-Bangladesh and India-poorer women were more likely to use LAPMs than wealthier women. The positive association between wealth and LAPM use was found most consistently in the Latin American and the Caribbean countries in our sample. These findings can help program implementers respond better to women's needs for modern contraception, especially in reaching women from lower- and middle-income households. © Ugaz et al.

Global Fund financing of public-private mix approaches for delivery of tuberculosis care.

PubMed

Lal, S S; Uplekar, Mukund; Katz, Itamar; Lonnroth, Knut; Komatsu, Ryuichi; Yesudian Dias, Hannah Monica; Atun, Rifat

2011-06-01

To map the extent and scope of public-private mix (PPM) interventions in tuberculosis (TB) control programmes supported by the Global Fund. We reviewed the Global Fund's official documents and data to analyse the distribution, characteristics and budgets of PPM approaches within Global Fund supported TB grants in recipient countries between 2003 and 2008. We supplemented this analysis with data on contribution of PPM to TB case notifications in 14 countries reported to World Health Organization in 2009, for the preparation of the global TB control report. Fifty-eight of 93 countries and multi-country recipients of Global Fund-supported TB grants had PPM activities in 2008. Engagement with 'for-profit' private sector was more prevalent in South Asia while involvement of prison health services has been common in Eastern Europe and central Asia. In the Middle East and North Africa, involving non-governmental organizations seemed to be the focus. Average and median spending on PPM within grants was 10% and 5% respectively, ranging from 0.03% to 69% of the total grant budget. In China, India, Nigeria and the Philippines, PPM contributed to detecting more than 25% TB cases while maintaining high treatment success rates. In spite of evidence of cost-effectiveness, PPM constitutes only a modest part of overall TB control activities. Scaling up PPM across countries could contribute to expanding access to TB care, increasing case detection, improving treatment outcomes and help achieve the global TB control targets. © 2011 Blackwell Publishing Ltd.

Economic Abuse as an Invisible Form of Domestic Violence: A Multicountry Review.

PubMed

Postmus, Judy L; Hoge, Gretchen L; Breckenridge, Jan; Sharp-Jeffs, Nicola; Chung, Donna

2018-01-01

The predominant perception of intimate partner violence (IPV) as constituting physical violence can still dominate, particularly in research and media reports, despite research documenting multiple forms of IPV including sexual violence occurring between intimate partners and various forms of psychological and emotional abuse. One frequently hidden or "invisible" form of abuse perpetrated within intimate partner relationships is economic abuse, also referred to as financial abuse in much of the literature. While the links between gendered economic insecurity and economic abuse are emerging, there remains a lack of consistency about definitions within the United States and globally, as there is no agreed upon index with which to measure economic abuse. As such, the purpose of this article is to review and analyze the global literature focused on either economic or financial abuse to determine how it is defined and what measures are used to capture its prevalence and impact. The 46 peer-reviewed articles that met all inclusion criteria for analysis came from a range of countries across six continents. Our review found that there is growing clarity and consistency of terminologies being used in these articles and found some consistency in the use of validated measures. Since this research is in its "infancy," we need to have stronger collaborative efforts to use similar measures and terminology. Part of that collaborative effort is to consider how language and cultural differences may play a part in our understanding of economic abuse.

A multi-country Salmonella Enteritidis phage type 14b outbreak associated with eggs from a German producer: 'near real-time' application of whole genome sequencing and food chain investigations, United Kingdom, May to September 2014.

PubMed

Inns, T; Lane, C; Peters, T; Dallman, T; Chatt, C; McFarland, N; Crook, P; Bishop, T; Edge, J; Hawker, J; Elson, R; Neal, K; Adak, G K; Cleary, P

2015-04-23

We report an outbreak of Salmonella Enteritidis phage type 14b (PT14b) in the United Kingdom (UK) between May and September 2014 where Public Health England launched an investigation to identify the source of infection and implement control measures. During the same period, outbreaks caused by a Salmonella Enteritidis strain with a specific multilocus variable-number tandem repeat analysis (MLVA) profile occurred in other European Union Member States. Isolates from a number of persons affected by the UK outbreak, who had initially been tested by MLVA also shared this particular profile. Cases were defined as any person infected with S. Enteritidis PT14b, resident in England or Wales and without history of travel outside of this geographical area during the incubation period, reported from 1 June 2014 onwards, with a MLVA profile of 2–11–9-7–4-3–2-8–9 or a single locus variant thereof. In total, 287 cases met the definition. Food traceback investigations in the UK and other affected European countries linked the outbreaks to chicken eggs from a German company. We undertook whole genome sequencing of isolates from UK and European cases, implicated UK premises, and German eggs: isolates were highly similar. Combined with food traceback information, this confirmed that the UK outbreak was also linked to a German producer.

Use of antiretroviral therapy in resource-limited countries in 2006: distribution and uptake of first- and second-line regimens.

PubMed

Renaud-Théry, Françoise; Nguimfack, Boniface Dongmo; Vitoria, Marco; Lee, Evan; Graaff, Peter; Samb, Badara; Perriëns, Joseph

2007-07-01

To address the information gap on current use of antiretroviral drugs (ARTs) in developing countries. The AIDS Medicines and Diagnostics Service of the World Health Organization (WHO) carried out a multi-country survey in early 2006. Questionnaires covered the use of first- and second-line regimens in adults and children, and the rates of switching from first-line to second-line regimen. Weighted percentages of use of ARTs across the cohort of adults and children were calculated and correlated with 2006 WHO guidelines. A second analysis compared demand for ARTs with rates of production of active pharmaceutical ingredients. Twenty-three countries (96%) returned the questionnaires, representing 53% of relevant patients in developing countries as of June 2006, and comprising 92% adults and 8% children receiving ARTs. Response rates were highest for questions regarding first-line use and lowest for those regarding pediatric regimens. The distribution of first-line: second-line use was 96%: 4% among adults and 99%: 1% among children. For adults, 95% of those receiving first-line treatment, but only 25% of those receiving second-line treatment, were on regimens consistent with those preferred by the WHO. Among first-line users, the most common regimen (61%) was stavudine+lamivudine+nevirapine. Among second-line users, abacavir+didanosine+lopinavir/ritonavir was the most common regimen (24%). Among children, compliance with WHO guidelines was high among the respondents, with zidovudine+lamivudine+nevirapine reported as the main option. Estimates of first-year switching rate were highly variable, ranging from 1% to 15%, with only ten responses. Comparison of supply and demand showed that the stated production capacity for active pharmaceutical ingredients is sufficient to meet current demands for ARTs. This survey has provided valuable information on the uptake of ARTs in developing countries and will help forecast future demand. Reporting for second-line and pediatric antiretroviral therapy should improve as national programs gain more experience. The current availability of active pharmaceutical ingredients appears to be sufficient to meet current demand. Further work is needed for an understanding of switching rates.

Delivering a sustainable trauma management training programme tailored for low-resource settings in East, Central and Southern African countries using a cascading course model.

PubMed

Peter, N A; Pandit, H; Le, G; Nduhiu, M; Moro, E; Lavy, C

2016-05-01

Injuries cause five million deaths and 279 Disability Adjusted Life Years (DALYS) each year worldwide. The COSECSA Oxford Orthopaedic Link (COOL) is a multi-country partnership programme that has delivered training in trauma management to nine sub-Saharan countries across a wide-cadre of health-workers using a model of "primary" courses delivered by UK instructors, followed by "cascading" courses led by local faculty. This study examines the impact on knowledge and clinical confidence among health-workers, and compares the performance of "cascading" and "primary" courses delivered in low-resource settings. Data was collated from 1030 candidates (119 Clinical Officers, 540 Doctors, 260 Nurses and 111 Medical Students) trained over 28 courses (9 "primary" and 19 "cascading" courses) in nine sub-Saharan countries between 2012 and 2013. Knowledge and clinical confidence of candidates were assessed using pre- and post-course MCQs and confidence matrix rating of clinical scenarios. Changes were measured in relation to co-variants of gender, job roles and primary versus cascading courses. Multivariate regression modelling and cost analysis was performed to examine the impact of primary versus cascading courses on candidates' performance. There was a significant improvement in knowledge (58% to 77%, p<0.05) and clinical confidence (68% to 90%, p<0.05) post-course. "Non-doctors" demonstrated a greater improvement in knowledge (22%) and confidence (24%) following the course (p<0.05). The degree of improvement of MCQ scores differed significantly, with the cascading courses (21%) outperforming primary courses (15%) (p<0.002). This is further supported by multivariate regression modelling where cascading courses are a strong predictor for improvement in MCQ scores (Coef=4.83, p<0.05). Trauma management training of health-workers plays a pivotal role in tackling the ever-growing trauma burden in Africa. Our study suggests cascading PTC courses may be an effective model in delivering trauma training in low-resource settings, however further studies are required to determine its efficacy in improving clinical competence and retention of knowledge and skills in the long term. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Barriers to the conduct of randomised clinical trials within all disease areas.

PubMed

Djurisic, Snezana; Rath, Ana; Gaber, Sabrina; Garattini, Silvio; Bertele, Vittorio; Ngwabyt, Sandra-Nadia; Hivert, Virginie; Neugebauer, Edmund A M; Laville, Martine; Hiesmayr, Michael; Demotes-Mainard, Jacques; Kubiak, Christine; Jakobsen, Janus C; Gluud, Christian

2017-08-01

Randomised clinical trials are key to advancing medical knowledge and to enhancing patient care, but major barriers to their conduct exist. The present paper presents some of these barriers. We performed systematic literature searches and internal European Clinical Research Infrastructure Network (ECRIN) communications during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. The following barriers to randomised clinical trials were identified: inadequate knowledge of clinical research and trial methodology; lack of funding; excessive monitoring; restrictive privacy law and lack of transparency; complex regulatory requirements; and inadequate infrastructures. There is a need for more pragmatic randomised clinical trials conducted with low risks of systematic and random errors, and multinational cooperation is essential. The present paper presents major barriers to randomised clinical trials. It also underlines the value of using a pan-European-distributed infrastructure to help investigators overcome barriers for multi-country trials in any disease area.

Moving towards universal health coverage: lessons from 11 country studies.

PubMed

Reich, Michael R; Harris, Joseph; Ikegami, Naoki; Maeda, Akiko; Cashin, Cheryl; Araujo, Edson C; Takemi, Keizo; Evans, Timothy G

2016-02-20

In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls--but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context. Copyright © 2016 Elsevier Ltd. All rights reserved.

The international development of forensic science standards - A review.

PubMed

Wilson-Wilde, Linzi

2018-04-16

Standards establish specifications and procedures designed to ensure products, services and systems are safe, reliable and consistently perform as intended. Standards can be used in the accreditation of forensic laboratories or facilities and in the certification of products and services. In recent years there have been various international activities aiming at developing forensic science standards and guidelines. The most significant initiative currently underway within the global forensic community is the development of International Organization for Standardization (ISO) standards. This paper reviews the main bodies working on standards for forensic science, the processes used and the implications for accreditation. This paper specifically discusses the work of ISO Technical Committee TC272, the future TC272 work program for the development of forensic science standards and associated timelines. Also discussed, are the lessons learnt to date in navigating the complex environment of multi-country stakeholder deliberations in standards development. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Progress of ambient air pollution and cardiovascular disease research in Asia.

PubMed

Su, Ta-Chen; Chen, Szu-Ying; Chan, Chang-Chuan

2011-01-01

Asian countries are with deteriorating air quality accompanying the rapid economic and social development of the past decades, and the potential health impacts of air pollution have been noticed by researchers in the region. We reviewed the scientific literature on air pollution and cardiovascular diseases (CVD) published by Asian researchers in English since the 1980s to determine whether the findings in Europe and North America can be extrapolated to Asia. Epidemiological studies show that short-term particulate matter pollution is a strong predictor for CVD morbidity and mortality and suggestive on cerebrovascular morbidity and mortality in newly developed countries in Asia. Multicountry epidemiological studies are needed to fully appreciate the extent of air pollution on CVD in Asia, especially less developed Asian countries. New cohort studies should be initiated to improve our understanding of particulate matter's toxicological pathways, long-term exposure effects, and gene-environment interaction on CVD among the Asian population. Copyright © 2011 Elsevier Inc. All rights reserved.

Thinking ahead about reproductive health: contingency planning and emergency preparedness in crisis situations (Iraq and West Africa).

PubMed

DeLargy, Pamela; Alakbarov, Ramiz

2004-09-01

The United Nations Population Fund (UNFPA) coordinated efforts to integrate RH into contingency planning for the 2003 Iraq crisis and the 2003 regional response for displaced populations in West Africa. Using UNFPA's network of country offices in the Middle East, staff developed logistics plans, conducted workshops and pre-positioned RH supplies. Though refugee movements did not occur, the contingency planning enhanced the response capacity of UNFPA offices and made it possible to rapidly provide assistance inside Iraq. In West Africa, multi-country workshops and follow-up resulted in country-level and regional action plans useful during the renewed crises of 2003; scarce funding, however, limited their full implementation. UNFPA's experiences show that contingency planning requires committing resources for crises, some of which will not occur; new staff skills; and follow-up. Moreover, RH is considered by some to be additional to the core elements of contingency planning. RH's political sensitivity, particularly with certain donors, further complicated integrated planning.

Evaluation of European Domestic Violence Perpetrator Programmes: Toward a Model for Designing and Reporting Evaluations Related to Perpetrator Treatment Interventions.

PubMed

Lilley-Walker, Sarah-Jane; Hester, Marianne; Turner, William

2018-03-01

This article is based on a review of 60 evaluations (published and unpublished) relating to European domestic violence perpetrator programmes, involving 7,212 programme participants across 12 countries. The purpose of the review, part of the "IMPACT: Evaluation of European Perpetrator Programmes" project funded by the European Commission (Daphne III Programme), was to provide detailed knowledge about the range of European evaluation studies with particular emphasis on the design, methods, input, output, and outcome measures used in order to identify the possibilities and challenges of a multicountry, Europe-wide evaluation methodology that could be used to assess perpetrator programmes in the future. We provide a model to standardise the reporting of evaluation studies and to ensure attention is paid to what information is being collected at different time points so as to understand what and how the behaviour and attitudes of perpetrators might change throughout the course of the programme.

Intimate partner violence and anxiety disorders in pregnancy: the importance of vocational training of the nursing staff in facing them1

PubMed Central

Fonseca-Machado, Mariana de Oliveira; Monteiro, Juliana Cristina dos Santos; Haas, Vanderlei José; Abrão, Ana Cristina Freitas de Vilhena; Gomes-Sponholz, Flávia

2015-01-01

Objective: to identify the relationship between posttraumatic stress disorder, trait and state anxiety, and intimate partner violence during pregnancy. Method: observational, cross-sectional study developed with 358 pregnant women. The Posttraumatic Stress Disorder Checklist - Civilian Version was used, as well as the State-Trait Anxiety Inventory and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women's Health and Domestic Violence. Results: after adjusting to the multiple logistic regression model, intimate partner violence, occurred during pregnancy, was associated with the indication of posttraumatic stress disorder. The adjusted multiple linear regression models showed that the victims of violence, in the current pregnancy, had higher symptom scores of trait and state anxiety than non-victims. Conclusion: recognizing the intimate partner violence as a clinically relevant and identifiable risk factor for the occurrence of anxiety disorders during pregnancy can be a first step in the prevention thereof. PMID:26487135

An ecologic study of dietary links to prostate cancer

NASA Technical Reports Server (NTRS)

Grant, W. B.

1999-01-01

BACKGROUND: The etiology of prostate cancer has not been fully resolved in the scientific and medical literature, although the non-fat portion of milk and calcium are emerging as leading dietary risk factors, with lycopene (found in tomatoes) and vitamin D apparently being risk reduction factors. METHODS: The ecologic (multi-country statistical) approach is used to study dietary links to prostate cancer. Mortality data from 1986 for various age groups in 41 countries are compared with national consumer macronutrient supply values for 1983 and tomato supply values for 1985. RESULTS: For 28 countries with more than five Kcal/day of tomatoes in the consumer supply, a linear combination of non-fat milk (risk factor) and tomatoes (risk reduction factor) was found to have the highest statistical association with prostate cancer mortality rates for men over the age of 35, with the Pearson regression coefficient (R2) for those aged 65-74 years = 0.67 and p < 0.001. For the 13 countries with fewer than six Kcal/day of tomatoes, non-fat milk had the highest association (R2 = 0.92, p < 0.001 for men aged 65-74 years). For 41 countries combined, the non-fat portion of milk had the highest association with prostate cancer mortality rates (R2 = 0.73, p < 0.001 for men aged 65-74 years). CONCLUSIONS: These results support the results of several cohort studies which found the non-fat portion of milk to have the highest association with prostate cancer, likely due to the calcium, and tomatoes to reduce the risk of prostate cancer, most likely due to lycopene.

Association between child marriage and reproductive health outcomes and service utilization: a multi-country study from South Asia.

PubMed

Godha, Deepali; Hotchkiss, David R; Gage, Anastasia J

2013-05-01

Despite the pervasiveness of child marriage and its potentially adverse consequences on reproductive health outcomes, there is relatively little empirical evidence available on this issue, which has hindered efforts to improve the targeting of adolescent health programs. The purpose of this study was to assess the association of child marriage with fertility, fertility control, and maternal health care use outcomes in four South Asian countries: India, Bangladesh, Nepal, and Pakistan. Data for the study come from the most recent Demographic and Health Surveys conducted in the study countries; we used a subsample of women aged 20-24 years. Child marriage, defined as first marriage before 18 years of age, is categorized into two groups: first married at ages 15-17 years and first married at age ≤14 years. We used multivariate logistic regression models. The results of the study suggest that child marriage is significantly associated with a history of rapid repeat childbirth, current modern contraceptive use, female sterilization, not using contraception before first childbirth, pregnancy termination, unintended pregnancy, and inadequate use of maternal health services, although the associations are not always consistent across countries. Furthermore, women who married in early adolescence or childhood show a higher propensity toward most of the negative outcomes, compared with women who married in middle adolescence. Child marriage adds a layer of vulnerability to women that leads to poor fertility control and fertility-related outcomes, and low maternal health care use. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

An ecologic study of dietary links to prostate cancer.

PubMed

Grant, W B

1999-06-01

The etiology of prostate cancer has not been fully resolved in the scientific and medical literature, although the non-fat portion of milk and calcium are emerging as leading dietary risk factors, with lycopene (found in tomatoes) and vitamin D apparently being risk reduction factors. The ecologic (multi-country statistical) approach is used to study dietary links to prostate cancer. Mortality data from 1986 for various age groups in 41 countries are compared with national consumer macronutrient supply values for 1983 and tomato supply values for 1985. For 28 countries with more than five Kcal/day of tomatoes in the consumer supply, a linear combination of non-fat milk (risk factor) and tomatoes (risk reduction factor) was found to have the highest statistical association with prostate cancer mortality rates for men over the age of 35, with the Pearson regression coefficient (R2) for those aged 65-74 years = 0.67 and p < 0.001. For the 13 countries with fewer than six Kcal/day of tomatoes, non-fat milk had the highest association (R2 = 0.92, p < 0.001 for men aged 65-74 years). For 41 countries combined, the non-fat portion of milk had the highest association with prostate cancer mortality rates (R2 = 0.73, p < 0.001 for men aged 65-74 years). These results support the results of several cohort studies which found the non-fat portion of milk to have the highest association with prostate cancer, likely due to the calcium, and tomatoes to reduce the risk of prostate cancer, most likely due to lycopene.

Malaria Elimination Campaigns in the Lake Kariba Region of Zambia: A Spatial Dynamical Model

PubMed Central

Nikolov, Milen; Bever, Caitlin A.; Upfill-Brown, Alexander; Hamainza, Busiku; Miller, John M.; Eckhoff, Philip A.; Wenger, Edward A.; Gerardin, Jaline

2016-01-01

As more regions approach malaria elimination, understanding how different interventions interact to reduce transmission becomes critical. The Lake Kariba area of Southern Province, Zambia, is part of a multi-country elimination effort and presents a particular challenge as it is an interconnected region of variable transmission intensities. In 2012–13, six rounds of mass test-and-treat drug campaigns were carried out in the Lake Kariba region. A spatial dynamical model of malaria transmission in the Lake Kariba area, with transmission and climate modeled at the village scale, was calibrated to the 2012–13 prevalence survey data, with case management rates, insecticide-treated net usage, and drug campaign coverage informed by surveillance. The model captured the spatio-temporal trends of decline and rebound in malaria prevalence in 2012–13 at the village scale. Various interventions implemented between 2016–22 were simulated to compare their effects on reducing regional transmission and achieving and maintaining elimination through 2030. Simulations predict that elimination requires sustaining high coverage with vector control over several years. When vector control measures are well-implemented, targeted mass drug campaigns in high-burden areas further increase the likelihood of elimination, although drug campaigns cannot compensate for insufficient vector control. If infections are regularly imported from outside the region into highly receptive areas, vector control must be maintained within the region until importations cease. Elimination in the Lake Kariba region is possible, although human movement both within and from outside the region risk damaging the success of elimination programs. PMID:27880764

Norovirus Infection and Acquired Immunity in 8 Countries: Results From the MAL-ED Study

PubMed Central

Rouhani, Saba; Peñataro Yori, Pablo; Paredes Olortegui, Maribel; Siguas Salas, Mery; Rengifo Trigoso, Dixner; Mondal, Dinesh; Bodhidatta, Ladaporn; Platts-Mills, James; Samie, Amidou; Kabir, Furqan; Lima, Aldo; Babji, Sudhir; Mason, Carl J.; Kalam, Adil; Bessong, Pascal; Ahmed, Tahmeed; Mduma, Estomih; Bhutta, Zulfiqar A.; Lima, Ila; Ramdass, Rakhi; Lang, Dennis; George, Ajila; Zaidi, Anita K. M.; Kang, Gagandeep; Houpt, Eric; Kosek, Margaret N.

2016-01-01

Background. Norovirus is an important cause of childhood diarrhea. We present data from a longitudinal, multicountry study describing norovirus epidemiology during the first 2 years of life. Methods. A birth cohort of 1457 children across 8 countries contributed 7077 diarrheal stools for norovirus testing. A subset of 199 children contributed additional asymptomatic samples (2307) and diarrheal stools (770), which were used to derive incidence rates and evaluate evidence for acquired immunity. Results. Across sites, 89% of children experienced at least 1 norovirus infection before 24 months, and 22.7% of all diarrheal stools were norovirus positive. Severity of norovirus-positive diarrhea was comparable to other enteropathogens, with the exception of rotavirus. Incidence of genogroup II (GII) infection was higher than genogroup I and peaked at 6–11 months across sites. Undernutrition was a risk factor for symptomatic norovirus infection, with an increase in 1 standard deviation of length-for-age z score associated with a 17% reduction (odds ratio, 0.83 [95% confidence interval, .72–.97]; P = .011) in the odds of experiencing diarrhea when norovirus was present, after accounting for genogroup, rotavirus vaccine, and age. Evidence of acquired immunity was observed among GII infections only: Children with prior GII infection were found to have a 27% reduction in the hazard of subsequent infection (hazard ratio, 0.727; P = .010). Conclusions. The high prevalence of norovirus across 8 sites in highly variable epidemiologic settings and demonstration of protective immunity for GII infections provide support for investment in vaccine development. PMID:27013692

Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance

PubMed Central

Sauvageot, Delphine; Njanpop-Lafourcade, Berthe-Marie; Akilimali, Laurent; Anne, Jean-Claude; Bidjada, Pawou; Bompangue, Didier; Bwire, Godfrey; Coulibaly, Daouda; Dengo-Baloi, Liliana; Dosso, Mireille; Orach, Christopher Garimoi; Inguane, Dorteia; Kagirita, Atek; Kacou-N’Douba, Adele; Keita, Sakoba; Kere Banla, Abiba; Kouame, Yao Jean-Pierre; Landoh, Dadja Essoya; Langa, Jose Paulo; Makumbi, Issa; Miwanda, Berthe; Malimbo, Muggaga; Mutombo, Guy; Mutombo, Annie; NGuetta, Emilienne Niamke; Saliou, Mamadou; Sarr, Veronique; Senga, Raphael Kakongo; Sory, Fode; Sema, Cynthia; Tante, Ouyi Valentin; Gessner, Bradford D.; Mengel, Martin A.

2016-01-01

Background Cholera burden in Africa remains unknown, often because of weak national surveillance systems. We analyzed data from the African Cholera Surveillance Network (www.africhol.org). Methods/ Principal findings During June 2011–December 2013, we conducted enhanced surveillance in seven zones and four outbreak sites in Togo, the Democratic Republic of Congo (DRC), Guinea, Uganda, Mozambique and Cote d’Ivoire. All health facilities treating cholera cases were included. Cholera incidences were calculated using culture-confirmed cholera cases and culture-confirmed cholera cases corrected for lack of culture testing usually due to overwhelmed health systems and imperfect test sensitivity. Of 13,377 reported suspected cases, 34% occurred in Conakry, Guinea, 47% in Goma, DRC, and 19% in the remaining sites. From 0–40% of suspected cases were aged under five years and from 0.3–86% had rice water stools. Within surveillance zones, 0–37% of suspected cases had confirmed cholera compared to 27–38% during outbreaks. Annual confirmed incidence per 10,000 population was <0.5 in surveillance zones, except Goma where it was 4.6. Goma and Conakry had corrected incidences of 20.2 and 5.8 respectively, while the other zones a median of 0.3. During outbreaks, corrected incidence varied from 2.6 to 13.0. Case fatality ratios ranged from 0–10% (median, 1%) by country. Conclusions/Significance Across different African epidemiological contexts, substantial variation occurred in cholera incidence, age distribution, clinical presentation, culture confirmation, and testing frequency. These results can help guide preventive activities, including vaccine use. PMID:27186885

Nurses' practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country, multilevel study.

PubMed

Leineweber, Constanze; Chungkham, Holendro Singh; Lindqvist, Rikard; Westerlund, Hugo; Runesdotter, Sara; Smeds Alenius, Lisa; Tishelman, Carol

2016-06-01

Nursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied. The aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction. Multilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied. Regarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied. We conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Knowledge and use of emergency contraception: a multicountry analysis.

PubMed

Palermo, Tia; Bleck, Jennifer; Westley, Elizabeth

2014-06-01

Globally, evidence on knowledge and use of emergency contraception from population-based data is limited, though such information would be helpful in increasing access to the method. We examined knowledge and use of emergency contraception in 45 countries using population-based survey data. Demographic and Health Survey (DHS) data on women aged 15-49 were analyzed by country in logistic regressions to identify associations between women's characteristics and their having heard of emergency contraception or having ever used it. Trends were examined, by region and globally, according to individual, household and community descriptors, including women's age, education, marital status, socioeconomic status, and urban or rural location. The proportion of women who had heard of emergency contraception ranged from 2% in Chad to 66% in Colombia, and the proportion of sexually experienced women who had used it ranged from less than 0.1% in Chad to 12% in Colombia. The odds of having heard of or used the method generally increased with wealth, and although the relationship between marital status and knowing of the method varied by region, never-married women were more likely than married women to have used emergency contraception in countries where significant differences existed. In some countries, urban residence was associated with having heard of the method, but in only three countries were women from urban areas more likely to have used it. Our findings support the need for broader dissemination of information on emergency contraception, particularly among low-income individuals. Variations in use and knowledge within regions suggest a need for programs to be tailored to country-level characteristics.

Nonlinear Analysis to Detect if Excellent Nursing Work Environments Have Highest Well-Being.

PubMed

Casalicchio, Giuseppe; Lesaffre, Emmanuel; Küchenhoff, Helmut; Bruyneel, Luk

2017-09-01

To detect potentially nonlinear associations between nurses' work environment and nurse staffing on the one hand and nurse burnout on the other hand. A cross-sectional multicountry study for which data collection using a survey of 33,731 registered nurses in 12 European countries took place during 2009 to 2010. A semiparametric latent variable model that describes both linear and potentially nonlinear associations between burnout (Maslach Burnout Inventory: emotional exhaustion, depersonalization, personal accomplishment) and work environment (Practice Environment Scale of the Nursing Work Index: managerial support for nursing, doctor-nurse collegial relations, promotion of care quality) and staffing (patient-to-nurse ratio). Similar conclusions are reached from linear and nonlinear models estimating the association between work environment and burnout. For staffing, an increase in the patient-to-nurse ratio is associated with an increase in emotional exhaustion. At about 15 patients per nurse, no further increase in emotional exhaustion is seen. Absence of evidence for diminishing returns of improving work environments suggests that continuous improvement and achieving excellence in nurse work environments pays off strongly in terms of lower nurse-reported burnout rates. Nurse staffing policy would benefit from a larger number of studies that identify specific minimum as well as maximum thresholds at which inputs affect nurse and patient outcomes. Nurse burnout is omnipresent and has previously been shown to be related to worse patient outcomes. Additional increments in characteristics of excellent work environments, up to the highest possible standard, correspond to lower nurse burnout. © 2017 Sigma Theta Tau International.

Is Exposure to Animal Feces Harmful to Child Nutrition and Health Outcomes? A Multicountry Observational Analysis

PubMed Central

Headey, Derek; Nguyen, Phuong; Kim, Sunny; Rawat, Rahul; Ruel, Marie; Menon, Purnima

2017-01-01

It has recently been hypothesized that exposure to livestock constitutes a significant risk factor for diarrhea and environmental enteric disorder in young children, which may significantly contribute to undernutrition. To date, though, very little research has documented the extent of exposure to animal feces and whether this exposure is associated with child anthropometry in large samples and diverse settings. This study investigates these issues using data from the Alive and Thrive study conducted in rural areas of Ethiopia, Bangladesh, and Vietnam. These surveys used spot-checks to collect data on proxies of hygiene behaviors such as the cleanliness of mothers, young children, and the homestead environment, including the presence of animal feces. Animal feces were visible in 38–42% of household compounds across the three countries and were positively associated with household livestock ownership and negatively associated with maternal and child cleanliness. One-sided tests from multivariate least squares models for children 6–24 months of age indicate that the presence of animal feces is significantly and negatively associated with child height-for-age z scores in Ethiopia (β = −0.22), Bangladesh (β = −0.13), and in a pooled sample (β = −0.11), but not in Vietnam. There is also suggestive evidence that animal feces may be positively associated with diarrhea symptoms in Bangladesh. The results in this article, therefore, contribute to a growing body of evidence suggesting that animal ownership may pose a significant risk to child nutrition and health outcomes in developing countries. PMID:27994099

Consumption of processed food dietary patterns in four African populations.

PubMed

Holmes, Michelle D; Dalal, Shona; Sewram, Vikash; Diamond, Megan B; Adebamowo, Sally N; Ajayi, Ikeoluwapo O; Adebamowo, Clement; Chiwanga, Faraja S; Njelekela, Marina; Laurence, Carien; Volmink, Jimmy; Bajunirwe, Francis; Nankya-Mutyoba, Joan; Guwatudde, David; Reid, Todd G; Willett, Walter C; Adami, Hans-Olov; Fung, Teresa T

2018-06-01

To identify predominant dietary patterns in four African populations and examine their association with obesity. Cross-sectional study.Setting/SubjectsWe used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of non-communicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men. We identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern's lowest tertile (both P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity. We identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.

Centralized Data Management in a Multicountry, Multisite Population-based Study.

PubMed

Rahman, Qazi Sadeq-ur; Islam, Mohammad Shahidul; Hossain, Belal; Hossain, Tanvir; Connor, Nicholas E; Jaman, Md Jahiduj; Rahman, Md Mahmudur; Ahmed, A S M Nawshad Uddin; Ahmed, Imran; Ali, Murtaza; Moin, Syed Mamun Ibne; Mullany, Luke; Saha, Samir K; El Arifeen, Shams

2016-05-01

A centralized data management system was developed for data collection and processing for the Aetiology of Neonatal Infection in South Asia (ANISA) study. ANISA is a longitudinal cohort study involving neonatal infection surveillance and etiology detection in multiple sites in South Asia. The primary goal of designing such a system was to collect and store data from different sites in a standardized way to pool the data for analysis. We designed the data management system centrally and implemented it to enable data entry at individual sites. This system uses validation rules and audit that reduce errors. The study sites employ a dual data entry method to minimize keystroke errors. They upload collected data weekly to a central server via internet to create a pooled central database. Any inconsistent data identified in the central database are flagged and corrected after discussion with the relevant site. The ANISA Data Coordination Centre in Dhaka provides technical support for operations, maintenance and updating the data management system centrally. Password-protected login identifications and audit trails are maintained for the management system to ensure the integrity and safety of stored data. Centralized management of the ANISA database helps to use common data capture forms (DCFs), adapted to site-specific contextual requirements. DCFs and data entry interfaces allow on-site data entry. This reduces the workload as DCFs do not need to be shipped to a single location for entry. It also improves data quality as all collected data from ANISA goes through the same quality check and cleaning process.

Mortality and cause-of-death reporting and analysis systems in seven Pacific Island countries.

PubMed

Carter, Karen L; Rao, Chalapati; Lopez, Alan D; Taylor, Richard

2012-06-13

Mortality statistics are essential for population health assessment. Despite limitations in data availability, Pacific Island Countries are considered to be in epidemiological transition, with non-communicable diseases increasingly contributing to premature adult mortality. To address rapidly changing health profiles, countries would require mortality statistics from routine death registration given their relatively small population sizes. This paper uses a standard analytical framework to examine death registration systems in Fiji, Kiribati, Nauru, Palau, Solomon Islands, Tonga and Vanuatu. In all countries, legislation on death registration exists but does not necessarily reflect current practices. Health departments carry the bulk of responsibility for civil registration functions. Medical cause-of-death certificates are completed for at least hospital deaths in all countries. Overall, significantly more information is available than perceived or used. Use is primarily limited by poor understanding, lack of coordination, limited analytical skills, and insufficient technical resources. Across the region, both registration and statistics systems need strengthening to improve the availability, completeness, and quality of data. Close interaction between health staff and local communities provides a good foundation for further improvements in death reporting. System strengthening activities must include a focus on clear assignment of responsibility, provision of appropriate authority to perform assigned tasks, and fostering ownership of processes and data to ensure sustained improvements. These human elements need to be embedded in a culture of data sharing and use. Lessons from this multi-country exercise would be applicable in other regions afflicted with similar issues of availability and quality of vital statistics.

Healthcare Resource Waste Associated with Patient Nonadherence and Early Discontinuation of Traditional Continuous Glucose Monitoring in Real-World Settings: A Multicountry Analysis.

PubMed

Yu, Shengsheng; Varughese, Biju; Li, Zhiyi; Kushner, Pam R

2018-06-01

Traditional continuous glucose monitoring (CGM) provides detailed information on glucose patterns and trends to inform daily diabetes management decisions, which is particularly beneficial for patients with a history of hypoglycemia unawareness. However, a high level of patient adherence (≥70%) is required to achieve clinical benefits. The aim of this study was to assess the impact of real-world patient nonadherence and early discontinuation on healthcare resource use. A cost calculator was designed to evaluate monthly healthcare resource waste within the first year of traditional CGM initiation by combining estimates of real-world nonadherence and early discontinuation from the literature with the wholesale acquisition costs of the current technology in the United States (for a commercial payer and for Medicare), or its equivalent in Sweden, Germany, or the Netherlands. Based on an early discontinuation rate of 27% and nonadherence rates of 13.9%-31.1% over the 12 months following initiation, the healthcare resource waste associated with nonadherence and early discontinuation was $220,289 and $21,775, respectively, for every 100 patients initiating CGM in the U.S. commercial payer scenario. In the Medicare scenario, the corresponding figures were $72,648 and $5,675, respectively. In both scenarios, nonadherence and early discontinuation accounted for ∼24% of resources being wasted within the first year of CGM initiation. Similar results were observed using the local costs in the other countries analyzed. The healthcare resource waste associated with traditional CGM nonadherence and early discontinuation warrants deliberate consideration when selecting suitable patients for this technology.

Comparative performance characteristics of the urine lipoarabinomannan strip test and sputum smear microscopy in hospitalized HIV-infected patients with suspected tuberculosis in Harare, Zimbabwe.

PubMed

Zijenah, Lynn Sodai; Kadzirange, Gerard; Bandason, Tsitsi; Chipiti, Maria Mary; Gwambiwa, Bevel; Makoga, Forget; Chungu, Pauline; Kaguru, Philip; Dheda, Keertan

2016-01-22

In Zimbabwe, sputum smear microscopy (SSM) is the routinely used TB diagnostic tool in hospitalised HIV-infected patients. However, SSM has poor sensitivity in HIV-infected patients. We compared performance of urine lipoarabinomannan strip test (LAM) and SSM among hospitalized HIV-infected patients with suspected TB. Hospitalized HIV-infected patients with suspected TB were randomized to LAM plus SSM or SSM alone groups as part of a larger multi-country parent study. Here we present a comparison of LAM versus SSM performance from the Zimbabwe study site. LAM analyses (grade 2 cut-off) were conducted using (i) a microbiological reference standard (MRS; culture positivity for M.tb and designated definite TB) and (ii) a composite reference standard (CRS; definite TB plus probable TB i.e. patients with clinical TB excluded from the culture negative group). CRS constituted the primary analysis. 82/457 (18%) of the patients randomized to the LAM group were M.tuberculosis culture positive. Using CRS, sensitivity (%, 95% CI) of LAM was significantly higher than SSM [49.2 (42.1-56.4) versus 29.4(23.2-36.3); p < 0.001]. Specificity and PPV were 98.1%, and 95.8%, respectively. By contrast, using MRS, LAM sensitivity was similar to SSM and specificity was significantly lower, however, the combined sensitivity of LAM and SSM was significantly higher than that of SSM alone, p = 0.009. Using CRS, LAM sensitivity (%, CI) was CD4 count dependent [60.6(50.7-69.8) at ≤50 cells/μL; 40.0(22.7-59.4) at 51-100 cells/μL, and 32.8(21.0-46.3) at >100 cells/μL. The combined sensitivity of LAM and SSM was higher than SSM alone being highest at CD4 counts <50 cells/μL [67.6(57.9-76.3); p = <0.001]. Specificity of LAM or SSM alone, or of combined LAM and SSM was >97% in all the 3 CD4 strata. Among hospitalized HIV-infected patients with suspected TB, the sensitivity of LAM is significantly higher than that of SSM, especially at low CD4 counts. LAM and SSM are complimentary tests for diagnosis of TB in HIV-infected patients. We recommend a combination of LAM and SSM for TB diagnosis in HIV-infected patients with low CD4 counts in HIV/TB co-endemic countries, where alternative methods are unavailable.

Effects of Growing-Up Milk Supplemented With Prebiotics and LCPUFAs on Infections in Young Children

PubMed Central

Chatchatee, Pantipa; Lee, Way S.; Carrilho, Eugenia; Kosuwon, Pensri; Simakachorn, Nipat; Yavuz, Yalcin; Schouten, Bastiaan; Graaff, Patricia Logtens-de; Szajewska, Hania

2014-01-01

ABSTRACT Objective: The aim of this study was to investigate the effect of growing-up milk (GUM) with added short-chain galacto-oligosaccharides (scGOS)/long-chain fructo-oligosaccharides (lcFOS) (9:1) (Immunofortis) and n-3 long-chain polyunsaturated fatty acids (LCPUFAs) on the occurrence of infections in healthy children attending day care centres. Methods: In a randomised double-blind controlled, parallel, multicountry intervention study, 767 healthy children, ages 11 to 29 months, received GUM with scGOS/lcFOS/LCPUFAs (the active group, n = 388), GUM without scGOS/lcFOS/LCPUFAs (the control group, n = 379), or cow's milk (n = 37) for 52 weeks. The primary outcome measure was the number of episodes of upper respiratory tract infections or gastrointestinal infections based on a combination of subject's illness symptoms reported by the parents during the intervention period. Results: Children in the active group compared with the control group had a decreased risk of developing at least 1 infection (299/388 [77%] vs 313/379 [83%], respectively, relative risk 0.93, 95% confidence interval [CI] 0.87–1.00; logistic regression P = 0.03). There was a trend toward a reduction (P = 0.07) in the total number of infections in the active group, which was significant when confirmed by one of the investigators (268/388 [69%] vs 293/379 [77%], respectively, relative risk 0.89, 95% CI 0.82–0.97; P = 0.004, post hoc). More infectious episodes were observed in the cow's milk group, when compared with both GUM groups (34/37 [92%] vs 612/767 [80%], respectively, relative risk 1.15, 95% CI 1.04–1.28). Conclusions: This is the first study in children to show a reduced risk of infection following consumption of GUM supplemented with scGOS/lcFOS/n-3 LCPUFAs. The borderline statistical significance justifies a new study to confirm this finding. PMID:24614142

Prompt access to effective malaria treatment among children under five in sub-Saharan Africa: a multi-country analysis of national household survey data.

PubMed

Shah, Jui A; Emina, Jacques B O; Eckert, Erin; Ye, Yazoume

2015-08-25

Scaling up diagnostic testing and treatment is a key strategy to reduce the burden of malaria. Delays in accessing treatment can have fatal consequences; however, few studies have systematically assessed these delays among children under five years of age in malaria-endemic countries of sub-Saharan Africa. This study identifies predictors of prompt treatment with first-line artemisinin combination therapy (ACT) and describes profiles of children who received this recommended treatment. This study uses data from the most recent Demographic and Health Survey, Malaria Indicator Survey, or Anaemia and Parasite Prevalence Survey conducted in 13 countries. A Chi square automatic interaction detector (CHAID) model was used to identify factors associated with prompt and effective treatment among children under five years of age. The percentage of children with fever who received any anti-malarial treatment varies from 3.6 % (95 % CI 2.8-4.4 %) in Ethiopia to 64.5 % (95 % CI 62.7-66.2 %) in Uganda. Among those who received prompt treatment with any anti-malarial medicine, the percentage who received ACT ranged from 32.2 % (95 % CI 26.1-38.4 %) in Zambia to nearly 100 % in Tanzania mainland and Zanzibar. The CHAID analysis revealed that country of residence is the best predictor of prompt and effective treatment (p < 0.001). Depending on the country, the second best predictor was maternal education (p = 0.004), place of residence (p = 0.008), or household wealth index (p < 0.001). This study reveals that country of residence, maternal education, place of residence, and socio-economic status are key predictors of prompt access to malaria treatment. Achieving universal coverage and the elimination agenda will require effective monitoring to detect disparities early and sustained investments in routine data collection and policy formulation.

Use of health systems evidence by policymakers in eastern mediterranean countries: views, practices, and contextual influences

PubMed Central

2012-01-01

Background Health systems evidence can enhance policymaking and strengthen national health systems. In the Middle East, limited research exists on the use of evidence in the policymaking process. This multi-country study explored policymakers’ views and practices regarding the use of health systems evidence in health policymaking in 10 eastern Mediterranean countries, including factors that influence health policymaking and barriers and facilitators to the use of evidence. Methods This study utilized a survey adapted and customized from a similar tool developed in Canada. Health policymakers from 10 countries (Algeria, Bahrain, Jordan, Lebanon Oman, Pakistan, Palestine, Sudan, Tunisia, and Yemen) were surveyed. Descriptive and bi-variate analyses were performed for quantitative questions and thematic analysis was done for qualitative questions. Results A total of 237 policymakers completed the survey (56.3% response rate). Governing parties, limited funding for the health sector and donor organizations exerted a strong influence on policymaking processes. Most (88.5%) policymakers reported requesting evidence and 43.1% reported collaborating with researchers. Overall, 40.1% reported that research evidence is not delivered at the right time. Lack of an explicit budget for evidence-informed health policymaking (55.3%), lack of an administrative structure for supporting evidence-informed health policymaking processes (52.6%), and limited value given to research (35.9%) all limited the use of research evidence. Barriers to the use of evidence included lack of research targeting health policy, lack of funding and investments, and political forces. Facilitators included availability of health research and research institutions, qualified researchers, research funding, and easy access to information. Conclusions Health policymakers in several countries recognize the importance of using health systems evidence. Study findings are important in light of changes unfolding in some Arab countries and can help undertake an analysis of underlying transformations and their respective health policy implications including the way evidence will be used in policy decisions. PMID:22799440

Gender Associated with the Intention to Choose a Medical Specialty in Medical Students: A Cross-Sectional Study in 11 Countries in Latin America

PubMed Central

Mayta-Tristán, Percy; Pereyra-Elías, Reneé; Montenegro-Idrogo, Juan José; Inga-Berrospi, Fiorella; Ancalli, Felix; Bonilla-Escobar, Francisco; Diaz-Velez, Cristian; Gutierrez-Quezada, Erick; Gomez-Alhach, Jennifer; Muñoz-Medina, Carlos E.; Sanchez-Pozo, Adriana; Vidal, Milisen

2016-01-01

Introduction The selection of a medical specialty has been associated with multiple factors, such as personal preferences, academic exposure, motivational factors and sociodemographic factors, such as gender. The number of women in the medical field has increased in recent years. In Latin America, we have not found any studies that explore this relationship. Objective To determine whether there is an association between gender and the intention to choose a medical specialty in medical students from 11 countries in Latin America. Methods Secondary analysis of the Collaborative Working Group for the Research of Human Resources for Health (Red-LIRHUS) data; a multi-country project of students in their first year and fifth year of study, from 63 medical schools in 11 Latin American countries. All students who referred intention to choose a certain medical specialty were considered as participants. Results Of the 11073 surveyed students, 9235 indicated the name of a specific specialty. The specialties chosen most often in the fifth year were General Surgery (13.0%), Pediatrics (11.0%), Internal Medicine (10.3%) and Obstetrics/Gynecology (9.0%). For women, the top choices were Pediatrics (15.8%), Obstetrics/Gynecology (11.0%), Cardiology (8.7%), General Surgery (8.6%), and Oncology (6.4%). In the adjusted analysis, the female gender was associated with the choice of Obstetrics/Gynecology (RP: 2.75; IC95%: 2.24–3.39); Pediatric Surgery (RP: 2.19; IC95%: 1.19–4.00), Dermatology (RP: 1.91; IC95%:1.24–2.93), Pediatrics (RP: 1.83; IC95%: 1.56–2.17), and Oncology (RP: 1.37; IC95%: 1.10–1.71). Conclusions There is an association between the female gender and the intention to choose Obstetrics/Gynecology, Pediatrics, Pediatric Surgery, Dermatology, and Oncology. We recommend conducting studies that consider other factors that can influence the choice of a medical specialty. PMID:27519055

Cost analysis of routine immunisation in Zambia.

PubMed

Schütte, Carl; Chansa, Collins; Marinda, Edmore; Guthrie, Teresa A; Banda, Stanley; Nombewu, Zipozihle; Motlogelwa, Katlego; Lervik, Marita; Brenzel, Logan; Kinghorn, Anthony

2015-05-07

This study aimed to inform planning and funding by providing updated, detailed information on total and unit costs of routine immunisation (RI) in Zambia, a GAVI-eligible lower middle-income country with a population of 13 million. The exercise was part of a multi-country study on costs and financing of routine immunisation (EPIC) that utilized a common, ingredients-based approach to costing. Data on inputs, prices and outputs were collected in a stratified, random sample of 51 facilities in nine districts between December 2012 and March 2013 using a pre-tested questionnaire. Shared inputs were allocated to RI costs on the basis of tracing factors developed for the study. A comprehensive set of costs were analysed to obtain total and unit costs, at facility and above-facility levels. The total annual economic cost of RI was $38.16 million, equivalent to approximately 10% of government health spending. Government contributed 83% of finances. Labour accounted for the lion's share (49%) of total costs followed by vaccines (16%) and travel allowances (12%). Analysis of specific activity costs showed that outreach and facility-based services accounted for half of total economic costs. Costs for managing the program at district, provincial and national levels (above-facility costs) represented 24% of total costs. Average unit costs were $7.18 per dose, $59.32 per infant and $65.89 per DPT3 immunised child, with markedly higher unit costs in rural facilities. Analyses suggest that greater efficiency is associated with higher utilisation levels and urban facility type. Total and unit costs, and government's contribution, were considerably higher than previous Zambian estimates and international benchmarks. These findings have substantial implications for planners, efficiency improvement and sustainable financing, particularly as new vaccines are introduced. Variations in immunisation costs at facility level warrant further statistical analyses. Copyright © 2015 Elsevier Ltd. All rights reserved.

SisLeish: A multi-country standardized information system to monitor the status of Leishmaniasis in the Americas.

PubMed

Maia-Elkhoury, Ana N S; O B Valadas, Samantha Y; Puppim-Buzanovsky, Lia; Rocha, Felipe; Sanchez-Vazquez, Manuel J

2017-09-01

In the Americas, leishmaniasis is endemic in 18 countries, and from 2001 through 2015, 17 countries reported 843,931 cases of cutaneous and mucocutaneous leishmaniasis, and 12 countries reported 52,176 cases of visceral leishmaniasis. A Regional Information System (SisLeish) was created in order to provide knowledge of the distribution and tendency of this disease to analyze and monitor the leishmaniasis status. This article analyses the performance and progress of SisLeish from 2012-2015. The performance of SisLeish was evaluated by country adhesion, data completeness and delay in entering the data, and also by the SWOT technique. Furthermore, we outlined the structure and modus operandi of the system and indicators utilized. In 2012, only 18% of the countries entered the data in SisLeish before the deadline, where 66.7% and 50% of the countries with autochthonous CL/ML and VL reported their cases to the system, respectively. Whereas in 2015, 59% of the countries reached the deadline, where 94.4% and 58.3% of the countries reported their CL/ML and VL data, respectively. Regarding data completeness, there was great progress for different variables since its launch, such as gender, which had an approximately 100% improvement from 2012 to 2015. The SWOT analysis of SisLeish showed 12 strengths, 11 opportunities, seven weaknesses and six threats. From 2012-2015 there has been an improvement in the adhesion, quality and data completeness, showing the effort of the majority of the countries to enhance their national database. The SWOT analysis demonstrated that strengths and opportunities exceed weaknesses and threats; however, it highlighted the system frailties and challenges that need to be addressed. Furthermore, it has stimulated several National Programs to advance their surveillance system. Therefore, SisLeish has become an essential tool to prioritize areas, assist in decision-making processes, and to guide surveillance and control actions.

SisLeish: A multi-country standardized information system to monitor the status of Leishmaniasis in the Americas

PubMed Central

Rocha, Felipe

2017-01-01

Background In the Americas, leishmaniasis is endemic in 18 countries, and from 2001 through 2015, 17 countries reported 843,931 cases of cutaneous and mucocutaneous leishmaniasis, and 12 countries reported 52,176 cases of visceral leishmaniasis. A Regional Information System (SisLeish) was created in order to provide knowledge of the distribution and tendency of this disease to analyze and monitor the leishmaniasis status. This article analyses the performance and progress of SisLeish from 2012–2015. Methodology The performance of SisLeish was evaluated by country adhesion, data completeness and delay in entering the data, and also by the SWOT technique. Furthermore, we outlined the structure and modus operandi of the system and indicators utilized. Results In 2012, only 18% of the countries entered the data in SisLeish before the deadline, where 66.7% and 50% of the countries with autochthonous CL/ML and VL reported their cases to the system, respectively. Whereas in 2015, 59% of the countries reached the deadline, where 94.4% and 58.3% of the countries reported their CL/ML and VL data, respectively. Regarding data completeness, there was great progress for different variables since its launch, such as gender, which had an approximately 100% improvement from 2012 to 2015. The SWOT analysis of SisLeish showed 12 strengths, 11 opportunities, seven weaknesses and six threats. Conclusions From 2012–2015 there has been an improvement in the adhesion, quality and data completeness, showing the effort of the majority of the countries to enhance their national database. The SWOT analysis demonstrated that strengths and opportunities exceed weaknesses and threats; however, it highlighted the system frailties and challenges that need to be addressed. Furthermore, it has stimulated several National Programs to advance their surveillance system. Therefore, SisLeish has become an essential tool to prioritize areas, assist in decision-making processes, and to guide surveillance and control actions. PMID:28873400

Facilitating Factors and Barriers to the Use of Emerging Technologies for Suicide Prevention in Europe: Multicountry Exploratory Study

PubMed Central

Delgado, Carmen; Sánchez-Prada, Andrés; Parra-Vidales, Esther; de Leo, Diego; Franco-Martín, Manuel

2018-01-01

Background This study provides an analysis on the use of emerging technologies for the prevention of suicide in 8 different European countries. Objective The objective of this study was to analyze the potentiality of using emerging technologies in the area of suicide prevention based on the opinion of different professionals involved in suicide prevention. Methods Opinions of 3 groups of stakeholders (ie, relevant professionals in suicide field) were gathered using a specifically designed questionnaire to explore dimensions underlying perceptions of facilitating factors and barriers in relation to the use of emerging technologies for suicide prevention. Results Goal 1 involved facilitating factors for the use of emerging technologies in suicide prevention. Northern European countries, except for Belgium, attach greater relevance to those that optimize implementation and benefits. On the other hand, Southern European countries attach greater importance to professionally oriented and user-centered facilitating factors. According to different stakeholders, the analysis of these facilitating factors suggest that professionals in the field of social work attach greater relevance to those that optimize implementation and benefits. However, professionals involved in the area of mental health, policy makers, and political decision makers give greater importance to professionally oriented and user-centered facilitating factors. Goal 2 was related to barriers to the usability of emerging technologies for suicide prevention. Both countries and stakeholders attach greater importance to barriers associated with resource constraints than to those centered on personal limitations. There are no differences between countries or between stakeholders. Nevertheless, there is a certain stakeholders-countries interaction that indicates that the opinions on resource constraints expressed by different stakeholders do not follow a uniform pattern in different countries, but they differ depending on the country. Conclusions Although all countries and stakeholders agree in identifying resource constraints as the main barrier to the use of emerging technologies, factors facilitating their use in suicide prevention differ among countries and among stakeholders. PMID:29367183

Use of health systems and policy research evidence in the health policymaking in eastern Mediterranean countries: views and practices of researchers.

PubMed

El-Jardali, Fadi; Lavis, John N; Ataya, Nour; Jamal, Diana

2012-01-11

Limited research exists on researchers' knowledge transfer and exchange (KTE) in the eastern Mediterranean region (EMR). This multi-country study explores researchers' views and experiences regarding the role of health systems and policy research evidence in health policymaking in the EMR, including the factors that influence health policymaking, barriers and facilitators to the use of evidence, and the factors that increase researchers' engagement in KTE. Researchers who published health systems and policy relevant research in 12 countries in the EMR (Bahrain, Egypt, Iran, Jordan, Lebanon, Libya, Morocco, Oman, Palestine, Sudan, Syria, and Yemen) were surveyed. Descriptive analysis and Linear Mixed Regression Models were performed for quantitative sections and the simple thematic analysis approach was used for open-ended questions. A total of 238 researchers were asked to complete the survey (response rate 56%). Researchers indicated transferring results to other researchers (67.2%) and policymakers in the government (40.5%). Less than one-quarter stated that they produced policy briefs (14.5%), disseminated messages that specified possible actions (24.4%), interacted with policymakers and stakeholders in priority-setting (16%), and involved them in their research (19.8%). Insufficient policy dialogue opportunities and collaboration between researchers and policymakers and stakeholders (67.9%), practical constraints to implementation (66%), non-receptive policy environment (61.3%), and politically sensitive findings (57.7%) hindered the use of evidence. Factors that increase researchers' engagement in KTE activities in the region were associated with involving policymakers and stakeholders at various stages such as priority-setting exercises and provision of technical assistance. Researchers in the EMR recognize the importance of using health systems evidence in health policymaking. Potential strategies to improve the use of research evidence emphasize two-way communication between researchers and policymakers. Findings are critical for the upcoming World Health Report 2012, which will emphasize the significance of conducting and translating health research to inform health policies. © 2012 El-Jardali et al; licensee BioMed Central Ltd.

Assessing the burden of paediatric influenza in Europe: the European Paediatric Influenza Analysis (EPIA) project.

PubMed

Paget, W John; Balderston, Catherine; Casas, Inmaculada; Donker, Gé; Edelman, Laurel; Fleming, Douglas; Larrauri, Amparo; Meijer, Adam; Puzelli, Simona; Rizzo, Caterina; Simonsen, Lone

2010-08-01

The European Paediatric Influenza Analysis (EPIA) project is a multi-country project that was created to collect, analyse and present data regarding the paediatric influenza burden in European countries, with the purpose of providing the necessary information to make evidence-based decisions regarding influenza immunisation recommendations for children. The initial approach taken is based on existing weekly virological and age-specific influenza-like illness (ILI) data from surveillance networks across Europe. We use a multiple regression model guided by longitudinal weekly patterns of influenza virus to attribute the weekly ILI consultation incidence pattern to each influenza (sub)type, while controlling for the effect of respiratory syncytial virus (RSV) epidemics. Modelling the ILI consultation incidence during 2002/2003-2008 revealed that influenza infections that presented for medical attention as ILI affected between 0.3% and 9.8% of children aged 0-4 and 5-14 years in England, Italy, the Netherlands and Spain in an average season. With the exception of Spain, these rates were always higher in children aged 0-4 years. Across the six seasons analysed (five seasons were analysed from the Italian data), the model attributed 47-83% of the ILI burden in primary care to influenza virus infection in the various countries, with the A(H3N2) virus playing the most important role, followed by influenza viruses B and A(H1N1). National season averages from the four countries studied indicated that between 0.4% and 18% of children consulted a physician for ILI, with the percentage depending on the country and health care system. Influenza virus infections explained the majority of paediatric ILI consultations in all countries. The next step will be to apply the EPIA modelling approach to severe outcomes indicators (i.e. hospitalisations and mortality data) to generate a complete range of mild and severe influenza burden estimates needed for decision making concerning paediatric influenza vaccination.

Use of health systems and policy research evidence in the health policymaking in eastern Mediterranean countries: views and practices of researchers

PubMed Central

2012-01-01

Background Limited research exists on researchers' knowledge transfer and exchange (KTE) in the eastern Mediterranean region (EMR). This multi-country study explores researchers' views and experiences regarding the role of health systems and policy research evidence in health policymaking in the EMR, including the factors that influence health policymaking, barriers and facilitators to the use of evidence, and the factors that increase researchers' engagement in KTE. Methods Researchers who published health systems and policy relevant research in 12 countries in the EMR (Bahrain, Egypt, Iran, Jordan, Lebanon, Libya, Morocco, Oman, Palestine, Sudan, Syria, and Yemen) were surveyed. Descriptive analysis and Linear Mixed Regression Models were performed for quantitative sections and the simple thematic analysis approach was used for open-ended questions. Results A total of 238 researchers were asked to complete the survey (response rate 56%). Researchers indicated transferring results to other researchers (67.2%) and policymakers in the government (40.5%). Less than one-quarter stated that they produced policy briefs (14.5%), disseminated messages that specified possible actions (24.4%), interacted with policymakers and stakeholders in priority-setting (16%), and involved them in their research (19.8%). Insufficient policy dialogue opportunities and collaboration between researchers and policymakers and stakeholders (67.9%), practical constraints to implementation (66%), non-receptive policy environment (61.3%), and politically sensitive findings (57.7%) hindered the use of evidence. Factors that increase researchers' engagement in KTE activities in the region were associated with involving policymakers and stakeholders at various stages such as priority-setting exercises and provision of technical assistance. Conclusions Researchers in the EMR recognize the importance of using health systems evidence in health policymaking. Potential strategies to improve the use of research evidence emphasize two-way communication between researchers and policymakers. Findings are critical for the upcoming World Health Report 2012, which will emphasize the significance of conducting and translating health research to inform health policies. PMID:22236561

A cluster randomised controlled trial to determine the effect of community mobilisation and advocacy on men’s use of violence in periurban South Africa: study protocol

PubMed Central

Christofides, Nicola J; Hatcher, Abigail M; Pino, Angelica; Rebombo, Dumisani; McBride, Ruari Santiago; Anderson, Althea; Peacock, Dean

2018-01-01

Objective This paper describes the design and methods of a cluster randomised controlled trial (C-RCT) to determine the effectiveness of a community mobilisation intervention that is designed to reduce the perpetration of violence against women (VAW). Methods and analysis A C-RCT of nine intervention and nine control clusters is being carried out in a periurban, semiformal settlement near Johannesburg, South Africa, between 2016 and 2018. A community mobilisation and advocacy intervention, called Sonke CHANGE is being implemented over 18 months. It comprises local advocacy and group activities to engage community members to challenge harmful gender norms and reduce VAW. The intervention is hypothesised to improve equitable masculinities, reduce alcohol use and ultimately, to reduce VAW. Intervention effectiveness will be determined through an audio computer-assisted self-interview questionnaire with behavioural measures among 2600 men aged between 18 and 40 years at baseline, 12 months and 24 months. The primary trial outcome is men’s use of physical and/or sexual VAW. Secondary outcomes include harmful alcohol use, gender attitudes, controlling behaviours, transactional sex and social cohesion. The main analysis will be intention-to-treat based on the randomisation of clusters. A qualitative process evaluation is being conducted alongside the C-RCT. Implementers and men participating in the intervention will be interviewed longitudinally over the period of intervention implementation and observations of the workshops and other intervention activities are being carried out. Ethics and dissemination Ethical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee and procedures comply with ethical recommendations of the United Nations Multi-Country Study on Men and Violence. Dissemination of research findings will take place with local stakeholders and through peer-reviewed publications, with data available on request or after 5 years of trial completion. Trial registration number NCT02823288; Pre-result. PMID:29574438

[Prevalence of intimate partner violence in heterosexual men attending HIV voluntary counsel and test clinics and related factors in Shanghai].

PubMed

Liu, Y; Yang, Y M; Ning, Z; Zheng, H; Liu, H; Tang, H F; Zhang, Y Y; He, N

2016-07-01

To understand prevalence of intimate partner violence(IPV)in heterosexual men(HM)attending HIV voluntary counseling and testing(VCT)clinics and related factors in Shanghai. All the HM attending two VCT clinics in Shanghai during March-August, 2015 were recruited to participate in a cross-sectional survey with questionnaire interview and blood test for HIV. IPV was evaluated by using the questionnaire developed by WHO Multi-Country Study on Women' s Health and Domestic Violence against Women. A total of 327 participants were recruited, their average age was 29.4 years(s∶6.1). Among them 60.2%(197/327)were aged 26-35, 57.8%(189/327)never married, 78.8%(260/327)had educational level of ≥college degree, 49.5%(162/327)were not local residents; 72.2%(236/327)had steady female partners, 72.2%(236/327)had 2 or more female partners in the past year, 6.1%(20/327)reported being diagnosed with sexually transmitted disease(STD). 1.8%(6/327)were tested to be HIV-positive. 28.4%(93/327)had IPV behaviors against heterosexual partners. Multivariate logistic regression analysis indicated that IPV behavior against heterosexual partners was significantly associated with experience of commercial sex(aOR=2.19, 95%CI: 1.16-4.15)and witness of domestic violence in early life(aOR=3.19; 95%CI: 1.58-6.45). IPV prevalence was relatively high in HM attendants in VCT clinics in Shanghai and IPV intervention is needed to conduct in VCT clinics. Multivariate regression analysis showed that the factors associated with IPV behaviors included having sex with female sex workers and the witness of domestic violence between parents. Future research is needed to further explore the association between IPV and HIV infection.

Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

PubMed Central

Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

2014-01-01

Background Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. Methods & Findings In 2010–2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2–8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77–95% alive and on treatment). Conclusions This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation. PMID:25389777

Prevalence and associated factors of illicit drug use among university students in the association of southeast Asian nations (ASEAN).

PubMed

Yi, Siyan; Peltzer, Karl; Pengpid, Supa; Susilowati, Indri Hapsari

2017-04-06

Illicit drug use among university students has been recognized as a global public health issue in recent years. It may lead to poor academic performance that in turn leads to poor productivity in their later life. This study explores prevalence of and factors associated with illicit drug use among university students in the Association of Southeast Asian Nations (ASEAN). This multi-country cross-sectional study was conducted in 2015 in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam. A multi-stage cluster sampling was used to select undergraduate students from one or two universities in each country for self-administered questionnaire survey. Multivariate logistic regression analyses was performed to explore risk factors related to illicit drug use. Participants included 7,923 students with a mean age of 20.6 years (SD = 2.8), ranging from 18-30 years. The overall prevalence of frequent (≥10 times), infrequent (1-9 times) and ever (at least once) illicit drug use in the past 12 months was 2.2, 14.7, and 16.9%, respectively. After adjustment, male students were significantly less likely to be infrequent (1-9 times vs. never), but significantly more likely to be ever users compared to females. Compared to those living with parents/guardians, students living away from parents/guardians were significantly less likely to be frequent (≥10 times vs. never) and infrequent users. Students from lower-middle-income countries were significantly more likely to be frequent and infrequent users, but significantly less likely to be ever users compared to those from upper-middle or high-income countries. Students with poor subjective health status were significantly more likely to be frequent users compared to those who reported good subjective health status. Students who reported binge drinking in the past month were significantly more likely to be infrequent users, but significantly less likely to be ever users. Our findings indicate that prevalence of illicit drug use among university students in the ASEAN region varied by country. Concerted social intervention programs should be designed to address related health and behavioral problems such as illicit drug use and alcohol drinking with particular emphasis on at-risk subgroups of this young population.

The Ebola outbreak, 2013–2016: old lessons for new epidemics

PubMed Central

Lindsey, Benjamin; Ghinai, Isaac; Johnson, Anne M.; Heymann, David L.

2017-01-01

Ebola virus causes a severe haemorrhagic fever in humans with high case fatality and significant epidemic potential. The 2013–2016 outbreak in West Africa was unprecedented in scale, being larger than all previous outbreaks combined, with 28 646 reported cases and 11 323 reported deaths. It was also unique in its geographical distribution and multicountry spread. It is vital that the lessons learned from the world's largest Ebola outbreak are not lost. This article aims to provide a detailed description of the evolution of the outbreak. We contextualize this outbreak in relation to previous Ebola outbreaks and outline the theories regarding its origins and emergence. The outbreak is described by country, in chronological order, including epidemiological parameters and implementation of outbreak containment strategies. We then summarize the factors that led to rapid and extensive propagation, as well as highlight the key successes, failures and lessons learned from this outbreak and the response. This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’. PMID:28396469

Retirement effects on health in Europe.

PubMed

Coe, Norma B; Zamarro, Gema

2011-01-01

What are the health impacts of retirement? As talk of raising retirement ages in pensions and social security schemes continues around the world, it is important to know both the costs and benefits for the individual, as well as the governments' budgets. In this paper we use the Survey of Health, Ageing and Retirement in Europe (SHARE) dataset to address this question in a multi-country setting. We use country-specific early and full retirement ages as instruments for retirement behavior. These statutory retirement ages clearly induce retirement, but are not related to an individual's health. Exploiting the discontinuities in retirement behavior across countries, we find significant evidence that retirement has a health-preserving effect on overall general health. Our estimates indicate that retirement leads to a 35 percent decrease in the probability of reporting to be in fair, bad, or very bad health, and an almost one standard deviation improvement in the health index. While the self-reported health seems to be a temporary impact, the health index indicates there are long-lasting health differences. Copyright © 2010 Elsevier B.V. All rights reserved.

Data Management and Data Quality in PERCH, a Large International Case-Control Study of Severe Childhood Pneumonia.

PubMed

Watson, Nora L; Prosperi, Christine; Driscoll, Amanda J; Higdon, Melissa M; Park, Daniel E; Sanza, Megan; DeLuca, Andrea N; Awori, Juliet O; Goswami, Doli; Hammond, Emily; Hossain, Lokman; Johnson, Catherine; Kamau, Alice; Kuwanda, Locadiah; Moore, David P; Neyzari, Omid; Onwuchekwa, Uma; Parker, David; Sapchookul, Patranuch; Seidenberg, Phil; Shamsul, Arifin; Siazeele, Kazungu; Srisaengchai, Prasong; Sylla, Mamadou; Levine, Orin S; Murdoch, David R; O'Brien, Katherine L; Wolff, Mark; Deloria Knoll, Maria

2017-06-15

The Pneumonia Etiology Research for Child Health (PERCH) study is the largest multicountry etiology study of pediatric pneumonia undertaken in the past 3 decades. The study enrolled 4232 hospitalized cases and 5325 controls over 2 years across 9 research sites in 7 countries in Africa and Asia. The volume and complexity of data collection in PERCH presented considerable logistical and technical challenges. The project chose an internet-based data entry system to allow real-time access to the data, enabling the project to monitor and clean incoming data and perform preliminary analyses throughout the study. To ensure high-quality data, the project developed comprehensive quality indicator, data query, and monitoring reports. Among the approximately 9000 cases and controls, analyzable laboratory results were available for ≥96% of core specimens collected. Selected approaches to data management in PERCH may be extended to the planning and organization of international studies of similar scope and complexity. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Moderating effects of age, gender and education on the associations of perceived neighborhood environment attributes with accelerometer-based physical activity: The IPEN adult study.

PubMed

Van Dyck, Delfien; Cerin, Ester; De Bourdeaudhuij, Ilse; Salvo, Deborah; Christiansen, Lars B; Macfarlane, Duncan; Owen, Neville; Mitas, Josef; Troelsen, Jens; Aguinaga-Ontoso, Ines; Davey, Rachel; Reis, Rodrigo; Sarmiento, Olga L; Schofield, Grant; Conway, Terry L; Sallis, James F

2015-11-01

The study's purpose was to examine age, gender, and education as potential moderators of the associations of perceived neighborhood environment variables with accelerometer-based moderate-to-vigorous physical activity (MVPA). Data were from 7273 adults from 16 sites (11 countries) that were part of a coordinated multi-country cross-sectional study. Age moderated the associations of perceived crime safety, and perceiving no major physical barriers to walking, with MVPA: positive associations were only found in older adults. Perceived land use mix-access was linearly (positive) associated with MVPA in men, and curvilinearly in women. Perceived crime safety was related to MVPA only in women. No moderating relationships were found for education. Overall the associations of adults' perceptions of environmental attributes with MVPA were largely independent of the socio-demographic factors examined. These findings are encouraging, suggesting that efforts to optimize the perceived built and social environment may act in a socially-equitable manner to facilitate MVPA. Copyright © 2015 Elsevier Ltd. All rights reserved.

Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study.

PubMed

Stöckl, Heidi; March, Laura; Pallitto, Christina; Garcia-Moreno, Claudia

2014-07-25

Little is known about the prevalence of intimate partner violence (IPV) and its associated factors among adolescents and younger women. This study analyzed data from nine countries of the WHO Multi-country Study on Women's Health and Domestic Violence against Women, a population based survey conducted in ten countries between 2000 and 2004. The lifetime prevalence of IPV ranged from 19 to 66 percent among women aged 15 to 24, with most sites reporting prevalence above 50 percent. Factors significantly associated with IPV across most sites included witnessing violence against the mother, partner's heavy drinking and involvement in fights, women's experience of unwanted first sex, frequent quarrels and partner's controlling behavior. Adolescent and young women face a substantially higher risk of experiencing IPV than older women. Adolescence and early adulthood is an important period in laying the foundation for healthy and stable relationships, and women's health and well-being overall. Ensuring that adolescents and young women enjoy relationships free of violence is an important investment in their future.

Integrating male sexual diversity into violence prevention efforts with men and boys: evidence from the Asia-Pacific Region.

PubMed

Miedema, Stephanie S; Yount, Kathryn M; Chirwa, Esnat; Dunkle, Kristin; Fulu, Emma

2017-02-01

Men's perpetration of gender-based violence remains a global public health issue. Violence prevention experts call for engagement of boys and men to change social norms around masculinity in order to prevent gender-based violence. Yet, men do not comprise a homogenous category. Drawing on probability estimates of men who report same-sex practices and preferences captured in a multi-country gender-based violence prevention survey in the Asia-Pacific region, we test the effects of sexuality-related factors on men's adverse life experiences. We find that sexual minority men face statistically higher risk of lifetime adversity related to gender-based violence, stemming from gender inequitable norms in society. Sexuality is thus a key axis of differentiation among men in the Asia-Pacific region, influencing health and wellbeing and reflecting men's differential engagement with dominant norms of masculinity. Integrating awareness of male sexual diversity into gender-based violence prevention interventions, particularly those that work with boys and men, and bridging violence prevention programming between sexual minority communities and women, are essential to tackle the root drivers of violence.

Is democracy good for health?

PubMed

Safaei, Jalil

2006-01-01

Studies of health have recognized the influence of socioeconomic position on health outcomes. People with higher socioeconomic ranking, in general, tend to be healthier than those with lower socioeconomic rankings. The effect of political environment on population health has not been adequately researched, however. This study investigates the effect of democracy (or lack thereof) along with socioeconomic factors on population health. It is maintained that democracy may have an impact on health independent of the effects of socioeconomic factors. Such impact is considered as the direct effect of democracy on health. Democracy may also affect population health indirectly by affecting socioeconomic position. To investigate these theoretical links, some broad measures of population health (e.g., mortality rates and life expectancies) are empirically examined across a spectrum of countries categorized as autocratic, incoherent, and democratic polities. The regression findings support the positive influence of democracy on population health. Incoherent polities, however, do not seem to have any significant health advantage over autocratic polities as the reference category. More rigorous tests of the links between democracy and health should await data from multi-country population health surveys that include specific measures of mental and physical morbidity.

Profile and professional expectations of medical students from 11 Latin American countries: the Red-LIRHUS project.

PubMed

Mayta-Tristán, Percy; Pereyra-Elías, Reneé; Montenegro-Idrogo, Juan José; Mejia, Christian R; Inga-Berrospi, Fiorella; Mezones-Holguín, Edward

2017-04-20

Latin America is undergoing a human resource crisis in health care in terms of labor shortage, misdistribution and poor orientation to primary care. Workforce data are needed to inform the planning of long-term strategies to address this problem. This study aimed to evaluate the academic and motivational profile, as well as the professional expectations, of Latin American medical students. We conducted an observational, cross-sectional, multi-country study evaluating medical students from 11 Spanish-speaking countries in 2011-2012. Motivations to study medicine, migration intentions, intent to enter postgraduate programs, and perceptions regarding primary care were evaluated via a self-administered questionnaire. Outcomes were measured with pilot-tested questions and previously validated scales. A total of 11,072 valid surveys from 63 medical schools were gathered and analyzed. This study describes the profile and expectations of the future workforce being trained in Latin America. The obtained information will be useful for governments and universities in planning strategies to improve their current state of affairs regarding human resources for health care professions.

Adolescent Wound-Care Self-Efficacy and Practices After Voluntary Medical Male Circumcision—A Multicountry Assessment

PubMed Central

Mavhu, Webster; Hatzold, Karin; Dam, Kim H; Kaufman, Michelle R; Patel, Eshan U; Van Lith, Lynn M; Kahabuka, Catherine; Marcell, Arik V; Mahlasela, Lusanda; Njeuhmeli, Emmanuel; Seifert Ahanda, Kim; Ncube, Getrude; Lija, Gissenge; Bonnecwe, Collen; Tobian, Aaron A R

2018-01-01

Abstract Background Adolescent boys (aged 10–19 years) constitute the majority of voluntary medical male circumcision (VMMC) clients in sub-Saharan Africa. They are at higher risk of postoperative infections compared to adults. We explored adolescents’ wound-care knowledge, self-efficacy, and practices after VMMC to inform strategies for reducing the risks of infectious complications postoperatively. Methods Quantitative and qualitative data were collected in South Africa, Tanzania, and Zimbabwe between June 2015 to September 2016. A postprocedure survey was conducted approximately 7–10 days after VMMC among male adolescents (n = 1293) who had completed a preprocedure survey; the postprocedure survey assessed knowledge of proper wound care and wound-care self-efficacy. We also conducted in-depth interviews (n = 92) with male adolescents 6–10 weeks after the VMMC procedure to further explore comprehension of providers’ wound-care instructions as well as wound-care practices, and we held 24 focus group discussions with randomly selected parents/guardians of the adolescents. Results Adolescent VMMC clients face multiple challenges with postcircumcision wound care owing to factors such as forgetting, misinterpreting, and disregarding provider instructions. Although younger adolescents stated that parental intervention helped them overcome potential hindrances to wound care, parents and guardians lacked crucial information on wound care because most had not attended counseling sessions. Some older adolescents reported ignoring symptoms of infection and not returning to the clinic for review when an adverse event had occurred. Conclusions Increased involvement of parents/guardians in wound-care counseling for younger adolescents and in wound-care supervision, alongside the development of age-appropriate materials on wound care, are needed to minimize postoperative complications after VMMC. PMID:29617777

Evaluating capacity-building for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners and researchers.

PubMed

Hanlon, C; Semrau, M; Alem, A; Abayneh, S; Abdulmalik, J; Docrat, S; Evans-Lacko, S; Gureje, O; Jordans, M; Lempp, H; Mugisha, J; Petersen, I; Shidhaye, R; Thornicroft, G

2018-02-01

Efforts to support the scale-up of integrated mental health care in low- and middle-income countries (LMICs) need to focus on building human resource capacity in health system strengthening, as well as in the direct provision of mental health care. In a companion editorial, we describe a range of capacity-building activities that are being implemented by a multi-country research consortium (Emerald: Emerging mental health systems in low- and middle-income countries) for (1) service users and caregivers, (2) service planners and policy-makers and (3) researchers in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda). In this paper, we focus on the methodology being used to evaluate the impact of capacity-building in these three target groups. We first review the evidence base for approaches to evaluation of capacity-building, highlighting the gaps in this area. We then describe the adaptation of best practice for the Emerald capacity-building evaluation. The resulting mixed method evaluation framework was tailored to each target group and to each country context. We identified a need to expand the evidence base on indicators of successful capacity-building across the different target groups. To address this, we developed an evaluation plan to measure the adequacy and usefulness of quantitative capacity-building indicators when compared with qualitative evaluation. We argue that evaluation needs to be an integral part of capacity-building activities and that expertise needs to be built in methods of evaluation. The Emerald evaluation provides a potential model for capacity-building evaluation across key stakeholder groups and promises to extend understanding of useful indicators of success.

Human epidermal growth factor receptor 2 status of gastric cancer patients in Asia: results from a large, multicountry study.

PubMed

Pathmanathan, Nirmala; Geng, Jing-Shu; Li, Wencai; Nie, Xiu; Veloso, Januario; Wang, John; Hill, Julie; Mccloud, Philip; Bilous, Michael

2017-06-01

Current estimates of the human epidermal growth factor receptor 2 (HER2)-positivity rate in gastric cancer vary widely in the literature, and there are limited data from countries in Asia. The primary aim of this study was to conduct a clinical audit of laboratories across seven countries in Asia to determine the incidence of HER2-positive gastric cancer in this region. Pathologists were asked to collect data on patient gender, age, cancer site, specimen type, tumor spread, type and grade, HER2 test results, including protein and/or gene copy enumeration, and final HER2 status on consecutive gastric cancer cases tested for HER2 in their laboratory over a 2-year period. HER2 results from 5,301 gastric cancers were submitted by 50 laboratories. The overall HER2-positivity rate was 9.7% which, after the exclusion of China, increased to 18.1%. The rate between countries ranged from 0% to 23.1%, and from 0% to 50.0% between laboratories. An equivocal HER2 result was recorded in 19.5% of cases. Despite the lack of centralized testing to confirm the accuracy of HER2 diagnoses, the incidence of HER2-positive gastric cancer observed here was comparable to that reported in the literature. Nevertheless, rates were highly variable between countries and laboratories, which suggests a lack of HER2 testing expertise in gastric cancer. Given that the mortality rates for gastric cancer in Eastern Asia are the highest in the world, efforts should focus on improving HER2 testing expertise in the region so that patients receive the appropriate treatment early in their disease. © 2016 The Authors. Asia-Pacific Journal of Clinical Oncology Published by John Wiley & Sons Australia, Ltd.

Evaluation of skill at simulating heatwave and heat-humidity indices in Global and Regional Climate Models

NASA Astrophysics Data System (ADS)

Goldie, J. K.; Alexander, L. V.; Lewis, S. C.; Sherwood, S. C.

2017-12-01

A wide body of literature now establishes the harm of extreme heat on human health, and work is now emerging on the projection of future health impacts. However, heat-health relationships vary across different populations (Gasparrini et al. 2015), so accurate simulation of regional climate is an important component of joint health impact projection. Here, we evaluate the ability of nine Global Climate Models (GCMs) from CMIP5 and the NARCliM Regional Climate Model to reproduce a selection of 15 health-relevant heatwave and heat-humidity indices over the historical period (1990-2005) using the Perkins skill score (Perkins et al. 2007) in five Australian cities. We explore the reasons for poor model skill, comparing these modelled distributions to both weather station observations and gridded reanalysis data. Finally, we show changes in the modelled distributions from the highest-performing models under RCP4.5 and RCP8.5 greenhouse gas scenarios and discuss the implications of simulated heat stress for future climate change adaptation. ReferencesGasparrini, Antonio, Yuming Guo, Masahiro Hashizume, Eric Lavigne, Antonella Zanobetti, Joel Schwartz, Aurelio Tobias, et al. "Mortality Risk Attributable to High and Low Ambient Temperature: A Multicountry Observational Study." The Lancet 386, no. 9991 (July 31, 2015): 369-75. doi:10.1016/S0140-6736(14)62114-0. Perkins, S. E., A. J. Pitman, N. J. Holbrook, and J. McAneney. "Evaluation of the AR4 Climate Models' Simulated Daily Maximum Temperature, Minimum Temperature, and Precipitation over Australia Using Probability Density Functions." Journal of Climate 20, no. 17 (September 1, 2007): 4356-76. doi:10.1175/JCLI4253.1.

Differences in psychiatric symptoms among Asian patients with depression: a multi-country cross-sectional study.

PubMed

Sulaiman, Ahmad H; Bautista, Dianne; Liu, Chia-Yih; Udomratn, Pichet; Bae, Jae Nam; Fang, Yiru; Chua, Hong C; Liu, Shen-Ing; George, Tom; Chan, Edwin; Tian-mei, Si; Hong, Jin Pyo; Srisurapanont, Manit; Rush, A John

2014-04-01

The aim of this study was to compare the symptomatic and clinical features of depression among five groups of patients with major depressive disorder (MDD) living in China, Korea, Malaysia/Singapore, Taiwan, and Thailand. Consecutive consenting adults (aged 18-65) who met DSM-IV criteria for non-psychotic MDD – based on the Mini International Neuropsychiatric Interview – and who were free of psychotropic medication were evaluated in a cross-sectional study. Depressive symptoms were evaluated using the 10-item Montgomery–Asberg Depression Rating Scale (MADRS) and the 13-item depression subscale of the Symptoms Checklist 90-Revised (SCL-90-R). In addition, the 10-item SCL-90-R Anxiety Subscale was completed. ancova were conducted, adjusting for confounders: age, completion of secondary education, marital status, work status, religion, index episode duration, and depressive severity. For the magnitude of differences, a threshold of 0.10 was taken as the minimum effect size representing clinical significance, and an effect size of 0.25 was considered moderate. Four MADRS symptoms differentiated these five groups, the most prominent being ‘lassitude’ and ‘inner tension’. Nine SCL-90-R depression items also differentiated the groups, as did eight SCL-90-R Anxiety Subscale items. The MADRS lassitude item had the largest effect size (0.131). The rest of those statistically significant differences did not exceed 0.10. MDD is more similar than different among outpatients in these diverse Asian countries. The between-country differences, while present and not due to chance, are small enough to enable the use of common clinician and self-report rating scales in studies involving Asians with MDD from various ethnic backgrounds.

Access to parks and physical activity: an eight country comparison.

PubMed

Schipperijn, Jasper; Cerin, Ester; Adams, Marc A; Reis, Rodrigo; Smith, Graham; Cain, Kelli; Christiansen, Lars B; van Dyck, Delfien; Gidlow, Christopher; Frank, Lawrence D; Mitáš, Josef; Pratt, Michael; Salvo, Deborah; Schofield, Grant; Sallis, James F

2017-10-01

Several systematic reviews have reported mixed associations between access to parks and physical activity, and suggest that this is due to inconsistencies in the study methods or differences across countries. An international study using consistent methods is needed to investigate the association between access to parks and physical activity. The International Physical Activity and Environment Network (IPEN) Adult Study is a multi-country cross-sectional study using a common design and consistent methods. Accelerometer, survey and Geographic Information Systems (GIS) data for 6,181 participants from 12 cities in 8 countries (Belgium, Brazil, Czech Republic, Denmark, Mexico, New Zealand, UK, USA) were used to estimate the strength and shape of associations of 11 measures of park access (1 perceived and 10 GIS-based measures) with accelerometer-based moderate-to-vigorous physical activity (MVPA) and four types of self-reported leisure-time physical activity. Associations were estimated using generalized additive mixed models. More parks within 1 km from participants' homes were associated with greater leisure-time physical activity and accelerometer-measured MVPA. Respondents who lived in the neighborhoods with the most parks did on average 24 minutes more MVPA per week than those living in the neighborhoods with the lowest number of parks. Perceived proximity to a park was positively associated with multiple leisure-time physical activity outcomes. Associations were homogeneous across all cities studied. Living in neighborhoods with many parks could contribute with up to 1/6 of the recommended weekly Having multiple parks nearby was the strongest positive correlate of PA. To increase comparability and validity of park access measures, we recommend that researchers, planners and policy makers use the number of parks within 1 km travel distance of homes as an objective indicator for park access in relation to physical activity.

Liver transplant associated with paracetamol overdose: results from the seven-country SALT study

PubMed Central

Gulmez, Sinem Ezgi; Larrey, Dominique; Pageaux, Georges-Philippe; Bernuau, Jacques; Bissoli, Franco; Horsmans, Yves; Thorburn, Douglas; McCormick, P Aiden; Stricker, Bruno; Toussi, Massoud; Lignot-Maleyran, Séverine; Micon, Sophie; Hamoud, Fatima; Lassalle, Régis; Jové, Jérémy; Blin, Patrick; Moore, Nicholas

2015-01-01

Aims Acute drug overdose, especially with paracetamol, may cause acute liver failure leading to registration for transplantation (ALFT). Population statistics and between-country differences for ALFT related to overdose have been poorly described. The aim of the present study was to evaluate overdose ALFT in the multi-country Study of Acute Liver Transplantation (SALT). Methods All adult overdose-related ALFT, with or without suicidal intent, in France, Greece, Ireland, Italy, the Netherlands, Portugal and the UK between 2005 and 2007 were identified from liver transplant registries and hospital records. These were compared with whole-country and per capita use of paracetamol. Results Six hundred cases of ALFT were identified in 52 of 57 eligible transplant centres, of which 114 involved overdose (72 intentional, 10 non-intentional, 32 uncertain). Overdose represented 20% of all-cause ALFT: Ireland 52%, UK 28%, France 18%, the Netherlands 8%, and Italy 1%. Overdose ALFT were mostly females (61%), mean age 33.6 ± 10.9 years. A total of 111 (97%) of the overdoses involved paracetamol. Event rates ranged from one ALFT for 20.7 tons of paracetamol in Ireland, to one for 1074 tons in Italy and one case in 60 million inhabitants over 3 years in Italy to one case in 286 000 inhabitants per year in Ireland. Per-country event rates for non-overdose ALFT exposed to paracetamol were between 2.5 and 4.0 per million treatment-years sold. Conclusions Paracetamol overdose was found to represent one-sixth of all-cause ALFT. There was a 50-fold difference in Europe in the rates of paracetamol overdose ALFT, and a 200-fold difference per million inhabitants. PMID:26017643

Liver transplant associated with paracetamol overdose: results from the seven-country SALT study.

PubMed

Gulmez, Sinem Ezgi; Larrey, Dominique; Pageaux, Georges-Philippe; Bernuau, Jacques; Bissoli, Franco; Horsmans, Yves; Thorburn, Douglas; McCormick, P Aiden; Stricker, Bruno; Toussi, Massoud; Lignot-Maleyran, Séverine; Micon, Sophie; Hamoud, Fatima; Lassalle, Régis; Jové, Jérémy; Blin, Patrick; Moore, Nicholas

2015-09-01

Acute drug overdose, especially with paracetamol, may cause acute liver failure leading to registration for transplantation (ALFT). Population statistics and between-country differences for ALFT related to overdose have been poorly described. The aim of the present study was to evaluate overdose ALFT in the multi-country Study of Acute Liver Transplantation (SALT). All adult overdose-related ALFT, with or without suicidal intent, in France, Greece, Ireland, Italy, the Netherlands, Portugal and the UK between 2005 and 2007 were identified from liver transplant registries and hospital records. These were compared with whole-country and per capita use of paracetamol. Six hundred cases of ALFT were identified in 52 of 57 eligible transplant centres, of which 114 involved overdose (72 intentional, 10 non-intentional, 32 uncertain). Overdose represented 20% of all-cause ALFT: Ireland 52%, UK 28%, France 18%, the Netherlands 8%, and Italy 1%. Overdose ALFT were mostly females (61%), mean age 33.6 ± 10.9 years. A total of 111 (97%) of the overdoses involved paracetamol. Event rates ranged from one ALFT for 20.7 tons of paracetamol in Ireland, to one for 1074 tons in Italy and one case in 60 million inhabitants over 3 years in Italy to one case in 286 000 inhabitants per year in Ireland. Per-country event rates for non-overdose ALFT exposed to paracetamol were between 2.5 and 4.0 per million treatment-years sold. Paracetamol overdose was found to represent one-sixth of all-cause ALFT. There was a 50-fold difference in Europe in the rates of paracetamol overdose ALFT, and a 200-fold difference per million inhabitants. © 2015 The British Pharmacological Society.

Factors and Regional Differences Associated with Endometriosis: A Multi-Country, Case-Control Study.

PubMed

Chapron, Charles; Lang, Jing-He; Leng, Jin-Hua; Zhou, Yingfang; Zhang, Xinmei; Xue, Min; Popov, Alexander; Romanov, Vladimir; Maisonobe, Pascal; Cabri, Patrick

2016-08-01

The present study aimed to investigate clinical, lifestyle, and environmental factors associated with endometrioma (OMA) and/or deep infiltrating endometriosis (DIE) as determined by case-control comparison [women with superficial peritoneal endometriosis (SUP) or no endometriosis], and compare differences between factor associated with endometriosis at a national level. This was three countries (China, Russia, and France), case-control study in 1008 patients. Patients were identified and enrolled during their first routine appointment with their physician post-surgery for a benign gynecologic indication, excluding pregnancy. Retrospective information on symptoms and previous medical history was collected via face-to-face interviews; patients also completed a questionnaire to provide information on current habits. For every DIE patient recruited (n = 143), two women without endometriosis (n = 288), two SUP patients (n = 288), and two OMA patients (n = 288) were recruited. For the overall population, factors significantly associated (P ≤ 0.05) with DIE or OMA [Odds ratio (OR) >1] were: previous use of hormonal treatment for endometriosis [OR 6.66; 95% confidence interval (CI) 4.05-10.93]; previous surgery for endometriosis (OR 1.95; 95% CI 1.11-3.43); and living or working in a city or by a busy area (OR 1.66; 95% CI 1.09-2.52). Differences between regions with regard to the diagnosis, symptomatology, and treatment of endometriosis exist. The findings provide insight into potential risk factors for endometriosis and differences between regions in terms of endometriosis management and symptomatology. Further investigations are required to confirm the associations found in this study. ClinicalTrials.gov identifier, NCT01351051. Ipsen.

Cigarette characteristic and emission variations across high-, middle- and low-income countries.

PubMed

O'Connor, R J; Wilkins, K J; Caruso, R V; Cummings, K M; Kozlowski, L T

2010-12-01

The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries. Multicountry observational study. Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank's per capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences. Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ(2)(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features. This study showed that as a country's income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries. Copyright © 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Cigarette characteristic and emission variations across high-, middle- and low-income countries

PubMed Central

O’Connor, R.J.; Wilkins, K.J.; Caruso, R.V.; Cummings, K.M.; Kozlowski, L.T.

2010-01-01

SUMMARY Objectives The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries. Study design Multicountry observational study. Methods Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank’s per-capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences. Results Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ2(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features. Conclusions This study showed that as a country’s income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries. PMID:21030055

Assessing the spatial and temporal variability of fine particulate matter components in Israeli, Jordanian, and Palestinian cities

NASA Astrophysics Data System (ADS)

Sarnat, Jeremy A.; Moise, Tamar; Shpund, Jacob; Liu, Yang; Pachon, Jorge E.; Qasrawi, Radwan; Abdeen, Ziad; Brenner, Shmuel; Nassar, Khaled; Saleh, Rami; Schauer, James J.

2010-07-01

This manuscript presents results from an extensive, multi-country comparative monitoring study of fine particulate matter (PM 2.5) and its primary chemical components in Israeli, Jordanian and Palestinian cities. This study represented the first time that researchers from these countries have worked together to examine spatial and temporal relationships for PM 2.5 and its major components among the study sites. The findings indicated that total PM 2.5 mass was relatively homogenous among many of the 11 sites as shown from strong between-site correlations. Mean annual concentrations ranged from 19.9 to 34.9 μg m -3 in Haifa and Amman, respectively, and exceeded accepted international air quality standards for annual PM 2.5 mass. Similarity of total mass was largely driven by SO 42- and crustal PM 2.5 components. Despite the close proximity of the seven, well correlated sites with respect to PM 2.5, there were pronounced differences among the cities for EC and, to a lesser degree, OC. EC, in particular, exhibited spatiotemporal trends that were indicative of strong local source contributions. Interestingly, there were moderate to strong EC correlations ( r > 0.65) among the large metropolitan cities, West Jerusalem, Tel Aviv and Amman. For these relatively large cities, (i.e., West Jerusalem, Tel Aviv and Amman), EC sources from the fleet of buses and cars typical for many urban areas predominate and likely drive spatiotemporal EC distributions. As new airshed management strategies and public health interventions are implemented throughout the Middle East, our findings support regulatory strategies that target integrated regional and local control strategies to reduce PM 2.5 mass and specific components suspected to drive adverse health effects of particulate matter exposure.

Women’s and men’s reports of past-year prevalence of intimate partner violence and rape and women’s risk factors for intimate partner violence: A multicountry cross-sectional study in Asia and the Pacific

PubMed Central

Fulu, Emma; Tabassam Naved, Ruchira; Chirwa, Esnat; Dunkle, Kristin; Haardörfer, Regine; Garcia-Moreno, Claudia

2017-01-01

Background Understanding the past-year prevalence of male-perpetrated intimate partner violence (IPV) and risk factors is essential for building evidence-based prevention and monitoring progress to Sustainable Development Goal (SDG) 5.2, but so far, population-based research on this remains very limited. The objective of this study is to compare the population prevalence rates of past-year male-perpetrated IPV and nonpartner rape from women’s and men’s reports across 4 countries in Asia and the Pacific. A further objective is to describe the risk factors associated with women’s experience of past-year physical or sexual IPV from women’s reports and factors driving women’s past-year experience of partner violence. Methods and findings This paper presents findings from the United Nations Multi-country Study on Men and Violence in Asia and the Pacific. In the course of this study, in population-based cross-sectional surveys, 5,206 men and 3,106 women aged 18–49 years were interviewed from 4 countries: Cambodia, China, Papua New Guinea (PNG), and Sri Lanka. To measure risk factors, we use logistic regression and structural equation modelling to show pathways and mediators. The analysis was not based on a written plan, and following a reviewer’s comments, some material was moved to supplementary files and the regression was performed without variable elimination. Men reported more lifetime perpetration of IPV (physical or sexual IPV range 32.5%–80%) than women did experience (physical or sexual IPV range 27.5%–67.4%), but women’s reports of past-year experience (physical or sexual IPV range 8.2%–32.1%) were not very clearly different from men’s (physical or sexual IPV range 10.1%–34.0%). Women reported much more emotional/economic abuse (past-year ranges 1.4%–5.7% for men and 4.1%–27.7% for women). Reports of nonpartner rape were similar for men (range 0.8%–1.9% in the past year) and women (range 0.4%–2.3% in past year), except in Bougainville, where they were higher for men (11.7% versus 5.7%). The risk factor modelling shows 4 groups of variables to be important in experience of past-year sexual and/or physical IPV: (1) poverty, (2) all childhood trauma, (3) quarrelling and women’s limited control in relationships, and (4) partner factors (substance abuse, unemployment, and infidelity). The population attributable fraction (PAF) was largest for quarrelling often, but the second greatest PAF was for the group related to exposure to violence in childhood. The relationship control variable group had the third highest PAF, followed by other partner factors. Currently married women were also more at risk. In the structural model, a resilience pathway showed less poverty, higher education, and more gender-equitable ideas were connected and conveyed protection from IPV. These are all amenable risk factors. This research was cross-sectional, so we cannot be sure of the temporal sequence of exposure, but the outcome being a past-year measure to some extent mitigates this problem. Conclusions Past-year IPV indicators based on women’s reported experience that were developed to track SDG 5 are probably reasonably reliable but will not always give the same prevalence as may be reported by men. Report validity requires further research. Interviews with men to track past-year nonpartner rape perpetration are feasible and important. The findings suggest a range of factors are associated with past-year physical and/or sexual IPV exposure; of particular interest is the resilience pathway suggested by the structural model, which is highly amenable to intervention and explains why combining economic empowerment of women and gender empowerment/relationship skills training has been successful. This study provides additional rationale for scaling up violence prevention interventions that combine economic and gender empowerment/relationship skills building of women, as well as the value of investing in girls’ education with a view to long-term violence reduction. PMID:28873087

Women's and men's reports of past-year prevalence of intimate partner violence and rape and women's risk factors for intimate partner violence: A multicountry cross-sectional study in Asia and the Pacific.

PubMed

Jewkes, Rachel; Fulu, Emma; Tabassam Naved, Ruchira; Chirwa, Esnat; Dunkle, Kristin; Haardörfer, Regine; Garcia-Moreno, Claudia

2017-09-01

Understanding the past-year prevalence of male-perpetrated intimate partner violence (IPV) and risk factors is essential for building evidence-based prevention and monitoring progress to Sustainable Development Goal (SDG) 5.2, but so far, population-based research on this remains very limited. The objective of this study is to compare the population prevalence rates of past-year male-perpetrated IPV and nonpartner rape from women's and men's reports across 4 countries in Asia and the Pacific. A further objective is to describe the risk factors associated with women's experience of past-year physical or sexual IPV from women's reports and factors driving women's past-year experience of partner violence. This paper presents findings from the United Nations Multi-country Study on Men and Violence in Asia and the Pacific. In the course of this study, in population-based cross-sectional surveys, 5,206 men and 3,106 women aged 18-49 years were interviewed from 4 countries: Cambodia, China, Papua New Guinea (PNG), and Sri Lanka. To measure risk factors, we use logistic regression and structural equation modelling to show pathways and mediators. The analysis was not based on a written plan, and following a reviewer's comments, some material was moved to supplementary files and the regression was performed without variable elimination. Men reported more lifetime perpetration of IPV (physical or sexual IPV range 32.5%-80%) than women did experience (physical or sexual IPV range 27.5%-67.4%), but women's reports of past-year experience (physical or sexual IPV range 8.2%-32.1%) were not very clearly different from men's (physical or sexual IPV range 10.1%-34.0%). Women reported much more emotional/economic abuse (past-year ranges 1.4%-5.7% for men and 4.1%-27.7% for women). Reports of nonpartner rape were similar for men (range 0.8%-1.9% in the past year) and women (range 0.4%-2.3% in past year), except in Bougainville, where they were higher for men (11.7% versus 5.7%). The risk factor modelling shows 4 groups of variables to be important in experience of past-year sexual and/or physical IPV: (1) poverty, (2) all childhood trauma, (3) quarrelling and women's limited control in relationships, and (4) partner factors (substance abuse, unemployment, and infidelity). The population attributable fraction (PAF) was largest for quarrelling often, but the second greatest PAF was for the group related to exposure to violence in childhood. The relationship control variable group had the third highest PAF, followed by other partner factors. Currently married women were also more at risk. In the structural model, a resilience pathway showed less poverty, higher education, and more gender-equitable ideas were connected and conveyed protection from IPV. These are all amenable risk factors. This research was cross-sectional, so we cannot be sure of the temporal sequence of exposure, but the outcome being a past-year measure to some extent mitigates this problem. Past-year IPV indicators based on women's reported experience that were developed to track SDG 5 are probably reasonably reliable but will not always give the same prevalence as may be reported by men. Report validity requires further research. Interviews with men to track past-year nonpartner rape perpetration are feasible and important. The findings suggest a range of factors are associated with past-year physical and/or sexual IPV exposure; of particular interest is the resilience pathway suggested by the structural model, which is highly amenable to intervention and explains why combining economic empowerment of women and gender empowerment/relationship skills training has been successful. This study provides additional rationale for scaling up violence prevention interventions that combine economic and gender empowerment/relationship skills building of women, as well as the value of investing in girls' education with a view to long-term violence reduction.

Implementing services for Early Infant Diagnosis (EID) of HIV: a comparative descriptive analysis of national programs in four countries.

PubMed

Chatterjee, Anirban; Tripathi, Sangeeta; Gass, Robert; Hamunime, Ndapewa; Panha, Sok; Kiyaga, Charles; Wade, Abdoulaye; Barnhart, Matthew; Luo, Chewe; Ekpini, Rene

2011-07-13

There is a significant increase in survival for HIV-infected children who have early access to diagnosis and treatment. The goal of this multi-country review was to examine when and where HIV-exposed infants and children are being diagnosed, and whether the EID service is being maximally utilized to improve health outcomes for HIV-exposed children. In four countries across Africa and Asia existing documents and data were reviewed and key informant interviews were conducted. EID testing data was gathered from the central testing laboratories and was then complemented by health facility level data extraction which took place using a standardized and validated questionnaire In the four countries reviewed from 2006 to 2009 EID sample volumes rose dramatically to an average of >100 samples per quarter in Cambodia and Senegal, >7,000 samples per quarter in Uganda, and >2,000 samples per quarter in Namibia. Geographic coverage of sites also rapidly expanded to 525 sites in Uganda, 205 in Namibia, 48 in Senegal, and 26 in Cambodia in 2009. However, only a small proportion of testing was done at lower-level health facilities: in Uganda Health Center IIs and IIIs comprised 47% of the EID collection sites, but only 11% of the total tests, and in Namibia 15% of EID sites collected >93% of all samples. In all countries except for Namibia, more than 50% of the EID testing was done after 2 months of age. Few sites had robust referral mechanisms between EID and ART. In a sub-sample of children, we noted significant attrition of infants along the continuum of care post testing. Only 22% (Senegal), 37% (Uganda), and 38% (Cambodia) of infants testing positive by PCR were subsequently initiated onto treatment. In Namibia, which had almost universal EID coverage, more than 70% of PCR-positive infants initiated ART in 2008. While EID testing has expanded dramatically, a large proportion of PCR- positive infants are initiated on treatment. As EID services continue to scale-up, more programmatic attention and support is needed to retain HIV-exposed infants in care and ensure that those testing positive initiate treatment in a timely manner. Namibia's experience demonstrates that it is feasible for a rural, low-income country to achieve high national coverage of infant testing and treatment.

Fast-food consumption and body mass index in children and adolescents: an international cross-sectional study.

PubMed

Braithwaite, Irene; Stewart, Alistair W; Hancox, Robert J; Beasley, Richard; Murphy, Rinki; Mitchell, Edwin A

2014-12-08

To investigate whether reported fast-food consumption over the previous year is associated with higher childhood or adolescent body mass index (BMI). Secondary analysis from a multicentre, multicountry cross-sectional study (International Study of Asthma and Allergies in Children (ISAAC) Phase Three). Parents/guardians of children aged 6-7 completed questionnaires which included questions about their children's asthma and allergies, fast-food consumption, height and weight. Adolescents aged 13-14 completed the same questionnaire. The questionnaire asked "In the past 12 months, how often on average did you (your child) eat fast-food/burgers?" The responses were infrequent (never/only occasionally), frequent (once/twice a week) or very frequent (three or more times per week). A general linear mixed model was used to determine the association between BMI and fast-food consumption, adjusting for Gross National Income per capita by country, measurement type (whether heights/weights were reported or measured), age and sex. 72,900 children (17 countries) and 199,135 adolescents (36 countries) provided data. Frequent and very frequent fast-food consumption was reported in 23% and 4% of children, and 39% and 13% of adolescents, respectively. Children in the frequent and very frequent groups had a BMI that was 0.15 and 0.22 kg/m(2) higher than those in the infrequent group (p<0.001). Male adolescents in the frequent and very frequent groups had a BMI that was 0.14 and 0.28 kg/m(2) lower than those in the infrequent group (p<0.001). Female adolescents in the frequent and very frequent groups had a BMI that was 0.19 kg/m(2) lower than those in the infrequent group (p<0.001). Reported fast-food consumption is high in childhood and increases in adolescence. Compared with infrequent fast-food consumption, frequent and very frequent consumption is associated with a higher BMI in children. Owing to residual confounding, reverse causation and likely misreporting, the reverse association observed in adolescents should be interpreted with caution. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Herd-level animal management factors associated with the occurrence of bovine neonatal pancytopenia in calves in a multi-country study.

PubMed

Sauter-Louis, Carola; Jones, Bryony A; Henning, Jörg; Stoll, Alexander; Nielen, Mirjam; Van Schaik, Gerdien; Smolenaars, Anja; Schouten, Matthijs; den Uijl, Ingrid; Fourichon, Christine; Guatteo, Raphael; Madouasse, Aurélien; Nusinovici, Simon; Deprez, Piet; De Vliegher, Sarne; Laureyns, Jozef; Booth, Richard; Cardwell, Jacqueline M; Pfeiffer, Dirk U

2017-01-01

Since 2007, mortality associated with a previously unreported haemorrhagic disease has been observed in young calves in several European countries. The syndrome, which has been named 'bovine neonatal pancytopenia' (BNP), is characterised by thrombocytopenia, leukocytopenia and a panmyelophthisis. A herd-level case-control study was conducted in four BNP affected countries (Belgium, France, Germany and the Netherlands) to identify herd management risk factors for BNP occurrence. Data were collected using structured face-to-face and telephone interviews of farm managers and their local veterinarians. In total, 363 case farms and 887 control farms were included in a matched multivariable conditional logistic regression analysis. Case-control status was strongly associated with the odds of herd level use of the vaccine PregSure® BVD (PregSure, Pfizer Animal Health) (matched adjusted odds ratio (OR) 107.2; 95% CI: 41.0-280.1). This was also the case for the practices of feeding calves colostrum from the calf's own dam (OR 2.0; 95% CI: 1.1-3.4) or feeding pooled colostrum (OR 4.1; 95% CI: 1.9-8.8). Given that the study had relatively high statistical power and represented a variety of cattle production and husbandry systems, it can be concluded with some confidence that no other herd level management factors are competent causes for a sufficient cause of BNP occurrence on herd level. It is suggested that genetic characteristics of the dams and BNP calves should be the focus of further investigations aimed at identifying the currently missing component causes that together with PregSure vaccination and colostrum feeding represent a sufficient cause for occurrence of BNP in calves.

Depressive disorder in pregnant Latin women: does intimate partner violence matter?

PubMed

Fonseca-Machado, Mariana de Oliveira; Alves, Lisiane Camargo; Monteiro, Juliana Cristina Dos Santos; Stefanello, Juliana; Nakano, Ana Márcia Spanó; Haas, Vanderlei José; Gomes-Sponholz, Flávia

2015-05-01

To identify the association of antenatal depressive symptoms with intimate partner violence during the current pregnancy in Brazilian women. Intimate partner violence is an important risk factor for antenatal depression. To the authors' knowledge, there has been no study to date that assessed the association between intimate partner violence during pregnancy and antenatal depressive symptoms among Brazilian women. Cross-sectional study. Three hundred and fifty-eight pregnant women were enrolled in the study. The Edinburgh Postnatal Depression Scale and an adapted version of the instrument used in the World Health Organization Multi-country Study on Women's Health and Domestic Violence were used to measure antenatal depressive symptoms and psychological, physical and sexual acts of intimate partner violence during the current pregnancy respectively. Multiple logistic regression and multiple linear regression were used for data analysis. The prevalence of antenatal depressive symptoms, as determined by the cut-off score of 12 in the Edinburgh Postnatal Depression Scale, was 28·2% (101). Of the participants, 63 (17·6%) reported some type of intimate partner violence during pregnancy. Among them, 60 (95·2%) reported suffering psychological violence, 23 (36·5%) physical violence and one (1·6%) sexual violence. Multiple logistic regression and multiple linear regression indicated that antenatal depressive symptoms are extremely associated with intimate partner violence during pregnancy. Among Brazilian women, exposure to intimate partner violence during pregnancy increases the chances of experiencing antenatal depressive symptoms. Clinical nurses and nurses midwifes should pay attention to the particularities of Brazilian women, especially with regard to the occurrence of intimate partner violence, whose impacts on the mental health of this population are extremely significant, both during the gestational period and postpartum. © 2015 John Wiley & Sons Ltd.

Content Analysis of Primary and Secondary School Textbooks Regarding Malaria Control: A Multi-Country Study

PubMed Central

Nonaka, Daisuke; Jimba, Masamine; Mizoue, Tetsuya; Kobayashi, Jun; Yasuoka, Junko; Ayi, Irene; Jayatilleke, Achini C.; Shrestha, Sabina; Kikuchi, Kimiyo; Haque, Syed E.; Yi, Siyan

2012-01-01

Background In tropical settings, malaria education at school is potentially useful, but textbook content related to malaria education has so far received little attention. This study aimed to examine whether school textbooks contain sufficient knowledge and skills to help children in primary and lower secondary schools and their family members to cope with malaria. Methodology/Principal Findings This was a descriptive, cross-country study. We collected textbooks that were used by children in grades one to nine from nine countries endemic for malaria: Laos, Cambodia, Nepal, Bangladesh, Sri Lanka, Zambia, Niger, Benin, and Ghana. Two reviewers per country identified descriptions about malaria by seeking the term “malaria” or a local word that corresponds to malaria in languages other than English. The authors categorized the identified descriptions according to the content of the descriptions. Additionally, the authors examined whether the identified contents addressed life skill messages. Of a total of 474 textbooks collected, 35 contained descriptions about malaria. The most commonly included content was transmission mode/vector (77.1%), followed by preventive measures (60.0%), epidemiology (57.1%), cause/agent (54.3%), signs/symptoms (37.1%) and treatment (22.9%). Treatment-related content was not included in any textbooks from four countries and textbooks failed to recommend the use of insecticide-treated bed nets in five countries. Very few textbooks included content that facilitated prompt treatment, protection of risk groups, and use of recommended therapy. Conclusion/Significance Textbooks rarely included knowledge and skills that are crucial to protect schoolchildren and their families from malaria. This study identified the need for improvement to textbook contents regarding malaria. PMID:22574203

Systematic review of raloxifene in postmenopausal Japanese women with osteoporosis or low bone mass (osteopenia)

PubMed Central

Fujiwara, Saeko; Hamaya, Etsuro; Sato, Masayo; Graham-Clarke, Peita; Flynn, Jennifer A; Burge, Russel

2014-01-01

Purpose To systematically review the literature describing the efficacy, effectiveness, and safety of raloxifene for postmenopausal Japanese women with osteoporosis or low bone mass (osteopenia). Materials and methods Medline via PubMed and Embase was systematically searched using prespecified terms. Retrieved publications were screened and included if they described randomized controlled trials or observational studies of postmenopausal Japanese women with osteoporosis or osteopenia treated with raloxifene and reported one or more outcome measures (change in bone mineral density [BMD]; fracture incidence; change in bone-turnover markers, hip structural geometry, or blood–lipid profile; occurrence of adverse events; and change in quality of life or pain). Excluded publications were case studies, editorials, letters to the editor, narrative reviews, or publications from non-peer-reviewed journals; multidrug, multicountry, or multidisease studies with no drug-, country-, or disease-level analysis; or studies of participants on dialysis. Results Of the 292 publications retrieved, 15 publications (seven randomized controlled trials, eight observational studies) were included for review. Overall findings were statistically significant increases in BMD of the lumbar spine (nine publications), but not the hip region (eight publications), a low incidence of vertebral fracture (three publications), decreases in markers of bone turnover (eleven publications), improved hip structural geometry (two publications), improved blood–lipid profiles (five publications), a low incidence of hot flushes, leg cramps, venous thromboembolism, and stroke (12 publications), and improved quality of life and pain relief (one publication). Conclusion Findings support raloxifene for reducing vertebral fracture risk by improving BMD and reducing bone turnover in postmenopausal Japanese women with osteoporosis or osteopenia. Careful consideration of fracture risk and the risk–benefit profile of antiosteoporosis medications is required when managing patients with osteoporosis. PMID:25395843

Domestic violence and its associated factors among married women of a village development committee of rural Nepal.

PubMed

Sapkota, Diksha; Bhattarai, Sailesh; Baral, Dharanidhar; Pokharel, Paras K

2016-03-19

Violence against women is a global public health problem occurring in multitude of contexts and domestic violence is considered to be the most pervasive one. Poor enforcement of policies, limitation of researches and expertise in this field largely accounts for persistence of this problem and nature of domestic violence and its associated factors are poorly understood. This research aimed to estimate the magnitude of different forms of domestic violence and identify its associated factors. Community based cross sectional study was conducted among 355 married women of reproductive age group of Kusheshwor, Sindhuli, Nepal. The questionnaire adapted from the World Health Organization Multi-Country Study was used for the face to face interviews. Occurrence of current domestic violence was used as outcome variable in logistic regression. Descriptive and multivariate analysis were performed in order to assess the magnitude of domestic violence and to identify its associated factors respectively. Self-reported lifetime prevalence of physical violence was 29.6% and past year prevalence was 15.2%, while corresponding figures for sexual violence were 6.8 and 2.3%, and for psychological violence were 31.0 and 18.3%. Lifetime domestic violence was 38.6% while in past 12 months, prevalence was 23.1%. Furthermore, 12.4% of women were experiencing all forms of violence concurrently. Women with controlling husband and having poor mental health were found to be at higher risk of domestic violence. Domestic violence is still rampant in our society with several forms of violence occurring together. In a country like Nepal, differentials power in relationship and poor mental health was found to be positively associated with violent episodes. This study highlights the infringement of women rights which can be the cause for serious public health consequences.

Systematic review of raloxifene in postmenopausal Japanese women with osteoporosis or low bone mass (osteopenia).

PubMed

Fujiwara, Saeko; Hamaya, Etsuro; Sato, Masayo; Graham-Clarke, Peita; Flynn, Jennifer A; Burge, Russel

2014-01-01

To systematically review the literature describing the efficacy, effectiveness, and safety of raloxifene for postmenopausal Japanese women with osteoporosis or low bone mass (osteopenia). Medline via PubMed and Embase was systematically searched using prespecified terms. Retrieved publications were screened and included if they described randomized controlled trials or observational studies of postmenopausal Japanese women with osteoporosis or osteopenia treated with raloxifene and reported one or more outcome measures (change in bone mineral density [BMD]; fracture incidence; change in bone-turnover markers, hip structural geometry, or blood-lipid profile; occurrence of adverse events; and change in quality of life or pain). Excluded publications were case studies, editorials, letters to the editor, narrative reviews, or publications from non-peer-reviewed journals; multidrug, multicountry, or multidisease studies with no drug-, country-, or disease-level analysis; or studies of participants on dialysis. Of the 292 publications retrieved, 15 publications (seven randomized controlled trials, eight observational studies) were included for review. Overall findings were statistically significant increases in BMD of the lumbar spine (nine publications), but not the hip region (eight publications), a low incidence of vertebral fracture (three publications), decreases in markers of bone turnover (eleven publications), improved hip structural geometry (two publications), improved blood-lipid profiles (five publications), a low incidence of hot flushes, leg cramps, venous thromboembolism, and stroke (12 publications), and improved quality of life and pain relief (one publication). Findings support raloxifene for reducing vertebral fracture risk by improving BMD and reducing bone turnover in postmenopausal Japanese women with osteoporosis or osteopenia. Careful consideration of fracture risk and the risk-benefit profile of antiosteoporosis medications is required when managing patients with osteoporosis.

Cost analysis of neonatal and pediatric parenteral nutrition in Europe: a multi-country study.

PubMed

Walter, E; Liu, F X; Maton, P; Storme, T; Perrinet, M; von Delft, O; Puntis, J; Hartigan, D; Dragosits, A; Sondhi, S

2012-05-01

Parenteral nutrition (PN) is critical in neonatal and pediatric care for patients unable to tolerate enteral feeding. This study assessed the total costs of compounding PN therapy for neonates, infants and children. Face-to-face and telephone interviews were conducted in 12 hospitals across four European countries (Belgium, France, Germany and UK) to collect information on resources utilized to compound PN, including nutrients, staff time, equipment cost and supplies. A bottom-up cost model was constructed to assess total costs of PN therapy by assigning monetary values to the resource utilization using published list prices and interview data. A total of 49,922 PN bags per year were used to treat 4295 neonatal and pediatric patients among these hospitals. The daily total costs of one compounded PN bag for neonates in the 12 hospitals across the four countries equalled euro 55.16 (Belgium euro 53.26, France euro 46.23, Germany euro 64.05, UK Ł 37.43/\\[euro]42.86). Overall, nutrients accounted for 25% of total costs, supplies 18%, wages 54% and equipment 3%. Average costs per bag for infants <2 year were euro 84.52 (euro 74.65 in Belgium, euro 83.84 in France, euro 92.70 in Germany and Ł 52.63/euro 60.26 in the UK), and for children 2-18 years euro 118.02 (euro 93.85 in Belgium, euro 121.35 in France, euro 124.54 in Germany and Ł 69.49/euro 79.56 in the UK), of which 63% is attributable to nutrients and 28% to wages. The data indicated that PN costs differ among countries and a major proportion was due to staff time (Ł 1=euro 1.144959).

Herd-level animal management factors associated with the occurrence of bovine neonatal pancytopenia in calves in a multi-country study

PubMed Central

Jones, Bryony A.; Henning, Jörg; Stoll, Alexander; Nielen, Mirjam; Van Schaik, Gerdien; Smolenaars, Anja; Schouten, Matthijs; den Uijl, Ingrid; Fourichon, Christine; Guatteo, Raphael; Madouasse, Aurélien; Nusinovici, Simon; Deprez, Piet; De Vliegher, Sarne; Laureyns, Jozef; Booth, Richard; Cardwell, Jacqueline M.; Pfeiffer, Dirk U.

2017-01-01

Since 2007, mortality associated with a previously unreported haemorrhagic disease has been observed in young calves in several European countries. The syndrome, which has been named ‘bovine neonatal pancytopenia’ (BNP), is characterised by thrombocytopenia, leukocytopenia and a panmyelophthisis. A herd-level case-control study was conducted in four BNP affected countries (Belgium, France, Germany and the Netherlands) to identify herd management risk factors for BNP occurrence. Data were collected using structured face-to-face and telephone interviews of farm managers and their local veterinarians. In total, 363 case farms and 887 control farms were included in a matched multivariable conditional logistic regression analysis. Case-control status was strongly associated with the odds of herd level use of the vaccine PregSure® BVD (PregSure, Pfizer Animal Health) (matched adjusted odds ratio (OR) 107.2; 95% CI: 41.0–280.1). This was also the case for the practices of feeding calves colostrum from the calf’s own dam (OR 2.0; 95% CI: 1.1–3.4) or feeding pooled colostrum (OR 4.1; 95% CI: 1.9–8.8). Given that the study had relatively high statistical power and represented a variety of cattle production and husbandry systems, it can be concluded with some confidence that no other herd level management factors are competent causes for a sufficient cause of BNP occurrence on herd level. It is suggested that genetic characteristics of the dams and BNP calves should be the focus of further investigations aimed at identifying the currently missing component causes that together with PregSure vaccination and colostrum feeding represent a sufficient cause for occurrence of BNP in calves. PMID:28678850

It is important that the process goes quickly, isn't it?" A qualitative multi-country study of colorectal or lung cancer patients' narratives of the timeliness of diagnosis and quality of care.

PubMed

Malmström, Marlene; Rasmussen, Birgit H; Bernhardson, Britt-Marie; Hajdarevic, Senada; Eriksson, Lars E; Andersen, Rikke Sand; MacArtney, John I

2018-06-01

The emphasis on early diagnosis to improve cancer survival has been a key factor in the development of cancer pathways across Europe. The aim of this analysis was to explore how the emphasis on early diagnosis and timely treatment is reflected in patient's accounts of care, from the first suspicion of colorectal or lung cancer to their treatment in Denmark, England and Sweden. We recruited 155 patients in Denmark, England and Sweden who were within six months of being diagnosed with lung or colorectal cancer. Data were collected via semi-structured narrative interviews and analysed using a thematic approach. Participants' accounts of quality of care were closely related to how quickly (or not) diagnosis, treatment and/or healthcare processes went. Kinetic metaphors as a description of care (such as treadmill) could be interpreted positively as participants were willing to forgo some degree of control and accept disruption to their lives to ensure more timely care. Drawing on wider cultural expectations of the benefits of diagnosing and treating cancer quickly, some participants were concerned that the waiting times between interventions might allow time for the cancer to grow. Initiatives emphasising the timeliness of diagnosis and treatment are reflected in the ways some patients experience their care. However, these accounts were open to further contextualisation about what speed of healthcare processes meant for evaluating the quality of their care. Healthcare professionals could therefore be an important patient resource in providing reassurance and support about the timeliness of diagnosis or treatment. Copyright © 2018. Published by Elsevier Ltd.

Newborn survival in Pakistan: a decade of change and future implications.

PubMed

Khan, Amanullah; Kinney, Mary V; Hazir, Tabish; Hafeez, Assad; Wall, Stephen N; Ali, Nabeela; Lawn, Joy E; Badar, Asma; Khan, Ali Asghar; Uzma, Qudsia; Bhutta, Zulfiqar A

2012-07-01

Pakistan has the world's third highest national number of newborn deaths (194 000 in 2010). Major national challenges over the past decade have affected health and development including several large humanitarian disasters, destabilizing political insurgency, high levels of poverty and an often hard-to-reach predominately rural population with diverse practices. As part of a multi-country analysis, we examined changes for newborn survival between 2000 and 2010 in terms of mortality, coverage and health system indicators as well as national and donor funding. Neonatal mortality declined by only 0.9% per annum between 2000 and 2010; less than the global average (2.1%) and less than national maternal and child mortality declines. Coverage of newborn care interventions increased marginally, with wide socio-economic variations. There was little focus on newborn health until 2000 when considerable policy change occurred, including integration of newborn care into existing community-based maternal and child packages delivered by the Lady Health Worker Programme and national behaviour change communications strategies and programmes. The National Maternal, Newborn and Child Health Programme catalyzed newborn services at both facility and community levels. Civil society and academics have linked with government and several research studies have been highly influential. Since 2005, donor funding mentioning the term 'newborn' has increased more for Pakistan than for other countries. The country faces ongoing challenges in reducing neonatal mortality, and in much of Pakistan, societal norms discourage care-seeking and many women are unable to access care for themselves or their children. The policy advances and existing delivery platforms offer the potential to substantially accelerate progress in reducing neonatal deaths. The recent decision to dismantle the national Ministry of Health and devolve responsibility for health sector management to the provincial level presents both challenges and opportunities for newborn health.

Exploring the Effectiveness of Mandatory Premarital Screening and Genetic Counselling Programmes for β-Thalassaemia in the Middle East: A Scoping Review.

PubMed

Saffi, Marwa; Howard, Natasha

2015-01-01

β-Thalassaemia is a common genetic blood disorder in the Middle Eastern region. Mandatory premarital screening and genetic counselling (PMSGC) programmes are implemented in 8 Middle East countries to reduce at-risk marriages and thus disease prevalence. A scoping review was conducted to explore the effectiveness of these programmes. The 6-stage scoping framework of Arksey and O'Malley [Int J Soc Res Methodol 2005;8:19-32] was used. Reported outcomes were analysed per country, with success defined as achieving a 65% reduction in at-risk marriages and/or thalassaemia-affected births. Emergent enablers and barriers were analysed thematically. Twenty-one sources were included from the 1,348 identified, discussing 7 country programmes, with 95% (20/21) published during 2003-2013. Five publications each were included for Iran and Saudi Arabia, 3 for Turkey, 2 each for Bahrain and Iraq (Kurdistan), and 1 for the United Arab Emirates, plus 2 multi-country evaluations. No programme achieved a 65% at-risk marriage cancellation rate. Though data on thalassaemia-affected birth reductions were minimal, programmes in Iran, Turkey and Iraq reported at least 65% reductions. A thematic analysis found that screening timing, access to prenatal detection and abortion, socio-religious issues, awareness and counselling affected decisions. This review found that PMSGC programmes were unsuccessful in discouraging at-risk marriages but successful in reducing the prevalence of affected births in countries providing prenatal detection and therapeutic abortion. A life cycle approach to prevention, incorporation of school screening, awareness campaigns, reconsideration of therapeutic abortion, and screening and counselling of couples married prior to programme inception are likely to improve the effectiveness of such programmes in the Middle Eastern region. © 2015 S. Karger AG, Basel.

An exploration of differences between Japan and two European countries in the self-reporting and valuation of pain and discomfort on the EQ-5D.

PubMed

Feng, Yan; Herdman, Mike; van Nooten, Floortje; Cleeland, Charles; Parkin, David; Ikeda, Shunya; Igarashi, Ataru; Devlin, Nancy J

2017-08-01

To investigate the systematic differences in the self-reporting and valuation of overall health and, in particular, pain/discomfort between three countries (England/UK, Japan, and Spain) on the EQ-5D. Existing datasets were used to explore differences in responses on the EQ-5D descriptive system between Japan (3L and 5L), the UK (3L), England (5L), and Spain (5L), particularly on the dimension of pain/discomfort. The role of different EQ dimensions in determining self-reported overall health scores for the EuroQol visual analog scale (EQ-VAS) was investigated using ordinary least squares regression. Time trade-off (TTO) results from Japanese and UK respondents for the EQ-5D-3L as well as Japanese and English respondents for the EQ-5D-5L were compared using t tests. For the EQ-5D-3L, a higher percentage of respondents in Japan than in the UK reported 'no pain/discomfort' (81.6 vs 67.0%, respectively); for the EQ-5D-5L, the proportions were 79.2% in Spain, 73.2% in Japan, and 63-64% in England, after adjusting for age differences in samples. The 'pain/discomfort' dimension had the largest impact on respondents' self-reported EQ-VAS only for EQ-5D-3L in Japan. Using the EQ-5D-3L, Japanese respondents were considerably less willing to trade off time to avoid pain/discomfort than the UK respondents; for example, moving from health state, 11121 (some problems with pain/discomfort) to 11131 (extreme pain/discomfort) represented a decrement of 0.65 on the observed TTO value in the UK compared with 0.15 in Japan. Using the EQ-5D-5L, Japanese respondents were also less willing to trade off time to avoid pain/discomfort than respondents in England; however, the difference in values was much smaller than that observed using EQ-5D-3L data. This study provides evidence of between-country differences in the self-reporting and valuation of health, including pain/discomfort, when using EQ-5D in general population samples. The results suggest a need for caution when comparing or aggregating EQ-5D self-reported data in multi-country studies.

Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America.

PubMed

Biello, Katie B; Oldenburg, Catherine E; Safren, Steven A; Rosenberger, Joshua G; Novak, David S; Mayer, Kenneth H; Mimiaga, Matthew J

2016-01-01

Latin America has some of the highest levels of antiretroviral therapy (ART) coverage of any developing region in the world. Early initiation and optimal adherence to ART are necessary for improved health outcomes and reduction in onward transmission. Previous work has demonstrated the role of psychosocial problems as barriers to uptake and adherence to ART, and recently, a syndemic framework has been applied to the role of multiple psychosocial syndemic factors and adherence to ART, in the USA. However, to our knowledge, these associations have not been investigated outside of the USA, nor in a multi-country context. To address these gaps, we assessed the association between multiple co-occurring psychosocial factors and engagement in HIV-related medical care and adherence to ART among a large, multinational sample of sexually-active HIV-infected men who have sex with men in Latin America. Among the 2020 respondents, 80.7% reported currently receiving HIV-related medical care, 72.3% reported currently receiving ART; among those, 62.5% reported 100% adherence. Compared with experiencing no psychosocial health problems, experiencing five or more psychosocial health problems is associated with 42% lower odds of currently receiving HIV-related medical care (adjusted odds ratio, aOR = 0.58, 95% CI 0.36, 0.95) and of currently receiving ART (aOR = 0.58, 95% CI 0.38, 0.91). The number of psychosocial health problems experienced was associated with self-reported ART adherence in a dose-response relationship; compared to those with none of the factors, individuals with one syndemic factor had 23% lower odds (aOR = 0.77, 95% CI 0.60, 0.97) and individuals with five or more syndemic factors had 72% lower odds (aOR = 0.28, 95% CI 0.14, 0.55) of reporting being 100% adherent to ART. Addressing co-occurring psychosocial problems as potential barriers to uptake and adherence of ART in Latin America may improve the effectiveness of secondary prevention interventions.

Factors affecting the views and experiences of women living in the city centre of Manisa, Turkey, regarding domestic violence.

PubMed

Özpinar, Saliha; Dinç Horasan, Gönül; Baydur, Hakan; Canbay, Tülin

2016-11-01

Domestic violence against women is an important social and public health problem worldwide resulting from unequal power relationships between men and women. The purpose of the present cross-sectional descriptive study was to determine the factors affecting the views and experiences of women living in the city centre of Manisa, Turkey, regarding domestic violence. The data were collected from a representative sample of women (n=873) in 2012. The socio-demographic questionnaire and the World Health Organization's Multi-country Study on Women's Health and Domestic Violence Against Women were used for data collection. The study results revealed that of the women, 14.8% were exposed to physical violence, 7.9% to sexual violence, 20.2% to emotional violence/abuse and 11.2% to economic violence/abuse within the last 12 months. Lower income level, lower social status, lower educational level, unemployment, being exposed to parental violence during childhood and being married to husbands exposed to parental violence during childhood were associated risk factors with domestic violence. The study results indicate that domestic violence against women is a common phenomenon in Manisa.

Adoption of the HPV vaccine: a case study of three emerging countries.

PubMed

Caro Martínez, Araceli; Espín Balbino, Jaime; Lemgruber, Alexandre; Martín Ruiz, Eva; Olry de Labry Lima, Antonio; García-Mochón, Leticia; Lessa, Fernanda

2017-05-01

The human papillomavirus (HPV) vaccine has recently attracted considerable attention in emerging countries, due to its potential to reduce the impact of HPV-related diseases. This case study sheds new light about the variety of HTA arrangements, methods and processes involved in the adoption and use of HPV vaccines in a selected sample of central, eastern and southern Europe and Latin America and the Caribbean, all of them emerging in the use of HTA. A multi-country case study was designed. Mixed methods, document review, semi-structured surveys and personal communication with experts, were used for data collection and triangulation. This study shows that common elements of good practice exist in the processes and methods used, with all countries arriving at the same appraisal recommendations. However, the influence of socio-politico-economic factors appears to be determinant on the final decisions and restrictions to access made. This case study intends to draw useful lessons for policymakers in emerging settings interested in the adoption of the HPV vaccine supported by evidence-informed processes, such as those offered by institutionalized HTA. Future studies are also recommended to elucidate the specific roles that social values and uncertainties play in vaccine decision-making across different societies.

Television food advertising and the prevalence of childhood overweight and obesity: a multicountry comparison.

PubMed

Goris, Janny M; Petersen, Solveig; Stamatakis, Emmanuel; Veerman, J Lennert

2010-07-01

To estimate the contribution of television (TV) food advertising to the prevalence of obesity among 6-11-year-old children in Australia, Great Britain (England and Scotland only), Italy, The Netherlands, Sweden and the United States. Data from contemporary representative studies on the prevalence of childhood obesity and on TV food advertising exposure in the above countries were entered into a mathematical simulation model. Two different effect estimators were used to calculate the reduction in prevalence of overweight and obesity in the absence of TV food advertising in each country; one based on literature and one based on experts' estimates. Six- to eleven-year-old children in six Western countries. Estimates of the average exposure of children to TV food advertising range from 1.8 min/d in The Netherlands to 11.5 min/d in the United States. Its contribution to the prevalence of childhood obesity is estimated at 16%-40% in the United States, 10%-28% in Australia and Italy and 4%-18% in Great Britain, Sweden and The Netherlands. The contribution of TV advertising of foods and drinks to the prevalence of childhood obesity differs distinctly by country and is likely to be significant in some countries.

Assesment of publication practices in geosciences in developing countries

NASA Astrophysics Data System (ADS)

Cazenave, A.; Barbe, V.

2003-12-01

We present results of a study which goal was to investigate in which journals scientists in geosciences (i.e., in the fields covered by the AGU) in developing countries publish most of their papers.We were interested in particular in looking at the percentage of publications in AGU journals. Using science indicators collected by the Institute for Scientific Information (ISI), we analysed publication practices for 1997-2002 in the following countries : India, China, Russia, Brazil, Argentina and Chile. We investigated the evolution of the number of publications through time, identified most used journals, determined times cited and impact factors of papers published in the top 15 most used journals. We also determined the percentage of articles published in AGU journals versus other journals. We found that for the 6 counties considered, this percentage varies from about 2 to 3 percent (Argentina, China) to about 8 percent (the other 4 countries). Investigation of authors addresses indicates that the majority of articles published in AGU journals are multi-countries publications, involving international collaboration mainly with scientists from North America and Europe. Implications on page-charge and access to AGU journals are also discussed.

The effect of household poverty on tuberculosis.

PubMed

Siroka, A; Law, I; Macinko, J; Floyd, K; Banda, R P; Hoa, N B; Tsolmon, B; Chanda-Kapata, P; Gasana, M; Lwinn, T; Senkoro, M; Tupasi, T; Ponce, N A

2016-12-01

pSETTING: Households in Malawi, Mongolia, Myanmar, the Philippines, Rwanda, Tanzania, Viet Nam and Zambia.OBJECTIVE To assess the relationship between household socio-economic level, both relative and absolute, and individual tuberculosis (TB) disease. We analysed national TB prevalence surveys from eight countries individually and in pooled multicountry models. Socio-economic level (SEL) was measured in terms of both relative household position and absolute wealth. The outcome of interest was whether or not an individual had TB disease. Logistic regression models were used to control for putative risk factors for TB disease such as age, sex and previous treatment history. Overall, a strong and consistent association between household SEL and individual TB disease was not found. Significant results were found in four individual country models, with the lowest socio-economic quintile being associated with higher TB risk in Mongolia, Myanmar, Tanzania and Viet Nam. TB prevalence surveys are designed to assess prevalence of disease and, due to the small numbers of cases usually detected, may not be the most efficient means of investigating TB risk factors. Different designs are needed, including measuring the SEL of individuals in nested case-control studies within TB prevalence surveys or among TB patients seeking treatment in health care facilities.

Moderating effects of age, gender and education on the associations of perceived neighborhood environment attributes with accelerometer-based physical activity: the IPEN Adult study Moderating effects of age, gender and education on the associations of perceived neighborhood environment attributes with accelerometer-based physical activity: the IPEN Adult study

PubMed Central

Van Dyck, Delfien; Cerin, Ester; De Bourdeaudhuij, Ilse; Salvo, Deborah; Christiansen, Lars B; Macfarlane, Duncan; Owen, Neville; Mitas, Josef; Troelsen, Jens; Aguinaga-Ontoso, Ines; Davey, Rachel; Reis, Rodrigo; Sarmiento, Olga L; Schofield, Grant; Conway, Terry L; Sallis, James F

2015-01-01

The study's purpose was to examine age, gender, and education as potential moderators of the associations of perceived neighborhood environment variables with accelerometer-based moderate-to-vigorous physical activity (MVPA). Data were from 7273 adults from 16 sites (11 countries) that were part of a coordinated multi-country cross-sectional study. Age moderated the associations of perceived crime safety, and perceiving no major physical barriers to walking, with MVPA: positive associations were only found in older adults. Perceived land use mix-access was linearly (positive) associated with MVPA in men, and curvilinearly in women. Perceived crime safety was related to MVPA only in women. No moderating relationships were found for education. Overall the associations of adults’ perceptions of environmental attributes with MVPA were largely independent of the socio-demographic factors examined. These findings are encouraging, suggesting that efforts to optimize the perceived built and social environment may act in a socially-equitable manner to facilitate MVPA. PMID:26454247

Preventing Mother-to-Child Transmission of HIV in Resource-Limited Settings: The Elizabeth Glaser Pediatric AIDS Foundation Experience

PubMed Central

Sripipatana, Tabitha; Turner, Abigail Norris; Hoblitzelle, Chuck; Robinson, Joanna; Wilfert, Catherine

2009-01-01

Objectives. In September 1999, the Elizabeth Glaser Pediatric AIDS Foundation initiated a multicountry, service-based programmatic effort in the developing world to reduce perinatally acquired HIV infection. We review 6½ years of one of the world's largest programs for the prevention of mother-to-child transmission (PMTCT) of HIV. Methods. Each PMTCT facility records patient data in antenatal clinics and labor and delivery settings about counseling, testing, HIV status, and antiretroviral prophylaxis and submits the data to foundation staff. Results. More than 2.6 million women have accessed foundation-affiliated services through June 2006. Overall, 92.9% of women who received antenatal care or were eligible for PMTCT services in labor and delivery have been counseled, and 82.8% of those counseled accepted testing. Among women identified as HIV positive, 75.0% received antiretroviral prophylaxis (most a single dose of nevirapine), as did 45.6% of their infants. Conclusions. The foundation's experience has demonstrated that opt-out testing, supplying mothers with medication at time of diagnosis, and providing the infant dose early have measurably improved program efficiency. PMTCT should be viewed as an achievable paradigm and an essential part of the continuum of care. PMID:18703458

Multicentre dose audit for clinical trials of radiation therapy in Asia

PubMed Central

Fukuda, Shigekazu; Fukumura, Akifumi; Nakamura, Yuzuru-Kutsutani; Jianping, Cao; Cho, Chul-Koo; Supriana, Nana; Dung, To Anh; Calaguas, Miriam Joy; Devi, C.R. Beena; Chansilpa, Yaowalak; Banu, Parvin Akhter; Riaz, Masooma; Esentayeva, Surya; Kato, Shingo; Karasawa, Kumiko; Tsujii, Hirohiko

2017-01-01

Abstract A dose audit of 16 facilities in 11 countries has been performed within the framework of the Forum for Nuclear Cooperation in Asia (FNCA) quality assurance program. The quality of radiation dosimetry varies because of the large variation in radiation therapy among the participating countries. One of the most important aspects of international multicentre clinical trials is uniformity of absolute dose between centres. The National Institute of Radiological Sciences (NIRS) in Japan has conducted a dose audit of participating countries since 2006 by using radiophotoluminescent glass dosimeters (RGDs). RGDs have been successfully applied to a domestic postal dose audit in Japan. The authors used the same audit system to perform a dose audit of the FNCA countries. The average and standard deviation of the relative deviation between the measured and intended dose among 46 beams was 0.4% and 1.5% (k = 1), respectively. This is an excellent level of uniformity for the multicountry data. However, of the 46 beams measured, a single beam exceeded the permitted tolerance level of ±5%. We investigated the cause for this and solved the problem. This event highlights the importance of external audits in radiation therapy. PMID:27864507

Exploring Risk and Protective Factors for Recent and Past Intimate Partner Violence Against New Zealand Women.

PubMed

Fanslow, Janet; Gulliver, Pauline

2015-01-01

The purpose of this investigation was to identify risk and protective factors associated with intimate partner violence (IPV) in a high-income country (New Zealand) and to identify those factors that distinguish between current versus previous exposure to IPV. Data were drawn from the New Zealand replication of the World Health Organization's Multi-Country Study on Women's Health and Domestic Violence. Logistic regression was conducted to identify those variables associated with experience of IPV. Problem drinking, a partner who has concurrent sexual relationships, and a partner who is violent outside the home were associated with increased likelihood of current as opposed to previous experience of IPV. Increased household income and both the respondent and her partner being employed were associated with reduced likelihood that women would experience current as opposed to prior IPV. The findings point toward the need for comprehensive approaches to reduce all forms of violence and to contribute to the primary prevention of IPV. Strategies that address early exposure to violence, problematic alcohol consumption, gender transformative approaches to working with boys and men, and economic empowerment for women may all hold promise.

Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. Results Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. Conclusions Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery. PMID:26390886

Global landscape assessment of screening technologies for medicine quality assurance: stakeholder perceptions and practices from ten countries.

PubMed

Roth, Lukas; Nalim, Ameena; Turesson, Beth; Krech, Laura

2018-04-25

The spread of substandard and falsified (SF) medical products constitutes a growing global public health concern. Some countries use portable, handheld screening technologies (STs) in the field to accelerate detection of SF medicines and reduce the number of medicine samples that undergo costly and time-consuming confirmatory analysis. A multi-country, multi-stakeholder landscape assessment utilizing qualitative methodology was used to examine practices and perceptions related to the use of STs. Qualitative interview guides were designed using the results of a literature review and comprised of open-ended questions with the study participants, who were from national medicine regulatory authorities, pharmaceutical manufacturers, pharmacies, and distributors. Ten geographically and economically diverse countries were selected: Argentina, China, Egypt, India, Jordan, Mexico, Nigeria, Philippines, the United States, and Zimbabwe. Of the completed 53 interviews, 32 were in-person, 16 were phone interviews, and 5 were via written questionnaires. Data analysis shows a wide variation in understanding and usage of STs in different sectors. Virtually all of the study participants indicated a lack of objective, accessible information on STs to advise them on what technologies would be beneficial for their needs. Study participants also described their ideal capabilities of the next generation of STs, including shareable spectral libraries, lower acquisition costs, lesser training requirements, and in-country maintenance and technical support. The results and recommendations presented in this article can be used to help regulators communicate and justify their needs to acquire and invest in new STs. There is a need for additional standardized, trustworthy and scientifically sound evaluations of STs, and to support regulators to effectively deploy the most promising technologies. ST manufacturers can take into account some of the limitations of the technologies the interviewees identified in this article, such as a dearth of technologies, which provide quantitative information about the active ingredient, and take steps to address them to better serve their customers. These results and recommendations, can catalyze research and actionable interventions into the development, review, application, and use of STs.

Predictors for patient knowledge and reported behaviour regarding driving under the influence of medicines: a multi-country survey.

PubMed

Monteiro, Susana P; van Dijk, Liset; Verstraete, Alain G; Alvarez, F Javier; Heissing, Michael; de Gier, Johan J

2012-01-20

Reports on the state of knowledge about medicines and driving showed an increased concern about the role that the use of medicines might play in car crashes. Much of patient knowledge regarding medicines comes from communications with healthcare professionals. This study, part of the DRUID (Driving Under the Influence of Drugs, alcohol and medicines) project, was carried out in four European countries and attempts to define predictors for knowledge of patients who use driving-impairing medicines. The influence of socio-demographic variables on patient knowledge was investigated as well as the influence of socio-demographic factors, knowledge and attitudes on patients' reported behaviour regarding driving under the influence of medicines. Pharmacists handed out questionnaires to patients who met the inclusion criteria: 1) prevalent user of benzodiazepines, antidepressants or first generation antihistamines for systemic use; 2) age between 18 and 75 years old and 3) actual driver of a motorised vehicle. Factors affecting knowledge and reported behaviour towards driving-impairing medicines were analysed by means of multiple linear regression analysis and multiple logistic regression analysis, respectively. A total of 633 questionnaires (out of 3.607 that were distributed to patients) were analysed. Patient knowledge regarding driving under the influence of medicines is better in younger and higher educated patients. Information provided to or accessed by patients does not influence knowledge. Patients who experienced side effects and who have a negative attitude towards driving under the influence of impairing medicines are more prone to change their driving frequency behaviour than those who use their motorised vehicles on a daily basis or those who use anti-allergic medicines. Changes in driving behaviour can be predicted by negative attitudes towards driving under the influence of medicines but not by patients' knowledge regarding driving under the influence of medicines. Future research should not only focus on information campaigns for patients but also for healthcare providers as this might contribute to improve communications with patients regarding the risks of driving under the influence of medicines.

Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-income countries: a WHO secondary analysis.

PubMed

Bilano, Ver Luanni; Ota, Erika; Ganchimeg, Togoobaatar; Mori, Rintaro; Souza, João Paulo

2014-01-01

Pre-eclampsia has an immense adverse impact on maternal and perinatal health especially in low- and middle-income settings. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes. We performed a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. The survey was a multi-country, facility-based cross-sectional study. A global sample consisting of 24 countries from three regions and 373 health facilities was obtained via a stratified multi-stage cluster sampling design. Maternal and offspring data were extracted from records using standardized questionnaires. Multi-level logistic regression modelling was conducted with random effects at the individual, facility and country levels. Data for 276,388 mothers and their infants was analysed. The prevalence of pre-eclampsia/eclampsia in the study population was 10,754 (4%). At the individual level, sociodemographic characteristics of maternal age ≥30 years and low educational attainment were significantly associated with higher risk of pre-eclampsia/eclampsia. As for clinical and obstetric variables, high body mass index (BMI), nulliparity (AOR: 2.04; 95%CI 1.92-2.16), absence of antenatal care (AOR: 1.41; 95%CI 1.26-1.57), chronic hypertension (AOR: 7.75; 95%CI 6.77-8.87), gestational diabetes (AOR: 2.00; 95%CI 1.63-2.45), cardiac or renal disease (AOR: 2.38; 95%CI 1.86-3.05), pyelonephritis or urinary tract infection (AOR: 1.13; 95%CI 1.03-1.24) and severe anemia (AOR: 2.98; 95%CI 2.47-3.61) were found to be significant risk factors, while having >8 visits of antenatal care was protective (AOR: 0.90; 95%CI 0.83-0.98). Pre-eclampsia/eclampsia was found to be a significant risk factor for maternal death, perinatal death, preterm birth and low birthweight. Chronic hypertension, obesity and severe anemia were the highest risk factors of preeclampsia/eclampsia. Implementation of effective interventions prioritizing risk factors, provision of quality health services during pre-pregnancy and during pregnancy for joint efforts in the areas of maternal health are recommended.

Facilitating Factors and Barriers to the Use of Emerging Technologies for Suicide Prevention in Europe: Multicountry Exploratory Study.

PubMed

Muñoz-Sánchez, Juan-Luis; Delgado, Carmen; Parra-Vidales, Esther; Franco-Martín, Manuel

2018-01-24

This study provides an analysis on the use of emerging technologies for the prevention of suicide in 8 different European countries. The objective of this study was to analyze the potentiality of using emerging technologies in the area of suicide prevention based on the opinion of different professionals involved in suicide prevention. Opinions of 3 groups of stakeholders (ie, relevant professionals in suicide field) were gathered using a specifically designed questionnaire to explore dimensions underlying perceptions of facilitating factors and barriers in relation to the use of emerging technologies for suicide prevention. Goal 1 involved facilitating factors for the use of emerging technologies in suicide prevention. Northern European countries, except for Belgium, attach greater relevance to those that optimize implementation and benefits. On the other hand, Southern European countries attach greater importance to professionally oriented and user-centered facilitating factors. According to different stakeholders, the analysis of these facilitating factors suggest that professionals in the field of social work attach greater relevance to those that optimize implementation and benefits. However, professionals involved in the area of mental health, policy makers, and political decision makers give greater importance to professionally oriented and user-centered facilitating factors. Goal 2 was related to barriers to the usability of emerging technologies for suicide prevention. Both countries and stakeholders attach greater importance to barriers associated with resource constraints than to those centered on personal limitations. There are no differences between countries or between stakeholders. Nevertheless, there is a certain stakeholders-countries interaction that indicates that the opinions on resource constraints expressed by different stakeholders do not follow a uniform pattern in different countries, but they differ depending on the country. Although all countries and stakeholders agree in identifying resource constraints as the main barrier to the use of emerging technologies, factors facilitating their use in suicide prevention differ among countries and among stakeholders. ©Juan-Luis Muñoz-Sánchez, Carmen Delgado, Esther Parra-Vidales, Manuel Franco-Martín. Originally published in JMIR Mental Health (http://mental.jmir.org), 24.01.2018.

Maternal CD4+ cell count decline after interruption of antiretroviral prophylaxis for the prevention of mother-to-child transmission of HIV.

PubMed

Ekouevi, Didier; Abrams, Elaine J; Schlesinger, Malka; Myer, Landon; Phanuphak, Nittaya; Carter, Rosalind J

2012-01-01

We evaluated maternal CD4+ cell count (CD4+) decline after PMTCT prophylaxis in a multi-country HIV care program. Analysis was restricted to antiretroviral therapy (ART)-naive, HIV-infected pregnant women with CD4+ ≥250 cells/mm(3) at enrollment. Single-dose nevirapine (sd-NVP) or short-course antiretroviral prophylaxis (sc-ARVp) with zidovudine (AZT) or AZT + lamivudine (3TC) was initiated in 11 programs while 2 programs offered triple-drug antiretroviral prophylaxis (tARVp) (AZT+3TC+ NVP or nelfinavir). All regimens were stopped at delivery. CD4+ decline was defined as proportion of women who declined to CD4+ <350 cells/mm(3) or <200 cells/mm(3) at 24 months. Weibull regression was used for multivariable analysis. A total of 1,393 women with enrollment CD4+ ≥250 cells/mm(3) initiated tARVp (172; 12%) or sc-ARVp (532; 38%) during pregnancy or received intrapartum sd-NVP (689; 50%). At enrollment, maternal median age was 27 years (interquartile range (IQR) 23-30), median CD4+ was 469 cells/mm(3) (IQR: 363-613). At 24 months post-delivery, the cumulative probability of CD4+ decline to <200 cells/mm(3) was 12% (95% CI: 10-14). Among a subgroup of 903 women with CD4+ ≥400 cells at enrollment, the 24 month cumulative probability of decline to CD4+ <350 cells/mm(3) was 28%; (95% CI: 25-32). Lower antepartum CD4+ was associated with higher probability of CD4+ decline to <350 cells/mm(3): 46% (CD4+400-499 cells/mm(3)) vs. 19% (CD4+ ≥500 cells/mm(3)). After adjusting for age, enrollment CD4+ and WHO stage, women who received tARVp or sd-NVP were twice as likely to experience CD4+ decline to <350 cells/mm(3) within 24 months than women receiving sc-ARVp (adjusted hazard ratio: 2.2; 95% CI: 1.5-3.2, p<0.0001). Decline in CD4+ cell count to ART eligibility thresholds by 24 months postpartum was common among women receiving PMTCT prophylaxis during pregnancy and/or delivery.

Human exposure assessment resources on the World Wide Web.

PubMed

Schwela, Dieter; Hakkinen, Pertti J

2004-05-20

Human exposure assessment is frequently noted as a weak link and bottleneck in the risk assessment process. Fortunately, the World Wide Web and Internet are providing access to numerous valuable sources of human exposure assessment-related information, along with opportunities for information exchange. Internet mailing lists are available as potential online help for exposure assessment questions, e.g. RISKANAL has several hundred members from numerous countries. Various Web sites provide opportunities for training, e.g. Web sites offering general human exposure assessment training include two from the US Environmental Protection Agency (EPA) and four from the US National Library of Medicine. Numerous other Web sites offer access to a wide range of exposure assessment information. For example, the (US) Alliance for Chemical Awareness Web site addresses direct and indirect human exposures, occupational exposures and ecological exposure assessments. The US EPA's Exposure Factors Program Web site provides a focal point for current information and data on exposure factors relevant to the United States. In addition, the International Society of Exposure Analysis Web site provides information about how this society seeks to foster and advance the science of exposure analysis. A major opportunity exists for risk assessors and others to broaden the level of exposure assessment information available via Web sites. Broadening the Web's exposure information could include human exposure factors-related information about country- or region-specific ranges in body weights, drinking water consumption, etc. along with residential factors-related information on air changeovers per hour in various types of residences. Further, country- or region-specific ranges on how various tasks are performed by various types of consumers could be collected and provided. Noteworthy are that efforts are underway in Europe to develop a multi-country collection of exposure factors and the European Commission is in the early stages of planning and developing a Web-accessible information system (EIS-ChemRisks) to serve as a single gateway to all major European initiatives on human exposure to chemicals contained and released from cleaning products, textiles, toys, etc.

Predictors for patient knowledge and reported behaviour regarding driving under the influence of medicines: a multi-country survey

PubMed Central

2012-01-01

Background Reports on the state of knowledge about medicines and driving showed an increased concern about the role that the use of medicines might play in car crashes. Much of patient knowledge regarding medicines comes from communications with healthcare professionals. This study, part of the DRUID (Driving Under the Influence of Drugs, alcohol and medicines) project, was carried out in four European countries and attempts to define predictors for knowledge of patients who use driving-impairing medicines. The influence of socio-demographic variables on patient knowledge was investigated as well as the influence of socio-demographic factors, knowledge and attitudes on patients' reported behaviour regarding driving under the influence of medicines. Methods Pharmacists handed out questionnaires to patients who met the inclusion criteria: 1) prevalent user of benzodiazepines, antidepressants or first generation antihistamines for systemic use; 2) age between 18 and 75 years old and 3) actual driver of a motorised vehicle. Factors affecting knowledge and reported behaviour towards driving-impairing medicines were analysed by means of multiple linear regression analysis and multiple logistic regression analysis, respectively. Results A total of 633 questionnaires (out of 3.607 that were distributed to patients) were analysed. Patient knowledge regarding driving under the influence of medicines is better in younger and higher educated patients. Information provided to or accessed by patients does not influence knowledge. Patients who experienced side effects and who have a negative attitude towards driving under the influence of impairing medicines are more prone to change their driving frequency behaviour than those who use their motorised vehicles on a daily basis or those who use anti-allergic medicines. Conclusions Changes in driving behaviour can be predicted by negative attitudes towards driving under the influence of medicines but not by patients' knowledge regarding driving under the influence of medicines. Future research should not only focus on information campaigns for patients but also for healthcare providers as this might contribute to improve communications with patients regarding the risks of driving under the influence of medicines. PMID:22264358

Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions.

PubMed

Simen-Kapeu, Aline; Seale, Anna C; Wall, Steve; Nyange, Christabel; Qazi, Shamim A; Moxon, Sarah G; Young, Mark; Liu, Grace; Darmstadt, Gary L; Dickson, Kim E; Lawn, Joy E

2015-01-01

Around one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity. A standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections. For neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges. Rapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups.

Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Around one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity. Methods A standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections. Results For neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges. Conclusions Rapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups. PMID:26391217

Determinants of early child development in rural Tanzania.

PubMed

Ribe, Ingeborg G; Svensen, Erling; Lyngmo, Britt A; Mduma, Estomih; Hinderaker, Sven G

2018-01-01

It has been estimated that more than 200 million children under the age of five do not reach their full potential in cognitive development. Much of what we know about brain development is based on research from high-income countries. There is limited evidence on the determinants of early child development in low-income countries, especially rural sub-Saharan Africa. The present study aimed to identify the determinants of cognitive development in children living in villages surrounding Haydom, a rural area in north-central Tanzania. This cohort study is part of the MAL-ED (The Interactions of Malnutrition & Enteric Infections: Consequences for Child Health and Development) multi-country consortium studying risk factors for ill health and poor development in children. Descriptive analysis and linear regression analyses were performed. Associations between nutritional status, socio-economic status, and home environment at 6 months of age and cognitive outcomes at 15 months of age were studied. The third edition of the Bayley Scales for Infant and Toddler Development was used to assess cognitive, language and motor development. There were 262 children enrolled into the study, and this present analysis included the 137 children with data for 15-month Bayley scores. Univariate regression analysis, weight-for-age and weight-for-length z-scores at 6 months were significantly associated with 15-month Bayley gross motor score, but not with other 15-month Bayley scores. Length-for-age z-scores at 6 months were not significantly associated with 15-month Bayley scores. The socio-economic status, measured by a set of assets and monthly income was significantly associated with 15-month Bayley cognitive score, but not with language, motor, nor total 15-month Bayley scores. Other socio-economic variables were not significantly associated with 15-month Bayley scores. No significant associations were found between the home environment and 15-month Bayley scores. In multivariate regression analyses we found higher Bayley scores for girls and higher Bayley scores in families with more assets. Adjusted R-squared of this model was 8%. We conclude that poverty is associated with a slower cognitive development in children and malnutrition is associated with slower gross motor development. This information should encourage authorities and other stakeholders to invest in improved welfare and nutrition programmes for children from early infancy.

Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions.

PubMed

Vesel, Linda; Bergh, Anne-Marie; Kerber, Kate J; Valsangkar, Bina; Mazia, Goldy; Moxon, Sarah G; Blencowe, Hannah; Darmstadt, Gary L; de Graft Johnson, Joseph; Dickson, Kim E; Ruiz Peláez, Juan; von Xylander, Severin; Lawn, Joy E

2015-01-01

Preterm birth is now the leading cause of under-five child deaths worldwide with one million direct deaths plus approximately another million where preterm is a risk factor for neonatal deaths due to other causes. There is strong evidence that kangaroo mother care (KMC) reduces mortality among babies with birth weight <2000 g (mostly preterm). KMC involves continuous skin-to-skin contact, breastfeeding support, and promotion of early hospital discharge with follow-up. The World Health Organization has endorsed KMC for stabilised newborns in health facilities in both high-income and low-resource settings. The objectives of this paper are to: (1) use a 12-country analysis to explore health system bottlenecks affecting the scale-up of KMC; (2) propose solutions to the most significant bottlenecks; and (3) outline priority actions for scale-up. The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale-up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for KMC. Marked differences were found in the perceived severity of health system bottlenecks between Asian and African countries, with the former reporting more significant or very major bottlenecks for KMC with respect to all the health system building blocks. Community ownership and health financing bottlenecks were significant or very major bottlenecks for KMC in both low and high mortality contexts, particularly in South Asia. Significant bottlenecks were also reported for leadership and governance and health workforce building blocks. There are at least a dozen countries worldwide with national KMC programmes, and we identify three pathways to scale: (1) champion-led; (2) project-initiated; and (3) health systems designed. The combination of all three pathways may lead to more rapid scale-up. KMC has the potential to save lives, and change the face of facility-based newborn care, whilst empowering women to care for their preterm newborns.

Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Preterm birth is now the leading cause of under-five child deaths worldwide with one million direct deaths plus approximately another million where preterm is a risk factor for neonatal deaths due to other causes. There is strong evidence that kangaroo mother care (KMC) reduces mortality among babies with birth weight <2000 g (mostly preterm). KMC involves continuous skin-to-skin contact, breastfeeding support, and promotion of early hospital discharge with follow-up. The World Health Organization has endorsed KMC for stabilised newborns in health facilities in both high-income and low-resource settings. The objectives of this paper are to: (1) use a 12-country analysis to explore health system bottlenecks affecting the scale-up of KMC; (2) propose solutions to the most significant bottlenecks; and (3) outline priority actions for scale-up. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale-up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for KMC. Results Marked differences were found in the perceived severity of health system bottlenecks between Asian and African countries, with the former reporting more significant or very major bottlenecks for KMC with respect to all the health system building blocks. Community ownership and health financing bottlenecks were significant or very major bottlenecks for KMC in both low and high mortality contexts, particularly in South Asia. Significant bottlenecks were also reported for leadership and governance and health workforce building blocks. Conclusions There are at least a dozen countries worldwide with national KMC programmes, and we identify three pathways to scale: (1) champion-led; (2) project-initiated; and (3) health systems designed. The combination of all three pathways may lead to more rapid scale-up. KMC has the potential to save lives, and change the face of facility-based newborn care, whilst empowering women to care for their preterm newborns. PMID:26391115

Hepatitis a virus genotypes and strains from an endemic area of Europe, Bulgaria 2012-2014.

PubMed

Bruni, Roberto; Taffon, Stefania; Equestre, Michele; Cella, Eleonora; Lo Presti, Alessandra; Costantino, Angela; Chionne, Paola; Madonna, Elisabetta; Golkocheva-Markova, Elitsa; Bankova, Diljana; Ciccozzi, Massimo; Teoharov, Pavel; Ciccaglione, Anna Rita

2017-07-14

Hepatitis A virus (HAV) infection is endemic in Eastern European and Balkan region countries. In 2012, Bulgaria showed the highest rate (67.13 cases per 100,000) in Europe. Nevertheless, HAV genotypes and strains circulating in this country have never been described. The present study reports the molecular characterization of HAV from 105 patients from Bulgaria. Anti-HAV IgM positive serum samples collected in 2012-2014 from different towns and villages in Bulgaria were analysed by nested RT-PCR, sequencing of the VP1/2A region and phylogenetic analysis; the results were analysed together with patient and geographical data. Phylogenetic analysis revealed two main sequence groups corresponding to the IA (78/105, 74%) and IB (27/105, 26%) sub-genotypes. In the IA group, a major and a minor cluster were observed (62 and 16 sequences, respectively). Most sequences from the major cluster (44/62, 71%) belonged to either of two strains, termed "strain 1" and "strain 2", differing only for a single specific nucleotide; the remaining sequences (18/62, 29%) showed few (1 to 4) nucleotide variations respect to strain 1 and 2. Strain 2 is identical to the strain previously responsible for an outbreak in the Czech Republic in 2008 and a large multi-country European outbreak caused by contaminated mixed frozen berries in 2013. Most sequences of the IA minor cluster and the IB group were detected in large/medium centers (LMCs). Overall, sequences from the IA major cluster were more frequent in small centers (SCs), but strain 1 and strain 2 showed an opposite relative frequency in SCs and LMCs (strain 1 more frequent in SCs, strain 2 in LMCs). Genotype IA predominated in Bulgaria in 2012-2014 and phylogenetic analysis identified a major cluster of highly related or identical IA sequences, representing 59% of the analysed cases; these isolates were mostly detected in SCs, in which HAV shows higher endemicity than in LMCs. The distribution of viral sequences suggests the existence of some differences between the transmission routes in SCs and LMCs. Molecular characterization of an increased number of isolates from Bulgaria, regularly collected over time, will be useful to explore specific transmission routes and plan appropriate preventing measures.

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Preterm birth complications are the leading cause of deaths for children under five years. Antenatal corticosteroids (ACS) are effective at reducing mortality and serious morbidity amongst infants born at <34 weeks gestation. WHO guidelines strongly recommend use of ACS for women at risk of imminent preterm birth where gestational age, imminent preterm birth, and risk of maternal infection can be assessed, and appropriate maternal/newborn care provided. However, coverage remains low in high-burden countries for reasons not previously systematically investigated. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for ACS. Results Eleven out of twelve countries provided data in response to the ACS questionnaire. Health system building blocks most frequently reported as having significant or very major bottlenecks were health information systems (11 countries), essential medical products and technologies (9 out of 11 countries) and health service delivery (9 out of 11 countries). Bottlenecks included absence of coverage data, poor gestational age metrics, lack of national essential medicines listing, discrepancies between prescribing authority and provider cadres managing care, delays due to referral, and lack of supervision, mentoring and quality improvement systems. Conclusions Analysis centred on health system building blocks in which 9 or more countries (>75%) reported very major or significant bottlenecks. Health information systems should include improved gestational age assessment and track ACS coverage, use and outcomes. Better health service delivery requires clarified policy assigning roles by level of care and cadre of provider, dependent on capability to assess gestational age and risk of preterm birth, and the implementation of guidelines with adequate supervision, mentoring and quality improvement systems, including audit and feedback. National essential medicines lists should include dexamethasone for antenatal use, and dexamethasone should be integrated into supply logistics. PMID:26390927

Private sector opportunities and threats to achieving malaria elimination in the Greater Mekong Subregion: results from malaria outlet surveys in Cambodia, the Lao PDR, Myanmar, and Thailand.

PubMed

Phok, Sochea; Phanalasy, Saysana; Thein, Si Thu; Likhitsup, Asawin

2017-05-02

The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016. Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People's Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which they were authorized to test and treat for malaria differed. Among outlets stocking at least one anti-malarial, public sector availability of the first-line treatment for uncomplicated Plasmodium falciparum or Plasmodium vivax malaria was >75%. In the anti-malarial stocking private sector, first-line treatment availability was variable (Cambodia, 70.9%; the Lao PDR, 40.8%; Myanmar P. falciparum = 42.7%, P. vivax = 19.6%; Thailand P. falciparum = 19.6%, P. vivax = 73.3%), as was availability of second-line treatment (the Lao PDR, 74.9%; Thailand, 39.1%; Myanmar, 19.8%; and Cambodia, 0.7%). Treatment not in the National Treatment Guidelines (NTGs) was most common in Myanmar (35.8%) and Cambodia (34.0%), and was typically stocked by the informal sector. The majority of anti-malarials distributed in Cambodia and Myanmar were first-line P. falciparum or P. vivax treatments (90.3% and 77.1%, respectively), however, 8.8% of the market share in Cambodia was treatment not in the NTGs (namely chloroquine) and 17.6% in Myanmar (namely oral artemisinin monotherapy). In the Lao PDR, approximately 9 in 10 anti-malarials distributed in the private sector were second-line treatments-typically locally manufactured chloroquine. In Cambodia, 90% of anti-malarials were distributed through outlets that had confirmatory testing available. Over half of all anti-malarial distribution was by outlets that did not have confirmatory testing available in the Lao PDR (54%) and Myanmar (59%). Availability of quality-assured rapid diagnostic tests (RDT) amongst the RDT-stocking public sector ranged from 99.3% in the Lao PDR to 80.1% in Cambodia. In Cambodia, the Lao PDR, and Myanmar, less than 50% of the private sector reportedly received engagement (access to subsidized commodities, supervision, training or caseload reporting), which was most common among private health facilities and pharmacies. Findings from this multi-country study suggest that Cambodia, the Lao PDR, Myanmar, and Thailand are generally in alignment with national regulations, treatment guidelines, and quality-assurance standards. However, important gaps persist in the private sector which pose a threat to national malaria control and elimination goals. Several options are discussed to help align the private sector anti-malarial market with national elimination strategies.

Multi-country assessment of residual bio-efficacy of insecticides used for indoor residual spraying in malaria control on different surface types: results from program monitoring in 17 PMI/USAID-supported IRS countries.

PubMed

Dengela, Dereje; Seyoum, Aklilu; Lucas, Bradford; Johns, Benjamin; George, Kristen; Belemvire, Allison; Caranci, Angela; Norris, Laura C; Fornadel, Christen M

2018-01-30

Indoor residual spraying (IRS) is the application of insecticide to the interior walls of household structures that often serve as resting sites for mosquito vectors of malaria. Human exposure to malaria vectors is reduced when IRS involves proper application of pre-determined concentrations of the active ingredient specific to the insecticide formulation of choice. The impact of IRS can be affected by the dosage of insecticide, spray coverage, vector behavior, vector susceptibility to insecticides, and the residual efficacy of the insecticide applied. This report compiles data on the residual efficacy of insecticides used in IRS campaigns implemented by the United States President's Malaria Initiative (PMI)/United States Agency for International Development (USAID) in 17 African countries and compares observed length of efficacy to ranges proposed in World Health Organization (WHO) guidelines. Additionally, this study provides initial analysis on variation of mosquito mortality depending on the surface material of sprayed structures, country spray program, year of implementation, source of tested mosquitoes, and type of insecticide. Residual efficacy of the insecticides used for PMI/USAID-supported IRS campaigns was measured in Benin, Burkina Faso, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Nigeria, Rwanda, Senegal, Tanzania, Uganda, Zambia and Zimbabwe. The WHO cone bioassay tests were used to assess the mortality rate of mosquitoes exposed to insecticide-treated mud, wood, cement, and other commonly used housing materials. Baseline tests were performed within weeks of IRS application and follow-up tests were continued until the mortality of exposed mosquitoes dropped below 80% or the program monitoring period ended. Residual efficacy in months was then evaluated with respect to WHO guidelines that provide suggested ranges of residual efficacy for insecticide formulations recommended for use in IRS. Where the data allowed, direct comparisons of mosquito mortality rates were then made to determine any significant differences when comparing insecticide formulation, country, year, surface type, and the source of the mosquitoes used in testing. The residual efficacy of alpha-cypermethrin ranged from 4 to 10 months (average = 6.4 months), with no reported incidents of underperformance when compared to the efficacy range provided in WHO guidelines. Deltamethrin residual efficacy results reported a range of 1 to 10 months (average = 4.9 months), with two instances of underperformance. The residual efficacy of bendiocarb ranged from 2 weeks to 7 months (average = 2.8 months) and failed to achieve proposed minimum efficacy on 14 occasions. Lastly, long-lasting pirimiphos-methyl efficacy ranged from 2 months to 9 months (average = 5.3 months), but reported 13 incidents of underperformance. Much of the data used to determine application rate and expected efficacy of insecticides approved for use in IRS programs are collected in controlled laboratory or pilot field studies. However, the generalizability of the results obtained under controlled conditions are limited and unlikely to account for variation in locally sourced housing materials, climate, and the myriad other factors that may influence the bio-efficacy of insecticides. Here, data are presented that confirm the variation in residual efficacy observed when monitoring household surfaces sprayed during PMI/USAID-supported IRS campaigns. All insecticides except alpha-cypermethrin showed evidence of failing to meet the minimum range of residual efficacy proposed in WHO criteria at least once. However, this initial effort in characterizing program-wide insecticide bio-efficacy indicates that some insecticides, such as bendiocarb and pirimiphos-methyl, may be vulnerable to variations in the local environment. Additionally, the comparative analysis performed in this study provides evidence that mosquito mortality rates differ with respect to factors including: the types of insecticide sprayed, surface material, geographical location, year of spraying, and tested mosquitoes. It is, therefore, important to locally assess the residual efficacy of insecticides on various surfaces to inform IRS programming.

Induced abortion, pregnancy loss and intimate partner violence in Tanzania: a population based study.

PubMed

Stöckl, Heidi; Filippi, Veronique; Watts, Charlotte; Mbwambo, Jessie K K

2012-03-05

Violence by an intimate partner is increasingly recognized as an important public and reproductive health issue. The aim of this study is to investigate the extent to which physical and/or sexual intimate partner violence is associated with induced abortion and pregnancy loss from other causes and to compare this with other, more commonly recognized explanatory factors. This study analyzes the data of the Tanzania section of the WHO Multi-Country Study on Women's Health and Domestic Violence, a large population-based cross-sectional survey of women of reproductive age in Dar es Salaam and Mbeya, Tanzania, conducted from 2001 to 2002. All women who answered positively to at least one of the questions about specific acts of physical or sexual violence committed by a partner towards her at any point in her life were considered to have experienced intimate partner violence. Associations between self reported induced abortion and pregnancy loss with intimate partner violence were analysed using multiple regression models. Lifetime physical and/or sexual intimate partner violence was reported by 41% and 56% of ever partnered, ever pregnant women in Dar es Salaam and Mbeya respectively. Among the ever pregnant, ever partnered women, 23% experienced involuntary pregnancy loss, while 7% reported induced abortion. Even after adjusting for other explanatory factors, women who experienced intimate partner violence were 1.6 (95%CI: 1.06,1.60) times more likely to report an pregnancy loss and 1.9 (95%CI: 1.30,2.89) times more likely to report an induced abortion. Intimate partner violence had a stronger influence on induced abortion and pregnancy loss than women's age, socio-economic status, and number of live born children. Intimate partner violence is likely to be an important influence on levels of induced abortion and pregnancy loss in Tanzania. Preventing intimate partner violence may therefore be beneficial for maternal health and pregnancy outcomes. © 2012 Stöckl et al; licensee BioMed Central Ltd.

Induced abortion, pregnancy loss and intimate partner violence in Tanzania: a population based study

PubMed Central

2012-01-01

Background Violence by an intimate partner is increasingly recognized as an important public and reproductive health issue. The aim of this study is to investigate the extent to which physical and/or sexual intimate partner violence is associated with induced abortion and pregnancy loss from other causes and to compare this with other, more commonly recognized explanatory factors. Methods This study analyzes the data of the Tanzania section of the WHO Multi-Country Study on Women's Health and Domestic Violence, a large population-based cross-sectional survey of women of reproductive age in Dar es Salaam and Mbeya, Tanzania, conducted from 2001 to 2002. All women who answered positively to at least one of the questions about specific acts of physical or sexual violence committed by a partner towards her at any point in her life were considered to have experienced intimate partner violence. Associations between self reported induced abortion and pregnancy loss with intimate partner violence were analysed using multiple regression models. Results Lifetime physical and/or sexual intimate partner violence was reported by 41% and 56% of ever partnered, ever pregnant women in Dar es Salaam and Mbeya respectively. Among the ever pregnant, ever partnered women, 23% experienced involuntary pregnancy loss, while 7% reported induced abortion. Even after adjusting for other explanatory factors, women who experienced intimate partner violence were 1.6 (95%CI: 1.06,1.60) times more likely to report an pregnancy loss and 1.9 (95%CI: 1.30,2.89) times more likely to report an induced abortion. Intimate partner violence had a stronger influence on induced abortion and pregnancy loss than women's age, socio-economic status, and number of live born children. Conclusions Intimate partner violence is likely to be an important influence on levels of induced abortion and pregnancy loss in Tanzania. Preventing intimate partner violence may therefore be beneficial for maternal health and pregnancy outcomes. PMID:22390254

Burden of illness and health care resource utilization in adult psychiatric outpatients with attention-deficit/hyperactivity disorder in Europe.

PubMed

Karlsdotter, Kristina; Bushe, Chris; Hakkaart, L; Sobanski, Esther; Kan, C C; Lebrec, Jeremie; Kraemer, Susanne; Dieteren, Nicole A H M; Deberdt, Walter

2016-09-01

To assess the burden of illness and health care resource utilization of adult nonpsychotic psychiatric outpatients with attention-deficit/hyperactivity disorder (ADHD) in Europe. This was a multicountry, cross-sectional, observational study where unselected routine patients from clinical psychiatric outpatient settings were screened and assessed for ADHD. Patients were evaluated using the Clinical Global Impressions of Severity (CGI-S) scale, the Sheehan Disability Scale (SDS), and the EuroQol-5 Dimensions questionnaire. Data on comorbidities, functional impairment, and health care resource utilization were captured. The study enrolled 2284 patients, of whom 1986 completed the study. The prevalence of ADHD was 17.4%, of whom 46.0% had a previous ADHD diagnosis. Patients with ADHD had a high clinical burden with psychiatric comorbidities, especially depression (43.0%) and anxiety disorders (36.4%). Substance abuse (9.2% vs. 3.4%) and alcohol abuse (10.3% vs. 5.2%) were more common in the ADHD cohort vs. the non-ADHD cohort. Only 11.5% of the patients with ADHD had no other psychiatric disorder. Various measures indicated a significantly poorer level of functioning for patients with ADHD than without ADHD, as indicated by higher scores for CGI-S (3.8 vs. 3.3) and SDS (18.9 vs. 11.6) and higher percentages of debt (35.5% vs. 24.3%) and criminality (13.8% vs. 6.1%). Lastly, the health care resource utilization was considerable and similar between adult psychiatric outpatients diagnosed and not diagnosed with ADHD. Although care was taken when choosing the sites for this study, to make it representative of the general outpatient adult psychiatric population, caution should be advised in generalizing the findings of our study to the general ADHD or psychiatric outpatient population. This was an observational study, thus no inference on causality can be drawn. Having ADHD imposes a considerable health and social burden on patient and health care resource utilization comparable to other chronic psychiatric disorders.

Physicians' real-world experience with IDegLira: results of a European survey.

PubMed

Drummond, Russell; Baru, Ankita; Dutkiewicz, Marcelina; Basse, Amaury; Tengmark, Bengt-Olov

2018-01-01

This study aimed to build on the current clinical findings and investigate physicians' experiences and level of satisfaction in using insulin degludec/liraglutide (IDegLira) to treat patients with type 2 diabetes (T2D). This multicountry, European online survey included respondents from primary (n=132) and secondary (n=103) care and examined physicians' use, confidence and satisfaction with IDegLira. To standardize responses, 24 of 28 questions pertained to an 'average patient' with T2D who has no major comorbidities, aged 35-70 years, with average cognitive ability/normal mental status and body mass index ≥25 kg/m 2 . The majority (70%) of respondents prescribe IDegLira in the same visit they first mention it, with uncontrolled glycated hemoglobin (HbA1c) (44%) and weight gain (22%) being the most common reasons. On average, physicians reported that patients weighed 95 kg and the HbA1c level was 9.0% at initiation. Physicians also reported the average HbA1c target set was 7.1%; 76% of patients achieved their target. On average, patients achieved their HbA1c target in <6 months, and the average dose of IDegLira in patients in glycemic control was 28 dose steps. Respondents were more satisfied with IDegLira than basal-bolus therapy across all parameters assessed, including reaching HbA1c targets (59%), number of injections (77%) and avoiding weight gain (84%). Correspondingly, 77% of physicians reported that IDegLira had more potential to improve patient motivation compared with basal-bolus to reach target blood glucose levels. Real-world experience of IDegLira is consistent with previous trials/studies, with no major differences between primary and secondary care. Importantly, the majority of respondents were more/much more satisfied with IDegLira than with basal-bolus therapy.

Where are we now? A multicountry qualitative study to explore access to pre-antiretroviral care services: a precursor to antiretroviral therapy initiation

PubMed Central

Bukenya, Dominic; Wringe, Alison; Skovdal, Morten; Ssekubugu, Robert; Paparini, Sara; McLean, Estelle; Bonnington, Oliver; Wamoyi, Joyce; Seeley, Janet

2017-01-01

Objective To explore barriers and facilitators to accessing postdiagnosis HIV care in five sub-Saharan African countries. Methods In-depth interviews were conducted with 77 people living with HIV (PLHIV) in pre-antiretroviral therapy care or not-yet-in care and 46 healthcare workers. Participants were purposely selected from health and demographic surveillance sites in Karonga (Malawi), Manicaland (Zimbabwe), uMkhanyakude (South Africa), Kisesa (Tanzania) and Rakai and Kyamulibwa (Uganda). Thematic content analysis was conducted, guided by the constructs of affordability, availability and acceptability of care.- Results Affordability: Transport and treatment costs were a barrier to HIV care, although some participants travelled to distant clinics to avoid being seen by people who knew them or for specific services. Broken equipment and drug stock-outs in local clinics could also necessitate travel to other facilities. Availability: Some facilities did not offer full HIV care, or only offered all services intermittently. PLHIV who frequently travelled complained that care was seldom available to them in places they visited. Acceptability: Severe pain or sickness was a key driver for accessing postdiagnosis care, whereas asymptomatic PLHIV often delayed care-seeking. A belief in witchcraft was a deterrent to accessing clinical care following diagnosis. Changing antiretroviral therapy guidelines generated uncertainty among PLHIV about when to start treatment and delayed postdiagnosis care. PLHIV reported that healthcare workers’ knowledge, attitudes and behaviours, and their ability to impart health education, also influenced whether they accessed HIV care. Conclusion Despite efforts to decentralise services over the past decade, many barriers to accessing HIV care persist. There is a need to increase sustained access to care for PLHIV not yet on treatment, with initiatives that encompass biomedical aspects of care alongside considerations for individual and collective challenges they faced. A failure to do so may undermine efforts to achieve universal access to antiretroviral therapy. PMID:28615327

Community participation in formulating the post-2015 health and development goal agenda: reflections of a multi-country research collaboration.

PubMed

Brolan, Claire E; Hussain, Sameera; Friedman, Eric A; Ruano, Ana Lorena; Mulumba, Moses; Rusike, Itai; Beiersmann, Claudia; Hill, Peter S

2014-10-10

Global discussion on the post-2015 development goals, to replace the Millennium Development Goals when they expire on 31 December 2015, is well underway. While the Millennium Development Goals focused on redressing extreme poverty and its antecedents for people living in developing countries, the post-2015 agenda seeks to redress inequity worldwide, regardless of a country's development status. Furthermore, to rectify the UN's top-down approach toward the Millennium Development Goals' formulation, widespread negotiations are underway that seek to include the voices of people and communities from around the globe to ground each post-2015 development goal. This reflexive commentary, therefore, reports on the early methodological challenges the Go4Health research project experienced in its engagement with communities in nine countries in 2013. Led by four research hubs in Uganda, Bangladesh, Australia and Guatemala, the purpose of this engagement has been to ascertain a 'snapshot' of the health needs and priorities of socially excluded populations particularly from the Global South. This is to inform Go4Health's advice to the European Commission on the post-2015 global goals for health and new governance frameworks. Five methodological challenges were subsequently identified from reflecting on the multidisciplinary, multiregional team's research practices so far: meanings and parameters around qualitative participatory research; representation of marginalization; generalizability of research findings; ethical research in project time frames; and issues related to informed consent. Strategies to overcome these methodological hurdles are also examined. The findings from the consultations represent the extraordinary diversity of marginal human experience requiring contextual analysis for universal framing of the post-2015 agenda. Unsurprisingly, methodological challenges will, and did, arise. We conclude by advocating for a discourse to emerge not only critically examining how and whose voices are being obtained at the community-level to inform the post-2015 health and development goal agenda, but also how these voices are being translated and integrated into post-2015 decision-making at national and global levels.

Severe physical punishment: risk of mental health problems for poor urban children in Brazil

PubMed Central

Duarte, Cristiane S; Peres, Clovis A; Nascimento, Rosimeire; Curto, Bartira M; Paula, Cristiane S

2009-01-01

Abstract Objective To examine the relationship between specific types of child mental health problems and severe physical punishment, in combination with other important known risk factors. Methods We conducted a cross-sectional study in Embu, São Paulo, Brazil, as the Brazilian component of a multicountry survey on abuse in the family environment. From a probabilistic sample of clusters that included all eligible households (women aged 15–49 years with a son or daughter < 18 years of age), we randomly selected one mother–child pair per household (n = 813; attrition rate: 17.6%). This study focused on children aged 6–17 years (n = 480). Child Behaviour Checklist CBCL/6–18 was used to identify children with internalizing problems only, externalizing problems only, and both internalizing and externalizing problems (comorbidity). Severe physical punishment was defined as being hit with an object, being kicked, choked, smothered, burnt, scalded, branded, beaten or threatened with a weapon. We examined other potential correlates from four domains: child (gender, age, ever witnessing marital violence); mother (education, unemployment, anxiety or depression, marital violence); father (absence, drunkenness); and family (socioeconomic status). The WHO Self-Reporting Questionnaire (SRQ-20) was used to identify maternal anxiety or depression (score > 7). Backward logistic regression analysis identified independent correlates and significant interactions. Findings Multivariate modelling showed that severe punishment was an independent correlate of comorbid internalizing and externalizing problems but was not associated with internalizing problems only. It increased the risk of externalizing problems alone only for children and adolescents not exposed to maternal anxiety or depression. Maternal anxiety or depression increased the risk only for children or adolescents not exposed to severe punishment. Conclusion Severe punishment may be related to child mental health problems, with the mechanism depending on the type of problem. Its influence persists in the presence of family stressors such as the father’s absence and maternal anxiety or depression. PMID:19551251

Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI) and Diarrhea in Children: A Multi-Country Study?

PubMed

Bawankule, Rahul; Singh, Abhishek; Kumar, Kaushalendra; Shetye, Sadanand

2017-01-01

Pneumonia and diarrhea occur either as complications or secondary infections in measles affected children. So, the integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD) by WHO and UNICEF includes measles vaccination as preventive measure in children. The objective of the study is to examine the effect of measles vaccination on Acute Respiratory Infection (ARI) and diarrhea in children in the Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan. We analyzed data from the most recent rounds of Demographic and Health Surveys (DHS) in the selected countries. We included children age 12-59 months in the analysis. We used multivariable binary logistic regression to examine the effect of measles vaccination on ARI and diarrhea in children. We also estimated Vaccination Effectiveness (VE). More than 60 percent of the children age 12-59 months were given measles vaccine before the survey in the Democratic Republic of Congo, Ethiopia, India and Pakistan. Children who were given the measles vaccine were less likely to suffer from ARI than unvaccinated children in India and Pakistan. Children who were given the measles vaccine had a lower risk of diarrhea than those who did not receive it in all the selected countries except Ethiopia. Measles vaccination was associated with reduction in ARI cases by 15-30 percent in India and Pakistan, and diarrhea cases by 12-22 percent in the Democratic Republic of Congo, India, Nigeria and Pakistan. The receipt of the measles vaccine was associated with decrease in ARI and diarrhea in children. The immunization program must ensure that each child gets the recommended doses of measles vaccine at the appropriate age. The measles vaccination should be given more attention as a preventive intervention under the Global Action Plan for Pneumonia and Diarrhea (GAPPD) in all low and middle-income countries.

A multi-country study of intussusception in children under 2 years of age in Latin America: analysis of prospective surveillance data.

PubMed

Sáez-Llorens, Xavier; Velázquez, F Raúl; Lopez, Pio; Espinoza, Felix; Linhares, Alexandre C; Abate, Hector; Nuñez, Ernesto; Venegas, Guillermo; Vergara, Rodrigo; Jimenez, Ana L; Rivera, Maribel; Aranza, Carlos; Richardson, Vesta; Macias-Parra, Mercedes; Palacios, Guillermo Ruiz; Rivera, Luis; Ortega-Barria, Eduardo; Cervantes, Yolanda; Rüttimann, Ricardo; Rubio, Pilar; Acosta, Camilo J; Newbern, Claire; Verstraeten, Thomas; Breuer, Thomas

2013-05-27

Intussusception (IS) is a form of acute intestinal obstruction that occurs mainly in infants and is usually of unknown cause. An association between IS and the first licensed rotavirus vaccine, a reassortant-tetravalent, rhesus-based rotavirus vaccine (RRV-TV), led to the withdrawal of the vaccine. New rotavirus vaccines have now been developed and extensively studied for their potential association with IS. This study aimed to describe the epidemiology and to estimate the incidence of IS in Latin American infants prior to new vaccine introduction. Children under 2 years of age representing potential IS cases were enrolled in 16 centers in 11 Latin American countries from January 2003 to May 2005. IS cases were classified as definite, probable, possible or suspected as stated on the Brighton Collaboration Working Group guidelines. From 517 potential cases identified, 476 (92%) cases were classified as definite, 21 probable, 10 possible and 10 suspected for intussusception. Among the 476 definite IS cases, the median age at presentation was 6.4 months with 89% of cases aged <1 year. The male to female ratio was 1.5:1. The incidence of definite IS per 100,000 subject-years ranged from 1.9 in Brazil to 62.4 in Argentina for children <2 years of age, and from 3.8 in Brazil to 105.3 in Argentina for children aged <1 year. Median hospital stay was 4 days with a high prevalence of surgery as the primary treatment (65%). Most cases (88%) made a complete recovery, but 13 (3%) died. No clear seasonal pattern of IS cases emerged. This study describes the epidemiology and estimates the incidence of IS in Latin American infants prior to the introduction of new rotavirus vaccines. The incidence of IS was found to vary between different countries, as observed in previous studies. Clinical study identifier 999910/204 (SERO-EPI-IS-204).

WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections

PubMed Central

2009-01-01

Background Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time. Methods We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates. Results The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively. Conclusion The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care. PMID:19874598

Heat Wave and Mortality: A Multicountry, Multicommunity Study

PubMed Central

Gasparrini, Antonio; Armstrong, Ben G.; Tawatsupa, Benjawan; Tobias, Aurelio; Lavigne, Eric; Coelho, Micheline de Sousa Zanotti Stagliorio; Pan, Xiaochuan; Kim, Ho; Hashizume, Masahiro; Honda, Yasushi; Guo, Yue-Liang Leon; Wu, Chang-Fu; Zanobetti, Antonella; Schwartz, Joel D.; Bell, Michelle L.; Scortichini, Matteo; Michelozzi, Paola; Punnasiri, Kornwipa; Li, Shanshan; Tian, Linwei; Garcia, Samuel David Osorio; Seposo, Xerxes; Overcenco, Ala; Zeka, Ariana; Goodman, Patrick; Dang, Tran Ngoc; Dung, Do Van; Mayvaneh, Fatemeh; Saldiva, Paulo Hilario Nascimento; Williams, Gail; Tong, Shilu

2017-01-01

Background: Few studies have examined variation in the associations between heat waves and mortality in an international context. Objectives: We aimed to systematically examine the impacts of heat waves on mortality with lag effects internationally. Methods: We collected daily data of temperature and mortality from 400 communities in 18 countries/regions and defined 12 types of heat waves by combining community-specific daily mean temperature ≥90th, 92.5th, 95th, and 97.5th percentiles of temperature with duration ≥2, 3, and 4 d. We used time-series analyses to estimate the community-specific heat wave–mortality relation over lags of 0–10 d. Then, we applied meta-analysis to pool heat wave effects at the country level for cumulative and lag effects for each type of heat wave definition. Results: Heat waves of all definitions had significant cumulative associations with mortality in all countries, but varied by community. The higher the temperature threshold used to define heat waves, the higher heat wave associations on mortality. However, heat wave duration did not modify the impacts. The association between heat waves and mortality appeared acutely and lasted for 3 and 4 d. Heat waves had higher associations with mortality in moderate cold and moderate hot areas than cold and hot areas. There were no added effects of heat waves on mortality in all countries/regions, except for Brazil, Moldova, and Taiwan. Heat waves defined by daily mean and maximum temperatures produced similar heat wave–mortality associations, but not daily minimum temperature. Conclusions: Results indicate that high temperatures create a substantial health burden, and effects of high temperatures over consecutive days are similar to what would be experienced if high temperature days occurred independently. People living in moderate cold and moderate hot areas are more sensitive to heat waves than those living in cold and hot areas. Daily mean and maximum temperatures had similar ability to define heat waves rather than minimum temperature. https://doi.org/10.1289/EHP1026 PMID:28886602

Depression, sleep problems, and perceived stress among informal caregivers in 58 low-, middle-, and high-income countries: A cross-sectional analysis of community-based surveys.

PubMed

Koyanagi, Ai; DeVylder, Jordan E; Stubbs, Brendon; Carvalho, André F; Veronese, Nicola; Haro, Josep M; Santini, Ziggi I

2018-01-01

Caregiving has been associated with adverse health outcomes. However, there is a paucity of multi-country, population-based studies on mental health outcomes of caregivers especially from low- and middle-income countries (LMICs). Thus, we assessed the association of caregiving with depression, sleep problems, and perceived stress in 10 high-, 27 middle-, and 21 low-income countries. Cross-sectional community-based data of the World Health Survey including 258,793 adults aged ≥18 years were analyzed. Multivariable logistic and linear regression analyses were conducted to explore the association of past 12-month caregiving with past 12-month DSM-IV depression, and past 30-day perceived stress [range 0 (low)-100 (high)] and severe/extreme sleep problems. Nearly 20% of the individuals were engaged in caregiving with particularly high rates observed in high-income countries (HICs) (e.g., Finland 43.3%). Across the entire sample, after adjustment for potential confounders, caregivers had a significantly higher likelihood of having depression (OR = 1.54; 95%CI = 1.37-1.73), sleep problems (OR = 1.37; 95%CI = 1.25-1.50), while their mean perceived stress score was 3.15 (95%CI = 2.46-3.84) points higher. These associations tended to be stronger in HICs. A greater number of caregiving activities was associated with a greater likelihood of depression, sleep problems, and perceived stress regardless of country income levels. In conclusion, caregiving has a negative impact on mental health worldwide with possibly greater effects in HICs. Given the growing contribution of caregivers in long-term care, interventions and policies to alleviate the mental health burden of caregivers are urgently needed to maintain sustainable and effective care practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

Correlation between changes in quality of life and symptomatic improvement in Chinese patients switched from typical antipsychotics to olanzapine.

PubMed

Montgomery, William; Kadziola, Zbigniew; Ye, Wenye; Xue, Hai Bo; Liu, Li; Treuer, Tamás

2015-01-01

The aim of this study was to investigate the correlation between changes in symptoms and changes in self-reported quality of life among Chinese patients with schizophrenia who were switched from a typical antipsychotic to olanzapine during usual outpatient care. This post hoc analysis was conducted using data from the Chinese subgroup (n=475) of a multicountry, 12-month, prospective, noninterventional, observational study. The primary publication previously reported the efficacy, safety, and quality of life among patients who switched from a typical antipsychotic to olanzapine. Patients with schizophrenia were included if their symptoms were inadequately controlled with a typical antipsychotic and they were switched to olanzapine. Symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions-Severity scale (CGI-S). Health-Related Quality of Life (HRQOL) was assessed using the World Health Organization Quality of Life-Abbreviated (WHOQOL-BREF). Paired t-tests were performed to assess changes from baseline to endpoint. Pearson's correlation coefficients (r) were used to assess the correlations between change in symptoms (BPRS and CGI-S scores) and change in HRQOL (WHOQOL-BREF scores). Symptoms and HRQOL both improved significantly over the 12 months of treatment (P<0.001). Significant correlations were observed between changes from baseline to end of study on the BPRS and the CGI-S and each of the WHOQOL-BREF four domain scores and two overall quality-of-life questions. The correlation coefficients ranged from r=-0.45 to r=-0.53 for the BPRS and WHOQOL-BREF. The correlation coefficients were slightly smaller between the CGI-S and WHOQOL-BREF, ranging from r=-0.33 to r=-0.40. For patients with schizophrenia, assessing quality of life has the potential to add valuable information to the clinical assessment that takes into account the patient's own perspective of well-being.

Determinants of intimate partner violence during pregnancy among married women in Abay Chomen district, Western Ethiopia: a community based cross sectional study.

PubMed

Abebe Abate, Bedilu; Admassu Wossen, Bitiya; Tilahun Degfie, Tizta

2016-03-10

Intimate partner violence during pregnancy is the most common form of violence that harms the health of women and the fetus but practiced commonly in developing countries. There is scarcity of information regarding intimate partner violence during pregnancy in Ethiopia. Thus, this study aimed to assess the prevalence and associated factors of intimate partner violence during recent pregnancy in Abay Chomen district, Western Ethiopia. Community based cross sectional study was conducted among married pregnant women in Abay Chomen district in April, 2014 using a standard WHO multi-country study questionnaire. Two hundred eighty two randomly selected pregnant women aged 15-49 years participated in the study. Logistic regression and multivariate analysis were employed. The prevalence of intimate partner violence during recent pregnancy was 44.5% (95% CI, 32.6, 56.4). More than half 157 (55.5%) experienced all three forms of intimate partner violence during recent pregnancy. The joint occurrence of intimate partner physical and psychological violence during recent pregnancy as well as joint occurrence of intimate partner physical and sexual violence was 160 (56.5%). Pregnant women who were ever lived with their partner's family were 46% less likely to experience recent intimate partner violence. Dowry payment decreases intimate partner violence during recent pregnancy (AOR 0.09, 95% CI 0.04, 0.2) and pregnant women who didn't undergo marriage ceremony during their marriage were 79% are less likely to experience violence (AOR 0.21, 95% CI 0.1, 0.44). Nearly half of interviewed pregnant women experienced intimate partner violence during pregnancy implying the prevalence of such practice in the study site. To that end, increasing community awareness about the consequences of the practice could be important. Moreover, as health extension workers works closely with households, they could be crucial players to increase community awareness about intimate partner violence on pregnant mothers and halt it or its risk factors.

Inequalities in Maternal Health Care Utilization in Sub-Saharan African Countries: A Multiyear and Multi-Country Analysis

PubMed Central

Alam, Nazmul; Hajizadeh, Mohammad; Dumont, Alexandre; Fournier, Pierre

2015-01-01

To assess social inequalities in the use of antenatal care (ANC), facility based delivery (FBD), and modern contraception (MC) in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda) had <350 MMR in 2010 with >4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe) had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS) before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda), ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries which made progress towards reducing maternal mortality. PMID:25853423

Understanding collaboration in a multi-national research capacity-building partnership: a qualitative study.

PubMed

Varshney, Dinansha; Atkins, Salla; Das, Arindam; Diwan, Vishal

2016-08-18

Research capacity building and its impact on policy and international research partnership is increasingly seen as important. High income and low- and middle-income countries frequently engage in research collaborations. These can have a positive impact on research capacity building, provided such partnerships are long-term collaborations with a unified aim, but they can also have challenges. What are these challenges, which often result in a short term/ non viable collaboration? Does such collaboration results in capacity building? What are the requirements to make any collaboration sustainable? This study aimed to answer these and other research questions through examining an international collaboration in one multi-country research capacity building project ARCADE RSDH (Asian Regional Capacity Development for Research on Social Determinants of Health). A qualitative study was conducted that focused on the reasons for the collaboration, collaboration patterns involved, processes of exchanging information, barriers faced and perceived growth in research capacity. In-depth interviews were conducted with the principal investigators (n = 12), research assistants (n = 2) and a scientific coordinator (n = 1) of the collaborating institutes. Data were analysed using thematic framework analysis. The initial contact between institutes was through previous collaborations. The collaboration was affected by the organisational structure of the partner institutes, political influences and the collaboration design. Communication was usually conducted online, which was affected by differences in time and language and inefficient infrastructure. Limited funding resulted in restricted engagement by some partners. This study explored work in a large, North-South collaboration project focusing on building research capacity in partner institutes. The project helped strengthen research capacity, though differences in organization types, existing research capacity, culture, time, and language acted as obstacles to the success of the project. Managing these differences requires preplanned strategies to develop functional communication channels among the partners, maintaining transparency, and sharing the rewards and benefits at all stages of collaboration.

Multi-Country analysis of palm oil consumption and cardiovascular disease mortality for countries at different stages of economic development: 1980-1997.

PubMed

Chen, Brian K; Seligman, Benjamin; Farquhar, John W; Goldhaber-Fiebert, Jeremy D

2011-12-16

Cardiovascular diseases represent an increasing share of the global disease burden. There is concern that increased consumption of palm oil could exacerbate mortality from ischemic heart disease (IHD) and stroke, particularly in developing countries where it represents a major nutritional source of saturated fat. The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and an interaction between palm oil consumption and country economic development level. Analyses examined changes in country-level outcomes over time employing linear panel regressions with country-level fixed effects, population weighting, and robust standard errors clustered by country. Sensitivity analyses included further adjustment for other major dietary sources of saturated fat. In developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant. For historically high-income countries, changes in IHD and stroke mortality rates from palm oil consumption were smaller (IHD: 17 deaths per 100,000 (95% CI [5.3-29]); stroke: 5.1 deaths per 100,000 (95% CI [-1.2-11.0])). Inclusion of other major saturated fat sources including beef, pork, chicken, coconut oil, milk cheese, and butter did not substantially change the differentially higher relationship between palm oil and IHD mortality in developing countries. Increased palm oil consumption is related to higher IHD mortality rates in developing countries. Palm oil consumption represents a saturated fat source relevant for policies aimed at reducing cardiovascular disease burdens.

WOMEN'S EDUCATION AND UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A MULTI-COUNTRY AND SOCIOECONOMIC STATUS ANALYSIS.

PubMed

Tsala Dimbuene, Zacharie; Amo-Adjei, Joshua; Amugsi, Dickson; Mumah, Joyce; Izugbara, Chimaraoke O; Beguy, Donatien

2017-11-06

There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over-generalization of the association between women's education and maternal health service utilization can be misleading. Efforts to improve maternal health service utilization in Africa must adopt an 'equity' approach, taking into account the specific needs of sub-populations.

A multi-country study of the “intrapartum stillbirth and early neonatal death indicator” in hospitals in low-resource settings

PubMed Central

Goldenberg, Robert L.; McClure, Elizabeth M.; Kodkany, Bhala; Wembodinga, Gilbert; Pasha, Omrana; Esamai, Fabian; Tshefu, Antoinette; Patel, Archana; Mabaye, Hillary; Goudar, Shivaparasad; Saleem, Sarah; Waikar, Manjushri; Langer, Ana; Bose, Carl L.; Rubens, Craig E.; Wright, Linda L.; Moore, Janet; Blanc, Ann

2013-01-01

Objective To determine the feasibility of introducing a simple indicator of quality of obstetric and neonatal care and to determine the proportion of potentially avoidable perinatal deaths in hospitals in low-income countries. Methods Between September 1, 2011, and February 29, 2012, data were collected from women who had a term pregnancy and were admitted to the labor ward of 1 of 6 hospitals in 4 low-income countries. Fetal heart tones on admission were monitored, and demographic and birth data were recorded. Results Data were obtained for 3555 women and 3593 neonates (including twins). The doptone was used on 97% of women admitted. The overall perinatal mortality rate was 34 deaths per 1000 deliveries. Of the perinatal deaths, 40%–45% occurred in the hospital and were potentially preventable by better hospital care. Conclusion The results demonstrated that it is possible to accurately determine fetal viability on admission via a doptone. Implementation of doptone use, coupled with a concise data record, might form the basis of a low-cost and sustainable program to monitor and evaluate efforts to improve quality of care and ultimately might to help to reduce the in-hospital component of perinatal mortality in low-income countries. PMID:23796259

Multicentre dose audit for clinical trials of radiation therapy in Asia.

PubMed

Mizuno, Hideyuki; Fukuda, Shigekazu; Fukumura, Akifumi; Nakamura, Yuzuru-Kutsutani; Jianping, Cao; Cho, Chul-Koo; Supriana, Nana; Dung, To Anh; Calaguas, Miriam Joy; Devi, C R Beena; Chansilpa, Yaowalak; Banu, Parvin Akhter; Riaz, Masooma; Esentayeva, Surya; Kato, Shingo; Karasawa, Kumiko; Tsujii, Hirohiko

2017-05-01

A dose audit of 16 facilities in 11 countries has been performed within the framework of the Forum for Nuclear Cooperation in Asia (FNCA) quality assurance program. The quality of radiation dosimetry varies because of the large variation in radiation therapy among the participating countries. One of the most important aspects of international multicentre clinical trials is uniformity of absolute dose between centres. The National Institute of Radiological Sciences (NIRS) in Japan has conducted a dose audit of participating countries since 2006 by using radiophotoluminescent glass dosimeters (RGDs). RGDs have been successfully applied to a domestic postal dose audit in Japan. The authors used the same audit system to perform a dose audit of the FNCA countries. The average and standard deviation of the relative deviation between the measured and intended dose among 46 beams was 0.4% and 1.5% (k = 1), respectively. This is an excellent level of uniformity for the multicountry data. However, of the 46 beams measured, a single beam exceeded the permitted tolerance level of ±5%. We investigated the cause for this and solved the problem. This event highlights the importance of external audits in radiation therapy. © The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

Large-scale road safety programmes in low- and middle-income countries: an opportunity to generate evidence.

PubMed

Hyder, Adnan A; Allen, Katharine A; Peters, David H; Chandran, Aruna; Bishai, David

2013-01-01

The growing burden of road traffic injuries, which kill over 1.2 million people yearly, falls mostly on low- and middle-income countries (LMICs). Despite this, evidence generation on the effectiveness of road safety interventions in LMIC settings remains scarce. This paper explores a scientific approach for evaluating road safety programmes in LMICs and introduces such a road safety multi-country initiative, the Road Safety in 10 Countries Project (RS-10). By building on existing evaluation frameworks, we develop a scientific approach for evaluating large-scale road safety programmes in LMIC settings. This also draws on '13 lessons' of large-scale programme evaluation: defining the evaluation scope; selecting study sites; maintaining objectivity; developing an impact model; utilising multiple data sources; using multiple analytic techniques; maximising external validity; ensuring an appropriate time frame; the importance of flexibility and a stepwise approach; continuous monitoring; providing feedback to implementers, policy-makers; promoting the uptake of evaluation results; and understanding evaluation costs. The use of relatively new approaches for evaluation of real-world programmes allows for the production of relevant knowledge. The RS-10 project affords an important opportunity to scientifically test these approaches for a real-world, large-scale road safety evaluation and generate new knowledge for the field of road safety.

A multi-country outbreak of Salmonella Newport gastroenteritis in Europe associated with watermelon from Brazil, confirmed by whole genome sequencing: October 2011 to January 2012.

PubMed

Byrne, L; Fisher, I; Peters, T; Mather, A; Thomson, N; Rosner, B; Bernard, H; McKeown, P; Cormican, M; Cowden, J; Aiyedun, V; Lane, C

2014-08-07

In November 2011, the presence of Salmonella Newport in a ready-to-eat watermelon slice was confirmed as part of a local food survey in England. In late December 2011, cases of S. Newport were reported in England, Wales, Northern Ireland, Scotland, Ireland and Germany. During the outbreak, 63 confirmed cases of S. Newport were reported across all six countries with isolates indistinguishable by pulsed-field gel electrophoresis from the watermelon isolate.A subset of outbreak isolates were whole-genome sequenced and were identical to, or one single nucleotide polymorphism different from the watermelon isolate.In total, 46 confirmed cases were interviewed of which 27 reported watermelon consumption. Further investigations confirmed the outbreak was linked to the consumption of watermelon imported from Brazil.Although numerous Salmonella outbreaks associated with melons have been reported in the United States and elsewhere, this is the first of its kind in Europe.Expansion of the melon import market from Brazil represents a potential threat for future outbreaks. Whole genome sequencing is rapidly becoming more accessible and can provide a compelling level of evidence of linkage between human cases and sources of infection,to support public health interventions in global food markets.

Milk and other dietary influences on coronary heart disease

NASA Technical Reports Server (NTRS)

Grant, W. B.

1998-01-01

While dietary links to ischemic heart disease (IHD) and coronary heart disease (CHD) mortality have been studied for many years, the correlation has not clearly been resolved, especially for older populations. In this paper, a multi-country statistical approach involving 32 countries is used to find dietary links to IHD and CHD for various age groups aged 35+. For IHD, milk carbohydrates were found to have the highest statistical association for males aged 35+ and females aged 65+, while for females aged 35-64, sugar was found to have the highest association. In the case of CHD, non-fat milk was found to have the highest association for males aged 45+ and females aged 75+, while for females 65-74, milk carbohydrates and sugar had the highest associations, and for females aged 45-64, sugar had the highest association. A number of mechanisms have been proposed in the literature that might explain the milk carbohydrate or non-fat milk association. One of the most prominent theories is that animal proteins contribute to homocysteine (Hcy) production; however, milk more than meat lacks adequate B vitamins to convert Hcy to useful products. Lactose and calcium in conjunction with Hcy from consumption of non-fat milk may also contribute to calcification of the arteries.

A multi-country outbreak of Salmonella Newport gastroenteritis in Europe associated with watermelon from Brazil, confirmed by whole genome sequencing: October 2011 to January 2012

PubMed Central

Byrne, L; Fisher, I; Peters, T; Mather, A; Thomson, N; Rosner, B; Bernard, H; McKeown, P; Cormican, M; Cowden, J; Aiyedun, V; Lane, C

2015-01-01

In November 2011, the presence of Salmonella Newport in a ready-to-eat watermelon slice was confirmed as part of a local food survey in England. In late December 2011, cases of S. Newport were reported in England, Wales, Northern Ireland, Scotland, Ireland and Germany. During the outbreak, 63 confirmed cases of S. Newport were reported across all six countries with isolates indistinguishable by pulsed-field gel electrophoresis from the watermelon isolate. A subset of outbreak isolates were whole-genome sequenced and were identical to, or one single nucleotide polymorphism different from the watermelon isolate. In total, 46 confirmed cases were interviewed of which 27 reported watermelon consumption. Further investigations confirmed the outbreak was linked to the consumption of watermelon imported from Brazil. Although numerous Salmonella outbreaks associated with melons have been reported in the United States and elsewhere, this is the first of its kind in Europe. Expansion of the melon import market from Brazil represents a potential threat for future outbreaks. Whole genome sequencing is rapidly becoming more accessible and can provide a compelling level of evidence of linkage between human cases and sources of infection, to support public health interventions in global food markets. PMID:25138971

A trial like ALIC4E: why design a platform, response-adaptive, open, randomised controlled trial of antivirals for influenza-like illness?

PubMed Central

Butler, Christopher C.; Coenen, Samuel; Saville, Benjamin R.; Cook, Johanna; van der Velden, Alike; Homes, Jane; de Jong, Menno; Little, Paul; Goossens, Herman; Ieven, Margareta; Francis, Nick; Moons, Pieter; Bongard, Emily; Verheij, Theo

2018-01-01

ALIC4E is the first publicly funded, multicountry, pragmatic study determining whether antivirals should be routinely prescribed for influenza-like illness in primary care. The trial aims to go beyond determining the average treatment effect in a population to determining effects in patients with combinations of participant characteristics (age, symptom duration, illness severity, and comorbidities). It is one of the first platform, response-adaptive, open trial designs implemented in primary care, and this article aims to provide an accessible description of key aspects of the study design. 1) The platform design allows the study to remain relevant to evolving circumstances, with the ability to add treatment arms. 2) Response adaptation allows the proportion of participants with key characteristics allocated to study arms to be altered during the course of the trial according to emerging outcome data, so that participants' information will be most useful, and increasing their chances of receiving the trial intervention that will be most effective for them. 3) Because the possibility of taking placebos influences participant expectations about their treatment, and determining effects of the interventions on patient help seeking and adherence behaviour in real-world care is critical to estimates of cost-effectiveness, ALIC4E is an open-label trial. PMID:29761108

Scaling up HIV self-testing in sub-Saharan Africa: a review of technology, policy and evidence.

PubMed

Indravudh, Pitchaya P; Choko, Augustine T; Corbett, Elizabeth L

2018-02-01

HIV self-testing (HIVST) can provide complementary coverage to existing HIV testing services and improve knowledge of status among HIV-infected individuals. This review summarizes the current technology, policy and evidence landscape in sub-Saharan Africa and priorities within a rapidly evolving field. HIVST is moving towards scaled implementation, with the release of WHO guidelines, WHO prequalification of the first HIVST product, price reductions of HIVST products and a growing product pipeline. Multicountry evidence from southern and eastern Africa confirms high feasibility, acceptability and accuracy across many delivery models and populations, with minimal harms. Evidence on the effectiveness of HIVST on increased testing coverage is strong, while evidence on demand generation for follow-on HIV prevention and treatment services and cost-effective delivery is emerging. Despite these developments, HIVST delivery remains limited outside of pilot implementation. Important technology gaps include increasing availability of more sensitive HIVST products in low and middle-income countries. Regulatory and postmarket surveillance systems for HIVST also require further development. Randomized trials evaluating the effectiveness and cost-effectiveness under multiple distribution models, including unrestricted delivery and with a focus on linkage to HIV prevention and treatment, remain priorities. Diversification of studies from west and central Africa and around blood-based products should be addressed.

A multi-country comparison of reasons for dental non-attendance

PubMed Central

Listl, Stefan; Moeller, John; Manski, Richard

2013-01-01

The purpose of this study was to describe cross-country differences with respect to the reasons for dental non-attendance by Europeans currently aged 50 yr and older. The analyses were based on retrospective life-history data from the Survey of Health, Ageing and Retirement in Europe and included information about various reasons why respondents from 13 European countries had never had regular dental visits in their lifetimes. A series of logistic regression models was estimated to identify reasons for dental non-attendance across different welfare state regimes. The highest percentage of respondents without any regular dental attendance throughout their lifetimes was found for the Southern welfare state regime, followed by the Eastern, the Bismarckian, and the Scandinavian welfare state regimes. Factors such as patients’ perception that regular dental treatment is ‘not necessary’ or ‘not usual’ appear to be the predominant reason for non-attendance in all welfare state regimes. Within the Southern, Eastern, and Bismarckian welfare state regimes, the health system level factor ‘no place to receive this type of care close to home’ and the perception of regular dental treatment as ‘not necessary’ were more often referred to than in Scandinavia. This could be relevant information for health care decision makers in order to prioritize interventions towards increasing rates of regular dental attendance. PMID:24147428

Equity in access to maternal and child health services in five developing countries: what works.

PubMed

Talukder, M D Noorunnabi; Rob, Ubaidur

2010-01-01

People living in rural areas are yet to have equitable access to maternal and child health services in many developing countries. This article examines selected health service delivery models that improved access to services in five developing countries. The article is based on the review of background papers on Bangladesh, Pakistan, Cambodia, Ghana, and Tanzania, prepared as part of a multi-country study on health systems and maternal and child health. Findings suggest that equity in access to health services largely depends on a system that ensures a combination of facility-based service delivery and outreach services with a functioning referral network. A key factor is the availability of health workforce at the community level. Community-based deployment of service providers or recruitment and training of community health workers is critical in enhancing service coverage and linking local populations to a health facility. Incentive is necessary to keep community health workers' interest in providing services. However, health workforce alone cannot ensure good health outcomes. They must be embedded in a functioning service delivery network to transform structural inputs into outcomes. Moreover, local-level health systems should have the ability to allocate resources in strategic ways addressing the pressing health needs of the people.

Economic impacts of policies affecting crop biotechnology and trade.

PubMed

Anderson, Kym

2010-11-30

Agricultural biotechnologies, and especially transgenic crops, have the potential to boost food security in developing countries by offering higher incomes for farmers and lower priced and better quality food for consumers. That potential is being heavily compromised, however, because the European Union and some other countries have implemented strict regulatory systems to govern their production and consumption of genetically modified (GM) food and feed crops, and to prevent imports of foods and feedstuffs that do not meet these strict standards. This paper analyses empirically the potential economic effects of adopting transgenic crops in Asia and Sub-Saharan Africa. It does so using a multi-country, multi-product model of the global economy. The results suggest the economic welfare gains from crop biotechnology adoption are potentially very large, and that those benefits are diminished only very slightly by the presence of the European Union's restriction on imports of GM foods. That is, if developing countries retain bans on GM crop production in an attempt to maintain access to EU markets for non-GM products, the loss to their food consumers as well as to farmers in those developing countries is huge relative to the slight loss that could be incurred from not retaining EU market access. Copyright © 2010 Elsevier B.V. All rights reserved.

Efficacy and safety of a combination of azithromycin and chloroquine for the treatment of uncomplicated Plasmodium falciparum malaria in two multi-country randomised clinical trials in African adults.

PubMed

Sagara, Issaka; Oduro, Abraham R; Mulenga, Modest; Dieng, Yemou; Ogutu, Bernhards; Tiono, Alfred B; Mugyenyi, Peter; Sie, Ali; Wasunna, Monique; Kain, Kevin C; Djimdé, Abdoulaye A; Sarkar, Shirsendu; Chandra, Richa; Robbins, Jeffery; Dunne, Michael W

2014-11-25

Given increasing rates of resistance to existing therapy, new options for treatment and prophylaxis of malaria are needed. Two randomised, comparative, non-inferiority studies were conducted in Africa, one double-blinded and one open-label. Adults with fever, a positive peripheral blood smear, and a positive rapid diagnostic test for Plasmodium falciparum were randomised in both studies to either azithromycin (AZ) 1,000 mg plus chloroquine (CQ) 600-mg base (AZCQ 1,000 mg) once daily for three days or mefloquine hydrochloride (MQ) 1,250 mg (split dose). In the first study, an additional regimen of AZ 500 mg plus CQ 600-mg base (AZCQ 500 mg) once daily for three days was included. All study participants were hospitalised until three consecutive daily blood smears were negative for asexual P. falciparum parasitaemia. Study participants were evaluated weekly for 42 days, with Day 28 polymerase chain reaction (PCR)-corrected parasitological clearance rate as primary endpoint. A total of 467 subjects were randomised in the two studies. At 28 days' follow-up, PCR-corrected parasitological clearance rates in the per protocol population in the first study were 101/103 (98%) with AZCQ 1,000 mg compared with 102/103 (99%) with MQ (95% confidence interval [CI]: -5.2, 3.3). The AZCQ 500-mg regimen was stopped during an interim study review (six [86%] clearance of seven evaluable; two lost to follow-up). In the second study, clearance rates were similar: AZCQ 1,000 mg 107/107 (100%) vs MQ 111/112 (99%; 95% CI: -1.8, 3.6). Among the participating countries, in vitro CQ resistance based on pfcrt mutation frequency in the baseline isolates across both studies ranged from 20.8% (Zambia) to 96.1% (Uganda). Serious adverse events (AEs; all causality) were observed more frequently with MQ compared with AZCQ (four vs one, respectively), though discontinuations for AEs were similar (four vs three, respectively). Common AEs in the AZ-containing arms included pruritus, vomiting, dizziness, and headache. Among adults with symptomatic uncomplicated falciparum malaria in Africa, the combination of AZ 1,000 mg and CQ 600-mg base once daily for three days resulted in Day 28 PCR-corrected parasitological clearance rates of ≥98% and was non-inferior to treatment with MQ. AZCQ was well tolerated. ClinicalTrials.gov identifiers NCT00082576 and NCT00367653.

A cross sectional study of maternal 'near-miss' cases in major public hospitals in Egypt, Lebanon, Palestine and Syria.

PubMed

Bashour, Hyam; Saad-Haddad, Ghada; DeJong, Jocelyn; Ramadan, Mohammed Cherine; Hassan, Sahar; Breebaart, Miral; Wick, Laura; Hassanein, Nevine; Kharouf, Mayada

2015-11-13

The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria. We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection. A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals. Findings from this formative stage confirmed the need for quality improvement interventions. The high reported coverage of the main clinical interventions in the study hospitals would appear to be in contradiction with the above findings as the level of coverage of key evidence-based interventions was high.

A method for estimating maternal and newborn lives saved from health-related investments funded by the UK government Department for International Development using the Lives Saved Tool.

PubMed

Friberg, Ingrid K; Baschieri, Angela; Abbotts, Jo

2017-11-07

In 2010, the UK Government Department for International Development (DFID) committed through its 'Framework for results for reproductive, maternal and newborn health (RMNH)' to save 50,000 maternal lives and 250,000 newborn lives by 2015. They also committed to monitoring the performance of this portfolio of investments to demonstrate transparency and accountability. Methods currently available to directly measure lives saved are cost-, time-, and labour-intensive. The gold standard for calculating the total number of lives saved would require measuring mortality with large scale population based surveys or annual vital events surveillance. Neither is currently available in all low- and middle-income countries. Estimating the independent effect of DFID support relative to all other effects on health would also be challenging. The Lives Saved Tool (LiST) is an evidence based software for modelling the effect of changes in health intervention coverage on reproductive, maternal, newborn and child mortality. A multi-country LiST-based analysis protocol was developed to retrospectively assess the total annual number of maternal and newborn lives saved from DFID aid programming in low- and middle-income countries. Annual LiST analyses using the latest program data from DFID country offices were conducted between 2013 and 2016, estimating the annual number of maternal and neonatal lives saved across 2010-2015. For each country, independent project results were aggregated into health intervention coverage estimates, with and in the absence of DFID funding. More than 80% of reported projects were suitable for inclusion in the analysis, with 151 projects analysed in the 2016 analysis. Between 2010 and 2014, it is estimated that DFID contributed to saving the lives of 15,000 women in pregnancy and childbirth with health programming and 88,000 with family planning programming. It is estimated that DFID health programming contributed to saving 187,000 newborn lives. It is feasible to estimate the overall contribution and impact of DFID's investment in RMNH from currently available information on interventions and coverage from individual country offices. This utilization of LiST, with estimated population coverage based on DFID program inputs, can be applied to similar types of datasets to quantify programme impact. The global data were used to estimate DFID's progress against the Framework for results targets to inform future programming. The identified limitations can also be considered to inform future monitoring and evaluation program design and implementation within DFID.

INSaFLU: an automated open web-based bioinformatics suite "from-reads" for influenza whole-genome-sequencing-based surveillance.

PubMed

Borges, Vítor; Pinheiro, Miguel; Pechirra, Pedro; Guiomar, Raquel; Gomes, João Paulo

2018-06-29

A new era of flu surveillance has already started based on the genetic characterization and exploration of influenza virus evolution at whole-genome scale. Although this has been prioritized by national and international health authorities, the demanded technological transition to whole-genome sequencing (WGS)-based flu surveillance has been particularly delayed by the lack of bioinformatics infrastructures and/or expertise to deal with primary next-generation sequencing (NGS) data. We developed and implemented INSaFLU ("INSide the FLU"), which is the first influenza-oriented bioinformatics free web-based suite that deals with primary NGS data (reads) towards the automatic generation of the output data that are actually the core first-line "genetic requests" for effective and timely influenza laboratory surveillance (e.g., type and sub-type, gene and whole-genome consensus sequences, variants' annotation, alignments and phylogenetic trees). By handling NGS data collected from any amplicon-based schema, the implemented pipeline enables any laboratory to perform multi-step software intensive analyses in a user-friendly manner without previous advanced training in bioinformatics. INSaFLU gives access to user-restricted sample databases and projects management, being a transparent and flexible tool specifically designed to automatically update project outputs as more samples are uploaded. Data integration is thus cumulative and scalable, fitting the need for a continuous epidemiological surveillance during the flu epidemics. Multiple outputs are provided in nomenclature-stable and standardized formats that can be explored in situ or through multiple compatible downstream applications for fine-tuned data analysis. This platform additionally flags samples as "putative mixed infections" if the population admixture enrolls influenza viruses with clearly distinct genetic backgrounds, and enriches the traditional "consensus-based" influenza genetic characterization with relevant data on influenza sub-population diversification through a depth analysis of intra-patient minor variants. This dual approach is expected to strengthen our ability not only to detect the emergence of antigenic and drug resistance variants but also to decode alternative pathways of influenza evolution and to unveil intricate routes of transmission. In summary, INSaFLU supplies public health laboratories and influenza researchers with an open "one size fits all" framework, potentiating the operationalization of a harmonized multi-country WGS-based surveillance for influenza virus. INSaFLU can be accessed through https://insaflu.insa.pt .

Economic evaluation of Community Level Interventions for Pre-eclampsia (CLIP) in South Asian and African countries: a study protocol.

PubMed

Khowaja, Asif R; Mitton, Craig; Bryan, Stirling; Magee, Laura A; Bhutta, Zulfiqar A; von Dadelszen, Peter

2015-05-26

Globally, hypertensive disorders of pregnancy, particularly pre-eclampsia and eclampsia, are the leading cause of maternal and neonatal mortality, and impose substantial burdens on the families of pregnant women, their communities, and healthcare systems. The Community Level Interventions for Pre-eclampsia (CLIP) Trial evaluates a package of care applied at both community and primary health centres to reduce maternal and perinatal disabilities and deaths resulting from the failure to identify and manage pre-eclampsia at the community level. Economic evaluation of health interventions can play a pivotal role in priority setting and inform policy decisions for scale-up. At present, there is a paucity of published literature on the methodology of economic evaluation of large, multi-country, community-based interventions in the area of maternal and perinatal health. This study protocol describes the application of methodology for economic evaluation of the CLIP in South Asia and Africa. A mixed-design approach i.e. cost-effectiveness analysis (CEA) and qualitative thematic analysis will be used alongside the trial to prospectively evaluate the economic impact of CLIP from a societal perspective. Data on health resource utilization, costs, and pregnancy outcomes will be collected through structured questionnaires embedded into the pregnancy surveillance, cross-sectional survey and budgetary reviews. Qualitative data will be collected through focus groups (FGs) with pregnant women, household male-decision makers, care providers, and district level health decision makers. The incremental cost-effectiveness ratio will be calculated for healthcare system and societal perspectives, taking into account the country-specific model inputs (costs and outcome) from the CLIP Trial. Emerging themes from FGs will inform the design of the model, and help to interpret findings of the CEA. The World Health Organization (WHO) strongly recommends cost-effective interventions as a key aspect of achieving Millennium Development Goal (MDG)-5 (i.e. 75 % reduction in maternal mortality from 1990 levels by 2015). To date, most cost-effectiveness studies in this field have focused specifically on the diagnostic and clinical management of pre-eclampsia, yet rarely on community-based interventions in low-and-middle-income countries (LMICs). This study protocol will be of interest to public health scientists and health economists undertaking community-based trials in the area of maternal and perinatal health, particularly in LMICs. ClinicalTrials.gov: NCT01911494.

Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Preterm birth is the leading cause of child death worldwide. Small and sick newborns require timely, high-quality inpatient care to survive. This includes provision of warmth, feeding support, safe oxygen therapy and effective phototherapy with prevention and treatment of infections. Inpatient care for newborns requires dedicated ward space, staffed by health workers with specialist training and skills. Many of the estimated 2.8 million newborns that die every year do not have access to such specialised care. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" (or factors that hinder the scale up) of maternal-newborn intervention packages. For this paper, we used quantitative and qualitative methods to analyse the bottleneck data, and combined these with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for inpatient care of small and sick newborns. Results Inpatient care of small and sick newborns is an intervention package highlighted by all country workshop participants as having critical health system challenges. Health system building blocks with the highest graded (significant or major) bottlenecks were health workforce (10 out of 12 countries) and health financing (10 out of 12 countries), followed by community ownership and partnership (9 out of 12 countries). Priority actions based on solution themes for these bottlenecks are discussed. Conclusions Whilst major bottlenecks to the scale-up of quality inpatient newborn care are present, effective solutions exist. For all countries included, there is a critical need for a neonatal nursing cadre. Small and sick newborns require increased, sustained funding with specific insurance schemes to cover inpatient care and avoid catastrophic out-of-pocket payments. Core competencies, by level of care, should be defined for monitoring of newborn inpatient care, as with emergency obstetric care. Rather than fatalism that small and sick newborns will die, community interventions need to create demand for accessible, high-quality, family-centred inpatient care, including kangaroo mother care, so that every newborn can survive and thrive. PMID:26391335

Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background An estimated two-thirds of the world's 2.7 million newborn deaths could be prevented with quality care at birth and during the postnatal period. Basic Newborn Care (BNC) is part of the solution and includes hygienic birth and newborn care practices including cord care, thermal care, and early and exclusive breastfeeding. Timely provision of resuscitation if needed is also critical to newborn survival. This paper describes health system barriers to BNC and neonatal resuscitation and proposes solutions to scale up evidence-based strategies. Methods The maternal and newborn bottleneck analysis tool was applied by 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" that hinder the scale up of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for BNC and neonatal resuscitation. Results Eleven of the 12 countries provided grading data. Overall, bottlenecks were graded more severely for resuscitation. The most severely graded bottlenecks for BNC were health workforce (8 of 11 countries), health financing (9 out of 11) and service delivery (7 out of 9); and for neonatal resuscitation, workforce (9 out of 10), essential commodities (9 out of 10) and service delivery (8 out of 10). Country teams from Africa graded bottlenecks overall more severely. Improving workforce performance, availability of essential commodities, and well-integrated health service delivery were the key solutions proposed. Conclusions BNC was perceived to have the least health system challenges among the seven maternal and newborn intervention packages assessed. Although neonatal resuscitation bottlenecks were graded more severe than for BNC, similarities particularly in the workforce and service delivery building blocks highlight the inextricable link between the two interventions and the need to equip birth attendants with requisite skills and commodities to assess and care for every newborn. Solutions highlighted by country teams include ensuring more investment to improve workforce performance and distribution, especially numbers of skilled birth attendants, incentives for placement in challenging settings, and skills-based training particularly for neonatal resuscitation. PMID:26391000

Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis

PubMed Central

Bilano, Ver Luanni; Ota, Erika; Ganchimeg, Togoobaatar; Mori, Rintaro; Souza, João Paulo

2014-01-01

Background Pre-eclampsia has an immense adverse impact on maternal and perinatal health especially in low- and middle-income settings. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes. Methods We performed a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. The survey was a multi-country, facility-based cross-sectional study. A global sample consisting of 24 countries from three regions and 373 health facilities was obtained via a stratified multi-stage cluster sampling design. Maternal and offspring data were extracted from records using standardized questionnaires. Multi-level logistic regression modelling was conducted with random effects at the individual, facility and country levels. Results Data for 276,388 mothers and their infants was analysed. The prevalence of pre-eclampsia/eclampsia in the study population was 10,754 (4%). At the individual level, sociodemographic characteristics of maternal age ≥30 years and low educational attainment were significantly associated with higher risk of pre-eclampsia/eclampsia. As for clinical and obstetric variables, high body mass index (BMI), nulliparity (AOR: 2.04; 95%CI 1.92–2.16), absence of antenatal care (AOR: 1.41; 95%CI 1.26–1.57), chronic hypertension (AOR: 7.75; 95%CI 6.77–8.87), gestational diabetes (AOR: 2.00; 95%CI 1.63–2.45), cardiac or renal disease (AOR: 2.38; 95%CI 1.86–3.05), pyelonephritis or urinary tract infection (AOR: 1.13; 95%CI 1.03–1.24) and severe anemia (AOR: 2.98; 95%CI 2.47–3.61) were found to be significant risk factors, while having >8 visits of antenatal care was protective (AOR: 0.90; 95%CI 0.83–0.98). Pre-eclampsia/eclampsia was found to be a significant risk factor for maternal death, perinatal death, preterm birth and low birthweight. Conclusion Chronic hypertension, obesity and severe anemia were the highest risk factors of preeclampsia/eclampsia. Implementation of effective interventions prioritizing risk factors, provision of quality health services during pre-pregnancy and during pregnancy for joint efforts in the areas of maternal health are recommended. PMID:24657964

Menstrual experiences and beliefs: a multicountry study of relationships with fertility and fertility regulating methods.

PubMed

Severy, L J; Thapa, S; Askew, I; Glor, J

1993-01-01

Knowledge is needed about what women generally experience (behavior and beliefs about sexual, personal, social, and dietary factors) during menstruation as baseline data. Data were obtained from a WHO non nationally representative sample of 5322 parous women from 14 cultural groups between 1973 to 1980 and a subsample of 500 women with detailed daily diaries from 10 countries (Egypt, India, Indonesia, jamaica, Korea, Mexico, Pakistan, Philippines, UK, and Yugoslavia). This study identified and analyzed 1) critical variables through principal component analysis and varimax rotation, 2) clusters of types of women with particular menstrual experiences and particular beliefs, and 3) the relationship between demographic variables and the 2 resultant cluster and the relationship between beliefs and experiences. Factor analysis resulted in the identification of 6 factors and 13 variables which accounted for more than 65% of the variance: amount of bleeding, activity during the last menstrual period, mood during last menstrual period, discomfort during last menstrual period, predictability, and blood characteristics (smell and color). Beliefs that explained more than 53% of the estimated variance were bathing behavior during menstruation, fertility and femininity issues, interpretations and implications of menstruation, and beliefs about not washing hair or body during menstruation. Alpha estimates of reliability for the belief ranged from .33 to .73, and for behavior the range was .40 to .59. The cluster analysis of type of persons identified 3 groups of women: type I (26.4%) who experienced low blood loss the first day and had a long duration of bleeding; type II (52.3%) who had a short duration of bleeding; and type III (21.2%) who had the heaviest bleeding and longest duration of bleeding. The cluster analysis of women's belief types indicated 9 profiles. For instance, Type 2 women tended to believe that menstruation is dirty but prefer more blood loss. Belief Profiles 3, 4, 5, 8, and 9 are consistently represented and profiles 1, 2, 6, and 7 show wide variability. 7 demographic factors were found to be significantly related to belief clusters: country of residence, religion, literacy, age, work environment, social status, and rural vs. urban area. There was evidence, for instance, that type 2 women were overrepresented in the use of modern methods, and that Belief Profile 1, which represents 10.23% of the sample, showed 17.86% using modern methods. The findings show that Belief Profile 1 persons who disagreed with many items were the most likely to use modern methods and have smaller family sizes. Beliefs, which reflect socialization according to demographic variables, appear to affect choice of methods and family size.

The Antenatal Corticosteroids Trial (ACT): a secondary analysis to explore site differences in a multi-country trial.

PubMed

Klein, Karen; McClure, Elizabeth M; Colaci, Daniela; Thorsten, Vanessa; Hibberd, Patricia L; Esamai, Fabian; Garces, Ana; Patel, Archana; Saleem, Sarah; Pasha, Omrana; Chomba, Elwyn; Carlo, Waldemar A; Krebs, Nancy F; Goudar, Shivaprasad; Derman, Richard J; Liechty, Edward A; Koso-Thomas, Marion; Buekens, Pierre M; Belizán, José M; Goldenberg, Robert L; Althabe, Fernando

2016-05-24

The Antenatal Corticosteroid Trial (ACT) assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but had no overall impact on neonatal mortality in the targeted <5(th) percentile birth weight infants. Being in the intervention clusters was also associated with an overall increase in neonatal deaths. We sought to explore plausible pathways through which this intervention increased neonatal mortality. We conducted secondary analyses to assess site differences in outcome and potential explanations for the differences in outcomes if found. By site, and in the intervention and control clusters, we evaluated characteristics of the mothers and care systems, the proportion of the <5(th) percentile infants and the overall population that received ACS, the rates of possible severe bacterial infection (pSBI), determined from clinical signs, and neonatal mortality rates. There were substantial differences between the sites in both participant and health system characteristics, with Guatemala and Argentina generally having the highest levels of care. In some sites there were substantial differences in the health system characteristics between the intervention and control clusters. The increase in ACS in the intervention clusters was similar among the sites. While overall, there was no difference in neonatal mortality among <5(th) percentile births between the intervention and control clusters, Guatemala and Pakistan both had significant reductions in neonatal mortality in the <5(th) percentile infants in the intervention clusters. The improvement in neonatal mortality in the Guatemalan site in the <5(th) percentile infants was associated with a higher level of care at the site and an improvement in care in the intervention clusters. There was a significant increase overall in neonatal mortality in the intervention clusters compared to the control. Across sites, this increase in neonatal mortality was statistically significant and most apparent in the African sites. This increase in neonatal mortality was accompanied by a significant increase in pSBI in the African sites. The improvement in neonatal mortality in the Guatemalan site in the <5(th) percentile infants was associated with a higher level of care and an improvement in care in the intervention clusters. The increase in neonatal mortality in the intervention clusters across all sites was largely driven by the poorer outcomes in the African sites, which also had an increase in pSBI in the intervention clusters. We emphasize that these results come from secondary analyses. Additional prospective studies are needed to assess the effectiveness and safety of ACS on neonatal health in low resource settings. clinicaltrials.gov (NCT01084096).

Urban-rural and geographic differences in overweight and obesity in four sub-Saharan African adult populations: a multi-country cross-sectional study.

PubMed

Ajayi, IkeOluwapo O; Adebamowo, Clement; Adami, Hans-Olov; Dalal, Shona; Diamond, Megan B; Bajunirwe, Francis; Guwatudde, David; Njelekela, Marina; Nankya-Mutyoba, Joan; Chiwanga, Faraja S; Volmink, Jimmy; Kalyesubula, Robert; Laurence, Carien; Reid, Todd G; Dockery, Douglas; Hemenway, David; Spiegelman, Donna; Holmes, Michelle D

2016-10-28

Overweight and obesity are on the rise in developing countries including sub-Saharan Africa. We undertook a four-country survey to show the collective burden of these health conditions as they occur currently in sub-Saharan Africa and to determine the differences between urban and rural populations and other socio-economic factors. Participants were nurses in two hospitals in Nigeria (200), school teachers in South Africa (489) and Tanzania (229), and village residents in one peri-urban (297) and one rural location in Uganda (200) who completed a standardised questionnaire. Their height and weight were measured and body mass index calculated. Factor analysis procedure (Principal component) was used to generate a wealth index. Univariate and multivariate analyses with binary logistic regression models were conducted to examine the associations between potential correlates and the prevalence of overweight and obesity with 95 % confidence intervals. The prevalence of overweight and obese (combined) was 46 %, 48 %, 68 %, 75 % and 85 % in rural Uganda, peri-urban Uganda, Nigeria, Tanzania and South Africa (SA), respectively. Rural Uganda, Peri- urban Uganda, Nigeria, Tanzania and SA had obesity prevalence of 10 %, 14 %, 31 %, 40 % and 54 %, respectively (p < 0.001). Overall, prevalence of overweight was 374 (31 %) and obesity, 414 (34 %). Female sex was a predictor of overweight and obesity (combined) in peri-urban Uganda [AOR = 8.01; 95 % CI: 4.02, 15.96) and obesity in rural Uganda [AOR = 11.22; 95%CI: 2.27, 55.40), peri-urban Uganda [AOR = 27.80; 95 % CI: 7.13, 108.41) and SA [AOR = 2.17; 95 % CI: 1.19, 4.00). Increasing age was a predictor of BMI > =25 kg/m 2 in Nigeria [Age > =45 - AOR = 9.11; 95 % CI: 1.72, 48.16] and SA [AOR = 6.22; 95 % CI: 2.75, 14.07], while marital status was predictor of BMI > =25 kg/m 2 only in peri-urban Uganda. [Married - AOR = 4.49; 95 % CI: 1.74, 11.57]. Those in Nigeria [AOR = 2.56; 95 % CI: 1.45, 4.53], SA [AOR = 4.97; 95 % CI: 3.18, 7.78], and Tanzania [AOR = 2.68; 95 % CI: 1.60, 4.49] were more likely to have BMI > =25 kg/m 2 compared with the rural and peri-urban sites. The high prevalence of overweight and obesity in these sub-Saharan African countries and the differentials in prevalence and risk factors further highlights the need for urgent focused intervention to stem this trend, especially among women, professionals and urban dwellers.

Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region.

PubMed Central

Siddiqi, Sameen; Masud, Tayyeb Imran; Sabri, Belgacem

2006-01-01

The public sector in developing countries is increasingly contracting with the non-state sector to improve access, efficiency and quality of health services. We conducted a multicountry study to assess the range of health services contracted out, the process of contracting and its influencing factors in ten countries of the Eastern Mediterranean Region: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Morocco, Pakistan, the Syrian Arab Republic and Tunisia. Our results showed that Afghanistan, Egypt, Islamic Republic of Iran and Pakistan had experience with outsourcing of primary care services; Jordan, Lebanon and Tunisia extensively contracted out hospital and ambulatory care services; while Bahrain, Morocco and the Syrian Arab Republic outsourced mainly non-clinical services. The interest of the non-state sector in contracting was to secure a regular source of revenue and gain enhanced recognition and credibility. While most countries promoted contracting with the private sector, the legal and bureaucratic support in countries varied with the duration of experience with contracting. The inherent risks evident in the contracting process were reliance on donor funds, limited number of providers in rural areas, parties with vested interests gaining control over the contracting process, as well as poor monitoring and evaluation mechanisms. Contracting provides the opportunity to have greater control over private providers in countries with poor regulatory capacity, and if used judiciously can improve health system performance. PMID:17143460

Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia.

PubMed

Morgan, Camille; Bowling, Michael; Bartram, Jamie; Lyn Kayser, Georgia

2017-08-01

Adequate access to water, sanitation, and hygiene (WaSH) in schools impacts health, educational outcomes, and gender disparities. Little multi-country research has been published on WaSH in rural schools in Sub-Saharan Africa. In this multi-national cross-sectional WaSH study, we document WaSH access, continuity, quality, quantity, and reliability in 2270 schools that were randomly sampled in rural regions of six Sub-Saharan African countries: Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Data collection included: school WaSH surveys containing internationally established WaSH indicators, direct observation, and field- and laboratory-based microbiological water quality testing. We found 1% of rural schools in Ethiopia and Mozambique to 23% of rural schools in Rwanda had improved water sources on premises, improved sanitation, and water and soap for handwashing. Fewer than 23% of rural schools in the six countries studied met the World Health Organization's recommended student-to-latrine ratios for boys and for girls. Fewer than 20% were observed to have at least four of five recommended menstrual hygiene services (separate-sex latrines with doors and locks, water for use, waste bin). The low access to safe and adequate WaSH services in rural schools suggest opportunities for WaSH interventions that could have substantive impact on health, education, and gender disparities. Copyright © 2017 Elsevier GmbH. All rights reserved.

Contracting but not without caution: experience with outsourcing of health services in countries of the Eastern Mediterranean Region.

PubMed

Siddiqi, Sameen; Masud, Tayyeb Imran; Sabri, Belgacem

2006-11-01

The public sector in developing countries is increasingly contracting with the non-state sector to improve access, efficiency and quality of health services. We conducted a multicountry study to assess the range of health services contracted out, the process of contracting and its influencing factors in ten countries of the Eastern Mediterranean Region: Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Lebanon, Morocco, Pakistan, the Syrian Arab Republic and Tunisia. Our results showed that Afghanistan, Egypt, Islamic Republic of Iran and Pakistan had experience with outsourcing of primary care services; Jordan, Lebanon and Tunisia extensively contracted out hospital and ambulatory care services; while Bahrain, Morocco and the Syrian Arab Republic outsourced mainly non-clinical services. The interest of the non-state sector in contracting was to secure a regular source of revenue and gain enhanced recognition and credibility. While most countries promoted contracting with the private sector, the legal and bureaucratic support in countries varied with the duration of experience with contracting. The inherent risks evident in the contracting process were reliance on donor funds, limited number of providers in rural areas, parties with vested interests gaining control over the contracting process, as well as poor monitoring and evaluation mechanisms. Contracting provides the opportunity to have greater control over private providers in countries with poor regulatory capacity, and if used judiciously can improve health system performance.

Optimal recall period for caregiver-reported illness in risk factor and intervention studies: a multicountry study.

PubMed

Arnold, Benjamin F; Galiani, Sebastian; Ram, Pavani K; Hubbard, Alan E; Briceño, Bertha; Gertler, Paul J; Colford, John M

2013-02-15

Many community-based studies of acute child illness rely on cases reported by caregivers. In prior investigations, researchers noted a reporting bias when longer illness recall periods were used. The use of recall periods longer than 2-3 days has been discouraged to minimize this reporting bias. In the present study, we sought to determine the optimal recall period for illness measurement when accounting for both bias and variance. Using data from 12,191 children less than 24 months of age collected in 2008-2009 from Himachal Pradesh in India, Madhya Pradesh in India, Indonesia, Peru, and Senegal, we calculated bias, variance, and mean squared error for estimates of the prevalence ratio between groups defined by anemia, stunting, and underweight status to identify optimal recall periods for caregiver-reported diarrhea, cough, and fever. There was little bias in the prevalence ratio when a 7-day recall period was used (<10% in 35 of 45 scenarios), and the mean squared error was usually minimized with recall periods of 6 or more days. Shortening the recall period from 7 days to 2 days required sample-size increases of 52%-92% for diarrhea, 47%-61% for cough, and 102%-206% for fever. In contrast to the current practice of using 2-day recall periods, this work suggests that studies should measure caregiver-reported illness with a 7-day recall period.

Drought - A Global Assessment

NASA Astrophysics Data System (ADS)

Lackner, S.; Barnwal, P.; von der Goltz, J.

2013-12-01

We investigate the lasting effects of early childhood exposure to drought on economic and health outcomes in a large multi-country dataset. By pooling all Demographic and Health Survey rounds for which household geocodes are available, we obtain an individual-level dataset covering 47 developing countries. Among other impact measures, we collect infant and child mortality data from 3.3m live births and data on stunting and wasting for 1.2m individuals, along with data on education, employment, wealth, marriage and childbearing later in life for similarly large numbers of respondents. Birth years vary from 1893 to 2012. We seek to improve upon existing work on the socio-economic impact of drought in a number of ways. First, we introduce from the hydrological literature a drought measure, the Standardized Precipitation Index (SPI), that has been shown to closely proxy the Palmer drought index, but has far less demanding data requirements, and can be obtained globally and for long time periods. We estimate the SPI for 110 years on a global 0.5° grid, which allows us to assign drought histories to the geocoded individual data. Additionally, we leverage our large sample size to explicitly investigate both how drought impacts have changed over time as adaptation occurred at a varying pace in different locations, and the role of the regional extent of drought in determining impacts.

Multi-country study on the prevalence and clinical features of peripheral arterial disease in Asian type 2 diabetes patients at high risk of atherosclerosis.

PubMed

Rhee, Sang Youl; Guan, Heng; Liu, Zhi Min; Cheng, Stephen Wing-Keung; Waspadji, Sarwono; Palmes, Patricio; Tai, Tong Yuan; Suwanwalaikorn, Sompongse; Kim, Young Seol

2007-04-01

PAD-SEARCH was the first international study to investigate the prevalence of peripheral arterial disease (PAD) in Asian type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. In total 6625 type 2 diabetic patients aged 50 and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in Korea, China, Taiwan, Hong Kong, Indonesia, Thailand and the Philippines. Mean patient age was 63.7+/-8.2 years and mean duration of diabetes was 10.3+/-8.0 years. One thousand one hundred and seventy-two (17.7%) subjects were diagnosed as PAD by ABI (< or =0.9). PAD subjects had a significantly longer duration of diabetes, hypertension, higher HbA1c, and a significantly lower mean BMI than non-PAD subjects. In terms of lipid profiles, triglyceride was the only significant variable. Notably, mean ABI and baPWV in females were significantly poorer than age matched males in subjects with a normal ABI. However, mean ABI and baPWV in males were significantly poorer than in age matched females in subjects with PAD. These findings suggest that PAD is a common complication in Asian type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for Asian diabetic patients with high risk factors.

A multi-country comparison of reasons for dental non-attendance.

PubMed

Listl, Stefan; Moeller, John; Manski, Richard

2014-02-01

The purpose of this study was to describe differences across countries with respect to the reasons for dental non-attendance by Europeans currently 50 yr of age and older. The analyses were based on retrospective life-history data from the Survey of Health, Ageing, and Retirement in Europe and included information on various reasons why respondents from 13 European countries had never had regular dental visits in their lifetime. A series of logistic regression models was estimated to identify reasons for dental non-attendance across different welfare-state regimes. The highest proportion of respondents without any regular dental attendance throughout their lifetime was found for the Southern welfare-state regime, followed by the Eastern, the Bismarckian, and the Scandinavian welfare-state regimes. Factors such as patients' perception that regular dental treatment is 'not necessary' or 'not usual' appear to be the predominant reason for non-attendance in all welfare-state regimes. The health system-level factor 'no place to receive this type of care close to home' and the perception of regular dental treatment as 'not necessary' were more often referred to within the Southern, Eastern, and Bismarckian welfare-state regimes than in Scandinavia. This could be relevant information for health-care decision makers in order to prioritize interventions towards increasing rates of regular dental attendance. © 2013 Eur J Oral Sci.

Impact of point-of-sale tobacco display bans: findings from the International Tobacco Control Four Country Survey

PubMed Central

Li, Lin; Borland, Ron; Fong, Geoffrey T.; Thrasher, James F.; Hammond, David; Cummings, Kenneth M.

2013-01-01

This study examined the impact of point-of-sale (POS) tobacco marketing restrictions in Australia and Canada, in relation to the United Kingdom and the United States where there were no such restrictions during the study period (2006–10). The data came from the International Tobacco Control Four Country Survey, a prospective multi-country cohort survey of adult smokers. In jurisdictions where POS display bans were implemented, smokers’ reported exposure to tobacco marketing declined markedly. From 2006 to 2010, in Canada, the percentages noticing POS tobacco displays declined from 74.1 to 6.1% [adjusted odds ratio (OR) = 0.26, P < 0.001]; and reported exposure to POS tobacco advertising decreased from 40.3 to 14.1% (adjusted OR = 0.61, P < 0.001). Similarly, in Australia, noticing of POS displays decreased from 73.9 to 42.9%. In contrast, exposure to POS marketing in the United States and United Kingdom remained high during this period. In parallel, there were declines in reported exposures to other forms of advertising/promotion in Canada and Australia, but again, not in the United States or United Kingdom. Impulse purchasing of cigarettes was lower in places that enacted POS display bans. These findings indicate that implementing POS tobacco display bans does result in lower exposure to tobacco marketing and less frequent impulse purchasing of cigarettes. PMID:23640986

Lessons learned about coordinating academic partnerships from an international network for health education.

PubMed

Luo, Airong; Omollo, Kathleen Ludewig

2013-11-01

There is a growing trend of academic partnerships between U.S., Canadian, and European health science institutions and academic health centers in low- and middle-income countries. These partnerships often encounter challenges such as resource disparities and power differentials, which affect the motivations, expectations, balance of benefits, and results of the joint projects. Little has been discussed in previous literature regarding the communication and project management processes that affect the success of such partnerships. To fill the gap in the literature, the authors present lessons learned from the African Health Open Educational Resources Network, a multicountry, multiorganizational partnership established in May 2008. The authors introduce the history of the network, then discuss actively engaging stakeholders throughout the project's life cycle (design, planning, execution, and closure) through professional development, relationship building, and assessment activities. They focus on communication and management practices used to identify mutually beneficial project goals, ensure timely completion of deliverables, and develop sustainable sociotechnical infrastructure for future collaborative projects. These activities yielded an interactive process of action, assessment, and reflection to ensure that project goals and values were aligned with implementation. The authors conclude with a discussion of lessons learned and how the partnership project may serve as a model for other universities and academic health centers in high-income countries and low- and middle-income countries that are interested in or currently pursuing international academic partnerships.

Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview.

PubMed

Agier, Lydiane; Martiny, Nadège; Thiongane, Oumy; Mueller, Judith E; Paireau, Juliette; Watkins, Eleanor R; Irving, Tom J; Koutangni, Thibaut; Broutin, Hélène

2017-01-01

Neisseria meningitidis is the major cause of seasonal meningitis epidemics in the African meningitis belt. In the changing context of a reduction in incidence of serogroup A and an increase in incidence of serogroups W and C and of Streptococcus pneumoniae, a better understanding of the determinants driving the disease transmission dynamics remains crucial to improving bacterial meningitis control. The literature was searched to provide a multi-disciplinary overview of the determinants of meningitis transmission dynamics in the African meningitis belt. Seasonal hyperendemicity is likely predominantly caused by increased invasion rates, sporadic localized epidemics by increased transmission rates, and larger pluri-annual epidemic waves by changing population immunity. Carriage likely involves competition for colonization and cross-immunity. The duration of immunity likely depends on the acquisition type. Major risk factors include dust and low humidity, and presumably human contact rates and co-infections; social studies highlighted environmental and dietary factors, with supernatural explanations. Efforts should focus on implementing multi-country, longitudinal seroprevalence and epidemiological studies, validating immune markers of protection, and improving surveillance, including more systematic molecular characterizations of the bacteria. Integrating climate and social factors into disease control strategies represents a high priority for optimizing the public health response and anticipating the geographic evolution of the African meningitis belt. Copyright © 2016. Published by Elsevier Ltd.

Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration

PubMed Central

Holz, Frank G; Tadayoni, Ramin; Beatty, Stephen; Berger, Alan; Cereda, Matteo G; Cortez, Rafael; Hoyng, Carel B; Hykin, Philip; Staurenghi, Giovanni; Heldner, Stephanie; Bogumil, Timon; Heah, Theresa; Sivaprasad, Sobha

2015-01-01

Background/aims Real-life anti-vascular endothelial growth factor (VEGF) therapy use in patients with wet age-related macular degeneration (wAMD) was assessed in a retrospective, observational study in Canada, France, Germany, Ireland, Italy, the Netherlands, UK and Venezuela. Methods Medical records of patients with wAMD, who started ranibizumab treatment between 1 January 2009 and 31 August 2009, were evaluated. Data were collected until the end of treatment and/or monitoring or until 31 August 2011. Results 2227 patients who received ≥1 anti-VEGF injection with a baseline visual acuity assessment and ≥1 postbaseline visual acuity assessment for the treated eye were evaluated. Visual acuity improved until about day 120; thereafter, visual acuity gains were not maintained. Mean change in visual acuity score from baseline to years 1 and 2 was +2.4 and +0.6 letters, respectively. Patients received a mean of 5.0 and 2.2 injections in the first and second year, respectively. There were substantial differences in visual outcomes and injection frequency between countries. More frequent visits and injections were associated with greater improvements in visual acuity. Conclusions In clinical practice, fewer injections are administered than in clinical trials. Anti-VEGF treatment resulted in an initial improvement in visual acuity; however, this was not maintained over time. Trial registration number NCT01447043. PMID:25193672

Spousal concordance in the use of alternative tobacco products: A multi-country investigation.

PubMed

Roberts, Megan E; Banse, Rainer; Ebbeler, Christine; Ferketich, Amy K

2017-02-01

Married couples often share similar health-related characteristics and behaviors, including cigarette smoking status. Despite their rising popularity in the U.S., little research has examined the patterns of spousal concordance (SC) for alternative tobacco products (ATPs), such as e-cigarettes, cigars, and hookah. The purpose of this project was to examine the roles of age, gender, and culture in the strength of SC for these ATPs. Analyses focused on a diverse community sample of married individuals in Ohio, U.S. (N=278), but also examined patterns in Austria, Greece, Israel, the Netherlands, and Slovakia. All participants completed a survey in which they indicated both their own, and their spouse's ever-use of various tobacco products. For the U.S. sample, SC was highest for e-cigarettes, flavored e-cigarettes, flavored cigarettes, and hookah (ϕs=0.48- 0.61); SC appeared to be stronger among younger couples, and when there was only a small female vs. male differences in use. Similar patterns were found in the other countries, with a few key exceptions. In particular, there was low SC for e-cigarettes and flavored e-cigarettes in the other countries, where e-cigarettes had been federally regulated by the time of data collection. Overall, these findings have implications for the continued spreading popularity of these tobacco use behaviors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Need for European Surveillance of CDI.

PubMed

Wiuff, Camilla; Banks, A-Lan; Fitzpatrick, Fidelma; Cottom, Laura

2018-01-01

Since the turn of the millennium, the epidemiology of Clostridium difficile infection (CDI) has continued to challenge. Over the last decade there has been a growing awareness that improvements to surveillance are needed. The increasing rate of CDI and emergence of ribotype 027 precipitated the implementation of mandatory national surveillance of CDI in the UK. Changes in clinical presentation, severity of disease, descriptions of new risk factors and the occurrence of outbreaks all emphasised the importance of early diagnosis and surveillance.However a lack of consensus on case definitions, clinical guidelines and optimal laboratory diagnostics across Europe has lead to the underestimation of CDI and impeded comparison between countries. These inconsistencies have prevented the true burden of disease from being appreciated.Acceptance that a multi-country surveillance programme and optimised diagnostic strategies are required not only to detect and control CDI in Europe, but for a better understanding of the epidemiology, has built the foundations for a more robust, unified surveillance. The concerted efforts of the European Centre for Disease Prevention and Control (ECDC) CDI networks, has lead to the development of an over-arching long-term CDI surveillance strategy for 2014-2020. Fulfilment of the ECDC priorities and targets will no doubt be challenging and will require significant investment however the hope is that both a national and Europe-wide picture of CDI will finally be realised.

Scaling up HIV self-testing in sub-Saharan Africa: a review of technology, policy and evidence

PubMed Central

Indravudh, Pitchaya P.; Choko, Augustine T.; Corbett, Elizabeth L.

2018-01-01

Purpose of review HIV self-testing (HIVST) can provide complementary coverage to existing HIV testing services and improve knowledge of status among HIV-infected individuals. This review summarizes the current technology, policy and evidence landscape in sub-Saharan Africa and priorities within a rapidly evolving field. Recent findings HIVST is moving towards scaled implementation, with the release of WHO guidelines, WHO prequalification of the first HIVST product, price reductions of HIVST products and a growing product pipeline. Multicountry evidence from southern and eastern Africa confirms high feasibility, acceptability and accuracy across many delivery models and populations, with minimal harms. Evidence on the effectiveness of HIVST on increased testing coverage is strong, while evidence on demand generation for follow-on HIV prevention and treatment services and cost-effective delivery is emerging. Despite these developments, HIVST delivery remains limited outside of pilot implementation. Summary Important technology gaps include increasing availability of more sensitive HIVST products in low and middle-income countries. Regulatory and postmarket surveillance systems for HIVST also require further development. Randomized trials evaluating the effectiveness and cost-effectiveness under multiple distribution models, including unrestricted delivery and with a focus on linkage to HIV prevention and treatment, remain priorities. Diversification of studies from west and central Africa and around blood-based products should be addressed. PMID:29232277

Guillain-Barré syndrome risk among individuals infected with Zika virus: a multi-country assessment.

PubMed

Mier-Y-Teran-Romero, Luis; Delorey, Mark J; Sejvar, James J; Johansson, Michael A

2018-05-15

Countries with ongoing outbreaks of Zika virus have observed a notable rise in reported cases of Guillain-Barré syndrome (GBS), with mounting evidence of a causal link between Zika virus infection and the neurological syndrome. However, the risk of GBS following a Zika virus infection is not well characterized. In this work, we used data from 11 locations with publicly available data to estimate the risk of GBS following an infection with Zika virus, as well as the location-specific incidence of infection and the number of suspect GBS cases reported per infection. We built a mathematical inference framework utilizing data from 11 locations that had reported suspect Zika and GBS cases, two with completed outbreaks prior to 2015 (French Polynesia and Yap) and nine others in the Americas covering partial outbreaks and where transmission was ongoing as of early 2017. We estimated that 2.0 (95% credible interval 0.5-4.5) reported GBS cases may occur per 10,000 Zika virus infections. The frequency of reported suspect Zika cases varied substantially and was highly uncertain, with a mean of 0.11 (95% credible interval 0.01-0.24) suspect cases reported per infection. These estimates can help efforts to prepare for the GBS cases that may occur during Zika epidemics and highlight the need to better understand the relationship between infection and the reported incidence of clinical disease.

Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries.

PubMed

Davé, Dattesh R; Nagarjan, Neeraja; Canner, Joseph K; Kushner, Adam L; Stewart, Barclay T

2018-02-20

Low-and middle-income (LMIC) countries account for 90% of all reported burns, nevertheless there is a paucity of providers to treat burns. Current studies on burns in LMICs have not evaluated the gap between care seeking and receiving. This study explores this gap across socioeconomically similar populations in a multi-country population based assessment to inform burn care strategies. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument is a cross sectional national, cluster random sampling survey administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. The survey identifies burn etiology, demographics, timing, disability, and barriers to receiving care. Among 13,763 individuals surveyed, 896 burns were identified. Rwanda had the highest proportion of individuals seeking and receiving care (91.6% vs 88.5%) while Sierra Leone reported the fewest (79.3% vs 70.3%). Rwanda reported the largest disability while Nepal reported the highest proportion with no disability (47.5% vs 76.2%). Lack of money, healthcare providers, and rural living reduce the odds of receiving care by 68% and 85% respectively. Despite similar country socioeconomic characteristics there was significant variability in burn demographics, timing, and disability. Nevertheless, being geographically and economically disadvantaged predict lack of access to burn care. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

The association of minimum wage change on child nutritional status in LMICs: A quasi-experimental multi-country study.

PubMed

Ponce, Ninez; Shimkhada, Riti; Raub, Amy; Daoud, Adel; Nandi, Arijit; Richter, Linda; Heymann, Jody

2017-08-02

There is recognition that social protection policies such as raising the minimum wage can favourably impact health, but little evidence links minimum wage increases to child health outcomes. We used multi-year data (2003-2012) on national minimum wages linked to individual-level data from the Demographic and Health Surveys (DHS) from 23 low- and middle-income countries (LMICs) that had least two DHS surveys to establish pre- and post-observation periods. Over a pre- and post-interval ranging from 4 to 8 years, we examined minimum wage growth and four nutritional status outcomes among children under 5 years: stunting, wasting, underweight, and anthropometric failure. Using a differences-in-differences framework with country and time-fixed effects, a 10% increase in minimum wage growth over time was associated with a 0.5 percentage point decline in stunting (-0.054, 95% CI (-0.084,-0.025)), and a 0.3 percentage point decline in failure (-0.031, 95% CI (-0.057,-0.005)). We did not observe statistically significant associations between minimum wage growth and underweight or wasting. We found similar results for the poorest households working in non-agricultural and non-professional jobs, where minimum wage growth may have the most leverage. Modest increases in minimum wage over a 4- to 8-year period might be effective in reducing child undernutrition in LMICs.

Choices Behind Numbers: a Review of the Major Air Pollution Health Impact Assessments in Europe.

PubMed

Malmqvist, E; Oudin, A; Pascal, M; Medina, S

2018-03-01

The aim of this review is to identify the key contextual and methodological differences in health impact assessments (HIA) of ambient air pollution performed for Europe. We limited our review to multi-country reviews. An additional aim is to quantify some of these differences by applying them in a HIA template in three European cities. Several HIAs of ambient air pollution have been performed for Europe, and their key results have been largely disseminated. Different studies have, however, come up with substantial differences in attributed health effects. It is of importance to review the background contributing to these differences and to quantify their importance for decision makers who will use them. We identified several methodological differences that could explain the discrepancy behind the number of attributable deaths or years of life lost. The main differences are due to the exposure-response functions chosen, the ways of assessing air pollution levels, the air pollution scenarios and the study population. In the quantification part, we found that using risk estimates from the European Study of Cohorts for Air Pollution Effects (ESCAPE) instead of the American Cancer Society (ACS) study could nearly double the attributable burden of ambient air pollution. This study provides some insights into the differential results in previously published HIAs on air pollution in Europe. These results are important for stakeholders in order to make informed decisions.

Assessing trade in health services in countries of the Eastern Mediterranean from a public health perspective.

PubMed

Siddiqi, Sameen; Shennawy, Azza; Mirza, Zafer; Drager, Nick; Sabri, Belgacem

2010-01-01

Assessing trade in health services (TiHS) in developing countries is challenging since the sources of information are diverse, information is not accessible and professionals lack grasp of issues. A multi-country study was conducted in the Eastern Mediterranean Region (EMR)--Egypt, Jordan, Lebanon, Morocco, Oman, Pakistan, Sudan, Syrian Arab Republic, Tunisia, and Yemen. The objective was to estimate the direction, volume, and value of TiHS; analyze country commitments; and assess the challenges and opportunities for health services.Trade liberalization favored an open trade regime and encouraged foreign direct investment. Consumption abroad and movement of natural persons were the two prevalent modes. Yemen and Sudan are net importers, while Jordan promotes health tourism. In 2002, Yemenis spent US$ 80 million out of pocket for treatment abroad, while Jordan generated US$ 620 million. Egypt, Pakistan, Sudan and Tunisia export health workers, while Oman relies on import and 40% of its workforce is non-Omani. There is a general lack of coherence between Ministries of Trade and Health in formulating policies on TiHS.This is the first organized attempt to look at TiHS in the EMR. The systematic approach has helped create greater awareness, and a move towards better policy coherence in the area of trade in health services. Copyright (c) 2009 John Wiley & Sons, Ltd.

Impact of point-of-sale tobacco display bans: findings from the International Tobacco Control Four Country Survey.

PubMed

Li, Lin; Borland, Ron; Fong, Geoffrey T; Thrasher, James F; Hammond, David; Cummings, Kenneth M

2013-10-01

This study examined the impact of point-of-sale (POS) tobacco marketing restrictions in Australia and Canada, in relation to the United Kingdom and the United States where there were no such restrictions during the study period (2006-10). The data came from the International Tobacco Control Four Country Survey, a prospective multi-country cohort survey of adult smokers. In jurisdictions where POS display bans were implemented, smokers' reported exposure to tobacco marketing declined markedly. From 2006 to 2010, in Canada, the percentages noticing POS tobacco displays declined from 74.1 to 6.1% [adjusted odds ratio (OR) = 0.26, P < 0.001]; and reported exposure to POS tobacco advertising decreased from 40.3 to 14.1% (adjusted OR = 0.61, P < 0.001). Similarly, in Australia, noticing of POS displays decreased from 73.9 to 42.9%. In contrast, exposure to POS marketing in the United States and United Kingdom remained high during this period. In parallel, there were declines in reported exposures to other forms of advertising/promotion in Canada and Australia, but again, not in the United States or United Kingdom. Impulse purchasing of cigarettes was lower in places that enacted POS display bans. These findings indicate that implementing POS tobacco display bans does result in lower exposure to tobacco marketing and less frequent impulse purchasing of cigarettes.

Housing Improvements and Malaria Risk in Sub-Saharan Africa: A Multi-Country Analysis of Survey Data.

PubMed

Tusting, Lucy S; Bottomley, Christian; Gibson, Harry; Kleinschmidt, Immo; Tatem, Andrew J; Lindsay, Steve W; Gething, Peter W

2017-02-01

Improvements to housing may contribute to malaria control and elimination by reducing house entry by malaria vectors and thus exposure to biting. We tested the hypothesis that the odds of malaria infection are lower in modern, improved housing compared to traditional housing in sub-Saharan Africa (SSA). We analysed 15 Demographic and Health Surveys (DHS) and 14 Malaria Indicator Surveys (MIS) conducted in 21 countries in SSA between 2008 and 2015 that measured malaria infection by microscopy or rapid diagnostic test (RDT). DHS/MIS surveys record whether houses are built with finished materials (e.g., metal) or rudimentary materials (e.g., thatch). This information was used to develop a binary housing quality variable where houses built using finished wall, roof, and floor materials were classified as "modern", and all other houses were classified as "traditional". Conditional logistic regression was used to determine the association between housing quality and prevalence of malaria infection in children aged 0-5 y, adjusting for age, gender, insecticide-treated net (ITN) use, indoor residual spraying, household wealth, and geographic cluster. Individual survey odds ratios (ORs) were combined to determine a summary OR using a random effects meta-analysis. Of 284,532 total children surveyed, 139,318 were tested for malaria infection using microscopy (n = 131,652) or RDT (n = 138,540). Within individual surveys, malaria prevalence measured by microscopy ranged from 0.4% (Madagascar 2011) to 45.5% (Burkina Faso 2010) among children living in modern houses and from 0.4% (The Gambia 2013) to 70.6% (Burkina Faso 2010) in traditional houses, and malaria prevalence measured by RDT ranged from 0.3% (Senegal 2013-2014) to 61.2% (Burkina Faso 2010) in modern houses and from 1.5% (The Gambia 2013) to 79.8% (Burkina Faso 2010) in traditional houses. Across all surveys, modern housing was associated with a 9% to 14% reduction in the odds of malaria infection (microscopy: adjusted OR 0.91, 95% CI 0.85-0.97, p = 0.003; RDT: adjusted OR 0.86, 95% CI 0.80-0.92, p < 0.001). This association was consistent regardless of ITN usage. As a comparison, the odds of malaria infection were 15% to 16% lower among ITN users versus non-users (microscopy: adjusted OR 0.84, 95% CI 0.79-0.90, p < 0.001; RDT: adjusted OR 0.85, 95% CI 0.80-0.90, p < 0.001). The main limitation of this study is that residual confounding by household wealth of the observed association between housing quality and malaria prevalence is possible, since the wealth index may not have fully captured differences in socioeconomic position; however, the use of multiple national surveys offers the advantage of a large sample size and the elimination of many biases typically associated with pooling observational data. Housing quality is an important risk factor for malaria infection across the spectrum of malaria endemicity in SSA, with a strength of association between housing quality and malaria similar to that observed between ITN use and malaria. Improved housing should be considered a promising intervention for malaria control and elimination and long-term prevention of reintroduction.

A multi-country study of dengue vaccination strategies with Dengvaxia and a future vaccine candidate in three dengue-endemic countries: Vietnam, Thailand, and Colombia.

PubMed

Lee, Jung-Seok; Lourenço, José; Gupta, Sunetra; Farlow, Andrew

2018-04-19

The dengue vaccination era began when Dengvaxia (CYD-TDV) became available in 2016. In addition, several second-generation vaccine candidates are currently in phase 3 trials, suggesting that a broader availability of dengue vaccines may be possible in the near future. Advancing on the recent WHO-SAGE recommendations for the safe and effective use of CYD-TDV at the regional level on average, this study investigates the vaccination impacts and cost-effectiveness of CYD-TDV and of a hypothetical new vaccine candidate (NVC) in a country-specific manner for three endemic countries: Vietnam, Thailand, and Colombia. The vaccination impacts of CYD-TDV and NVC were derived by fitting the empirical seroprevalence rates of 9 year olds into an individual-based meta-population transmission model, previously used for the WHO-SAGE working group. The disability-adjusted life years were estimated by applying country-specific parametric values. The cost-effectiveness analyses of four intervention strategies in combination with routine and catch-up campaigns were compared for both vaccines to inform decision makers regarding the most suitable immunization program in each of the three countries. Both CYD-TDV and NVC could be cost-effective at the DALY threshold cost of $2000 depending upon vaccination costs. With CYD-TDV, targeting 9 year olds in routine vaccination programs and 10-29 year olds as a one-off catch-up campaign was the most cost-effective strategy in all three countries. With NVC, while the most cost-effective strategy was to vaccinate 9-29 and 9-18 year olds in Vietnam and Thailand respectively, vaccinating younger age cohorts between 1 and 5 years old in Colombia was more cost-effective than other strategies. Given that three countries will soon face decisions regarding whether and how to incorporate CYD-TDV or future dengue vaccines into their budget-constrained national immunization programs, the current study outcomes can be used to help decision makers understand the expected impacts and cost-effectiveness of such vaccines. Copyright © 2018 Elsevier Ltd. All rights reserved.

Drivers of facility deliveries in Africa and Asia: regional analyses using the demographic and health surveys.

PubMed

Diamond-Smith, Nadia; Sudhinaraset, May

2015-01-16

In the past few decades many countries have worked to increase the number of women delivering in facilities, with the goal of improving maternal and neonatal health outcomes. The purpose of this study is to explore the current situation of facility deliveries in Africa and Asia to understand where and with whom women deliver. Furthermore, we aim to test potential drivers of facility delivery at the individual, household, and community-level. Demographic and Health Survey data collected since 2003 from 43 countries in Africa and Asia is explored to understand the patterns of where women are delivering. We look at patterns by region and wealth quintile and urban/rural status. We then run a series of multi-level models looking at relationships between individual, household and community-level factors and the odds of a woman delivering in a facility. We explore this for Asia and Africa separately. We also look at correlates of delivery with a trained provider, in a public facility, in a private facility, with a doctor and in a hospital. The majority of women deliver in a facility and with a provider; however, about 20% of deliveries are still with no one or a friend/relative or alone. Rates of facility delivery are lower in Asia overall, and a greater proportion of deliveries take place in private facilities in Asia compared to Africa. Most of the individual level factors that have been found in past studies to be associated with delivering in a facility hold true for the multi-country-level analyses, and small differences exist between Asia and Africa. Women who deliver in private facilities differ from women who deliver in public facilities or at home. Most women in Africa and Asia are delivering in a facility, and drivers of facility delivery identified in smaller level or country specific studies hold true in multi-country national level data. More data and research is needed on other drivers, especially at the country-level and relating to the quality of care and maternal health complications.

Validity of self-reported lunch recalls in Swedish school children aged 6-8 years.

PubMed

Hunsberger, Monica; Pena, Pablo; Lissner, Lauren; Grafström, Lisen; Vanaelst, Barbara; Börnhorst, Claudia; Pala, Valeria; Eiben, Gabriele

2013-09-18

Previous studies have suggested that young children are inaccurate reporters of dietary intake. The purpose of this study was to validate a single recall of the previous day's school lunch reported by 6-8 year old Swedish children and to assess teacher-recorded intake of the same meal in a standardized food journal. An additional research question was whether parents could report their child's intake of the previous day's lunch. Subjects constituted a convenience sample from the large, multi-country study Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS). Validations of both children's recalls and teachers' records were made by comparing results with the duplicate plate reference method. Twenty-five children (12 boys/13 girls) aged 6-8 years participated in the validation study at one school in western Sweden. Children were accurate self-reporters of their dietary intake at lunch, with no significant difference between reported and weighed intake (Mean difference (SD): 7(50) kcals, p=0.49). Teachers significantly over-reported intake (Mean difference (SD): 65(79) kcals, p=0.01). For both methods, child-reported and teacher-recorded, correlations with weighed intake were strong (Pearson's correlations r=0.92, p<0.001 and r=0.83, p<0.001 respectively). Bland-Altman plots showed strong agreement between child-reported and weighed intakes but confirmed systematic differences between teacher-records and weighed intakes. Foods were recalled by children with a food-match rate of 90%. In all cases parents themselves were unable to report on quantities consumed and only four of 25 children had parents with knowledge regarding food items consumed. Children 6-8 years of age accurately recalled their school lunch intake for one occasion while teachers recorded with less accuracy. Our findings suggest that children as young as six years of age may be better able to report on their dietary intake than previously suggested, at least for one main meal at school. Teacher-recorded intake provides a satisfactory estimate but with greater systematic deviation from the weighed intake. Parents were not able to report on their children's school lunches consumed on the previous day.

Impact of Adverse Childhood Experiences on Intimate Partner Violence Perpetration among Sri Lankan Men

PubMed Central

Fonseka, Ruvani W.; Minnis, Alexandra M.; Gomez, Anu Manchikanti

2015-01-01

In Sri Lanka, over one in three women experience intimate partner violence (IPV) victimization in their lifetime, making it a serious public health concern. Adverse childhood experiences (ACEs) such as child abuse and neglect, witnessing domestic violence, parental separation, and bullying are also widespread. Studies in Western settings have shown positive associations between ACEs and IPV perpetration in adulthood, but few have examined this relationship in a non-Western context. In the present study, we examined the association of ACEs with IPV perpetration among Sri Lankan men surveyed for the UN Multi-Country Study on Men and Violence in Asia and the Pacific. We found statistically significant positive associations between the number of ACE categories (ACE score) and emotional, financial, physical, and sexual IPV perpetration among Sri Lankan men. We analyzed the contributions of each ACE category and found that childhood abuse was strongly associated with perpetration of IPV in adulthood, with sexual abuse associated with the greatest increase in odds of perpetration (Adjusted odds ratio 2.36; 95% confidence interval: 1.69, 3.30). Witnessing abuse of one’s mother was associated with the greatest increase in the odds of perpetrating physical IPV (AOR 1.82; 95% CI: 1.29, 2.58), while lack of a male parental figure was not associated with physical IPV perpetration (AOR 0.76; 95% CI: 0.53, 1.09). These findings support a social learning theory of IPV perpetration, in which children who are exposed to violence learn to perpetrate IPV in adulthood. They also suggest that in Sri Lanka, being raised in a female-headed household does not increase the risk of IPV perpetration in adulthood compared to being raised in a household with a male parental figure. The relationship between being raised in a female-headed household (the number of which increased dramatically during Sri Lanka’s recent civil war) and perpetration of IPV warrants further study. Interventions that aim to decrease childhood abuse in Sri Lanka could both protect children now and reduce IPV in the future, decreasing violence on multiple fronts. PMID:26295577

Oxytocin and Migraine Headache.

PubMed

Tzabazis, Alexander; Kori, Shashi; Mechanic, Jordan; Miller, James; Pascual, Conrado; Manering, Neil; Carson, Dean; Klukinov, Michael; Spierings, Egilius; Jacobs, Daniel; Cuellar, Jason; Frey, William H; Hanson, Leah; Angst, Martin; Yeomans, David C

2017-05-01

This article reviews material presented at the 2016 Scottsdale Headache Symposium. This presentation provided scientific results and rationale for the use of intranasal oxytocin for the treatment of migraine headache. Results from preclinical experiments are reviewed, including in vitro experiments demonstrating that trigeminal ganglia neurons possess oxytocin receptors and are inhibited by oxytocin. Furthermore, most of these same neurons contain CGRP, the release of which is inhibited by oxytocin. Results are also presented which demonstrate that nasal oxytocin inhibits responses of trigeminal nucleus caudalis neurons to noxious stimulation using either noxious facial shock or nitroglycerin infusion. These studies led to testing the analgesic effect of intranasal oxytocin in episodic migraineurs-studies which did not meet their primary endpoint of pain relief at 2 h, but which were highly informative and led to additional rat studies wherein inflammation was found to dramatically upregulate the number of oxytocin receptors available on trigeminal neurons. This importance of inflammation was supported by a series of in vivo rat behavioral studies, which demonstrated a clear craniofacial analgesic effect when a pre-existing inflammatory injury was present. The significance of inflammation was further solidified by a small single-dose clinical study, which showed analgesic efficacy that was substantially stronger in chronic migraine patients that had not taken an anti-inflammatory drug within 24 h of oxytocin dosing. A follow-on open label study examining effects of one month of intranasal oxytocin dosing did show a reduction in pain, but a more impressive decrease in the frequency of headaches in both chronic and high frequency episodic migraineurs. This study led to a multicountry double blind, placebo controlled study studying whether, over 2 months of dosing, "as needed" dosing of intranasal oxytocin by chronic and high frequency migraineurs would reduce the frequency of their headaches compared to a 1-month baseline period. This study failed to meet its primary endpoint, due to an extraordinarily high placebo rate in the country of most of the patients (Chile), but was also highly informative, showing strong results in other countries and strong post hoc indications of efficacy. The results provide a strong argument for further development of intranasal oxytocin for migraine prophylaxis. © 2017 American Headache Society.

Influenza and respiratory syncytial virus in infants study (IRIS) of hospitalized and non-ill infants aged <1 year in four countries: study design and methods.

PubMed

Thompson, Mark G; Hunt, Danielle R; Arbaji, Ali K; Simaku, Artan; Tallo, Veronica L; Biggs, Holly M; Kulb, Carolyn; Gordon, Aubree; Khader, Ilham Abu; Bino, Silvia; Lucero, Marilla G; Azziz-Baumgartner, Eduardo; Shifflett, Pat; Sanchez, Felix; Marar, Basima I; Bakalli, Ilirjana; Simões, Eric A F; Levine, Min Z; Meece, Jennifer K; Balmaseda, Angel; Al-Sanouri, Tareq M; Dhimolea, Majlinda; de Jesus, Joanne N; Thornburg, Natalie J; Gerber, Susan I; Gresh, Lionel

2017-03-22

This multi-country prospective study of infants aged <1 year aims to assess the frequency of influenza virus and respiratory syncytial virus (RSV) infections associated with hospitalizations, to describe clinical features and antibody response to infection, and to examine predictors of very severe disease requiring intensive care. We are enrolling a hospital-based cohort and a sample of non-ill infants in four countries (Albania, Jordan, Nicaragua, and the Philippines) using a common protocol. We are currently starting year 2 of a 2- to 3-year study and will enroll approximately 3,000 infants hospitalized for any acute illness (respiratory or non-respiratory) during periods of local influenza and/or RSV circulation. After informed consent and within 24 h of admission, we collect blood and respiratory specimens and conduct an interview to assess socio-demographic characteristics, medical history, and symptoms of acute illness (onset ≤10 days). Vital signs, interventions, and medications are documented daily through medical record abstraction. A follow-up health assessment and collection of convalescent blood occurs 3-5 weeks after enrollment. Influenza and RSV infection is confirmed by singleplex real time reverse transcriptase polymerase chain reaction (rRT-PCR) assays. Serologic conversion will be assessed comparing acute and convalescent sera using hemagglutination inhibition assay for influenza antibodies and enzyme-linked immunosorbent assay (ELISA) for RSV. Concurrent with hospital-based enrollment, respiratory specimens are also being collected (and tested by rRT-PCR) from approximately 1,400 non-ill infants aged <1 year during routine medical or preventive care. The Influenza and RSV in Infants Study (IRIS) promises to expand our knowledge of the frequency, clinical features, and antibody profiles of serious influenza and RSV disease among infants aged <1 year, quantify the proportion of infections that may be missed by traditional surveillance, and inform decisions about the potential value of existing and new vaccines and other prevention and treatment strategies.

Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation.

PubMed

Tonkin-Crine, Sarah; Anthierens, Sibyl; Hood, Kerenza; Yardley, Lucy; Cals, Jochen W L; Francis, Nick A; Coenen, Samuel; van der Velden, Alike W; Godycki-Cwirko, Maciek; Llor, Carl; Butler, Chris C; Verheij, Theo J M; Goossens, Herman; Little, Paul

2016-05-12

Mixed methods are commonly used in health services research; however, data are not often integrated to explore complementarity of findings. A triangulation protocol is one approach to integrating such data. A retrospective triangulation protocol was carried out on mixed methods data collected as part of a process evaluation of a trial. The multi-country randomised controlled trial found that a web-based training in communication skills (including use of a patient booklet) and the use of a C-reactive protein (CRP) point-of-care test decreased antibiotic prescribing by general practitioners (GPs) for acute cough. The process evaluation investigated GPs' and patients' experiences of taking part in the trial. Three analysts independently compared findings across four data sets: qualitative data collected view semi-structured interviews with (1) 62 patients and (2) 66 GPs and quantitative data collected via questionnaires with (3) 2886 patients and (4) 346 GPs. Pairwise comparisons were made between data sets and were categorised as agreement, partial agreement, dissonance or silence. Three instances of dissonance occurred in 39 independent findings. GPs and patients reported different views on the use of a CRP test. GPs felt that the test was useful in convincing patients to accept a no-antibiotic decision, but patient data suggested that this was unnecessary if a full explanation was given. Whilst qualitative data indicated all patients were generally satisfied with their consultation, quantitative data indicated highest levels of satisfaction for those receiving a detailed explanation from their GP with a booklet giving advice on self-care. Both qualitative and quantitative data sets indicated higher patient enablement for those in the communication groups who had received a booklet. Use of CRP tests does not appear to engage patients or influence illness perceptions and its effect is more centred on changing clinician behaviour. Communication skills and the patient booklet were relevant and useful for all patients and associated with increased patient satisfaction. A triangulation protocol to integrate qualitative and quantitative data can reveal findings that need further interpretation and also highlight areas of dissonance that lead to a deeper insight than separate analyses.

The impact on healthcare, policy and practice from 36 multi-project research programmes: findings from two reviews.

PubMed

Hanney, Steve; Greenhalgh, Trisha; Blatch-Jones, Amanda; Glover, Matthew; Raftery, James

2017-03-28

We sought to analyse the impacts found, and the methods used, in a series of assessments of programmes and portfolios of health research consisting of multiple projects. We analysed a sample of 36 impact studies of multi-project research programmes, selected from a wider sample of impact studies included in two narrative systematic reviews published in 2007 and 2016. We included impact studies in which the individual projects in a programme had been assessed for wider impact, especially on policy or practice, and where findings had been described in such a way that allowed them to be collated and compared. Included programmes were highly diverse in terms of location (11 different countries plus two multi-country ones), number of component projects (8 to 178), nature of the programme, research field, mode of funding, time between completion and impact assessment, methods used to assess impact, and level of impact identified. Thirty-one studies reported on policy impact, 17 on clinician behaviour or informing clinical practice, three on a combined category such as policy and clinician impact, and 12 on wider elements of impact (health gain, patient benefit, improved care or other benefits to the healthcare system). In those multi-programme projects that assessed the respective categories, the percentage of projects that reported some impact was policy 35% (range 5-100%), practice 32% (10-69%), combined category 64% (60-67%), and health gain/health services 27% (6-48%). Variations in levels of impact achieved partly reflected differences in the types of programme, levels of collaboration with users, and methods and timing of impact assessment. Most commonly, principal investigators were surveyed; some studies involved desk research and some interviews with investigators and/or stakeholders. Most studies used a conceptual framework such as the Payback Framework. One study attempted to assess the monetary value of a research programme's health gain. The widespread impact reported for some multi-project programmes, including needs-led and collaborative ones, could potentially be used to promote further research funding. Moves towards greater standardisation of assessment methods could address existing inconsistencies and better inform strategic decisions about research investment; however, unresolved issues about such moves remain.

Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa

PubMed Central

Bukenya, Dominic; Darong, Gabriel; Wamoyi, Joyce; McLean, Estelle; Skovdal, Morten; Ddaaki, William; Ondeng’e, Kenneth; Bonnington, Oliver; Seeley, Janet; Hosegood, Victoria; Wringe, Alison

2017-01-01

Objectives There are concerns that medical pluralism may delay patients’ progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade. Methods We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism. Results Medical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds. Conclusion Medical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV. The role of sociocultural beliefs in mediating bottlenecks necessitate adoption of culture-sensitive approaches intervention designs and policy reforms appropriate to the context of sub-Saharan Africa. PMID:28736393

Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability

PubMed Central

Adair-Rohani, Heather; Zukor, Karen; Bonjour, Sophie; Wilburn, Susan; Kuesel, Annette C; Hebert, Ryan; Fletcher, Elaine R

2013-01-01

ABSTRACT Background: Access to electricity is critical to health care delivery and to the overarching goal of universal health coverage. Data on electricity access in health care facilities are rarely collected and have never been reported systematically in a multi-country study. We conducted a systematic review of available national data on electricity access in health care facilities in sub-Saharan Africa. Methods: We identified publicly-available data from nationally representative facility surveys through a systematic review of articles in PubMed, as well as through websites of development agencies, ministries of health, and national statistics bureaus. To be included in our analysis, data sets had to be collected in or after 2000, be nationally representative of a sub-Saharan African country, cover both public and private health facilities, and include a clear definition of electricity access. Results: We identified 13 health facility surveys from 11 sub-Saharan African countries that met our inclusion criteria. On average, 26% of health facilities in the surveyed countries reported no access to electricity. Only 28% of health care facilities, on average, had reliable electricity among the 8 countries reporting data. Among 9 countries, an average of 7% of facilities relied solely on a generator. Electricity access in health care facilities increased by 1.5% annually in Kenya between 2004 and 2010, and by 4% annually in Rwanda between 2001 and 2007. Conclusions: Energy access for health care facilities in sub-Saharan African countries varies considerably. An urgent need exists to improve the geographic coverage, quality, and frequency of data collection on energy access in health care facilities. Standardized tools should be used to collect data on all sources of power and supply reliability. The United Nations Secretary-General's “Sustainable Energy for All” initiative provides an opportunity to comprehensively monitor energy access in health care facilities. Such evidence about electricity needs and gaps would optimize use of limited resources, which can help to strengthen health systems. PMID:25276537

Variation in medication adherence across patient behavioral segments: a multi-country study in hypertension.

PubMed

Sandy, Robert; Connor, Ulla

2015-01-01

This study determines the following for a hypertensive patient population: 1) the prevalence of patient worldview clusters; 2) differences in medication adherence across these clusters; and 3) the adherence predictive power of the clusters relative to measures of patients' concerns over their medication's cost, side effects, and efficacy. Members from patient panels in the UK, Germany, Italy, and Spain were invited to participate in an online survey that included the Medication Adherence Report Scale-5 (MARS-5) adherence instrument and a patient segmentation instrument developed by CoMac Analytics, Inc, based on a linguistic analysis of patient talk. Subjects were screened to have a diagnosis of hypertension and treatment with at least one antihypertensive agent. A total of 353 patients completed the online survey in August/September 2011 and were categorized against three different behavioral domains: 1) control orientation (n=176 respondents [50%] for I, internal; n=177 respondents [50%] for E, external); 2) emotion (n=100 respondents [28%] for P, positive; n=253 respondents [72%] for N, negative); and 3) agency or ability to act on choices (n=227 respondents [64%] for H, high agency; n=126 [36%] for L, low agency). Domains were grouped into eight different clusters with EPH and IPH being the most prevalent (88 respondents [25%] in each cluster). The prevalence of other behavior clusters ranged from 6% (22 respondents, INH) to 12% (41 respondents, IPL). The proportion of patients defined as perfectly adherent (scored 25 on MARS-5) varied sharply across the segments: 51% adherent (45 of 88 respondents) for the IPH vs 8% adherent (2 of 25 respondents) classified as INL. Side effects, being employed, and stopping medicine because the patient got better were all significant determinants of adherence in a probit regression model. By categorizing patients into worldview clusters, we identified wide differences in adherence that can be used to prioritize interventions and to customize adherence messages. Also, the predictive power of segments was greater than that for variables measuring concerns over cost, side effects, and efficacy.

A cluster randomised controlled trial to determine the effect of community mobilisation and advocacy on men's use of violence in periurban South Africa: study protocol.

PubMed

Christofides, Nicola J; Hatcher, Abigail M; Pino, Angelica; Rebombo, Dumisani; McBride, Ruari Santiago; Anderson, Althea; Peacock, Dean

2018-03-23

This paper describes the design and methods of a cluster randomised controlled trial (C-RCT) to determine the effectiveness of a community mobilisation intervention that is designed to reduce the perpetration of violence against women (VAW). A C-RCT of nine intervention and nine control clusters is being carried out in a periurban, semiformal settlement near Johannesburg, South Africa, between 2016 and 2018. A community mobilisation and advocacy intervention, called Sonke CHANGE is being implemented over 18 months. It comprises local advocacy and group activities to engage community members to challenge harmful gender norms and reduce VAW. The intervention is hypothesised to improve equitable masculinities, reduce alcohol use and ultimately, to reduce VAW. Intervention effectiveness will be determined through an audio computer-assisted self-interview questionnaire with behavioural measures among 2600 men aged between 18 and 40 years at baseline, 12 months and 24 months. The primary trial outcome is men's use of physical and/or sexual VAW. Secondary outcomes include harmful alcohol use, gender attitudes, controlling behaviours, transactional sex and social cohesion. The main analysis will be intention-to-treat based on the randomisation of clusters. A qualitative process evaluation is being conducted alongside the C-RCT. Implementers and men participating in the intervention will be interviewed longitudinally over the period of intervention implementation and observations of the workshops and other intervention activities are being carried out. Ethical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee and procedures comply with ethical recommendations of the United Nations Multi-Country Study on Men and Violence. Dissemination of research findings will take place with local stakeholders and through peer-reviewed publications, with data available on request or after 5 years of trial completion. NCT02823288; Pre-result. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Domestic violence among antenatal attendees in a Kathmandu hospital and its associated factors: a cross-sectional study.

PubMed

Shrestha, Monika; Shrestha, Sumina; Shrestha, Binjwala

2016-11-21

Domestic violence during pregnancy is a public health problem which violates human rights and causes an adverse effect on both maternal and fetal health. The objectives of the study were to assess the prevalence of domestic violence among the pregnant women attending the antenatal clinic, to explore the associated factors, and to identify the perpetrators of domestic violence. A descriptive cross-sectional study was conducted among 404 pregnant women in their third trimester of pregnancy. Convenient sampling was used to select the study population. Data collection tools consisted of questionnaires on socio-demographic characteristics of the woman and her spouse, social support, and the woman's attitude towards domestic violence, along with her experiences of psychological, physical, and sexual violence. Domestic violence was assessed using a questionnaire adapted from a World Health Organization multi-country study on women's health and life experiences. Relationships between domestic violence and the various factors were determined by bivariate analysis using a chi-square test. Binary logistic regression with 95% confidence interval and adjusted odds ratio were then applied to assess the factors independently associated with domestic violence. More than one-quarter (27.2%) of the pregnant women had experienced some form of violence. The most common form of violence was sexual violence (17.3%), followed by psychological violence (16.6%) and physical violence (3.2%). Husbands within the age group 25-34 years (AOR = 0.38), women married for 2-5 years (AOR = 0.42) and who had one or two children (AOR = 0.32) were negatively associated with domestic violence. Whereas the presence of husband's controlling behavior (AOR = 1.88) and experience of violence before the current pregnancy (AOR = 24.55) increased the odds of experiencing violence during pregnancy. The husband was the major perpetrator in all type of violence. Domestic violence is common among pregnant women attending an antenatal clinic. It indicates a need for routine screening during antenatal visits to identify women experiencing violence and thus provide support services, thereby preventing them from adverse health consequences.

Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis.

PubMed

Glenton, Claire; Sorhaindo, Annik M; Ganatra, Bela; Lewin, Simon

2017-09-21

Allowing a broader range of trained health workers to deliver services can be an important way of improving access to safe abortion care. However, the expansion of health worker roles may be challenging to implement. This study aimed to explore factors influencing the implementation of role expansion strategies for non-physician providers to include the delivery of abortion care. We conducted a multi-country case study synthesis in Bangladesh, Ethiopia, Nepal, South Africa and Uruguay, where the roles of non-physician providers have been formally expanded to include the provision of abortion care. We searched for documentation from each country related to non-physician providers, abortion care services and role expansion through general internet searches, Google Scholar and PubMed, and gathered feedback from 12 key informants. We carried out a thematic analysis of the data, drawing on categories from the SURE Framework of factors affecting the implementation of policy options. Several factors appeared to affect the successful implementation of including non-physician providers to provide abortion care services. These included health workers' knowledge about abortion legislation and services; and health workers' willingness to provide abortion care. Health workers' willingness appeared to be influenced by their personal views about abortion, the method of abortion and stage of pregnancy and their perceptions of their professional roles. While managers' and co-workers' attitudes towards the use of non-physician providers varied, the synthesis suggests that female clients focused less on the type of health worker and more on factors such as trust, privacy, cost, and closeness to home. Health systems factors also played a role, including workloads and incentives, training, supervision and support, supplies, referral systems, and monitoring and evaluation. Strategies used, with varying success, to address some of these issues in the study countries included values clarification workshops, health worker rotation, access to emotional support for health workers, the incorporation of abortion care services into pre-service curricula, and in-service training strategies. To increase the likelihood of success for role expansion strategies in the area of safe abortion, programme planners must consider how to ensure motivation, support and reasonable working conditions for affected health workers.

Community-Based Interventions for Newborns in Ethiopia (COMBINE): Cost-effectiveness analysis.

PubMed

Mathewos, Bereket; Owen, Helen; Sitrin, Deborah; Cousens, Simon; Degefie, Tedbabe; Wall, Stephen; Bekele, Abeba; Lawn, Joy E; Daviaud, Emmanuelle

2017-10-01

About 87 000 neonates die annually in Ethiopia, with slower progress than for child deaths and 85% of births are at home. As part of a multi-country, standardized economic evaluation, we examine the incremental benefit and costs of providing management of possible serious bacterial infection (PSBI) for newborns at health posts in Ethiopia by Health Extension Workers (HEWs), linked to improved implementation of existing policy for community-based newborn care (Health Extension Programme). The government, with Save the Children/Saving Newborn Lives and John Snow, Inc., undertook a cluster randomized trial. Both trial arms involved improved implementation of the Health Extension Programme. The intervention arm received additional equipment, support and supervision for HEWs to identify and treat PSBI. In 2012, ∼95% of mothers in the study area received at least one pregnancy or postnatal visit in each arm, an average of 5.2 contacts per mother in the intervention arm (4.9 in control). Of all visits, 79% were conducted by volunteer community health workers. HEWs spent around 9% of their time on the programme. The financial cost per mother and newborn was $34 (in 2015 USD) in the intervention arm ($27 in control), economic costs of $37 and $30, respectively. Adding PSBI management at community level was estimated to reduce neonatal mortality after day 1 by 17%, translating to a cost per DALY averted of $223 or 47% of the GDP per capita, a highly cost-effective intervention by WHO thresholds. In a routine situation, the intervention programme cost would represent 0.3% of public health expenditure per capita and 0.5% with additional monthly supervision meetings. A platform wide approach to improved supervision including a dedicated transport budget may be more sustainable than a programme-specific approach. In this context, strengthening the existing HEW package is cost-effective and also avoids costly transfers to health centres/hospitals. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Social epidemiology of excess weight and central adiposity in older Indians: analysis of Study on global AGEing and adult health (SAGE)

PubMed Central

Samal, Sudipta; Panigrahi, Pinaki; Dutta, Ambarish

2015-01-01

Objectives We aimed to estimate the prevalence of overweight and obesity, represented by extra body weight and abdominal circumference, among older Indians; and to characterise the social pattern of obesity and measure the magnitude of hypertension attributable to it. Setting A nationally representative sample of older Indians was selected from 6 Indian states, including Rajasthan, Uttar Pradesh, West Bengal, Assam, Maharashtra and Karnataka, as a part of the multicountry Study on global AGEing and adult health (SAGE). Participants Indians aged 50 years or more (n=7273) were included in the first wave of the SAGE (2010), which we used in our study. Primary and secondary outcome measures The primary outcome measures included excess weight (EW), defined by body mass index (BMI) >25 kg/m2, and central adiposity (CA), defined by waist circumference >90 cm for men and >80 cm for women. The secondary outcome included hypertension, defined by systolic blood pressure >139 or diastolic blood pressure >79 mm Hg, or by those receiving antihypertensive medications. Results 14% of older Indians possessed EW, whereas 35% possessed CA; 50.9% of the wealthier third and 27.7% of the poorer two-thirds have CA; the proportions being 69.1% and 46.2%, respectively, in older women. Mostly wealth (adjusted OR for CA: 4.36 (3.23 to 5.95) and EW: 4.39 (3.49 to 5.53)), but also urban residence, privileged caste, higher education, white-collared occupation and female gender, were important determinants. One of 17 older Indians overall and 1 of 18 in the poorer 70% suffered from CA-driven hypertension, independent of BMI. Conclusions The problem of CA and its allied diseases is already substantial and expected to rise across all socioeconomic strata of older Indians, though currently, CA affects the privileged more than the underprivileged, in later life. Population-based promotion of appropriate lifestyles, with special emphasis on women, is required to counteract prosperity-driven obesity before it becomes too entrenched and expensive to uproot. PMID:26610757

Introduction and Progress of APOSOS Project

NASA Astrophysics Data System (ADS)

Zhao, You; Gao, P. Q.; Shen, Ming; Chaudhry, Maqbool A.; Guo, Xiaozhong; Teng, D. P.; Yang, Datao; Yu, Huanhuan; Zhao, Zhe

Asia-Pacific Ground-Based Optical Satellite Observation System (APOSOS) project is based on members of Asia-Pacific Space Cooperation Organization (APSCO). Its aim is to develop a regional or even global satellite tracking network basically composed of optical trackers. The system will be used to track objects of interest or space-debris for the safety of spacecraft launch mission or the intactness of operational satellites. The system will benefit from the distribution of APSCO members and multi-national fund support or technical cooperation. Thus APOSOS will have a potential capability to observe all the satellites orbiting earth with high precision but relatively low cost. This paper will present the introduction, progress and current status of APOSOS project, including: System Requirements Definition, System Main Mission, System Goal, System design, Services and Clients, Organization Framework of Observation Center, Major Function of Observation Center, Establishment of Observation Plan, Format Standard for Exchanging Data, Data Policy, Implementation Schedule, etc.. APOSOS will build a unified surveillance network from observational facilities of member states involved, to utilize the wide geographical distribution advantage of multi-country. It will be operated under the coordination of APSCO observation mission management department. (1)APOSOS should conduct observation missions of specific satellites, space-debris or other space objects of interest, based on requirements of member states. APOSOS should fulfill the basic requirement for satellites observation and tracking missions. And it should also have the potential ability of small debris detection to support collision avoidance planning, which can protect the members high valued space assets. (2)In some particular application, APOSOS would be able to be used for long-term tracking of specific space object of interest, and have the ability of data processing and analysis, so as to provide conjunction assessment, collision probability calculation and avoidance planning for space assets. (3)APOSOS should have the capability of publishing information and sharing data among member states, with the ability to deal with user’s requests for data and mange the data in different levels. (4)APOSOS should have the capability of providing services such as technical consultation, training and science popularization.

Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa.

PubMed

Moshabela, Mosa; Bukenya, Dominic; Darong, Gabriel; Wamoyi, Joyce; McLean, Estelle; Skovdal, Morten; Ddaaki, William; Ondeng'e, Kenneth; Bonnington, Oliver; Seeley, Janet; Hosegood, Victoria; Wringe, Alison

2017-07-01

There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade. We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism. Medical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds. Medical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV. The role of sociocultural beliefs in mediating bottlenecks necessitate adoption of culture-sensitive approaches intervention designs and policy reforms appropriate to the context of sub-Saharan Africa. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Self-reported cataracts in older adults in Ghana: sociodemographic and health related factors.

PubMed

Yawson, Alfred E; Ackuaku-Dogbe, Edith M; Seneadza, Nana A Hagan; Mensah, George; Minicuci, Nadia; Naidoo, Nirmala; Chatterji, Somnath; Kowal, Paul; Biritwum, Richard B

2014-09-12

Changes in function of sensory organs with increasing age have significant impact on health and wellbeing of older persons. This paper describes cataract, a chronic eye condition, self-reported among older adults in Ghana and the need for improving access to eye care services. This work was based on the World Health Organization's multi-country Study on global AGEing and adult health (SAGE), conducted in six countries including Ghana. SAGE Wave 1 in Ghana was conducted in 2007-2008 in a nationally representative sample of 4278 older adults, ≥ 50 years. Data were obtained on sociodemographic and health factors related to self-reported cataracts in older persons in Ghana. Data were analysed using descriptive measures (frequencies and proportions), chi-square test for associations in categorical outcome measures, and logistic regression for predictors of cataracts with SPSS version 21. Overall prevalence of self-reported cataracts among 4278 older adults in Ghana was 5.4%. Prevalence was proportionately higher for women (5.9%) than men (4.7%). Reported cataracts increased with age, among urban residents, in older adults living without partners and among those with the worse life satisfaction index. Older adults in lower income groups, poorly educated or living alone had difficulty seeking vision care services. Prevalence was 8.4% among persons with diabetes, 10.4% among hypertensives and 11.4% in persons with previous history of stroke. Among older persons who had ever used alcohol or tobacco, prevalence rates of reported cataracts were 5.7% and 4.9%, respectively. Logistic regression analysis indicated that increasing age, lower income status and self-reported hypertension were significantly associated with cataract among older adults in Ghana. Cataract is prevalent in older people in Ghana with approximately 1 in 20 people aged 50 years or older reporting a previous diagnosis of cataract. As cataract surgery is restorative, a public health approach on behavioural modification, well structured national outreach eye care services (for rural residents), inclusion of basic eye health services at sub-district levels, increased family support and national health insurance for older persons is indicated.

Risk factors of stunting among children living in an urban slum of Bangladesh: findings of a prospective cohort study.

PubMed

Islam, M Munirul; Sanin, Kazi Istiaque; Mahfuz, Mustafa; Ahmed, A M Shamsir; Mondal, Dinesh; Haque, Rashidul; Ahmed, Tahmeed

2018-01-30

Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented. Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age. Approximately, 18% of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48% at 24 months of age. Exclusive breastfeeding prevalence was only 9.4% following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95% CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95% CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95% CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95% CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95% CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population. As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.

Spanning maternal, newborn and child health (MNCH) and health systems research boundaries: conducive and limiting health systems factors to improving MNCH outcomes in West Africa.

PubMed

Agyepong, Irene Akua; Kwamie, Aku; Frimpong, Edith; Defor, Selina; Ibrahim, Abdallah; Aryeetey, Genevieve C; Lokossou, Virgil; Sombie, Issiaka

2017-07-12

Despite improvements over time, West Africa lags behind global as well as sub-Saharan averages in its maternal, newborn and child health (MNCH) outcomes. This is despite the availability of an increasing body of knowledge on interventions that improve such outcomes. Beyond our knowledge of what interventions work, insights are needed on others factors that facilitate or inhibit MNCH outcome improvement. This study aimed to explore health system factors conducive or limiting to MNCH policy and programme implementation and outcomes in West Africa, and how and why they work in context. We conducted a mixed methods multi-country case study focusing predominantly, but not exclusively, on the six West African countries (Burkina Faso, Benin, Mali, Senegal, Nigeria and Ghana) of the Innovating for Maternal and Child Health in Africa initiative. Data collection involved non-exhaustive review of grey and published literature, and 48 key informant interviews. We validated our findings and conclusions at two separate multi-stakeholder meetings organised by the West African Health Organization. To guide our data collection and analysis, we developed a unique theoretical framework of the link between health systems and MNCH, in which we conceptualised health systems as the foundations, pillars and roofing of a shelter for MNCH, and context as the ground on which the foundation is laid. A multitude of MNCH policies and interventions were being piloted, researched or implemented at scale in the sub-region, most of which faced multiple interacting conducive and limiting health system factors to effective implementation, as well as contextual challenges. Context acted through its effect on health system factors as well as on the social determinants of health. To accelerate and sustain improvements in MNCH outcomes in West Africa, an integrated approach to research and practice of simultaneously addressing health systems and contextual factors alongside MNCH service delivery interventions is needed. This requires multi-level, multi-sectoral and multi-stakeholder engagement approaches that span current geographical, language, research and practice community boundaries in West Africa, and effectively link the efforts of actors interested in health systems strengthening with those of actors interested in MNCH outcome improvement.

Building tobacco control research in Thailand: meeting the need for innovative change in Asia.

PubMed

Hamann, Stephen L; Mock, Jeremiah; Hense, Sibasis; Charoenca, Naowarut; Kungskulniti, Nipapun

2012-01-28

In low- and middle-income countries (LMICs) over the past two decades locally relevant tobacco control research has been scant. Experience shows that tobacco control measures should be based on sound research findings to ensure that measures are appropriate for local conditions and that they are likely to have an impact. Research should also be integrated within tobacco control measures to ensure ongoing learning and the production of knowledge. Thailand, a middle-income country, has a public health community with a record of successful tobacco control and a longstanding commitment to research. Thailand's comprehensive approach includes taxation; bans on tobacco advertising, sponsorship and promotion; smoke-free areas; graphic cigarette pack warnings; social marketing campaigns; cessation counseling; and an established tobacco control research program. The purpose of this study was to document and analyze the development of tobacco control research capacity in Thailand and the impact of research on Thai tobacco control measures. We used mixed methods including review of historical documentation and policy reports, qualitative interviews with key members of Thailand's tobacco control community, and an analysis of research productivity. In Thailand, tobacco control research has evolved through three phases: (1) discovery of the value of research in the policymaking arena, (2) development of a structure to support research capacity building through international collaborations supported by foreign funding agencies, and (3) delivery of locally relevant research made possible largely through substantial stable funding from a domestic health promotion foundation. Over two decades, Thai tobacco control advocates have constructed five steppingstones to success: (1) adapting foreign research to inform policymaking and lobbying for more support for domestic research; (2) attracting foreign funding agencies to support small-scale research and capacity building; (3) participating in multi-country research and capacity building programs; (4) using collaborative experiences to demonstrate the need for domestic support of locally relevant research; and (5) maintaining an unwavering commitment to research while being vigilant to ensure continued research support. The evolution of tobacco control research in Thailand provides examples of steppingstones that LMICs may be able to use to construct their own tobacco control research pathways.

Intraclass correlation and design effect in BMI, physical activity and diet: a cross-sectional study of 56 countries.

PubMed

Masood, Mohd; Reidpath, Daniel D

2016-01-07

Measuring the intraclass correlation coefficient (ICC) and design effect (DE) may help to modify the public health interventions for body mass index (BMI), physical activity and diet according to geographic targeting of interventions in different countries. The purpose of this study was to quantify the level of clustering and DE in BMI, physical activity and diet in 56 low-income, middle-income and high-income countries. Cross-sectional study design. Multicountry national survey data. The World Health Survey (WHS), 2003, data were used to examine clustering in BMI, physical activity in metabolic equivalent of task (MET) and diet in fruits and vegetables intake (FVI) from low-income, middle-income and high-income countries. Multistage sampling in the WHS used geographical clusters as primary sampling units (PSU). These PSUs were used as a clustering or grouping variable in this analysis. Multilevel intercept only regression models were used to calculate the ICC and DE for each country. The median ICC (0.039) and median DE (1.82) for BMI were low; however, FVI had a higher median ICC (0.189) and median DE (4.16). For MET, the median ICC was 0.141 and median DE was 4.59. In some countries, however, the ICC and DE for BMI were large. For instance, South Africa had the highest ICC (0.39) and DE (11.9) for BMI, whereas Uruguay had the highest ICC (0.434) for MET and Ethiopia had the highest ICC (0.471) for FVI. This study shows that across a wide range of countries, there was low area level clustering for BMI, whereas MET and FVI showed high area level clustering. These results suggested that the country level clustering effect should be considered in developing preventive approaches for BMI, as well as improving physical activity and healthy diets for each country. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A multi-country study of intussusception in children under 2 years of age in Latin America: analysis of prospective surveillance data

PubMed Central

2013-01-01

Background Intussusception (IS) is a form of acute intestinal obstruction that occurs mainly in infants and is usually of unknown cause. An association between IS and the first licensed rotavirus vaccine, a reassortant-tetravalent, rhesus-based rotavirus vaccine (RRV-TV), led to the withdrawal of the vaccine. New rotavirus vaccines have now been developed and extensively studied for their potential association with IS. This study aimed to describe the epidemiology and to estimate the incidence of IS in Latin American infants prior to new vaccine introduction. Methods Children under 2 years of age representing potential IS cases were enrolled in 16 centers in 11 Latin American countries from January 2003 to May 2005. IS cases were classified as definite, probable, possible or suspected as stated on the Brighton Collaboration Working Group guidelines. Results From 517 potential cases identified, 476 (92%) cases were classified as definite, 21 probable, 10 possible and 10 suspected for intussusception. Among the 476 definite IS cases, the median age at presentation was 6.4 months with 89% of cases aged <1 year. The male to female ratio was 1.5:1. The incidence of definite IS per 100,000 subject-years ranged from 1.9 in Brazil to 62.4 in Argentina for children <2 years of age, and from 3.8 in Brazil to 105.3 in Argentina for children aged <1 year. Median hospital stay was 4 days with a high prevalence of surgery as the primary treatment (65%). Most cases (88%) made a complete recovery, but 13 (3%) died. No clear seasonal pattern of IS cases emerged. Conclusions This study describes the epidemiology and estimates the incidence of IS in Latin American infants prior to the introduction of new rotavirus vaccines. The incidence of IS was found to vary between different countries, as observed in previous studies. Trial registration Clinical study identifier 999910/204 (SERO-EPI-IS-204) PMID:23710610

Cooking and Season as Risk Factors for Acute Lower Respiratory Infections in African Children: A Cross-Sectional Multi-Country Analysis

PubMed Central

Buchner, Hannes; Rehfuess, Eva A.

2015-01-01

Background Acute lower respiratory infections (ALRI) are a leading cause of death among African children under five. A significant proportion of these are attributable to household air pollution from solid fuel use. Methods We assessed the relationship between cooking practices and ALRI in pooled datasets of Demographic and Health Surveys conducted between 2000 and 2011 in countries of sub-Saharan Africa. The impacts of main cooking fuel, cooking location and stove ventilation were examined in 18 (n = 56,437), 9 (n = 23,139) and 6 countries (n = 14,561) respectively. We used a causal diagram and multivariable logistic mixed models to assess the influence of covariates at individual, regional and national levels. Results Main cooking fuel had a statistically significant impact on ALRI risk (p<0.0001), with season acting as an effect modifier (p = 0.034). During the rainy season, relative to clean fuels, the odds of suffering from ALRI were raised for kerosene (OR 1.64; CI: 0.99, 2.71), coal and charcoal (OR 1.54; CI: 1.21, 1.97), wood (OR 1.20; CI: 0.95, 1.51) and lower-grade biomass fuels (OR 1.49; CI: 0.93, 2.35). In contrast, during the dry season the corresponding odds were reduced for kerosene (OR 1.23; CI: 0.77, 1.95), coal and charcoal (OR 1.35; CI: 1.06, 1.72) and lower-grade biomass fuels (OR 1.07; CI: 0.69, 1.66) but increased for wood (OR 1.32; CI: 1.04, 1.66). Cooking location also emerged as a season-dependent statistically significant (p = 0.0070) determinant of ALRI, in particular cooking indoors without a separate kitchen during the rainy season (OR 1.80; CI: 1.30, 2.50). Due to infrequent use in Africa we could, however, not demonstrate an effect of stove ventilation. Conclusions We found differential and season-dependent risks for different types of solid fuels and kerosene as well as cooking location on child ALRI. Future household air pollution studies should consider potential effect modification of cooking fuel by season. PMID:26042802

Cooking and season as risk factors for acute lower respiratory infections in African children: a cross-sectional multi-country analysis.

PubMed

Buchner, Hannes; Rehfuess, Eva A

2015-01-01

Acute lower respiratory infections (ALRI) are a leading cause of death among African children under five. A significant proportion of these are attributable to household air pollution from solid fuel use. We assessed the relationship between cooking practices and ALRI in pooled datasets of Demographic and Health Surveys conducted between 2000 and 2011 in countries of sub-Saharan Africa. The impacts of main cooking fuel, cooking location and stove ventilation were examined in 18 (n = 56,437), 9 (n = 23,139) and 6 countries (n = 14,561) respectively. We used a causal diagram and multivariable logistic mixed models to assess the influence of covariates at individual, regional and national levels. Main cooking fuel had a statistically significant impact on ALRI risk (p<0.0001), with season acting as an effect modifier (p = 0.034). During the rainy season, relative to clean fuels, the odds of suffering from ALRI were raised for kerosene (OR 1.64; CI: 0.99, 2.71), coal and charcoal (OR 1.54; CI: 1.21, 1.97), wood (OR 1.20; CI: 0.95, 1.51) and lower-grade biomass fuels (OR 1.49; CI: 0.93, 2.35). In contrast, during the dry season the corresponding odds were reduced for kerosene (OR 1.23; CI: 0.77, 1.95), coal and charcoal (OR 1.35; CI: 1.06, 1.72) and lower-grade biomass fuels (OR 1.07; CI: 0.69, 1.66) but increased for wood (OR 1.32; CI: 1.04, 1.66). Cooking location also emerged as a season-dependent statistically significant (p = 0.0070) determinant of ALRI, in particular cooking indoors without a separate kitchen during the rainy season (OR 1.80; CI: 1.30, 2.50). Due to infrequent use in Africa we could, however, not demonstrate an effect of stove ventilation. We found differential and season-dependent risks for different types of solid fuels and kerosene as well as cooking location on child ALRI. Future household air pollution studies should consider potential effect modification of cooking fuel by season.

A Multi-Country Cross-Sectional Study of Vaginal Carriage of Group B Streptococci (GBS) and Escherichia coli in Resource-Poor Settings: Prevalences and Risk Factors

PubMed Central

Cools, Piet; Jespers, Vicky; Hardy, Liselotte; Crucitti, Tania; Delany-Moretlwe, Sinead; Mwaura, Mary; Ndayisaba, Gilles F.; van de Wijgert, Janneke H. H. M.; Vaneechoutte, Mario

2016-01-01

Background One million neonates die each year in low- and middle-income countries because of neonatal sepsis; group B Streptococcus (GBS) and Escherichia coli are the leading causes. In sub-Saharan Africa, epidemiological data on vaginal GBS and E. coli carriage, a prerequisite for GBS and E. coli neonatal sepsis, respectively, are scarce but necessary to design and implement prevention strategies. Therefore, we assessed vaginal GBS and E. coli carriage rates and risk factors and the GBS serotype distribution in three sub-Saharan countries. Methods A total of 430 women from Kenya, Rwanda and South Africa were studied cross-sectionally. Vaginal carriage of GBS and E. coli, and GBS serotype were assessed using molecular techniques. Risk factors for carriage were identified using multivariable logistic regression analysis. Results Vaginal carriage rates in reference groups from Kenya and South Africa were 20.2% (95% CI, 13.7–28.7%) and 23.1% (95% CI, 16.2–31.9%), respectively for GBS; and 25.0% (95% CI, 17.8–33.9%) and 27.1% (95% CI, 19.6–36.2%), respectively for E. coli. GBS serotypes Ia (36.8%), V (26.3%) and III (14.0%) were most prevalent. Factors independently associated with GBS and E. coli carriage were Candida albicans, an intermediate vaginal microbiome, bacterial vaginosis, recent vaginal intercourse, vaginal washing, cervical ectopy and working as a sex worker. GBS and E. coli carriage were positively associated. Conclusions Reduced vaginal GBS carriage rates might be accomplished by advocating behavioral changes such as abstinence from sexual intercourse and by avoidance of vaginal washing during late pregnancy. It might be advisable to explore the inclusion of vaginal carriage of C. albicans, GBS, E. coli and of the presence of cervical ectopy in a risk- and/or screening-based administration of antibiotic prophylaxis. Current phase II GBS vaccines (a trivalent vaccine targeting serotypes Ia, Ib, and III, and a conjugate vaccine targeting serotype III) would not protect the majority of women against carriage in our study population. PMID:26811897

Building tobacco control research in Thailand: meeting the need for innovative change in Asia

PubMed Central

2012-01-01

Introduction In low- and middle-income countries (LMICs) over the past two decades locally relevant tobacco control research has been scant. Experience shows that tobacco control measures should be based on sound research findings to ensure that measures are appropriate for local conditions and that they are likely to have an impact. Research should also be integrated within tobacco control measures to ensure ongoing learning and the production of knowledge. Thailand, a middle-income country, has a public health community with a record of successful tobacco control and a longstanding commitment to research. Thailand's comprehensive approach includes taxation; bans on tobacco advertising, sponsorship and promotion; smoke-free areas; graphic cigarette pack warnings; social marketing campaigns; cessation counseling; and an established tobacco control research program. The purpose of this study was to document and analyze the development of tobacco control research capacity in Thailand and the impact of research on Thai tobacco control measures. Method We used mixed methods including review of historical documentation and policy reports, qualitative interviews with key members of Thailand's tobacco control community, and an analysis of research productivity. Findings In Thailand, tobacco control research has evolved through three phases: (1) discovery of the value of research in the policymaking arena, (2) development of a structure to support research capacity building through international collaborations supported by foreign funding agencies, and (3) delivery of locally relevant research made possible largely through substantial stable funding from a domestic health promotion foundation. Over two decades, Thai tobacco control advocates have constructed five steppingstones to success: (1) adapting foreign research to inform policymaking and lobbying for more support for domestic research; (2) attracting foreign funding agencies to support small-scale research and capacity building; (3) participating in multi-country research and capacity building programs; (4) using collaborative experiences to demonstrate the need for domestic support of locally relevant research; and (5) maintaining an unwavering commitment to research while being vigilant to ensure continued research support. Conclusion The evolution of tobacco control research in Thailand provides examples of steppingstones that LMICs may be able to use to construct their own tobacco control research pathways. PMID:22284811

Prioritization of reproductive toxicants in unconventional oil and gas operations using a multi-country regulatory data-driven hazard assessment.

PubMed

Inayat-Hussain, Salmaan H; Fukumura, Masao; Muiz Aziz, A; Jin, Chai Meng; Jin, Low Wei; Garcia-Milian, Rolando; Vasiliou, Vasilis; Deziel, Nicole C

2018-08-01

Recent trends have witnessed the global growth of unconventional oil and gas (UOG) production. Epidemiologic studies have suggested associations between proximity to UOG operations with increased adverse birth outcomes and cancer, though specific potential etiologic agents have not yet been identified. To perform effective risk assessment of chemicals used in UOG production, the first step of hazard identification followed by prioritization specifically for reproductive toxicity, carcinogenicity and mutagenicity is crucial in an evidence-based risk assessment approach. To date, there is no single hazard classification list based on the United Nations Globally Harmonized System (GHS), with countries applying the GHS standards to generate their own chemical hazard classification lists. A current challenge for chemical prioritization, particularly for a multi-national industry, is inconsistent hazard classification which may result in misjudgment of the potential public health risks. We present a novel approach for hazard identification followed by prioritization of reproductive toxicants found in UOG operations using publicly available regulatory databases. GHS classification for reproductive toxicity of 157 UOG-related chemicals identified as potential reproductive or developmental toxicants in a previous publication was assessed using eleven governmental regulatory agency databases. If there was discordance in classifications across agencies, the most stringent classification was assigned. Chemicals in the category of known or presumed human reproductive toxicants were further evaluated for carcinogenicity and germ cell mutagenicity based on government classifications. A scoring system was utilized to assign numerical values for reproductive health, cancer and germ cell mutation hazard endpoints. Using a Cytoscape analysis, both qualitative and quantitative results were presented visually to readily identify high priority UOG chemicals with evidence of multiple adverse effects. We observed substantial inconsistencies in classification among the 11 databases. By adopting the most stringent classification within and across countries, 43 chemicals were classified as known or presumed human reproductive toxicants (GHS Category 1), while 31 chemicals were classified as suspected human reproductive toxicants (GHS Category 2). The 43 reproductive toxicants were further subjected to analysis for carcinogenic and mutagenic properties. Calculated hazard scores and Cytoscape visualization yielded several high priority chemicals including potassium dichromate, cadmium, benzene and ethylene oxide. Our findings reveal diverging GHS classification outcomes for UOG chemicals across regulatory agencies. Adoption of the most stringent classification with application of hazard scores provides a useful approach to prioritize reproductive toxicants in UOG and other industries for exposure assessments and selection of safer alternatives. Copyright © 2018 Elsevier Ltd. All rights reserved.

Projecting the health and economic impact of road safety initiatives: a case study of a multi-country project.

PubMed

Esperato, Alexo; Bishai, David; Hyder, Adnan A

2012-01-01

The Road Safety in 10 Countries (RS-10) project will implement 12 different road safety interventions at specific sites within 10 low- and middle-income countries (LMICs). This evaluation reports the number of lives that RS-10 is projected to save in those locations, the economic value of the risk reduction, and the maximum level of investment that a public health intervention of this magnitude would be able to incur before its costs outweigh its health benefits. We assumed a 5-year time implementation horizon corresponding to the duration of RS-10. Based on a preliminary literature review, we estimated the effectiveness for each of the RS-10 interventions. Applying these effectiveness estimates to the size of the population at risk at RS-10 sites, we calculated the number of lives and life years saved (LYS) by RS-10. We projected the value of a statistical life (VSL) in each RS-10 country based on gross national income (GNI) and estimated the value of the lives saved using each country's VSL. Sensitivity analysis addressed robustness to assumptions about elasticity, discount rates, and intervention effectiveness. From the evidence base reviewed, only 13 studies met our selection criteria. Such a limited base presents uncertainties about the potential impact of the modeled interventions. We tried to account for these uncertainties by allowing effectiveness to vary ± 20 percent for each intervention. Despite this variability, RS-10 remains likely to be worth the investment. RS-10 is expected to save 10,310 lives over 5 years (discounted at 3%). VSL and $/LYS methods provide concordant results. Based on our estimates of each country's VSL, the respective countries would be willing to pay $2.45 billion to lower these fatality risks (varying intervention effectiveness by ± 20 percent, the corresponding range is $2.0-$2.9 billion). Analysis based on $/LYS shows that the RS-10 project will be cost-effective as long as its costs do not exceed $5.14 billion (under ± 20% intervention effectiveness, the range = $4.1-$6.2 billion). Even at low efficacy, these estimates are still several orders of magnitude above the $125 million projected investment. RS-10 is likely to yield high returns for invested resources. The study's chief limitation was the reliance on the world's limited evidence base on how effective the road safety interventions will be. Planned evaluation of RS-10 will enhance planners' ability to conduct economic assessments of road safety in developing countries.

The logical underpinnings and benefits of pooled pharmaceutical procurement: a pragmatic role for our public institutions?

PubMed

Huff-Rousselle, Maggie

2012-11-01

Multi-national pharmaceutical companies have long operated across national boundaries, and exercised significant leverage because of the breadth and depth of their market control. The goals of public health can be better served by redressing the imbalance in market leverage between supply and demand. Consolidation of purchasing power across borders, as well as within countries across organizational entities, is one means to addressing this imbalance. In those existing pooled procurement models that consolidate purchasing across national boundaries, benefits have included: 1) reductions in unit purchase prices; 2) improved quality assurance; 3) reduction or elimination of procurement corruption; 4) rationalized choice through better-informed selection and standardization; 5) reduction of operating costs and administrative burden; 6) increased equity between members; 7) augmented practical utility in the role of the host institutions (regional or international) administering the system; and finally, 8) increased access to essential medical products within each participating country. Many barriers to implementation of a multi-country pooled procurement system are eliminated when the mechanism is established within a regional or international institution, especially where participating countries are viewed (and view themselves) as clients/members of the institution, so that they have some sense of ownership over the procurement mechanism. This review article is based on two literature reviews, conducted between 2007 and 2009 (including publications from 1996 through 2009), and interviews with key informants. Copyright © 2012 Elsevier Ltd. All rights reserved.

The prevalence of intimate partner violence in the family: a systematic review of the implications for adolescents in Africa.

PubMed

Roman, Nicolette V; Frantz, José M

2013-06-01

Intimate partner violence (IPV) and its multiple effects are well documented in Western research, but these are not adequately described in Africa. The effects of IPV on adolescent health and well-being are not conclusive. The aim of this review was to systematically appraise prevalence studies conducted on the African continent to establish the prevalence of IPV and the implications of exposure on adolescents in Africa. A comprehensive search was conducted in May 2012 for the previous 10 years, using databases such as Ebscohost (Medline, CINAHL, PsyArticles), Directory of Open Access Journals (DOAJ), Project Muse and BioMed Central and also specific journals Lancet, and JSTOR. Two reviewers independently evaluated the methodological quality of the studies reviewed. Seven eligible epidemiological studies were included in this review. Five of the studies were conducted in South Africa, one in Liberia, and another was a multi-country study that included Egypt, Kenya, Malawi, Rwanda and Zambia. The prevalence of IPV in African countries ranged from approximately 26.5% to 48%. All studies reported exposure to family violence during childhood. The findings support the global burden of IPV. There is also a need for standardized tools to determine IPV in Africa and a clear definition that can be used in research to allow comparison with future IPV studies. In addition, the studies point to a need for interventions focusing on adolescents exposed to family violence.

Standardised surveillance of Clostridium difficile infection in European acute care hospitals: a pilot study, 2013.

PubMed

van Dorp, Sofie M; Kinross, Pete; Gastmeier, Petra; Behnke, Michael; Kola, Axel; Delmée, Michel; Pavelkovich, Anastasia; Mentula, Silja; Barbut, Frédéric; Hajdu, Agnes; Ingebretsen, André; Pituch, Hanna; Macovei, Ioana S; Jovanović, Milica; Wiuff, Camilla; Schmid, Daniela; Olsen, Katharina Ep; Wilcox, Mark H; Suetens, Carl; Kuijper, Ed J

2016-07-21

Clostridium difficile infection (CDI) remains poorly controlled in many European countries, of which several have not yet implemented national CDI surveillance. In 2013, experts from the European CDI Surveillance Network project and from the European Centre for Disease Prevention and Control developed a protocol with three options of CDI surveillance for acute care hospitals: a 'minimal' option (aggregated hospital data), a 'light' option (including patient data for CDI cases) and an 'enhanced' option (including microbiological data on the first 10 CDI episodes per hospital). A total of 37 hospitals in 14 European countries tested these options for a three-month period (between 13 May and 1 November 2013). All 37 hospitals successfully completed the minimal surveillance option (for 1,152 patients). Clinical data were submitted for 94% (1,078/1,152) of the patients in the light option; information on CDI origin and outcome was complete for 94% (1,016/1,078) and 98% (294/300) of the patients in the light and enhanced options, respectively. The workload of the options was 1.1, 2.0 and 3.0 person-days per 10,000 hospital discharges, respectively. Enhanced surveillance was tested and was successful in 32 of the hospitals, showing that C. difficile PCR ribotype 027 was predominant (30% (79/267)). This study showed that standardised multicountry surveillance, with the option of integrating clinical and molecular data, is a feasible strategy for monitoring CDI in Europe. This article is copyright of The Authors, 2016.

Experience from a multi-country initiative to improve the monitoring of selected reproductive health indicators in Africa.

PubMed

Barreix, Maria; Tunçalp, Özge; Mutombo, Namuunda; Adegboyega, Ayotunde A; Say, Lale

2017-05-01

Universal access to sexual and reproductive health remains part of the unfinished business of global development in Africa. To achieve it, health interventions should be monitored using programmatic indicators. WHO's Strengthening Measurement of Reproductive Health Indicators in Africa initiative, implemented in Ghana, Nigeria, Kenya, Uganda, and Zimbabwe, aimed to improve national information systems for routine monitoring of reproductive health indicators. Participating countries developed action plans employing a two-pronged strategy: (1) revising, standardizing, and harmonizing existing reproductive health indicators captured through routine information-systems; and (2) building data-collection capacity through training and supervision at select pilot sites. Country teams evaluated existing and new indicators, and outlined barriers to strengthening routine measurement. Activities included updating abortion-care guidelines (spontaneous and induced abortions), providing training on laws surrounding induced abortions, and improving feedback mechanisms. The country teams updated monitoring and evaluation frameworks, and attempted to build recording/reporting capacity in selected pilot areas. Barriers to implementing the initiative that were encountered included restrictive induced-abortion laws, staff turn-over, and administrative delays, including low capacity among healthcare staff and competing priorities for staff time. The areas identified for further improvement were up-scaling programs to a national level, creating scorecards to record data, increasing collaborations with the private sector, conducting related costing exercises, and performing ex-post evaluations. © 2017 World Health Organization; licensed by Wiley on behalf of International Federation of Gynecology and Obstetrics.

Mycobacterium chimaera infections in post–operative patients exposed to heater–cooler devices: An overview

PubMed Central

Ogunremi, T; Taylor, G; Johnston, L; Amaratunga, K; Muller, M; Coady, A; Defalco, K; Dunn, K; Johnstone, J; Smith, S; Embree, J; Henry, B; Stafford, J

2017-01-01

A multi-country outbreak of Mycobacterium chimaera infection associated with contaminated heater–cooler devices (HCDs) has been reported, with more than 70 cases in Europe and the United States and two cases in Canada to date. The epidemiological and microbiological characteristics of this outbreak provide evidence for common-source transmission of M. chimaera from the exhaust air of intrinsically contaminated HCDs to patients during cardiac surgery. To date, all reported cases have been associated with Stöckert 3T HCDs manufactured at one plant by LivaNova prior to September 2014. Implantation of prosthetic material increases the risk of infection. Infections usually present as prosthetic valve endocarditis, vascular graft infection or disseminated infection. Reported mortality rates have varied, but were often over 40%. Several measures are recommended to facilitate case-finding and mitigate risk of exposure. The feasibility of some risk mitigation measures and their effectiveness in reducing the risk of exposure are yet to be determined. Until HCDs are redesigned in a manner that prevents water contamination and aerosolization, separating the HCD exhaust air from the operating room air during surgery may be the most effective risk mitigation strategy. However, possible unintended consequences of this approach should be considered. This overview summarizes findings from peer-reviewed and other relevant national documents on key features of the outbreak, including the source, identified risk factors for infection, signs and symptoms of infection, burden of disease, risk mitigation measures, management challenges and knowledge gaps.

Mycobacterium chimaera infections in post-operative patients exposed to heater-cooler devices: An overview.

PubMed

Ogunremi, T; Taylor, G; Johnston, L; Amaratunga, K; Muller, M; Coady, A; Defalco, K; Dunn, K; Johnstone, J; Smith, S; Embree, J; Henry, B; Stafford, J

2017-05-04

A multi-country outbreak of Mycobacterium chimaera infection associated with contaminated heater-cooler devices (HCDs) has been reported, with more than 70 cases in Europe and the United States and two cases in Canada to date. The epidemiological and microbiological characteristics of this outbreak provide evidence for common-source transmission of M. chimaera from the exhaust air of intrinsically contaminated HCDs to patients during cardiac surgery. To date, all reported cases have been associated with Stöckert 3T HCDs manufactured at one plant by LivaNova prior to September 2014. Implantation of prosthetic material increases the risk of infection. Infections usually present as prosthetic valve endocarditis, vascular graft infection or disseminated infection. Reported mortality rates have varied, but were often over 40%. Several measures are recommended to facilitate case-finding and mitigate risk of exposure. The feasibility of some risk mitigation measures and their effectiveness in reducing the risk of exposure are yet to be determined. Until HCDs are redesigned in a manner that prevents water contamination and aerosolization, separating the HCD exhaust air from the operating room air during surgery may be the most effective risk mitigation strategy. However, possible unintended consequences of this approach should be considered. This overview summarizes findings from peer-reviewed and other relevant national documents on key features of the outbreak, including the source, identified risk factors for infection, signs and symptoms of infection, burden of disease, risk mitigation measures, management challenges and knowledge gaps.

[Systematic Review of the Methodology Quality in Lung Cancer Screening Guidelines].

PubMed

Li, Jiang; Su, Kai; Li, Fang; Tang, Wei; Huang, Yao; Wang, Le; Huang, Huiyao; Shi, Jufang; Dai, Min

2016-10-20

Lung cancer is the most common malignancy and screening can decrease the mortality. High quality screening guideline is necessary and important for effective work. Our study is to review and evaluate the basic characteristics and methodology quality of the current global lung cancer screening guidelines so as to provide useful information for domestic study in the future. Electronic searches were done in English and Chinese databases including PubMed, the Cochrane Library, Web of Science, Embase, CNKI, CBM, Wanfang, and some cancer official websites. Articles were screened according to the predefined inclusion and exclusion criteria by two researchers. The quality of guidelines was assessed by AGREE II. At last, a total of 11 guidelines with methodology were included. The guidelines were issued mainly by USA (81%). Canada and China developed one, respectively. As for quality, the average score in the "Scale and objective" of all guidelines was 80, the average score in the "Participants" was 52, the average score in the "rigorism" was 50, the average score in the "clarity" was 76, the average score in the "application" was 43 and the average score in the "independence" was 59. The highest average score was found in 2013 and 2015. Canada guideline had higher quality in six domains. 7 guidelines were evaluated as A level. The number of clinical guidelines showed an increasing trend. Most guidelines were issued by developed countries with heavy burden. Multi-country contribution to one guideline was another trend. Evidence-based methodology was accepted globally in the guideline development.

The Link Between Community-Based Violence and Intimate Partner Violence: the Effect of Crime and Male Aggression on Intimate Partner Violence Against Women.

PubMed

Kiss, Ligia; Schraiber, Lilia Blima; Hossain, Mazeda; Watts, Charlotte; Zimmerman, Cathy

2015-08-01

Both intimate partner violence (IPV) and community violence are prevalent globally, and each is associated with serious health consequences. However, little is known about their potential links or the possible benefits of coordinated prevention strategies. Using aggregated data on community violence from the São Paulo State Security Department (INFOCRIM) merged with WHO multi-country study on women's health and domestic violence data, random intercept models were created to assess the effect of crime on women's probability of experiencing IPV. The association between IPV and male aggression (measured by women's reports of their partner's fights with other men) was examined using logistic regression models. We found little variation in the likelihood of male IPV perpetration related to neighborhood crime level but did find an increased likelihood of IPV experiences among women whose partners were involved in male-to-male violence. Emerging evidence on violence prevention has suggested some promising avenues for primary prevention that address common risk factors for both perpetration of IPV and male interpersonal violence. Strategies such as early identification and effective treatment of emotional disorders, alcohol abuse prevention and treatment, complex community-based interventions to change gender social norms and social marketing campaigns designed to modify social and cultural norms that support violence may work to prevent simultaneously male-on-male aggression and IPV. Future evaluations of these prevention strategies should simultaneously assess the impact of interventions on IPV and male interpersonal aggression.

Gender-based violence and socioeconomic inequalities: does living in more deprived neighbourhoods increase women's risk of intimate partner violence?

PubMed

Kiss, Ligia; Schraiber, Lilia Blima; Heise, Lori; Zimmerman, Cathy; Gouveia, Nelson; Watts, Charlotte

2012-04-01

This study investigates the influence of neighbourhood socioeconomic conditions on women's likelihood of experiencing intimate partner violence (IPV) in Sao Paulo, Brazil. Data from 940 women who were interviewed as part of the WHO multi-country study on women's health and domestic violence against women, and census data for Sao Paulo City, were analyzed using multilevel regression techniques. A neighbourhood socioeconomic-level scale was created, and proxies for the socioeconomic positions of the couple were included. Other individual level variables included factors related to partner's behaviour and women's experiences and attitudes. Women's risk of IPV did not vary across neighbourhoods in Sao Paulo nor was it influenced by her individual socioeconomic characteristics. However, women in the middle range of the socioeconomic scale were significantly more likely to report having experienced violence by a partner. Partner behaviours such as excessive alcohol use, controlling behaviour and multiple sexual partnerships were important predictors of IPV. A women's likelihood of IPV also increased if either her mother had experienced IPV or if she used alcohol excessively. These findings suggest that although the characteristics of people living in deprived neighbourhoods may influence the probability that a woman will experience IPV, higher-order contextual dynamics do not seem to affect this risk. While poverty reduction will improve the lives of individuals in many ways, strategies to reduce IPV should prioritize shifting norms that reinforce certain negative male behaviours. Copyright © 2012 Elsevier Ltd. All rights reserved.

IAI Training in Climate and Health in the Americas

NASA Astrophysics Data System (ADS)

Aron, J. L.

2007-05-01

The Inter-American Institute for Global Change Research (IAI) has addressed training in climate and health in the Americas in two major ways. First, IAI supports students to engage in research training. A multi-country health activity funded by IAI was the collaborative research network (CRN) on Diagnostics and Prediction of Human Health Impacts in the Tropical Americas, which focused principally on the effect of El Nino/Southern Oscillation and other aspects of climate variability on mosquito-borne diseases malaria and dengue. The CRN involved students in Brazil, Mexico, Venezuela, Colombia and Jamaica. The CRN was also linked to other climate and health projects that used a similar approach. Second, IAI organizes training institutes to expand the network of global change research scientists and facilitate the transfer of global change research into practice. The IAI Training Institute on Climate and Health in the Americas was held on November 7 - 18, 2005 at the University of the West Indies in Kingston, Jamaica, engaging participants from the CRN and other programs in the Americas. The Training Institute's central objective was to help strengthen local and regional capacity to address the impacts of climate variability and climate change on human health in the populations of the Americas, particularly Latin America and the Caribbean. The Training Institute had three core components: Science; Applications; and Proposal Development for Seed Grants. Recommendations for future Training Institutes included incorporating new technologies and communicating with policy-makers to develop more proactive societal strategies to manage risks.

Housing Improvements and Malaria Risk in Sub-Saharan Africa: A Multi-Country Analysis of Survey Data

PubMed Central

Bottomley, Christian; Gibson, Harry; Kleinschmidt, Immo; Tatem, Andrew J.; Gething, Peter W.

2017-01-01

Background Improvements to housing may contribute to malaria control and elimination by reducing house entry by malaria vectors and thus exposure to biting. We tested the hypothesis that the odds of malaria infection are lower in modern, improved housing compared to traditional housing in sub-Saharan Africa (SSA). Methods and Findings We analysed 15 Demographic and Health Surveys (DHS) and 14 Malaria Indicator Surveys (MIS) conducted in 21 countries in SSA between 2008 and 2015 that measured malaria infection by microscopy or rapid diagnostic test (RDT). DHS/MIS surveys record whether houses are built with finished materials (e.g., metal) or rudimentary materials (e.g., thatch). This information was used to develop a binary housing quality variable where houses built using finished wall, roof, and floor materials were classified as “modern”, and all other houses were classified as “traditional”. Conditional logistic regression was used to determine the association between housing quality and prevalence of malaria infection in children aged 0–5 y, adjusting for age, gender, insecticide-treated net (ITN) use, indoor residual spraying, household wealth, and geographic cluster. Individual survey odds ratios (ORs) were combined to determine a summary OR using a random effects meta-analysis. Of 284,532 total children surveyed, 139,318 were tested for malaria infection using microscopy (n = 131,652) or RDT (n = 138,540). Within individual surveys, malaria prevalence measured by microscopy ranged from 0.4% (Madagascar 2011) to 45.5% (Burkina Faso 2010) among children living in modern houses and from 0.4% (The Gambia 2013) to 70.6% (Burkina Faso 2010) in traditional houses, and malaria prevalence measured by RDT ranged from 0.3% (Senegal 2013–2014) to 61.2% (Burkina Faso 2010) in modern houses and from 1.5% (The Gambia 2013) to 79.8% (Burkina Faso 2010) in traditional houses. Across all surveys, modern housing was associated with a 9% to 14% reduction in the odds of malaria infection (microscopy: adjusted OR 0.91, 95% CI 0.85–0.97, p = 0.003; RDT: adjusted OR 0.86, 95% CI 0.80–0.92, p < 0.001). This association was consistent regardless of ITN usage. As a comparison, the odds of malaria infection were 15% to 16% lower among ITN users versus non-users (microscopy: adjusted OR 0.84, 95% CI 0.79–0.90, p < 0.001; RDT: adjusted OR 0.85, 95% CI 0.80–0.90, p < 0.001). The main limitation of this study is that residual confounding by household wealth of the observed association between housing quality and malaria prevalence is possible, since the wealth index may not have fully captured differences in socioeconomic position; however, the use of multiple national surveys offers the advantage of a large sample size and the elimination of many biases typically associated with pooling observational data. Conclusions Housing quality is an important risk factor for malaria infection across the spectrum of malaria endemicity in SSA, with a strength of association between housing quality and malaria similar to that observed between ITN use and malaria. Improved housing should be considered a promising intervention for malaria control and elimination and long-term prevention of reintroduction. PMID:28222094

Sexual violence against women: the scope of the problem.

PubMed

Dartnall, Elizabeth; Jewkes, Rachel

2013-02-01

Rape and sexual violence occur in all societies, and cut across all social classes. Prevalence estimates of rape victimisation range between 6 and 59% of women having experienced sexual abuse from their husbands or boyfriends in their lifetime. Two population-based studies from South Africa have found that 28% and 37% of men, respectively, have perpetrated rape. Estimates of rape perpetration from high-income countries seem to be lower than those from low- and middle-income countries; however, current data make it impossible to confirm this. Women and girls are much more likely to be the victims and men the perpetrators and, in most instances, the perpetrator is known to the victim. Children are particularly vulnerable to sexual abuse, with girls being at greater risk, especially while at school and at home. High rates of child sexual abuse are emerging from the research, with an increasing understanding of the effect of child sexual abuse on later perpetration and victimisation, highlighting the importance of primary prevention for sexual violence to address childhood exposures to violence. Much of our knowledge about sexual violence has historically been based on research undertaken in high-income countries. This, however, is changing with the emergence of good-quality studies from other settings, particularly in Africa, alongside an increasing number of multi-country studies looking at interpersonal and sexual violence. Most countries lack population data on perpetration of sexual violence, across all categories, including children, and a major gap exists in research on sexual violence among sub-groups and populations. Much of the existing research has limitations that affect cross-study comparability, owing to differences in definitions, research tools, methods and sampling used. Improved research is essential. Research priorities for understanding the magnitude of sexual violence prevalence include assessment of the prevalence and patterns of sexual violence victimisation and perpetration in a range of settings, across a range of acts of sexual violence, in men and women, in adults and children, using methodologies based on best practice in gender-based violence research and standard measures of different forms of sexual violence; research on the social context of sexual violence perpetration and victimisation by both men and women; and methodological research to measure sexual violence for particular population sub-groups or violence types, such as child perpetrators or young child victims, or sexual harassment at work and school. Copyright © 2012 Elsevier Ltd. All rights reserved.

Validity of self-reported lunch recalls in Swedish school children aged 6–8 years

PubMed Central

2013-01-01

Background Previous studies have suggested that young children are inaccurate reporters of dietary intake. The purpose of this study was to validate a single recall of the previous day’s school lunch reported by 6–8 year old Swedish children and to assess teacher-recorded intake of the same meal in a standardized food journal. An additional research question was whether parents could report their child’s intake of the previous day’s lunch. Subjects constituted a convenience sample from the large, multi-country study Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS). Validations of both children’s recalls and teachers’ records were made by comparing results with the duplicate plate reference method. Findings Twenty-five children (12 boys/13 girls) aged 6–8 years participated in the validation study at one school in western Sweden. Children were accurate self-reporters of their dietary intake at lunch, with no significant difference between reported and weighed intake (Mean difference (SD): 7(50) kcals, p=0.49). Teachers significantly over-reported intake (Mean difference (SD): 65(79) kcals, p=0.01). For both methods, child-reported and teacher-recorded, correlations with weighed intake were strong (Pearson’s correlations r=0.92, p<0.001 and r=0.83, p<0.001 respectively). Bland-Altman plots showed strong agreement between child-reported and weighed intakes but confirmed systematic differences between teacher-records and weighed intakes. Foods were recalled by children with a food-match rate of 90%. In all cases parents themselves were unable to report on quantities consumed and only four of 25 children had parents with knowledge regarding food items consumed. Conclusions Children 6–8 years of age accurately recalled their school lunch intake for one occasion while teachers recorded with less accuracy. Our findings suggest that children as young as six years of age may be better able to report on their dietary intake than previously suggested, at least for one main meal at school. Teacher-recorded intake provides a satisfactory estimate but with greater systematic deviation from the weighed intake. Parents were not able to report on their children’s school lunches consumed on the previous day. PMID:24047239

Countdown to 2015 country case studies: systematic tools to address the "black box" of health systems and policy assessment.

PubMed

Singh, Neha S; Huicho, Luis; Afnan-Holmes, Hoviyeh; John, Theopista; Moran, Allisyn C; Colbourn, Tim; Grundy, Chris; Matthews, Zoe; Maliqi, Blerta; Mathai, Matthews; Daelmans, Bernadette; Requejo, Jennifer; Lawn, Joy E

2016-09-12

Evaluating health systems and policy (HSP) change and implementation is critical in understanding reproductive, maternal, newborn and child health (RMNCH) progress within and across countries. Whilst data for health outcomes, coverage and equity have advanced in the last decade, comparable analyses of HSP changes are lacking. We present a set of novel tools developed by Countdown to 2015 (Countdown) to systematically analyse and describe HSP change for RMNCH indicators, enabling multi-country comparisons. International experts worked with eight country teams to develop HSP tools via mixed methods. These tools assess RMNCH change over time (e.g. 1990-2015) and include: (i) Policy and Programme Timeline Tool (depicting change according to level of policy); (ii) Health Policy Tracer Indicators Dashboard (showing 11 selected RMNCH policies over time); (iii) Health Systems Tracer Indicators Dashboard (showing four selected systems indicators over time); and (iv) Programme implementation assessment. To illustrate these tools, we present results from Tanzania and Peru, two of eight Countdown case studies. The Policy and Programme Timeline tool shows that Tanzania's RMNCH environment is complex, with increased funding and programmes for child survival, particularly primary-care implementation. Maternal health was prioritised since mid-1990s, yet with variable programme implementation, mainly targeting facilities. Newborn health only received attention since 2005, yet is rapidly scaling-up interventions at facility- and community-levels. Reproductive health lost momentum, with re-investment since 2010. Contrastingly, Peru moved from standalone to integrated RMNCH programme implementation, combined with multi-sectoral, anti-poverty strategies. The HSP Tracer Indicators Dashboards show that Peru has adopted nine of 11 policy tracer indicators and Tanzania has adopted seven. Peru costed national RMNCH plans pre-2000, whereas Tanzania developed a national RMNCH plan in 2006 but only costed the reproductive health component. Both countries included all lifesaving RMNCH commodities on their essential medicines lists. Peru has twice the health worker density of Tanzania (15.4 vs. 7.1/10,000 population, respectively), although both are below the 22.8 WHO minimum threshold. These are the first HSP tools using mixed methods to systematically analyse and describe RMNCH changes within and across countries, important in informing accelerated progress for ending preventable maternal, newborn and child mortality in the post-2015 era.

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU.

PubMed

Ewald, Dominik A; Huss, Gottfried; Auras, Silke; Caceres, Juan Ruiz-Canela; Hadjipanayis, Adamos; Geraedts, Max

2018-06-01

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi-country collaborative effort. The method combined a systematic literature review and a consensus process among European paediatric experts. • The quality indicator set can facilitate quality improvement of PPC. After studying the feasibility, providers can use COSI-PPC-EU to monitor, compare and improve performance of practices, regions and countries.

Cost of dengue cases in eight countries in the Americas and Asia: a prospective study.

PubMed

Suaya, Jose A; Shepard, Donald S; Siqueira, João B; Martelli, Celina T; Lum, Lucy C S; Tan, Lian Huat; Kongsin, Sukhontha; Jiamton, Sukhum; Garrido, Fàtima; Montoya, Romeo; Armien, Blas; Huy, Rekol; Castillo, Leticia; Caram, Mariana; Sah, Binod K; Sughayyar, Rana; Tyo, Karen R; Halstead, Scott B

2009-05-01

Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

Pre-Antiretroviral Therapy Serum Selenium Concentrations Predict WHO Stages 3, 4 or Death but not Virologic Failure Post-Antiretroviral Therapy

PubMed Central

Shivakoti, Rupak; Gupte, Nikhil; Yang, Wei-Teng; Mwelase, Noluthando; Kanyama, Cecilia; Tang, Alice M.; Pillay, Sandy; Samaneka, Wadzanai; Riviere, Cynthia; Berendes, Sima; Lama, Javier R.; Cardoso, Sandra W.; Sugandhavesa, Patcharaphan; Semba, Richard D.; Christian, Parul; Campbell, Thomas B.; Gupta, Amita

2014-01-01

A case-cohort study, within a multi-country trial of antiretroviral therapy (ART) efficacy (Prospective Evaluation of Antiretrovirals in Resource Limited Settings (PEARLS)), was conducted to determine if pre-ART serum selenium deficiency is independently associated with human immunodeficiency virus (HIV) disease progression after ART initiation. Cases were HIV-1 infected adults with either clinical failure (incident World Health Organization (WHO) stage 3, 4 or death by 96 weeks) or virologic failure by 24 months. Risk factors for serum selenium deficiency (<85 μg/L) pre-ART and its association with outcomes were examined. Median serum selenium concentration was 82.04 μg/L (Interquartile range (IQR): 57.28–99.89) and serum selenium deficiency was 53%, varying widely by country from 0% to 100%. In multivariable models, risk factors for serum selenium deficiency were country, previous tuberculosis, anemia, and elevated C-reactive protein. Serum selenium deficiency was not associated with either clinical failure or virologic failure in multivariable models. However, relative to people in the third quartile (74.86–95.10 μg/L) of serum selenium, we observed increased hazards (adjusted hazards ratio (HR): 3.50; 95% confidence intervals (CI): 1.30–9.42) of clinical failure but not virologic failure for people in the highest quartile. If future studies confirm this relationship of high serum selenium with increased clinical failure, a cautious approach to selenium supplementation might be needed, especially in HIV-infected populations with sufficient or unknown levels of selenium. PMID:25401501

Rapid urban malaria appraisal (RUMA) in sub-Saharan Africa

PubMed Central

Wang, Shr-Jie; Lengeler, Christian; Smith, Thomas A; Vounatsou, Penelope; Cissé, Guéladio; Diallo, Diadie A; Akogbeto, Martin; Mtasiwa, Deo; Teklehaimanot, Awash; Tanner, Marcel

2005-01-01

Background The rapid urban malaria appraisal (RUMA) methodology aims to provide a cost-effective tool to conduct rapid assessments of the malaria situation in urban sub-Saharan Africa and to improve the understanding of urban malaria epidemiology. Methods This work was done in Yopougon municipality (Abidjan), Cotonou, Dar es Salaam and Ouagadougou. The study design consists of six components: 1) a literature review, 2) the collection of available health statistics, 3) a risk mapping, 4) school parasitaemia surveys, 5) health facility-based surveys and 6) a brief description of the health care system. These formed the basis of a multi-country evaluation of RUMA's feasibility, consistency and usefulness. Results A substantial amount of literature (including unpublished theses and statistics) was found at each site, providing a good overview of the malaria situation. School and health facility-based surveys provided an overview of local endemicity and the overall malaria burden in different city areas. This helped to identify important problems for in-depth assessment, especially the extent to which malaria is over-diagnosed in health facilities. Mapping health facilities and breeding sites allowed the visualization of the complex interplay between population characteristics, health services and malaria risk. However, the latter task was very time-consuming and required special expertise. RUMA is inexpensive, costing around 8,500–13,000 USD for a six to ten-week period. Conclusion RUMA was successfully implemented in four urban areas with different endemicity and proved to be a cost-effective first approach to study the features of urban malaria and provide an evidence basis for planning control measures. PMID:16153298

Mortality and morbidity among HIV type-1-infected patients during the first 5 years of a multicountry HIV workplace programme in Africa.

PubMed

Van der Borght, Stefaan F; Clevenbergh, Philippe; Rijckborst, Henk; Nsalou, Paul; Onyia, Ngozi; Lange, Joep M; de Wit, Tobias F Rinke; Van der Loeff, Maarten F Schim

2009-01-01

This study aimed to evaluate the effectiveness of an HIV workplace programme in sub-Saharan Africa. The international brewing company, Heineken, introduced an HIV workplace programme in its African subsidiaries in 2001. Beneficiaries from 16 sites in 5 countries were eligible. HIV type-1 (HIV-1)-infected individuals were assessed clinically and immunologically, and started highly active antiretroviral therapy (HAART) if they had AIDS or had a CD4+ T-cell count <300 cells/microl. In this cohort, study patients were followed-up for vital status, new AIDS events, CD4+ T-cell count and haemoglobin. Over the first 5 years of the programme, 431 adults were found to be HIV-1-infected. The mortality rate among those not yet taking HAART was 2.6 per 100 person-years of observation (pyo). By October 2006, 249 patients had started HAART at a median CD4+ T-cell count of 170 cells/microl; 59 (23.7%) patients were in CDC stage C. Among patients on HAART, 25 died and 7 were lost to follow-up. The mortality rate was 3.7 per 100 pyo overall, 14 per 100 pyo in the first 16 weeks and 2.5 per 100 pyo thereafter (P < 0.0001). At 4 years after start of treatment, 89% of patients were known to be alive. The CD4+ T-cell count increased by a median of 153 and 238 cells/microl after 1 and 4 years of HAART, respectively. In this HIV workplace programme in sub-Saharan Africa, long-term high survival was achieved.

Improvement of early detection of breast cancer through collaborative multi-country efforts: Medical physics component.

PubMed

Mora, Patricia; Faulkner, Keith; Mahmoud, Ahmed M; Gershan, Vesna; Kausik, Aruna; Zdesar, Urban; Brandan, María-Ester; Kurt, Serap; Davidović, Jasna; Salama, Dina H; Aribal, Erkin; Odio, Clara; Chaturvedi, Arvind K; Sabih, Zahida; Vujnović, Saša; Paez, Diana; Delis, Harry

2018-04-01

The International Atomic Energy Agency (IAEA) through a Coordinated Research Project on "Enhancing Capacity for Early Detection and Diagnosis of Breast Cancer through Imaging", brought together a group of mammography radiologists, medical physicists and radiographers; to investigate current practices and improve procedures for the early detection of breast cancer by strengthening both the clinical and medical physics components. This paper addresses the medical physics component. The countries that participated in the CRP were Bosnia and Herzegovina, Costa Rica, Egypt, India, Kenya, the Frmr. Yug. Rep. of Macedonia, Mexico, Nigeria, Pakistan, Philippines, Slovenia, Turkey, Uganda, United Kingdom and Zambia. Ten institutions participated using IAEA quality control protocols in 9 digital and 3 analogue mammography equipment. A spreadsheet for data collection was generated and distributed. Evaluation of image quality was done using TOR MAX and DMAM2 Gold phantoms. QC results for analogue equipment showed satisfactory results. QC tests performed on digital systems showed that improvements needed to be implemented, especially in thickness accuracy, signal difference to noise ratio (SDNR) values for achievable levels, uniformity and modulation transfer function (MTF). Mean glandular dose (MGD) was below international recommended levels for patient radiation protection. Evaluation of image quality by phantoms also indicated the need for improvement. Common activities facilitated improvement in mammography practice, including training of medical physicists in QC programs and infrastructure was improved and strengthened; networking among medical physicists and radiologists took place and was maintained over time. IAEA QC protocols provided a uniformed approach to QC measurements. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

A Multicountry Ecological Study of Cancer Incidence Rates in 2008 with Respect to Various Risk-Modifying Factors

PubMed Central

Grant, William B.

2013-01-01

Observational and ecological studies are generally used to determine the presence of effect of cancer risk-modifying factors. Researchers generally agree that environmental factors such as smoking, alcohol consumption, poor diet, lack of physical activity, and low serum 25-hdyroxyvitamin D levels are important cancer risk factors. This ecological study used age-adjusted incidence rates for 21 cancers for 157 countries (87 with high-quality data) in 2008 with respect to dietary supply and other factors, including per capita gross domestic product, life expectancy, lung cancer incidence rate (an index for smoking), and latitude (an index for solar ultraviolet-B doses). The factors found to correlate strongly with multiple types of cancer were lung cancer (direct correlation with 12 types of cancer), energy derived from animal products (direct correlation with 12 types of cancer, inverse with two), latitude (direct correlation with six types, inverse correlation with three), and per capita gross national product (five types). Life expectancy and sweeteners directly correlated with three cancers, animal fat with two, and alcohol with one. Consumption of animal products correlated with cancer incidence with a lag time of 15–25 years. Types of cancer which correlated strongly with animal product consumption, tended to correlate weakly with latitude; this occurred for 11 cancers for the entire set of countries. Regression results were somewhat different for the 87 high-quality country data set and the 157-country set. Single-country ecological studies have inversely correlated nearly all of these cancers with solar ultraviolet-B doses. These results can provide guidance for prevention of cancer. PMID:24379012

Functional Capacity Evaluation in Different Societal Contexts: Results of a Multicountry Study.

PubMed

Ansuategui Echeita, Jone; Bethge, Matthias; van Holland, Berry J; Gross, Douglas P; Kool, Jan; Oesch, Peter; Trippolini, Maurizio A; Chapman, Elizabeth; Cheng, Andy S K; Sellars, Robert; Spavins, Megan; Streibelt, Marco; van der Wurff, Peter; Reneman, Michiel F

2018-05-25

Purpose To examine factors associated with Functional Capacity Evaluation (FCE) results in patients with painful musculoskeletal conditions, with focus on social factors across multiple countries. Methods International cross-sectional study was performed within care as usual. Simple and multiple multilevel linear regression analyses which considered measurement's dependency within clinicians and country were conducted: FCE characteristics and biopsychosocial variables from patients and clinicians as independent variables; and FCE results (floor-to-waist lift, six-minute walk, and handgrip strength) as dependent variables. Results Data were collected for 372 patients, 54 clinicians, 18 facilities and 8 countries. Patients' height and reported pain intensity were consistently associated with every FCE result. Patients' sex, height, reported pain intensity, effort during FCE, social isolation, and disability, clinician's observed physical effort, and whether FCE test was prematurely ended were associated with lift. Patient's height, Body Mass Index, post-test heart-rate, reported pain intensity and effort during FCE, days off work, and whether FCE test was prematurely ended were associated with walk. Patient's age, sex, height, affected body area, reported pain intensity and catastrophizing, and physical work demands were associated with handgrip. Final regression models explained 38‒65% of total variance. Clinician and country random effects composed 1-39% of total residual variance in these models. Conclusion Biopsychosocial factors were associated with every FCE result across multiple countries; specifically, patients' height, reported pain intensity, clinician, and measurement country. Social factors, which had been under-researched, were consistently associated with FCE performances. Patients' FCE results should be considered from a biopsychosocial perspective, including different social contexts.

Motivation of Community Health Workers in Diagnosing, Treating, and Referring Sick Young Children in a Multicountry Study.

PubMed

Sanou, Armande K; Jegede, Ayodele S; Nsungwa-Sabiiti, Jesca; Siribié, Mohamadou; Ajayi, IkeOluwapo O; Turinde, Asaf; Oshiname, Frederick O; Sermé, Luc; Kabarungi, Vanessa; Falade, Catherine O; Kyaligonza, Josephine; Afonne, Chinenye; Balyeku, Andrew; Castellani, Joëlle; Gomes, Melba

2016-12-15

 Community health workers (CHWs) are an important element of care provision for a wide range of conditions, but their turnover rate is high. Many studies have been conducted on health workers' motivation, focusing on formal sector staff but not CHWs. Although CHWs are easy to recruit, motivating and retaining them for service delivery is difficult. This article investigates factors influencing CHW motivation and retention in health service delivery.  Quantitative and qualitative data were collected to identify the key factors favoring motivation and retention of CHWs as well as those deterring them. We interviewed 47, 25, and 134 CHWs in Burkina Faso, Nigeria, and Uganda, respectively, using a structured questionnaire. Focus group discussions (FGDs) were also conducted with CHWs, community participants, and facility health workers.  Except for Burkina Faso, most CHWs were female. Average age was between 38 and 41 years, and most came from agricultural communities. The majority (52%-80%) judged they had a high to very high level of satisfaction, but most CHWs (approximately 75%) in Burkina Faso and Uganda indicated that they would be prepared to leave the job, citing income as a major reason. Community recognition and opportunities for training and supervision were major incentives in all countries, but the volume of unremunerated work, at a time when both malaria-positive cases and farming needs were at their peak, was challenging.  Most CHWs understood the volunteer nature of their position but desired community recognition and modest financial remuneration.  ISRCTN13858170. © 2016 World Health Organization; licensee Oxford Journals.

Application of the European quality indicators for psychosocial dementia care in long-term care facilities in the Asia-Pacific region: a pilot study.

PubMed

Jeon, Yun-Hee; Chien, Wai Tong; Ha, Ju-Young; Ibrahim, Rahimah; Kirley, Belinda; Tan, Lay Ling; Thaipisuttikul, Papan; Vasse, Emmelyne; Vernooij-Dassen, Myrra; Wang, Huali; Youn, Jong-Chul; Brodaty, Henry

2017-07-17

An Asia-Pacific regional collaboration group conducted its first multi-country research project to determine whether or not European quality indicators (QIs) for psychosocial care in dementia could be implemented as a valid tool in residential aged care across seven Asia-Pacific sites (Australia, Hong Kong Special Administrative Region, Mainland China, Malaysia, Singapore, South Korea, and Thailand). Following the European QI protocol, auditing and data extraction of medical records of consenting residents with dementia were conducted by trained auditors with relevant health care backgrounds. Detailed field notes by the auditors were also obtained to describe the characteristics of the participating care facilities, as well as key issues and challenges encountered, for each of the 12 QIs. Sixteen residential care facilities in the seven Asia-Pacific sites participated in this study. Data from 275 residents' records revealed each of the 12 Qis' endorsement varied widely within and between the study sites (0%-100%). Quality of the medical records, family and cultural differences, definitions and scoring of certain indicators, and time-consuming nature of the QI administration were main concerns for implementation. Several items in the European QIs in the current format were deemed problematic when used to measure the quality of psychosocial care in the residential aged care settings in participating Asia-Pacific countries. We propose refinements of the European QIs for the Asian-Pacific context, taking into account multiple factors identified in this study. Our findings provide crucial insights for future research and implementation of psychosocial dementia care QIs in this region.

Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states.

PubMed

Martineau, Tim; McPake, Barbara; Theobald, Sally; Raven, Joanna; Ensor, Tim; Fustukian, Suzanne; Ssengooba, Freddie; Chirwa, Yotamu; Vong, Sreytouch; Wurie, Haja; Hooton, Nick; Witter, Sophie

2017-01-01

Conflict and fragility are increasing in many areas of the world. This context has been referred to as the 'new normal' and affects a billion people. Fragile and conflict-affected states have the worst health indicators and the weakest health systems. This presents a major challenge to achieving universal health coverage. The evidence base for strengthening health systems in these contexts is very weak and hampered by limited research capacity, challenges relating to insecurity and apparent low prioritisation of this area of research by funders. This article reports on findings from a multicountry consortium examining health systems rebuilding post conflict/crisis in Sierra Leone, Zimbabwe, northern Uganda and Cambodia. Across the ReBUILD consortium's interdisciplinary research programme, three cross-cutting themes have emerged through our analytic process: communities, human resources for health and institutions. Understanding the impact of conflict/crisis on the intersecting inequalities faced by households and communities is essential for developing responsive health policies. Health workers demonstrate resilience in conflict/crisis, yet need to be supported post conflict/crisis with appropriate policies related to deployment and incentives that ensure a fair balance across sectors and geographical distribution. Postconflict/crisis contexts are characterised by an influx of multiple players and efforts to support coordination and build strong responsive national and local institutions are critical. The ReBUILD evidence base is starting to fill important knowledge gaps, but further research is needed to support policy makers and practitioners to develop sustainable health systems, without which disadvantaged communities in postconflict and postcrisis contexts will be left behind in efforts to promote universal health coverage.

CREED study: Hypoglycaemia during Ramadan in individuals with Type 2 diabetes mellitus from three continents.

PubMed

Jabbar, Abdul; Hassanein, Mohamed; Beshyah, Salem A; Boye, Kristina S; Yu, Maria; Babineaux, Steven M

2017-10-01

To describe diabetes treatment and hypoglycaemia in individuals with Type 2 diabetes mellitus during Ramadan. A multi-country, retrospective, observational study with data captured before, during, and after Ramadan. We report on a cohort of people (N=3250) with Type 2 diabetes mellitus in four culturally distinct regions: Asia, North Africa, Europe, and the Middle East. During Ramadan, the proportion of participants on oral anti-diabetic medication alone ranged from 68.4% (Middle East) to 80.5% (Asia); the proportion on insulin alone ranged from 3.7% (Middle East) to 8.6% (Europe). The average number of days fasted for individuals with an American Diabetes Association (ADA) risk status of very high was 27 (Middle East), 25.7 (Asia), 25.4 (North Africa), and 21 (Europe). The incidence of hypoglycaemia according to an ADA risk status of very high was 5.6% (n=1/18, Europe), 6.1% (n=2/33, Middle East), 8.7% (n=4/46, Asia), and 38% (n=10/26, North Africa). The incidence of hypoglycaemia, during Ramadan, for the entire cohort was 16.8% with insulin treatment and 5.3% with oral anti-diabetic medication. Having an episode of hypoglycaemia before Ramadan was associated with hypoglycaemia during Ramadan (odds ratio 7.80; 95% confidence interval 5.31-11.45). Approaches to the management of Type 2 diabetes mellitus during Ramadan varied across regions. Episodes of hypoglycaemia and insulin therapy predicted risk of hypoglycaemia during Ramadan and identified individuals who required Ramadan-specific education. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

The disappearing Environmental Kuznets Curve: a study of water quality in the Lower Mekong Basin (LMB).

PubMed

Wong, Yoon Loong Andrew; Lewis, Lynne

2013-12-15

The literature is flush with articles focused on estimating the Environmental Kuznets Curve (EKC) for various pollutants and various locations. Most studies have utilized air pollution variables; far fewer have utilized water quality variables, all with mixed results. We suspect that mixed evidence of the EKC stems from model and error specification. We analyze annual data for four water quality indicators, three of them previously unstudied - total phosphorus (TOTP), dissolved oxygen (DO), ammonium (NH4) and nitrites (NO2) - from the Lower Mekong Basin region to determine whether an Environmental Kuznets Curve (EKC) is evident for a transboundary river in a developing country and whether that curve is dependent on model specification and/or pollutant. We build upon previous studies by correcting for the problems of heteroskedasticity, serial correlation and cross-sectional dependence. Unlike multi-country EKC studies, we mitigate for potential distortion from pooling data across geographically heterogeneous locations by analyzing data drawn from proximate locations within a specific international river basin in Southeast Asia. We also attempt to identify vital socioeconomic determinants of water pollution by including a broad list of explanatory variables alongside the income term. Finally, we attempt to shed light on the pollution-income relationship as it pertains to trans-boundary water pollution by examining data from an international river system. We do not find consistent evidence of an EKC for any of the 4 pollutant indicators in this study, but find the results are entirely dependent on model and error specification as well as pollutant. Copyright © 2013 Elsevier Ltd. All rights reserved.

Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review.

PubMed

Stead, Martine; Angus, Kathryn; Holme, Ingrid; Cohen, David; Tait, Gayle

2009-09-01

Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be. This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs' engagement in smoking cessation and the factors that influence their engagement. Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills. The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs' engagement in smoking cessation include GPs' own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs' engagement in smoking cessation. Strategies to improve the frequency and quality of GPs' engagement in smoking cessation need to address the multifaceted influences on GPs' practice and to reflect the widely differing contexts across Europe.

Community Mental Health Services in Latin America for People with Severe Mental Disorders

PubMed Central

Minoletti, Alberto; Galea, Sandro; Susser, Ezra

2013-01-01

Mental disorders are highly prevalent in Latin American countries and exact a serious emotional toll, yet investment in public mental health remains insufficient. Most countries of the region have developed national and local initiatives to improve delivery of mental health services over the last 22 years, following the technical leadership of the Pan American Health Organization/World Health Organization (PAHO/WHO). It is especially notable that PAHO/WHO facilitated the development of national policies and plans, as well as local programs, to deliver specialized community care for persons with severe mental disorders. Nevertheless, at present, the majority of Latin American countries maintain a model of services for severe mental disorders based primarily on psychiatric hospitals that consume most of the national mental health budget. To accelerate the pace of change, this article emphasizes the need to develop cross-country regional initiatives that promote mental health service development, focusing on severe mental disorders. As one specific example, the authors describe work with RedeAmericas, which has brought together an interdisciplinary group of international investigators to research regional approaches and train a new generation of leaders in public mental health. More generally, four regional strategies are proposed to complement the work of PAHO/ WHO in Latin America: 1) to develop multi-country studies on community services, 2) to study new strategies and interventions in countries with more advanced mental health services, 3) to strengthen advocacy groups by cross-country interchange, and 4) to develop a network of well-trained leaders to catalyze progress across the region. PMID:25339792

Motivation of Community Health Workers in Diagnosing, Treating, and Referring Sick Young Children in a Multicountry Study

PubMed Central

Sanou, Armande K.; Jegede, Ayodele S.; Nsungwa-Sabiiti, Jesca; Siribié, Mohamadou; Ajayi, IkeOluwapo O.; Turinde, Asaf; Oshiname, Frederick O.; Sermé, Luc; Kabarungi, Vanessa; Falade, Catherine O.; Kyaligonza, Josephine; Afonne, Chinenye; Balyeku, Andrew; Castellani, Joëlle; Gomes, Melba

2016-01-01

Background. Community health workers (CHWs) are an important element of care provision for a wide range of conditions, but their turnover rate is high. Many studies have been conducted on health workers’ motivation, focusing on formal sector staff but not CHWs. Although CHWs are easy to recruit, motivating and retaining them for service delivery is difficult. This article investigates factors influencing CHW motivation and retention in health service delivery. Methods. Quantitative and qualitative data were collected to identify the key factors favoring motivation and retention of CHWs as well as those deterring them. We interviewed 47, 25, and 134 CHWs in Burkina Faso, Nigeria, and Uganda, respectively, using a structured questionnaire. Focus group discussions (FGDs) were also conducted with CHWs, community participants, and facility health workers. Results. Except for Burkina Faso, most CHWs were female. Average age was between 38 and 41 years, and most came from agricultural communities. The majority (52%–80%) judged they had a high to very high level of satisfaction, but most CHWs (approximately 75%) in Burkina Faso and Uganda indicated that they would be prepared to leave the job, citing income as a major reason. Community recognition and opportunities for training and supervision were major incentives in all countries, but the volume of unremunerated work, at a time when both malaria-positive cases and farming needs were at their peak, was challenging. Conclusions. Most CHWs understood the volunteer nature of their position but desired community recognition and modest financial remuneration. Clinical Trials Registration. ISRCTN13858170. PMID:27941104

Date rape among Cypriot female college students: an explorative study.

PubMed

Kouta, Christiana; Tolma, Eleni L; Pavlou, Susana Elisa

2013-09-01

This study examined the prevalence and reporting of date rape among female college students (aged 18-24) in Cyprus and assessed the students' attitudes and awareness regarding date rape. In addition, the study examined how date rape is perceived among representatives of related private and governmental organizations in Cyprus. This is part of a larger multi-country study. This paper will focus only on the results pertaining to Cyprus. The study was coordinated by the Mediterranean Institute of Gender Studies. This study used quantitative and qualitative methods. In total, 476 female college students responded to an anonymous questionnaire, two focus group discussions were carried out, and five key-informant interviews with relevant institutional representatives were conducted. The results of the study indicated that unwanted sexual experiences and sexual violence, including date rape, do exist among young Cypriot women. Specifically, 1.3% of the research participants reported experiencing an attempted rape by their date, and 1.9 % of the study participants reported being raped on a date. Often this was caused by their boyfriend, friend or sexual partner (54.2%). The results of the qualitative study showed that young female Cypriots agreed that many women give in to psychological pressure because they feel guilty about letting the other person down or because they 'didn't satisfy him' or fear they might lose him. Despite the explorative nature of the study, it is significant as research on date rape in Cyprus is almost non-existent. The authors anticipate that the results of the study will be useful to other researchers and policy-makers involved in this area of research.

Indicators of Family Care for Development for Use in Multicountry Surveys

PubMed Central

Kariger, Patricia; Engle, Patrice; Britto, Pia M. Rebello; Sywulka, Sara M.; Menon, Purnima

2012-01-01

Indicators of family care for development are essential for ascertaining whether families are providing their children with an environment that leads to positive developmental outcomes. This project aimed to develop indicators from a set of items, measuring family care practices and resources important for caregiving, for use in epidemiologic surveys in developing countries. A mixed method (quantitative and qualitative) design was used for item selection and evaluation. Qualitative and quantitative analyses were conducted to examine the validity of candidate items in several country samples. Qualitative methods included the use of global expert panels to identify and evaluate the performance of each candidate item as well as in-country focus groups to test the content validity of the items. The quantitative methods included analyses of item-response distributions, using bivariate techniques. The selected items measured two family care practices (support for learning/stimulating environment and limit-setting techniques) and caregiving resources (adequacy of the alternate caregiver when the mother worked). Six play-activity items, indicative of support for learning/stimulating environment, were included in the core module of UNICEF's Multiple Cluster Indictor Survey 3. The other items were included in optional modules. This project provided, for the first time, a globally-relevant set of items for assessing family care practices and resources in epidemiological surveys. These items have multiple uses, including national monitoring and cross-country comparisons of the status of family care for development used globally. The obtained information will reinforce attention to efforts to improve the support for development of children. PMID:23304914

An education and motivation intervention to change clinical management of the third stage of labor - the GIRMMAHP Initiative.

PubMed

Figueras, Albert; Narváez, Edgar; Valsecia, Mabel; Vásquez, Susana; Rojas, Germán; Camilo, Angiolina; del Valle, José-María; Aguilera, Cristina

2008-12-01

Hemorrhage and hypertensive disorders are major contributors to death after delivery in developing countries. The GIRMMAHP Initiative was designed to describe the actual delivery care in five Latin American countries and to educate and motivate clinical staff at 17 hospitals with the purpose of implementing their own clinical practice guidelines to prevent postpartum hemorrhage. A multicountry education intervention was developed in four consecutive stages, using two analyses: (a) an observational study of the clinical records in eight teaching and nine nonteaching hospitals and (b) a study of the long-term changes measured 12 months after completion of an education intervention and writing a local clinical guideline. Data from 2,247 pregnant women showed that only 23.3 percent had an active management of the third stage of labor and that 22.7 percent received no prenatal care visit. These data were used to prepare local clinical practice guidelines in each participant hospital. The proportion of active management increased to 72.6 percent of deliveries at 3 months and 58.7 percent 1 year later. Use of oxytocin during the third stage of labor increased to 85.9 percent of included deliveries. The proportion of women who had postpartum hemorrhage decreased from 12.7 percent at baseline to 5 percent at 1 year after the intervention. An education intervention and discussion of actual clinical practice problems with health professionals and their involvement in drafting clinical guidelines helped improve health care quality and practitioners' adherence to these guidelines.

Enabled or Disabled: Is the Environment Right for Using Biodiversity to Improve Nutrition?

PubMed Central

Hunter, Danny; Özkan, Isa; Moura de Oliveira Beltrame, Daniela; Samarasinghe, Wellakke Lokuge Gamini; Wasike, Victor Wafula; Charrondière, U. Ruth; Borelli, Teresa; Sokolow, Jessica

2016-01-01

How can we ensure that 9 billion people will have access to a nutritious and healthy diet that is produced in a sustainable manner by 2050? Despite major advances, our global food system still fails to feed a significant part of humanity adequately. Diversifying food systems and diets to include nutrient-rich species can help reduce malnutrition, while contributing other multiple benefits including healthy ecosystems. While research continues to demonstrate the value of incorporating biodiversity into food systems and diets, perverse subsidies, and barriers often prevent this. Countries like Brazil have shown that, by strategic actions and interventions, it is indeed possible to create better contexts to mainstream biodiversity for improved nutrition into government programs and public policies. Despite some progress, there are few global and national policy mechanisms or processes that effectively join biodiversity with agriculture and nutrition efforts. This perspective paper discusses the benefits of biodiversity for nutrition and explores what an enabling environment for biodiversity to improve nutrition might look like, including examples of steps and actions from a multi-country project that other countries might replicate. Finally, we suggest what it might take to create enabling environments to mainstream biodiversity into global initiatives and national programs and policies on food and nutrition security. With demand for new thinking about how we improve agriculture for nutrition and growing international recognition of the role biodiversity, the 2030 Agenda for Sustainable Development presents an opportunity to move beyond business-as-usual to more holistic approaches to food and nutrition security. PMID:27376067

Enabled or Disabled: Is the Environment Right for Using Biodiversity to Improve Nutrition?

PubMed

Hunter, Danny; Özkan, Isa; Moura de Oliveira Beltrame, Daniela; Samarasinghe, Wellakke Lokuge Gamini; Wasike, Victor Wafula; Charrondière, U Ruth; Borelli, Teresa; Sokolow, Jessica

2016-01-01

How can we ensure that 9 billion people will have access to a nutritious and healthy diet that is produced in a sustainable manner by 2050? Despite major advances, our global food system still fails to feed a significant part of humanity adequately. Diversifying food systems and diets to include nutrient-rich species can help reduce malnutrition, while contributing other multiple benefits including healthy ecosystems. While research continues to demonstrate the value of incorporating biodiversity into food systems and diets, perverse subsidies, and barriers often prevent this. Countries like Brazil have shown that, by strategic actions and interventions, it is indeed possible to create better contexts to mainstream biodiversity for improved nutrition into government programs and public policies. Despite some progress, there are few global and national policy mechanisms or processes that effectively join biodiversity with agriculture and nutrition efforts. This perspective paper discusses the benefits of biodiversity for nutrition and explores what an enabling environment for biodiversity to improve nutrition might look like, including examples of steps and actions from a multi-country project that other countries might replicate. Finally, we suggest what it might take to create enabling environments to mainstream biodiversity into global initiatives and national programs and policies on food and nutrition security. With demand for new thinking about how we improve agriculture for nutrition and growing international recognition of the role biodiversity, the 2030 Agenda for Sustainable Development presents an opportunity to move beyond business-as-usual to more holistic approaches to food and nutrition security.

ED51: Using International Networks to Develop the Future Global Geoscience Workforce

NASA Astrophysics Data System (ADS)

Velasco, E. E.; Pangman, P.; Jacobs, R. L.

2011-12-01

Developed nations face the immediate need to replace the current wave of retiring geoscientists at the same time developing nations need to build an infrastructure to train future geoscientists. But what does a successful geoscientist look like? Recruiters seem to favor candidates from respected universities that pair applied book knowledge with excellent communication skills and the ability to take a multidisciplinary approach to challenges. Students should be global thinking, business minded, and socially aware. The Society of Exploration Geophysicists as a successful global society addresses the needs of a growing diverse membership through an international approach. Student membership has doubled over the past five years to almost 10,000. The Society is building momentum through targeted, yet diverse programs. Students are eager to participate in the unique SEG/Chevron Student Leadership Symposium, SEG/ExxonMobil Student Education Program, Challenge Bowls, Student Expositions, Honorary Lecturer presentations and related events. These are transformative educational opportunities that provide the impetus for expanded and very effective international networking and transfer of knowledge. As SEG's students build on these relationships and newly acquired leadership skills, they affect the scope and breadth of SEG Student Chapter activities. There has been a resulting increase in multi-country field camps. The Geoscientists Without Borders° humanitarian program provides cross-cultural field opportunities that demonstrate how applied geoscience can make a difference in the global society, while providing students with valuable workforce skills that employers seek. These collaborative efforts are facilitated by social media and on-line communities that cause boundaries to dissolve and time zones to become irrelevant.

Perspectives on the Impact of Varicella Immunization on Herpes Zoster. A Model-Based Evaluation from Three European Countries

PubMed Central

Poletti, Piero; Melegaro, Alessia; Ajelli, Marco; del Fava, Emanuele; Guzzetta, Giorgio; Faustini, Luca; Scalia Tomba, Giampaolo; Lopalco, Pierluigi; Rizzo, Caterina; Merler, Stefano; Manfredi, Piero

2013-01-01

The introduction of mass vaccination against Varicella-Zoster-Virus (VZV) is being delayed in many European countries because of, among other factors, the possibility of a large increase in Herpes Zoster (HZ) incidence in the first decades after the initiation of vaccination, due to the expected decline of the boosting of Cell Mediated Immunity caused by the reduced varicella circulation. A multi-country model of VZV transmission and reactivation, is used to evaluate the possible impact of varicella vaccination on HZ epidemiology in Italy, Finland and the UK. Despite the large uncertainty surrounding HZ and vaccine-related parameters, surprisingly robust medium-term predictions are provided, indicating that an increase in HZ incidence is likely to occur in countries where the incidence rate is lower in absence of immunization, possibly due to a higher force of boosting (e.g. Finland), whereas increases in HZ incidence might be minor where the force of boosting is milder (e.g. the UK). Moreover, a convergence of HZ post vaccination incidence levels in the examined countries is predicted despite different initial degrees of success of immunization policies. Unlike previous model-based evaluations, our investigation shows that after varicella immunization an increase of HZ incidence is not a certain fact, rather depends on the presence or absence of factors promoting a strong boosting intensity and which might or not be heavily affected by changes in varicella circulation due to mass immunization. These findings might explain the opposed empirical evidences observed about the increases of HZ in sites where mass varicella vaccination is ongoing. PMID:23613740

A multicountry ecological study of cancer incidence rates in 2008 with respect to various risk-modifying factors.

PubMed

Grant, William B

2013-12-27

Observational and ecological studies are generally used to determine the presence of effect of cancer risk-modifying factors. Researchers generally agree that environmental factors such as smoking, alcohol consumption, poor diet, lack of physical activity, and low serum 25-hdyroxyvitamin D levels are important cancer risk factors. This ecological study used age-adjusted incidence rates for 21 cancers for 157 countries (87 with high-quality data) in 2008 with respect to dietary supply and other factors, including per capita gross domestic product, life expectancy, lung cancer incidence rate (an index for smoking), and latitude (an index for solar ultraviolet-B doses). The factors found to correlate strongly with multiple types of cancer were lung cancer (direct correlation with 12 types of cancer), energy derived from animal products (direct correlation with 12 types of cancer, inverse with two), latitude (direct correlation with six types, inverse correlation with three), and per capita gross national product (five types). Life expectancy and sweeteners directly correlated with three cancers, animal fat with two, and alcohol with one. Consumption of animal products correlated with cancer incidence with a lag time of 15-25 years. Types of cancer which correlated strongly with animal product consumption, tended to correlate weakly with latitude; this occurred for 11 cancers for the entire set of countries. Regression results were somewhat different for the 87 high-quality country data set and the 157-country set. Single-country ecological studies have inversely correlated nearly all of these cancers with solar ultraviolet-B doses. These results can provide guidance for prevention of cancer.

Do cigarette health warning labels comply with requirements: A 14-country study.

PubMed

Cohen, Joanna E; Brown, Jennifer; Washington, Carmen; Welding, Kevin; Ferguson, Jacqueline; Smith, Katherine C

2016-12-01

The Framework Convention on Tobacco Control, a global health treaty ratified by over 175 countries, calls on countries to ensure that tobacco packages carry health warning labels (HWLs) describing the harmful effects of tobacco use. We assessed the extent of compliance with 14 countries' HWL requirements. Unique cigarette packs were purchased in 2013 using a systematic protocol in 12 distinct neighborhoods within three of the ten most populous cities in the 14 low- and middle-income countries with the greatest number (count) of smokers. HWL compliance codebooks were developed for each country based on the details of country-specific HWL requirements, with up to four common compliance indicators assessed for each country (location, size, label elements, text size). Packs (n=1859) were double coded for compliance. Compliance was examined by country and pack characteristics, including parent company and brand family. Overall, 72% of coded cigarette packs were compliant with all relevant compliance indicators, ranging from 17% in the Philippines to 94% in Mexico. Compliance was highest for location of the warning (ranging from 75%-100%) and lowest for warning size (ranging from 46%-99%). Compliance was higher for packs bought in high SES neighborhoods, and varied by parent company and brand family. This multi-country study found at least one pack in every country - and many packs in some countries - that were not compliant with key requirements for health warning labels in the country of purchase. Non-compliance may be exacerbating health disparities. Tobacco companies should be held accountable for complying with country HWL requirements. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

The United States and Canada as a coupled epidemiological system: An example from hepatitis A

PubMed Central

Amariei, Raluca; Willms, Allan R; Bauch, Chris T

2008-01-01

Background Hepatitis A (HA) is a low-incidence, non-endemic disease in Canada and the United States (US). However, a large difference in HA incidence between Canada and HA-endemic countries has made travel an important contributor to hepatitis A prevalence in Canada. There is also a (smaller) incidence differential between Canada and the US. Although the US has only moderately higher HA incidence, the volume of travel by Canadians to the US is many times higher than travel volume to endemic countries. Hence, travel to the US may constitute a source of low to moderate risk for Canadian travelers. To our knowledge, travel to the US has never been included as a potential risk factor for HA infection in Canadian epidemiologic analyses. The objective of this study was to use dynamic models to investigate the possible effects on hepatitis A incidence in Canada due to (1) implementing vaccination in the US, and (2) varying the volume of travel by Canadians to the US. Methods We developed and analyzed age-structured compartmental models for the transmission and vaccination of hepatitis A, for both Canada and the US. Models were parameterized using data on seroprevalence, case reporting, and travel patterns. The potential effect of hepatitis A prevalence in the US on hepatitis A prevalence in Canada was captured through a term representing infection of Canadians due to travel in the US. Results The model suggests that approximately 22% of HA cases in Canada in the mid 1990s may have been attributable to travel to the US. A universal vaccination programme that attained 70% coverage in young children in the US in the mid 1990s could have reduced Canadian incidence by 21% within 5 years. Conclusion Since not all necessary data were available to parameterize the model, the results should be considered exploratory. However, the analysis shows that, under plausible assumptions, the US may be more important for determining HA prevalence in Canada than is currently supposed. As international travel continues to grow, making vaccination policies ever more relevant to populations beyond a country's borders, such multi-country models will most likely come into wider use as predictive aids for policy development. PMID:18307785

Learning to Be Gendered: Gender Socialization in Early Adolescence Among Urban Poor in Delhi, India, and Shanghai, China.

PubMed

Basu, Sharmistha; Zuo, Xiayun; Lou, Chaohua; Acharya, Rajib; Lundgren, Rebecka

2017-10-01

The purpose of the study is to understand the gender socialization process in early adolescence. The study was located in two disadvantaged urban communities in Delhi, India and Shanghai, China and was part of the multicountry (15) Global Early Adolescent Study. Qualitative methodologies were used with boys and girls aged 11-13 years, including 16 group-based timeline exercises and 65 narrative interviews. In addition, 58 parents of participating adolescents were interviewed. Interviews were recorded, transcribed, translated, and uploaded into Atlas.ti for coding and thematic analysis. Boys and girls growing up in the same community were directed onto different pathways during their transition from early to late adolescence. Adolescents and parents in both sites identified mothers as the primary actor, socializing adolescents into how to dress and behave and what gender roles to play, although fathers were also mentioned as influential. Opposite-sex interactions were restricted, and violations enforced by physical violence. In Delhi, gender roles and mobility were more strictly enforced for girls than boys. Restrictions on opposite-sex interactions were rigid for both boys and girls in Delhi and Shanghai. Sanctions, including beating, for violating norms about boy-girl relationships were more punitive than those related to dress and demeanor, especially in Delhi. Education and career expectations were notably more equitable in Shanghai. Parents teach their children to adhere to inequitable gender norms in both Delhi and Shanghai. However, education and career expectations for boys and girls in the two sites differed. Although gender norms varied by site according to the particular cultural and historical context, similar patterns of gender inequity reflect the underlying patriarchal system in both settings. The tendency of parents to pass on the norms they grew up with is evident, yet these results illustrate the social construction of gender through children's interaction with the social ecology, including evolving political and economic systems. Efforts to bend gender norms toward greater equality can build on these results by empowering children and parents to reflect critically on inequitable gender norms and roles and by mobilizing economic and social support at key turning points in adolescents' lives. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Behind the silence of harmony: risk factors for physical and sexual violence among women in rural Indonesia

PubMed Central

2011-01-01

Background Indonesia has the fourth largest population in the world. Few studies have identified the risk factors of Indonesian women for domestic violence. Such research will be useful for the development of prevention programs aiming at reducing domestic violence. Our study examines associations between physical and sexual violence among rural Javanese Indonesian women and sociodemographic factors, husband's psychosocial and behavioral characteristics and attitudes toward violence and gender roles. Methods A cohort of pregnant women within the Demographic Surveillance Site (DSS) in Purworejo district, Central Java, Indonesia, was enrolled in a longitudinal study between 1996 and 1998. In the following year (1999), a cross-sectional domestic violence household survey was conducted with 765 consenting women from that cohort. Female field workers, trained using the WHO Multi-Country study instrument on domestic violence, conducted interviews. Crude and adjusted odds ratios at 95% CI were applied for analysis. Results Lifetime exposure to sexual and physical violence was 22% and 11%. Sexual violence was associated with husbands' demographic characteristics (less than 35 years and educated less than 9 years) and women's economic independence. Exposure to physical violence among a small group of women (2-6%) was strongly associated with husbands' personal characteristics; being unfaithful, using alcohol, fighting with other men and having witnessed domestic violence as a child. The attitudes and norms expressed by the women confirm that unequal gender relationships are more common among women living in the highlands and being married to poorly educated men. Slightly more than half of the women (59%) considered it justifiable to refuse coercive sex. This attitude was also more common among financially independent women (71%), who also had a higher risk of exposure to sexual violence. Conclusions Women who did not support the right of women to refuse sex were more likely to experience physical violence, while those who justified hitting for some reasons were more likely to experience sexual violence. Our study suggests that Javanese women live in a high degree of gender-based subordination within marriage relationships, maintained and reinforced through physical and sexual violence. Our findings indicate that women's risk of physical and sexual violence is related to traditional gender norms. PMID:22112243

Postnatal depression and intimate partner violence: a nationwide clinic-based cross-sectional study in Malaysia

PubMed Central

Silim, Umi Adzlin; Rosman, Azriman; Mohamed, Majdah; Chan, Ying Ying; Mohd Kasim, Noraida; Yusof, Muslimah; Abd Razak, Mohamad Aznuddin; Omar, Maisarah; Abdul Aziz, Fazly Azry; Jamaluddin, Rasidah; Ismail, Fatanah; Ibrahim, Nurashikin; Aris, Tahir

2018-01-01

Introduction An estimated 13% of women in the postnatal period suffer from postnatal depression (PND) worldwide. In addition to underprivileged women, women who are exposed to violence are at higher risk of PND. This study aimed to investigate the relationship between intimate partner violence (IPV) and PND in Malaysia. Methods This survey was conducted as a nationwide cross-sectional study using a cluster sampling design. Probable PND was assessed using a self-administered Edinburgh Postnatal Depression Scale (EPDS). Demographic profiles and IPV were assessed using a locally validated WHO Multicountry Study on Women’s Health and Life Events Questionnaire that was administered in a face-to-face interview. An EPDS total score of 12 or more and/or a positive tendency to self-harm were used to define PND. Results Out of 6669 women, 5727 respondents were successfully interviewed with a response rate of 85.9%. The prevalence of probable PND was 4.4% (95% CI 2.9 to 6.7). The overall prevalence of IPV was 4.9% (95% CI 3.8 to 6.4). Among the women in this group, 3.7% (95% CI 2.7 to 5.0), 2.6% (95% CI 1.9 to 3.5) and 1.2% (95% CI 0.9 to 1.7) experienced emotional, physical and sexual violence, respectively. Logistic regression analysis revealed that women who were exposed to IPV were at 2.3 times the risk for probable PND, with an adjusted OR (aOR) of 2.34 (95% CI 1.12 to 4.87). Other factors for PND were reported emotional violence (aOR 3.79, 95% CI 1.93 to 7.45), unplanned pregnancy (aOR 3.32, 95% CI 2.35 to 4.69), lack of family support during confinement (aOR 1.79, 95% CI 1.12 to 2.87), partner’s use of alcohol (aOR 1.59, 95% CI 1.07 to 2.35) or being from a household with a low income (aOR 2.99; 95% CI 1.63 to 5.49). Conclusions Exposure to IPV was significantly associated with probable PND. Healthcare personnel should be trained to detect and manage both problems. An appropriate referral system and support should be made available. PMID:29764882

Estimation of the impacts of different homogenization approaches on the variability of temperature series in Catalonia (North Eastern-Spain), Andorra and South Eastern - France. An experiment under the umbrella of the HOME-COST action.

NASA Astrophysics Data System (ADS)

Aguilar, E.; Prohom, M.; Mestre, O.; Esteban, P.; Kuglitsch, F. G.; Gruber, C.; Herrero, M.

2008-12-01

The almost unanimously accepted fact of climate change has brought many scientists to investigate the seasonal and interannual variability and change in instrumental climatic records. Unfortunately, these records are nearly always affected by homogeneity problems caused by changes in the station or its environment. The European Cooperation in the Field of Scientific and Technical Research (COST) is sponsoring the action COST-ES0601: Advances in homogenisation methods of climate series: an integrated approach (HOME), which aims amongst others to investigate the impacts of different homogenisation ap-proaches on the observed data series. In this work, we apply different detection/correction methods (SNHT, RhTest, Caussinus-Mestre, Vincent Interpolation Method, HOM Method) to annual, sea-sonal, monthly and daily data of a multi-country quality controlled dataset (17 stations in Catalonia (NE Spain); 3 stations in Andorra and 11 stations in SE France). The different outputs are analysed and the differences in the final se-ries studied. After this experiment, we can state that - although all the applied methods im-prove the homogeneity of the original series - the conclusions extracted from the analysis of the homogenised annual, seasonal, monthly data and extreme indices derived from daily data demonstrate important differences. As an exam-ple, some methods (SNHT) tend to detect fewer breakpoints than others (Caussinus-Mestre). Even if metadata or a pre-identified list of breakpoints is available, the correction factors calculated by the different approaches differ both in annual, seasonal, monthly and daily scales. In the latter case, some methods like HOM - based on the modelling of a candidate series against a reference series - present a richest solution than others based on the mere in-terpolation of monthly factors (Vincent Method), although the former are not al-ways applicable due to lack of good reference stations. In order to identify the best performing method (or suite of methods) COST-HOME action is conducting an intensive testing of the different homogenisation methods over simulated, surrogated and real series. At the end of the action (2011), we expect to present a significant contribution to a better evaluation of seasonal and interannual variability and change.

A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa

PubMed Central

Al-Emran, Hassan M.; Eibach, Daniel; Krumkamp, Ralf; Ali, Mohammad; Baker, Stephen; Biggs, Holly M.; Bjerregaard-Andersen, Morten; Breiman, Robert F.; Clemens, John D.; Crump, John A.; Cruz Espinoza, Ligia Maria; Deerin, Jessica; Dekker, Denise Myriam; Gassama Sow, Amy; Hertz, Julian T.; Im, Justin; Ibrango, Samuel; von Kalckreuth, Vera; Kabore, Leon Parfait; Konings, Frank; Løfberg, Sandra Valborg; Meyer, Christian G.; Mintz, Eric D.; Montgomery, Joel M.; Olack, Beatrice; Pak, Gi Deok; Panzner, Ursula; Park, Se Eun; Razafindrabe, Jean Luco Tsiriniaina; Rabezanahary, Henintsoa; Rakotondrainiarivelo, Jean Philibert; Rakotozandrindrainy, Raphaël; Raminosoa, Tiana Mirana; Schütt-Gerowitt, Heidi; Sampo, Emmanuel; Soura, Abdramane Bassiahi; Tall, Adama; Warren, Michelle; Wierzba, Thomas F.; May, Jürgen; Marks, Florian

2016-01-01

Background. Salmonella enterica serovar Typhi is a predominant cause of bloodstream infections in sub-Saharan Africa (SSA). Increasing numbers of S. Typhi with resistance to ciprofloxacin have been reported from different parts of the world. However, data from SSA are limited. In this study, we aimed to measure the ciprofloxacin susceptibility of S. Typhi isolated from patients with febrile illness in SSA. Methods. Febrile patients from 9 sites within 6 countries in SSA with a body temperature of ≥38.0°C were enrolled in this study. Blood samples were obtained for bacterial culture, and Salmonella isolates were identified biochemically and confirmed by multiplex polymerase chain reaction (PCR). Antimicrobial susceptibility of all Salmonella isolates was performed by disk diffusion test, and minimum inhibitory concentrations (MICs) against ciprofloxacin were measured by Etest. All Salmonella isolates with reduced susceptibility to ciprofloxacin (MIC > 0.06 µg/mL) were screened for mutations in quinolone resistance-determining regions in target genes, and the presence of plasmid-mediated quinolone resistance (PMQR) genes was assessed by PCR. Results. A total of 8161 blood cultures were performed, and 100 (1.2%) S. Typhi, 2 (<0.1%) Salmonella enterica serovar Paratyphi A, and 27 (0.3%) nontyphoid Salmonella (NTS) were isolated. Multidrug-resistant S. Typhi were isolated in Kenya (79% [n = 38]) and Tanzania (89% [n = 8]) only. Reduced ciprofloxacin-susceptible (22% [n = 11]) S. Typhi were isolated only in Kenya. Among those 11 isolates, all had a Glu133Gly mutation in the gyrA gene combined with either a gyrA (Ser83Phe) or gyrB mutation (Ser464Phe). One Salmonella Paratyphi A isolate with reduced susceptibility to ciprofloxacin was found in Senegal, with 1 mutation in gyrA (Ser83Phe) and a second mutation in parC (Ser57Phe). Mutations in the parE gene and PMQR genes were not detected in any isolate. Conclusions. Salmonella Typhi with reduced susceptibility to ciprofloxacin was not distributed homogenously throughout SSA. Its prevalence was very high in Kenya, and was not observed in other study countries. Continuous monitoring of antimicrobial susceptibility is required to follow the potential spread of antimicrobial-resistant isolates throughout SSA. PMID:26933020

A multi-country perspective on nurses' tasks below their skill level: reports from domestically trained nurses and foreign trained nurses from developing countries.

PubMed

Bruyneel, Luk; Li, Baoyue; Aiken, Linda; Lesaffre, Emmanuel; Van den Heede, Koen; Sermeus, Walter

2013-02-01

Several studies have concluded that the use of nurses' time and energy is often not optimized. Given widespread migration of nurses from developing to developed countries, it is important for human resource planning to know whether nursing education in developing countries is associated with more exaggerated patterns of inefficiency. First, to describe nurses' reports on tasks below their skill level. Second, to examine the association between nurses' migratory status (domestically trained nurse or foreign trained nurse from a developing country) and reports on these tasks. The Registered Nurse Forecasting Study used a cross-sectional quantitative research design to gather data from 33,731 nurses (62% response rate) in 486 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden and Switzerland. For this analysis, nurse-reported information on migratory status and tasks below their skill level performed during their last shift was used. Random effects models estimated the effect of nurses' migratory status on reports of these tasks. 832 nurses were trained in a developing country (2.5% of total sample). Across countries, a high proportion of both domestically trained and foreign trained nurses from developing countries reported having performed tasks below their skill level during their last shift. After adjusting for nurses' type of last shift worked, years of experience, and level of education, there remained a pronounced overall effect of being a foreign trained nurse from a developing country and an increase in reports of tasks below skill level performed during the last shift. The findings suggest that there remains much room for improvement to optimize the use of nurses' time and energy. Special attention should be given to raising the professional level of practice of foreign trained nurses from developing countries. Further research is needed to understand the influence of professional practice standards, skill levels of foreign trained nurses from developing countries and values attached to these tasks resulting from previous work experiences in their home countries. This will allow us to better understand the conditions under which foreign trained nurses from developing countries can optimally contribute to professional nursing practice in developed country contexts. Copyright © 2012 Elsevier Ltd. All rights reserved.

Characterizing the burden of premature ejaculation from a patient and partner perspective: a multi-country qualitative analysis

PubMed Central

Revicki, Dennis; Howard, Kellee; Hanlon, Jennifer; Mannix, Sally; Greene, Alison; Rothman, Margaret

2008-01-01

Background Premature ejaculation (PE) is a common sexual dysfunction among men which affects men and their partners. Little qualitative data are available to characterize the impact of PE on men and their partners about ejaculatory control, sexual satisfaction, emotional distress and relationships. The objective of this study was to assess the impact of PE from the perspective of men with PE and the female partners of men with PE on their sexual experience, distress and relationships. Methods Qualitative data were collected through 14 focus groups in the US and through one-on-one interviews in the US, UK, Italy, France, Germany, and Poland. Study participants included heterosexual men with PE and female partners of males with PE. All participants were asked about how PE affects their daily life, including emotional impacts. One-on-one interviews also included obtaining feedback on the male and female versions of 4-single item measures of PE focusing on ejaculatory control, satisfaction with intercourse, interpersonal distress, and relationship difficulty. Results Participants included 172 males with PE and 67 female partners of men with PE. Lack of control over ejaculation and dissatisfaction with intercourse emerged as central themes of PE. Lack of ejaculatory control resulted in greater dissatisfaction and greater emotional distress, including feelings of inadequacy, disappointment, and anxiety. Continued PE ultimately leads to greater problems with partners and often disrupts partner relationships. Participants indicated that PE was keeping them from attaining complete intimacy in their relationships even when their partners were generally satisfied with sexual intercourse. Impacts of PE on sexual satisfaction, emotional distress and partner relationships were consistent across countries. Feedback on the single-item PE measures confirmed relevance of the item content and further confirmed major themes identified from the qualitative data. Conclusion This qualitative study provides valuable insights on the substantial psychosocial burden of PE in the US and the Europe. Lack of control over ejaculation resulted in dissatisfaction with intercourse and increased emotional distress, and wide-ranging impact for both men with PE and their partners of men with PE. Data collected in this study may help inform the content of new patient reported measures for use in PE research. PMID:18474090

The neighbourhood physical environment and active travel in older adults: a systematic review and meta-analysis.

PubMed

Cerin, Ester; Nathan, Andrea; van Cauwenberg, Jelle; Barnett, David W; Barnett, Anthony

2017-02-06

Perceived and objectively-assessed aspects of the neighbourhood physical environment have been postulated to be key contributors to regular engagement in active travel (AT) in older adults. We systematically reviewed the literature on neighbourhood physical environmental correlates of AT in older adults and applied a novel meta-analytic approach to statistically quantify the strength of evidence for environment-AT associations. Forty two quantitative studies that estimated associations of aspects of the neighbourhood built environment with AT in older adults (aged ≥ 65 years) and met selection criteria were reviewed and meta-analysed. Findings were analysed according to five AT outcomes (total walking for transport, within-neighbourhood walking for transport, combined walking and cycling for transport, cycling for transport, and all AT outcomes combined) and seven categories of the neighbourhood physical environment (residential density/urbanisation, walkability, street connectivity, access to/availability of services/destinations, pedestrian and cycling infrastructure, aesthetics and cleanliness/order, and safety and traffic). Most studies examined correlates of total walking for transport. A sufficient amount of evidence of positive associations with total walking for transport was found for residential density/urbanisation, walkability, street connectivity, overall access to destinations/services, land use mix, pedestrian-friendly features and access to several types of destinations. Littering/vandalism/decay was negatively related to total walking for transport. Limited evidence was available on correlates of cycling and combined walking and cycling for transport, while sufficient evidence emerged for a positive association of within-neighbourhood walking with pedestrian-friendly features and availability of benches/sitting facilities. Correlates of all AT combined mirrored those of walking for transport. Positive associations were also observed with food outlets, business/institutional/industrial destinations, availability of street lights, easy access to building entrance and human and motorised traffic volume. Several but inconsistent individual- and environmental-level moderators of associations were identified. Results support strong links between the neighbourhood physical environment and older adults' AT. Future research should focus on the identification of types and mixes of destinations that support AT in older adults and how these interact with individual characteristics and other environmental factors. Future research should also aim to clarify dose-response relationships through multi-country investigations and data-pooling from diverse geographical regions.

Social epidemiology of excess weight and central adiposity in older Indians: analysis of Study on global AGEing and adult health (SAGE).

PubMed

Samal, Sudipta; Panigrahi, Pinaki; Dutta, Ambarish

2015-11-26

We aimed to estimate the prevalence of overweight and obesity, represented by extra body weight and abdominal circumference, among older Indians; and to characterise the social pattern of obesity and measure the magnitude of hypertension attributable to it. A nationally representative sample of older Indians was selected from 6 Indian states, including Rajasthan, Uttar Pradesh, West Bengal, Assam, Maharashtra and Karnataka, as a part of the multicountry Study on global AGEing and adult health (SAGE). Indians aged 50 years or more (n=7273) were included in the first wave of the SAGE (2010), which we used in our study. The primary outcome measures included excess weight (EW), defined by body mass index (BMI) >25 kg/m(2), and central adiposity (CA), defined by waist circumference >90 cm for men and >80 cm for women. The secondary outcome included hypertension, defined by systolic blood pressure >139 or diastolic blood pressure >79 mm Hg, or by those receiving antihypertensive medications. 14% of older Indians possessed EW, whereas 35% possessed CA; 50.9% of the wealthier third and 27.7% of the poorer two-thirds have CA; the proportions being 69.1% and 46.2%, respectively, in older women. Mostly wealth (adjusted OR for CA: 4.36 (3.23 to 5.95) and EW: 4.39 (3.49 to 5.53)), but also urban residence, privileged caste, higher education, white-collared occupation and female gender, were important determinants. One of 17 older Indians overall and 1 of 18 in the poorer 70% suffered from CA-driven hypertension, independent of BMI. The problem of CA and its allied diseases is already substantial and expected to rise across all socioeconomic strata of older Indians, though currently, CA affects the privileged more than the underprivileged, in later life. Population-based promotion of appropriate lifestyles, with special emphasis on women, is required to counteract prosperity-driven obesity before it becomes too entrenched and expensive to uproot. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Using theories of practice to understand HIV-positive persons varied engagement with HIV services: a qualitative study in six Sub-Saharan African countries

PubMed Central

Wringe, Alison; Seeley, Janet; Renju, Jenny; Paparini, Sara; Wamoyi, Joyce; Moshabela, Mosa; Ddaaki, William; Nyamukapa, Constance; Ondenge, Kenneth; Bernays, Sarah; Bonnington, Oliver

2017-01-01

Objectives This article considers the potential of ‘theories of practice’ for studying and understanding varied (dis)engagement with HIV care and treatment services and begins to unpack the assemblage of elements and practices that shape the nature and duration of individuals’ interactions with HIV services. Methods We obtained data from a multicountry qualitative study that explores the use of HIV care and treatment services, with a focus on examining the social organisation of engagement with care as a practice and as manifested in the lives of people living with HIV in sub-Saharan Africa. The dataset comprised of 356 interviews with participants from six countries. Results We noted fluctuating interactions with HIV services in all countries. In line with theories of practice, we found that such varied engagement can be explained by (1) the availability, absence and connections between requisite ‘materialities’ (eg, health infrastructure, medicines), ‘competencies’ (eg, knowing how to live with HIV) and ‘meanings’ (eg, trust in HIV services, stigma, normalisation of HIV) and (2) a host of other life practices, such as working or parenting. These dynamics either facilitated or inhibited engagement with HIV services and were intrinsically linked to the discursive, cultural, political and economic fabric of the participating countries. Conclusion Practice theory provides HIV researchers and practitioners with a useful vocabulary and analytical tools to understand and steer people’s differentiated HIV service (dis)engagement. Our application of practice theory to engagement in HIV care, as experienced by HIV service users and providers in six sub-Saharan African countries, highlights the need for a practice-based approach in the delivery of differentiated and patient-centred HIV services. PMID:28736396

Communicating the AMFm message: exploring the effect of communication and training interventions on private for-profit provider awareness and knowledge related to a multi-country anti-malarial subsidy intervention

PubMed Central

2014-01-01

Background The Affordable Medicines Facility - malaria (AMFm), implemented at national scale in eight African countries or territories, subsidized quality-assured artemisinin combination therapy (ACT) and included communication campaigns to support implementation and promote appropriate anti-malarial use. This paper reports private for-profit provider awareness of key features of the AMFm programme, and changes in provider knowledge of appropriate malaria treatment. Methods This study had a non-experimental design based on nationally representative surveys of outlets stocking anti-malarials before (2009/10) and after (2011) the AMFm roll-out. Results Based on data from over 19,500 outlets, results show that in four of eight settings, where communication campaigns were implemented for 5–9 months, 76%-94% awareness of the AMFm ‘green leaf’ logo, 57%-74% awareness of the ACT subsidy programme, and 52%-80% awareness of the correct recommended retail price (RRP) of subsidized ACT were recorded. However, in the remaining four settings where communication campaigns were implemented for three months or less, levels were substantially lower. In six of eight settings, increases of at least 10 percentage points in private for-profit providers’ knowledge of the correct first-line treatment for uncomplicated malaria were seen; and in three of these the levels of knowledge achieved at endline were over 80%. Conclusions The results support the interpretation that, in addition to the availability of subsidized ACT, the intensity of communication campaigns may have contributed to the reported levels of AMFm-related awareness and knowledge among private for-profit providers. Future subsidy programmes for anti-malarials or other treatments should similarly include communication activities. PMID:24495691

Undergraduate medical education in the Gulf Cooperation Council: a multi-countries study (Part 1).

PubMed

Hamdy, H; Telmesani, A W; Al Wardy, N; Abdel-Khalek, N; Carruthers, G; Hassan, F; Kassab, S; Abu-Hijleh, M; Al-Roomi, K; O'malley, K; El Din Ahmed, M G; Raj, G A; Rao, G M; Sheikh, K

2010-01-01

The Gulf Cooperation Council (GCC) countries have witnessed over the last 40 years a rapid and major social, cultural, and economic transformation. The development of medical education in the region is relatively new, dating from the late 1960s. An important goal among the medical colleges in the region is to graduate national physicians who can populate the healthcare service of each country. The aim of this study is to provide understanding of undergraduate medical education in each of the six GCC countries and the challenges that each face. This is a descriptive cross-sectional study. Fourteen senior medical faculty were requested to submit information about undergraduate medical education in their own countries, focusing on its historical background, student selection, curriculum, faculty, and challenges. The information provided was about 27 medical colleges: 16 from the Kingdom of Saudi Arabia (KSA), five from the United Arab Emirates (UAE), two from the Kingdom of Bahrain, two from Sultanate of Oman, one from Kuwait, and one from the State of Qatar. It was found that older colleges are reviewing their curriculum while new colleges are developing their programs following current trends in medical education, particularly problem-based learning and integrated curricula. The programs as described 'on paper' look good but what needs to be evaluated is the curriculum 'in action'. Faculty development in medical education is taking place in most of the region's medical colleges. The challenges reported were mainly related to shortages of faculty, availability of clinical training facilities and the need to more integration with the National Health Care services. Attention to quality, standards, and accreditation is considered essential by all colleges.

Undergraduate medical education in the Gulf Cooperation Council: a multi-countries study (Part 2).

PubMed

Hamdy, H; Telmesani, A W; Wardy, N Al; Abdel-Khalek, N; Carruthers, G; Hassan, F; Kassab, S; Abu-Hijleh, M; Al-Roomi, K; O'Malley, K; El Din Ahmed, M G; Raj, G A; Rao, G M; Sheikh, J

2010-01-01

The Gulf Cooperation Council (GCC) countries have witnessed over the last 40 years a rapid and major social, cultural, and economic transformation. The development of medical education in the region is relatively new, dating from the late 1960s. An important goal among the medical colleges in the region is to graduate national physicians who can populate the healthcare service of each country. The aim of this study is to provide understanding of undergraduate medical education in each of the six GCC countries and the challenges that each face. This is a descriptive cross-sectional study. Fourteen senior medical faculty were requested to submit information about undergraduate medical education in their own countries, focusing on its historical background, student selection, curriculum, faculty, and challenges. The information provided was about 27 medical colleges: 16 from the Kingdom of Saudi Arabia (KSA), five from the United Arab Emirates, two from the Kingdom of Bahrain, two from Sultanate of Oman, one from Kuwait and one from the State of Qatar. It was found that older colleges are reviewing their curriculum while new colleges are developing their programs following current trends in medical education particularly problem-based learning and integrated curricula. The programs as described 'on paper' look good but what needs to be evaluated is the curriculum 'in action'. Faculty development in medical education is taking place in most of the region's medical colleges. The challenges reported were mainly related to shortages of faculty, availability of clinical training facilities, and the need to more integration with the National Health Care services. Attention to quality, standards, and accreditation is considered essential by all colleges.

Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review

PubMed Central

Stead, Martine; Angus, Kathryn; Holme, Ingrid; Cohen, David; Tait, Gayle

2009-01-01

Background Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be. Aim This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs' engagement in smoking cessation and the factors that influence their engagement. Method Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills. Results The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs' engagement in smoking cessation include GPs' own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs' engagement in smoking cessation. Conclusion Strategies to improve the frequency and quality of GPs' engagement in smoking cessation need to address the multifaceted influences on GPs' practice and to reflect the widely differing contexts across Europe. PMID:19674514

HIV Disclosure and Sexual Transmission Behaviors among an Internet Sample of HIV-positive Men Who Have Sex with Men in Asia: Implications for Prevention with Positives

PubMed Central

Wei, Chongyi; Lim, Sin How; Guadamuz, Thomas E.; Koe, Stuart

2012-01-01

The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR = 37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR = 1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1–5 years ago (AOR = 2.23, 95% CI: 1.05, 4.74), and not knowing one’s viral load (AOR = 2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men. PMID:22198313

Community-directed interventions for priority health problems in Africa: results of a multicountry study.

PubMed

2010-07-01

To determine the extent to which the community-directed approach used in onchocerciasis control in Africa could effectively and efficiently provide integrated delivery of other health interventions. A three-year experimental study was undertaken in 35 health districts from 2005 to 2007 in seven research sites in Cameroon, Nigeria and Uganda. Four trial districts and one comparison district were randomly selected in each site. All districts had established ivermectin treatment programmes, and in the trial districts four other established interventions - vitamin A supplementation, use of insecticide-treated nets, home management of malaria and short-course, directly-observed treatment for tuberculosis patients - were progressively incorporated into a community-directed intervention (CDI) process. At the end of each of the three study years, we performed quantitative evaluations of intervention coverage and provider costs, as well as qualitative assessments of the CDI process. With the CDI strategy, significantly higher coverage was achieved than with other delivery approaches for all interventions except for short-course, directly-observed treatment. The coverage of malaria interventions more than doubled. The district-level costs of delivering all five interventions were lower in the CDI districts, but no cost difference was found at the first-line health facility level. Process evaluation showed that: (i) participatory processes were important; (ii) recurrent problems with the supply of intervention materials were a major constraint to implementation; (iii) the communities and community implementers were deeply committed to the CDI process; (iv) community implementers were more motivated by intangible incentives than by external financial incentives. The CDI strategy, which builds upon the core principles of primary health care, is an effective and efficient model for integrated delivery of appropriate health interventions at the community level in Africa.

Regional Contingencies in the Relationship between Aboveground Biomass and Litter in the World’s Grasslands

PubMed Central

O’Halloran, Lydia R.; Borer, Elizabeth T.; Seabloom, Eric W.; MacDougall, Andrew S.; Cleland, Elsa E.; McCulley, Rebecca L.; Hobbie, Sarah; Harpole, W. Stan; DeCrappeo, Nicole M.; Chu, Chengjin; Bakker, Jonathan D.; Davies, Kendi F.; Du, Guozhen; Firn, Jennifer; Hagenah, Nicole; Hofmockel, Kirsten S.; Knops, Johannes M. H.; Li, Wei; Melbourne, Brett A.; Morgan, John W.; Orrock, John L.; Prober, Suzanne M.; Stevens, Carly J.

2013-01-01

Based on regional-scale studies, aboveground production and litter decomposition are thought to positively covary, because they are driven by shared biotic and climatic factors. Until now we have been unable to test whether production and decomposition are generally coupled across climatically dissimilar regions, because we lacked replicated data collected within a single vegetation type across multiple regions, obfuscating the drivers and generality of the association between production and decomposition. Furthermore, our understanding of the relationships between production and decomposition rests heavily on separate meta-analyses of each response, because no studies have simultaneously measured production and the accumulation or decomposition of litter using consistent methods at globally relevant scales. Here, we use a multi-country grassland dataset collected using a standardized protocol to show that live plant biomass (an estimate of aboveground net primary production) and litter disappearance (represented by mass loss of aboveground litter) do not strongly covary. Live biomass and litter disappearance varied at different spatial scales. There was substantial variation in live biomass among continents, sites and plots whereas among continent differences accounted for most of the variation in litter disappearance rates. Although there were strong associations among aboveground biomass, litter disappearance and climatic factors in some regions (e.g. U.S. Great Plains), these relationships were inconsistent within and among the regions represented by this study. These results highlight the importance of replication among regions and continents when characterizing the correlations between ecosystem processes and interpreting their global-scale implications for carbon flux. We must exercise caution in parameterizing litter decomposition and aboveground production in future regional and global carbon models as their relationship is complex. PMID:23405103

Is aircraft noise exposure associated with cardiovascular disease and hypertension? Results from a cohort study in Athens, Greece.

PubMed

Dimakopoulou, Konstantina; Koutentakis, Konstantinos; Papageorgiou, Ifigeneia; Kasdagli, Maria-Iosifina; Haralabidis, Alexandros S; Sourtzi, Panayota; Samoli, Evangelia; Houthuijs, Danny; Swart, Wim; Hansell, Anna L; Katsouyanni, Klea

2017-11-01

We followed up, in 2013, the subjects who lived near the Athens International Airport and had participated in the cross-sectional multicountry HYENA study in 2004-2006. To evaluate the association of exposure to aircraft and road traffic noise with the incidence of hypertension and other cardiovascular outcomes. From the 780 individuals who participated in the cross-sectional study, 537 were still living in the same area and 420 accepted to participate in the follow-up. Aircraft and road traffic noise exposure was based on the estimations conducted in 2004-2006, linking geocoded residential addresses of the participants to noise levels. We applied multiple logistic regression and Cox proportional hazards models, adjusting for potential confounders. The incidence of hypertension was significantly associated with higher aircraft noise exposure during the night. Specifically, the OR for hypertension per 10 dB increase in Lnight aircraft noise exposure was 2.63 (95% CI 1.21 to 5.71). Doctor-diagnosed cardiac arrhythmia was significantly associated with Lnight aircraft noise exposure, when prevalent and incident cases were considered with an OR of 2.09 (95% CI 1.07 to 4.08). Stroke risk was also increased with increasing noise exposure but the association was not significant. Twenty-four-hour road traffic noise associations with the outcomes considered were weaker and less consistent. In conclusion, our cohort study suggests that long-term exposure to aircraft noise, particularly during the night, is associated with incident hypertension and possibly, also, cardiovascular effects. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Community-directed interventions for priority health problems in Africa: results of a multicountry study

PubMed Central

2010-01-01

Abstract Objective To determine the extent to which the community-directed approach used in onchocerciasis control in Africa could effectively and efficiently provide integrated delivery of other health interventions. Methods A three-year experimental study was undertaken in 35 health districts from 2005 to 2007 in seven research sites in Cameroon, Nigeria and Uganda. Four trial districts and one comparison district were randomly selected in each site. All districts had established ivermectin treatment programmes, and in the trial districts four other established interventions – vitamin A supplementation, use of insecticide-treated nets, home management of malaria and short-course, directly-observed treatment for tuberculosis patients – were progressively incorporated into a community-directed intervention (CDI) process. At the end of each of the three study years, we performed quantitative evaluations of intervention coverage and provider costs, as well as qualitative assessments of the CDI process. Findings With the CDI strategy, significantly higher coverage was achieved than with other delivery approaches for all interventions except for short-course, directly-observed treatment. The coverage of malaria interventions more than doubled. The district-level costs of delivering all five interventions were lower in the CDI districts, but no cost difference was found at the first-line health facility level. Process evaluation showed that: (i) participatory processes were important; (ii) recurrent problems with the supply of intervention materials were a major constraint to implementation; (iii) the communities and community implementers were deeply committed to the CDI process; (iv) community implementers were more motivated by intangible incentives than by external financial incentives. Conclusion The CDI strategy, which builds upon the core principles of primary health care, is an effective and efficient model for integrated delivery of appropriate health interventions at the community level in Africa. PMID:20616970

International study of perceived neighbourhood environmental attributes and Body Mass Index: IPEN Adult study in 12 countries.

PubMed

De Bourdeaudhuij, Ilse; Van Dyck, Delfien; Salvo, Deborah; Davey, Rachel; Reis, Rodrigo S; Schofield, Grant; Sarmiento, Olga L; Mitas, Josef; Christiansen, Lars Breum; MacFarlane, Duncan; Sugiyama, Takemi; Aguinaga-Ontoso, Ines; Owen, Neville; Conway, Terry L; Sallis, James F; Cerin, Ester

2015-05-16

Ecological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries. A multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n = 14222, 18-66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries. Three environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI. Environmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity.

Magnetic Resonance Biomarkers in Neonatal Encephalopathy (MARBLE): a prospective multicountry study.

PubMed

Lally, Peter J; Pauliah, Shreela; Montaldo, Paolo; Chaban, Badr; Oliveira, Vania; Bainbridge, Alan; Soe, Aung; Pattnayak, Santosh; Clarke, Paul; Satodia, Prakash; Harigopal, Sundeep; Abernethy, Laurence J; Turner, Mark A; Huertas-Ceballos, Angela; Shankaran, Seetha; Thayyil, Sudhin

2015-09-30

Despite cooling, adverse outcomes are seen in up to half of the surviving infants after neonatal encephalopathy. A number of novel adjunct drug therapies with cooling have been shown to be highly neuroprotective in animal studies, and are currently awaiting clinical translation. Rigorous evaluation of these therapies in phase II trials using surrogate MR biomarkers may speed up their bench to bedside translation. A recent systematic review of single-centre studies has suggested that MR spectroscopy biomarkers offer the best promise; however, the prognostic accuracy of these biomarkers in cooled encephalopathic babies in a multicentre setting using different MR scan makers is not known. The MR scanners (3 T; Philips, Siemens, GE) in all the participating sites will be harmonised using phantom experiments and healthy adult volunteers before the start of the study. We will then recruit 180 encephalopathic infants treated with whole body cooling from the participating centres. MRI and spectroscopy will be performed within 2 weeks of birth. Neurodevelopmental outcomes will be assessed at 18-24 months of age. Agreement between MR cerebral biomarkers and neurodevelopmental outcome will be reported. The sample size is calculated using the 'rule of 10', generally used to calculate the sample size requirements for developing prognostic models. Considering 9 parameters, we require 9×10 adverse events, which suggest that a total sample size of 180 is required. Human Research Ethics Committee approvals have been received from Brent Research Ethics Committee (London), and from Imperial College London (Sponsor). We will submit the results of the study to relevant journals and offer national and international presentations. Clinical Trials.gov Number: NCT01309711. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The role of the International Classification of Functioning, Disability, and Health and quality criteria for improving assistive technology service delivery in Europe.

PubMed

Steel, Emily J; Gelderblom, Gert Jan; de Witte, Luc P

2012-02-01

People with disabilities are entitled to access assistive technology (AT) to facilitate their full and effective participation in society and may reasonably expect to be central to the decision-making processes of services that provide these technologies. European projects have improved the knowledge and resources available for AT service delivery in many countries, but the outputs are not consistently implemented or published in scientific literature. This article examines European developments in AT service delivery and the barriers to its effective provision. Specifically, it analyzes the role of the International Classification of Functioning, Disability, and Health in service delivery improvement. Published scientific papers, as well as reports from and descriptions of European projects related to AT service delivery, were reviewed. The publications were analyzed in relation to six criteria for AT service delivery described in an earlier, major European project. The findings and recommendations from the publications are synthesized in this article to identify advances and gaps in AT service delivery and to assess the current status and direction of AT service delivery improvement in Europe. Multicountry projects have brought together AT researchers from across Europe to work together and produced promising results that are contextually relevant. Access to AT information and training of practitioners has improved, and efforts are being made to facilitate user involvement. More effort should be put into integrating research and resources from European projects into practice. Use of the International Classification of Functioning, Disability, and Health model and terminology may support coordination of service delivery systems. The AT research and practice communities in Europe may be able to learn from developments in North America, while continuing to work together, sharing resources and strategies, and communicating results internationally.

Can the deployment of community health workers for the delivery of HIV services represent an effective and sustainable response to health workforce shortages? Results of a multicountry study.

PubMed

Celletti, Francesca; Wright, Anna; Palen, John; Frehywot, Seble; Markus, Anne; Greenberg, Alan; de Aguiar, Rafael Augusto Teixeira; Campos, Francisco; Buch, Eric; Samb, Badara

2010-01-01

In countries severely affected by HIV/AIDS, shortages of health workers present a major obstacle to scaling up HIV services. Adopting a task shifting approach for the deployment of community health workers (CHWs) represents one strategy for rapid expansion of the health workforce. This study aimed to evaluate the contribution of CHWs with a focus on identifying the critical elements of an enabling environment that can ensure they provide quality services in a manner that is sustainable. The method of work included a collection of primary data in five countries: Brazil, Ethiopia, Malawi, Namibia, and Uganda. The findings show that delegation of specific tasks to cadres of CHWs with limited training can increase access to HIV services, particularly in rural areas and among underserved communities, and can improve the quality of care for HIV. There is also evidence that CHWs can make a significant contribution to the delivery of a wide range of other health services. The findings also show that certain conditions must be observed if CHWs are to contribute to well-functioning and sustainable service delivery. These conditions involve adequate systems integration with significant attention to: political will and commitment; collaborative planning; definition of scope of practice; selection and educational requirements; registration, licensure and certification; recruitment and deployment; adequate and sustainable remuneration; mentoring and supervision including referral system; career path and continuous education; performance evaluation; supply of equipment and commodities. The study concludes that, where there is the necessary support, the potential contribution of CHWs can be optimized and represents a valuable addition to the urgent expansion of human resources for health, and to universal coverage of HIV services.

Human epidermal growth factor receptor 2 status of breast cancer patients in Asia: Results from a large, multicountry study.

PubMed

Pathmanathan, Nirmala; Geng, Jing-Shu; Li, Wencai; Nie, Xiu; Veloso, Januario; Hill, Julie; McCloud, Philip; Bilous, Michael

2016-12-01

Current estimates of the human epidermal growth factor receptor 2 (HER2)-positivity rate in breast cancer are largely based on studies from the United States, Europe and Australia, and might not reflect the rate among breast cancer patients in Asia. The primary aim of this study was to conduct a clinical audit of laboratories across eight countries in Asia to determine the incidence of HER2-positive breast cancer in this region. Pathology laboratories submitted data on breast cancers consecutively tested for HER2 over a two-year period. The proportion of HER2-positive, -equivocal and -negative tumors was determined for each country and overall. HER2-positivity rate by age and histological grade was also determined. HER2 results from 30 179 breast cancers were submitted by 96 laboratories. The overall HER2-positivity rate was 23.5%; the rate between countries ranged from 19.7% to 44.2%, and from 4.4% to 51.6% between laboratories. An equivocal HER2 result was recorded in 18.2% of cases. Discrepancies between laboratories suggest that testing expertise contributes to variations seen in HER2 status across laboratories, as well as the generally higher rate of HER2-positivity that was recorded. In this study, the incidence of HER2-positive breast cancer diagnosed in Asian women was higher than published studies on women from Western countries. In addition, the study found that women in Asian countries presented with breast cancer at an earlier age, with a higher histological grade. This study serves to highlight the challenges with HER2 testing and data collection in a large multicenter Asian cohort. © 2016 The Authors. Asia-Pacific Journal of Clinical Oncology Published by John Wiley & Sons Australia, Ltd.

Measuring the quality of child health care at first-level facilities.

PubMed

Gouws, Eleanor; Bryce, Jennifer; Pariyo, George; Armstrong Schellenberg, Joanna; Amaral, João; Habicht, Jean-Pierre

2005-08-01

Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.

Infection Surveillance Protocol for a Multicountry Population-based Study in South Asia to Determine the Incidence, Etiology and Risk Factors for Infections Among Young Infants of 0 to 59 Days Old.

PubMed

Islam, Mohammad Shahidul; Baqui, Abdullah H; Zaidi, Anita K; Bhutta, Zulfiqar A; Panigrahi, Pinaki; Bose, Anuradha; Soofi, Sajid B; Kazi, Abdul Momin; Mitra, Dipak K; Isaac, Rita; Nanda, Pritish; Connor, Nicholas E; Roth, Daniel E; Qazi, Shamim A; El Arifeen, Shams; Saha, Samir K

2016-05-01

Insufficient knowledge of the etiology and risk factors for community-acquired neonatal infection in low-income countries is a barrier to designing appropriate intervention strategies for these settings to reduce the burden and treatment of young infant infection. To address these gaps, we are conducting the Aetiology of Neonatal Infection in South Asia (ANISA) study among young infants in Bangladesh, India and Pakistan. The objectives of ANISA are to establish a comprehensive surveillance system for registering newborns in study catchment areas and collecting data on bacterial and viral etiology and associated risk factors for infections among young infants aged 0-59 days. We are conducting active surveillance in 1 peri-urban and 4 rural communities. During 2 years of surveillance, we expect to enroll an estimated 66,000 newborns within 7 days of their birth and to follow-up them until 59 days of age. Community health workers visit each young infant in the study area 3 times in the first week of life and once a week thereafter. During these visits, community health workers assess the newborns using a clinical algorithm and refer young infants with signs of suspected infection to health care facilities where study physicians reassess them and provide care if needed. On physician confirmation of suspected infection, blood and respiratory specimens are collected and tested to identify the etiologic agent. ANISA is one of the largest initiatives ever undertaken to understand the etiology of young infant infection in low-income countries. The data generated from this surveillance will help guide evidence-based decision making to improve health care in similar settings.

Respondent-driven sampling for an adolescent health study in vulnerable urban settings: a multi-country study.

PubMed

Decker, Michele R; Marshall, Beth Dail; Emerson, Mark; Kalamar, Amanda; Covarrubias, Laura; Astone, Nan; Wang, Ziliang; Gao, Ersheng; Mashimbye, Lawrence; Delany-Moretlwe, Sinead; Acharya, Rajib; Olumide, Adesola; Ojengbede, Oladosu; Blum, Robert W; Sonenstein, Freya L

2014-12-01

The global adolescent population is larger than ever before and is rapidly urbanizing. Global surveillance systems to monitor youth health typically use household- and school-based recruitment methods. These systems risk not reaching the most marginalized youth made vulnerable by conditions of migration, civil conflict, and other forms of individual and structural vulnerability. We describe the methodology of the Well-Being of Adolescents in Vulnerable Environments survey, which used respondent-driven sampling (RDS) to recruit male and female youth aged 15-19 years and living in economically distressed urban settings in Baltimore, MD; Johannesburg, South Africa; Ibadan, Nigeria; New Delhi, India; and Shanghai, China (migrant youth only) for a cross-sectional study. We describe a shared recruitment and survey administration protocol across the five sites, present recruitment parameters, and illustrate challenges and necessary adaptations for use of RDS with youth in disadvantaged urban settings. We describe the reach of RDS into populations of youth who may be missed by traditional household- and school-based sampling. Across all sites, an estimated 9.6% were unstably housed; among those enrolled in school, absenteeism was pervasive with 29% having missed over 6 days of school in the past month. Overall findings confirm the feasibility, efficiency, and utility of RDS in quickly reaching diverse samples of youth, including those both in and out of school and those unstably housed, and provide direction for optimizing RDS methods with this population. In our rapidly urbanizing global landscape with an unprecedented youth population, RDS may serve as a valuable tool in complementing existing household- and school-based methods for health-related surveillance that can guide policy. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Respondent-driven sampling for an adolescent health study in vulnerable urban settings: a multi-country study

PubMed Central

Decker, Michele R.; Marshall, Beth; Emerson, Mark; Kalamar, Amanda; Covarrubias, Laura; Astone, Nan; Wang, Ziliang; Gao, Ersheng; Mashimbye, Lawrence; Delany-Moretlwe, Sinead; Acharya, Rajib; Olumide, Adesola; Ojengbede, Oladosu; Blum, Robert

2015-01-01

The global adolescent population is larger than ever before and is rapidly urbanizing. Global surveillance systems to monitor youth health typically use household- and school-based recruitment methods. These systems risk not reaching the most marginalized youth made vulnerable by conditions of migration, civil conflict and other forms of individual and structural vulnerability. We describe the methodology of the Well Being of Adolescents in Vulnerable Environments (WAVE) survey, which used respondent-driven sampling (RDS) to recruit male and female youth aged 15 to 19 years and living in economically distressed urban settings in Baltimore, USA, Johannesburg, South Africa, Ibadan, Nigeria, Delhi, India and Shanghai, China (migrant youth only) for a cross-sectional study. We describe a shared recruitment and survey administration protocol across the five sites, present recruitment parameters, and illustrate challenges and necessary adaptations for use of RDS with youth in disadvantaged urban settings. We describe the reach of RDS into populations of youth who may be missed by traditional householdbased and school-based sampling. Across all sites, an estimated 9.6% were unstably housed; among those enrolled in school, absenteeism was pervasive with 29% having missed over 6 days of school in the past month. Overall findings confirm the feasibility, efficiency and utility of RDS in quickly reaching diverse samples of youth, including those both in and out of school and those unstably housed, and provide direction for optimizing RDS methods with this population. In our rapidly urbanizing global landscape with an unprecedented youth population, RDS may serve as a valuable tool in complementing existing household- and school-based methods for health-related surveillance that can guide policy. PMID:25454005