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Sharma R, Gaffey MF, Alderman H, Bassani DG, Bogard K, Darmstadt GL, Das JK, de Graft-Johnson JE, Hamadani JD, Horton S, Huicho L, Hussein J, Lye S, Pérez-Escamilla R, Proulx K, Marfo K, Mathews-Hanna V, Mclean MS, Rahman A, Silver KL, Singla DR, Webb P, Bhutta ZA. Prioritizing research for integrated implementation of early childhood development and maternal, newborn, child and adolescent health and nutrition platforms. J Glob Health 2018; 7:011002. [PMID: 28685048 PMCID: PMC5481896 DOI: 10.7189/jogh.07.011002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Existing health and nutrition services present potential platforms for scaling up delivery of early childhood development (ECD) interventions within sensitive windows across the life course, especially in the first 1000 days from conception to age 2 years. However, there is insufficient knowledge on how to optimize implementation for such strategies in an integrated manner. In light of this knowledge gap, we aimed to systematically identify a set of integrated implementation research priorities for health, nutrition and early child development within the 2015 to 2030 timeframe of the Sustainable Development Goals (SDGs). Methods We applied the Child Health and Nutrition Research Initiative method, and consulted a diverse group of global health experts to develop and score 57 research questions against five criteria: answerability, effectiveness, deliverability, impact, and effect on equity. These questions were ranked using a research priority score, and the average expert agreement score was calculated for each question. Findings The research priority scores ranged from 61.01 to 93.52, with a median of 82.87. The average expert agreement scores ranged from 0.50 to 0.90, with a median of 0.75. The top–ranked research question were: i) “How can interventions and packages to reduce neonatal mortality be expanded to include ECD and stimulation interventions?”; ii) “How does the integration of ECD and MNCAH&N interventions affect human resource requirements and capacity development in resource–poor settings?”; and iii) “How can integrated interventions be tailored to vulnerable refugee and migrant populations to protect against poor ECD and MNCAH&N outcomes?”. Most highly–ranked research priorities varied across the life course and highlighted key aspects of scaling up coverage of integrated interventions in resource–limited settings, including: workforce and capacity development, cost–effectiveness and strategies to reduce financial barriers, and quality assessment of programs. Conclusions Investing in ECD is critical to achieving several of the SDGs, including SDG 2 on ending all forms of malnutrition, SDG 3 on ensuring health and well–being for all, and SDG 4 on ensuring inclusive and equitable quality education and promotion of life–long learning opportunities for all. The generated research agenda is expected to drive action and investment on priority approaches to integrating ECD interventions within existing health and nutrition services.
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Affiliation(s)
- Renee Sharma
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Harold Alderman
- International Food Policy Research Institute, Washington, DC, USA
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kimber Bogard
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jai K Das
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Jena D Hamadani
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Luis Huicho
- Centro de Investigación para el Desarrollo Integral y Sostenible, Centro de Investigación en Salud Materna e Infantil, and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julia Hussein
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Stephen Lye
- Fraser Mustard Institute for Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Kerrie Proulx
- Fraser Mustard Institute for Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Kofi Marfo
- Aga Khan University (South-Central Asia, East Africa, UK), Nairobi, Kenya
| | | | - Mireille S Mclean
- The Sackler Institute for Nutrition Science at the New York Academy of Sciences, New York, New York, USA
| | - Atif Rahman
- Institute Of Psychology, Health And Society, University of Liverpool, Liverpool, UK
| | | | - Daisy R Singla
- Sinai Health System; Lunenfeld Tanenbaum Research Institute; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,Patan Academy of Health Sciences, Patan, Nepal
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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Rockliffe L, Chorley AJ, McBride E, Waller J, Forster AS. Assessing the acceptability of incentivising HPV vaccination consent form return as a means of increasing uptake. BMC Public Health 2018; 18:382. [PMID: 29558923 PMCID: PMC5859432 DOI: 10.1186/s12889-018-5278-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uptake of human papillomavirus (HPV) vaccination is high overall but there are disparities in uptake, particularly by ethnicity. Incentivising vaccination consent form return is a promising approach to increase vaccination uptake. As part of a randomised feasibility trial we qualitatively assessed the acceptability of increasing uptake of HPV vaccination by incentivising consent form return. METHODS In the context of a two-arm, cluster randomised feasibility trial, qualitative free-text questionnaire responses were collected from adolescent girls (n = 181) and their parents (n = 61), assessing the acceptability of an incentive intervention to increase HPV vaccination consent form return. In the incentive intervention arm, girls who returned a signed consent form (regardless of whether consent was given or refused), had a 1-in-10 chance of winning a £50 shopping voucher. Telephone interviews were also conducted with members of staff from participating schools (n = 6), assessing the acceptability of the incentive. Data were analysed thematically. RESULTS Girls and parents provided a mix of positive, negative and ambivalent responses about the use of the incentive to encourage HPV vaccination consent form return. Both girls and parents held misconceptions about the nature of the incentive, wrongly believing that the incentive was dependent on vaccination receipt rather than consent form return. School staff members also expressed a mix of opinions on the acceptability of the incentive, including perceptions of effectiveness and ethics. CONCLUSIONS The use of an incentive intervention to encourage the return of HPV vaccination consent forms was found to be moderately acceptable to those receiving and delivering the intervention, although a number of changes are required to improve this. In particular, improving communication about the nature of the incentive to reduce misconceptions is vital. These findings suggest that incentivising consent form return may be an acceptable means of improving HPV vaccination rates, should improvements be made. TRIAL REGISTRATION ISRCTN Registry; ISRCTN72136061 , 26 September 2016, retrospectively registered.
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Affiliation(s)
- Lauren Rockliffe
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
| | - Amanda J. Chorley
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
| | - Emily McBride
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
| | - Alice S. Forster
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
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53
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Relton C, Strong M, Thomas KJ, Whelan B, Walters SJ, Burrows J, Scott E, Viksveen P, Johnson M, Baston H, Fox-Rushby J, Anokye N, Umney D, Renfrew MJ. Effect of Financial Incentives on Breastfeeding: A Cluster Randomized Clinical Trial. JAMA Pediatr 2018; 172:e174523. [PMID: 29228160 PMCID: PMC5839268 DOI: 10.1001/jamapediatrics.2017.4523] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although breastfeeding has a positive effect on an infant's health and development, the prevalence is low in many communities. The effect of financial incentives to improve breastfeeding prevalence is unknown. OBJECTIVE To assess the effect of an area-level financial incentive for breastfeeding on breastfeeding prevalence at 6 to 8 weeks post partum. DESIGN, SETTING, AND PARTICIPANTS The Nourishing Start for Health (NOSH) trial, a cluster randomized trial with 6 to 8 weeks follow-up, was conducted between April 1, 2015, and March 31, 2016, in 92 electoral ward areas in England with baseline breastfeeding prevalence at 6 to 8 weeks post partum less than 40%. A total of 10 010 mother-infant dyads resident in the 92 study electoral ward areas where the infant's estimated or actual birth date fell between February 18, 2015, and February 17, 2016, were included. Areas were randomized to the incentive plus usual care (n = 46) (5398 mother-infant dyads) or to usual care alone (n = 46) (4612 mother-infant dyads). INTERVENTIONS Usual care was delivered by clinicians (mainly midwives, health visitors) in a variety of maternity, neonatal, and infant feeding services, all of which were implementing the UNICEF UK Baby Friendly Initiative standards. Shopping vouchers worth £40 (US$50) were offered to mothers 5 times based on infant age (2 days, 10 days, 6-8 weeks, 3 months, 6 months), conditional on the infant receiving any breast milk. MAIN OUTCOMES AND MEASURES The primary outcome was electoral ward area-level 6- to 8-week breastfeeding period prevalence, as assessed by clinicians at the routine 6- to 8-week postnatal check visit. Secondary outcomes were area-level period prevalence for breastfeeding initiation and for exclusive breastfeeding at 6 to 8 weeks. RESULTS In the intervention (5398 mother-infant dyads) and control (4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government area and weighting to reflect unequal cluster-level breastfeeding prevalence variances, a difference in mean 6- to 8-week breastfeeding prevalence of 5.7 percentage points (37.9% vs 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P < .001) in favor of the intervention vs usual care was observed. No significant differences were observed for the mean prevalence of breastfeeding initiation (61.9% vs 57.5%; adjusted mean difference, 2.9 percentage points; 95%, CI, -0.4 to 6.2; P = .08) or the mean prevalence of exclusive breastfeeding at 6 to 8 weeks (27.0% vs 24.1%; adjusted mean difference, 2.3 percentage points; 95% CI, -0.2 to 4.8; P = .07). CONCLUSIONS AND RELEVANCE Financial incentives may improve breastfeeding rates in areas with low baseline prevalence. Offering a financial incentive to women in areas of England with breastfeeding rates below 40% compared with usual care resulted in a modest but statistically significant increase in breastfeeding prevalence at 6 to 8 weeks. This was measured using routinely collected data. TRIAL REGISTRATION International Standard Randomized Controlled Trial Registry: ISRCTN44898617.
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Affiliation(s)
- Clare Relton
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Mark Strong
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Kate J. Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Barbara Whelan
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Stephen J. Walters
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Julia Burrows
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Elaine Scott
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Petter Viksveen
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Helen Baston
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Julia Fox-Rushby
- Faculty of Life Sciences and Medicine, Kings College London, London, England
| | - Nana Anokye
- Health Economics Research Group, Brunel University London, Uxbridge, England
| | - Darren Umney
- Department of Engineering and Innovation, Open University, Milton Keynes, England
| | - Mary J. Renfrew
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland
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54
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“It just forces hardship”: impacts of government financial penalties on non-vaccinating parents. J Public Health Policy 2018; 39:156-169. [DOI: 10.1057/s41271-017-0116-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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55
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Weaver RG, Beets MW, Brazendale K, Brusseau TA. Summer Weight Gain and Fitness Loss: Causes and Potential Solutions. Am J Lifestyle Med 2018; 13:116-128. [PMID: 30800015 DOI: 10.1177/1559827617750576] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/20/2022] Open
Abstract
Over the past 3 decades, public health professionals have worked to stem the rising childhood obesity epidemic. Despite the field's best efforts, no progress has been made in reducing child obesity. One reason for this failure may be that obesity prevention and treatment efforts have predominately been delivered during the 9-month school year. However, recent evidence suggests that the summer, not the school year, is when unhealthy changes in body composition (ie, accelerated increases in percent body fat) and fitness losses occur. This unhealthy change in body composition and fitness loss during the summer could be explained by the "Structured Days Hypothesis," which posits that children engage in a greater number of unhealthy obesogenic behaviors on unstructured days when compared with structured days. Furthermore, the summer may be contributing to a widening "health gap" between children from low-income and middle- to upper-income families. During summer, fewer opportunities exist for children from low-income households to access healthy structured programs that do not require fees for participation. Moving forward, public health professionals should prioritize efforts to mitigate unhealthy changes in body composition and fitness loss during the summer by identifying ways to provide access to structured programming during this timeframe for children from low-income households.
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Affiliation(s)
- R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (RGW, MWB, KB).,Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah (TAB)
| | - Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (RGW, MWB, KB).,Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah (TAB)
| | - Keith Brazendale
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (RGW, MWB, KB).,Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah (TAB)
| | - Timothy A Brusseau
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (RGW, MWB, KB).,Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah (TAB)
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Prudhon C, Benelli P, Maclaine A, Harrigan P, Frize J. Informing infant and young child feeding programming in humanitarian emergencies: An evidence map of reviews including low and middle income countries. MATERNAL & CHILD NUTRITION 2018; 14:e12457. [PMID: 28670790 PMCID: PMC6865874 DOI: 10.1111/mcn.12457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 01/08/2023]
Abstract
Around 200 million people were affected by conflict and natural disasters in 2015. Whereas those populations are at a particular high risk of death, optimal breastfeeding and complementary feeding practices could prevent almost 20% of deaths amongst children less than 5 years old. Yet, coverage of interventions for improving infant and young child feeding (IYCF) practices in emergencies is low, partly due to lack of evidence. Considering the paucity of data generated in emergencies to inform programming, we conducted an evidence map from reviews that included low- and middle-income countries and looked at several interventions: (a) social and behavioural change interpersonal and mass communication for promoting breastfeeding and adequate complementary feeding; (b) provision of donated complementary food; (c) home-based fortification with multiple micronutrient powder; (d) capacity building; (e) cash transfers; (f) agricultural or fresh food supply interventions; and (g) psychological support to caretakers. We looked for availability of evidence of these interventions to improve IYCF practices and nutritional status of infants and young children. We identified 1,376 records and included 28 reviews meeting the inclusion criteria. The highest number of reviews identified was for behavioural change interpersonal communication for promoting breastfeeding, whereas no review was identified for psychological support to caretakers. We conclude that any further research should focus on the mechanisms and delivery models through which effectiveness of interventions can be achieved and on the influence of contextual factors. Efforts should be renewed to generate evidence of effectiveness of IYCF interventions during humanitarian emergencies despite the challenges.
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Lassi ZS, Irfan O, Hadi R, Das JK, Bhutta ZA. PROTOCOL: Effects of interventions for infant and young child feeding (IYCF) promotion on optimal IYCF practices, nutrition, growth and health in low- and middle-income countries: a systematic review. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-26. [PMID: 37131389 PMCID: PMC8427994 DOI: 10.1002/cl2.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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58
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Raghunathan K, Chakrabarti S, Avula R, Kim SS. Can conditional cash transfers improve the uptake of nutrition interventions and household food security? Evidence from Odisha's Mamata scheme. PLoS One 2017; 12:e0188952. [PMID: 29228022 PMCID: PMC5724821 DOI: 10.1371/journal.pone.0188952] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022] Open
Abstract
There is considerable global evidence on the effectiveness of cash transfers in improving health and nutrition outcomes; however, the evidence from South Asia, particularly India, is limited. In the context of India where more than a third of children are undernourished, and where there is considerable under-utilization of health and nutrition interventions, it is opportune to investigate the impact of cash transfer programs on the use of interventions. We study one conditional cash transfer program, Mamata scheme, implemented in the state of Odisha, in India that targeted pregnant and lactating women. Using survey data on 1161 households from three districts in the state of Odisha, we examine the effect of the scheme on eight outcomes: 1) pregnancy registration; 2) receipt of antenatal services; 3) receipt of iron and folic acid (IFA) tablets; 4) exposure to counseling during pregnancy; 5) exposure to postnatal counseling; 6) exclusive breastfeeding; 7) full immunization; and 8) household food security. We conduct regression analyses and correct for endogeneity using nearest-neighbor matching and inverse-probability weighting models. We find that the receipt of payments from the Mamata scheme is associated with a 5 percentage point (pp) increase in the likelihood of receiving antenatal services, a 10 pp increase in the likelihood of receiving IFA tablets, and a decline of 0.84 on the Household Food Insecurity Access Scale. These results provide the first quantitative estimates of effects associated with the Mamata scheme, which can inform the design of government policies related to conditional cash transfers.
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Affiliation(s)
- Kalyani Raghunathan
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), New Delhi, India
- * E-mail:
| | - Suman Chakrabarti
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), New Delhi, India
| | - Rasmi Avula
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), New Delhi, India
| | - Sunny S. Kim
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington D.C., United States of America
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Sherr L, Tomlinson M, Macedo A, Skeen S, Hensels IS, Cluver LD. Can cash break the cycle of educational risks for young children in high HIV-affected communities? A cross-sectional study in South Africa and Malawi. J Glob Health 2017; 7:020409. [PMID: 29302316 PMCID: PMC5735773 DOI: 10.7189/jogh.07.020409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Household cash grants are associated with beneficial outcomes; enhanced if provided in combination with care. OBJECTIVES This study describes the impact of cash grants and parenting quality on 854 children aged 5-15 (South African and Malawi) on educational outcomes including enrolment, regular attendance, correct class for age and school progress (controlling for cognitive performance). Consecutive attenders at randomly selected Community based organisations were recruited. The effects of cash plus good parenting, HIV status and gender were examined. RESULTS Overall 73.1% received a grant - significantly less children with HIV (57.3% vs 75.6% (χ2 = 17.21, P < 0.001). Controlling for cognitive ability, grant receipt was associated with higher odds of being in the correct grade (odds ratio (OR) = 2.00; 95% confidence interval (CI) = 1.36, 2.95), higher odds of attending school regularly (OR = 3.62; 95% CI = 1.77, 7.40), and much higher odds of having missed less than a week of school recently (OR = 8.95; 95% CI = 2.27, 35.23). Grant receipt was not associated with how well children performed in school compared to their classmates or with school enrolment. Linear regression revealed that grant receipt was associated with a significant reduction in educational risk (B = -0.32, t(420) = 2.84, P = 0.005) for girls. CONCLUSION Cash plus good parenting affected some educational outcomes in a stepwise manner, but did not provide additive protection.
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Affiliation(s)
- Lorraine Sherr
- Research Department of Global Health, University College London, London, United Kingdom
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Ana Macedo
- Research Department of Global Health, University College London, London, United Kingdom
| | - Sarah Skeen
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape town, South Africa
| | - Imca Sifra Hensels
- Department of Psychology, University of Manchester, Manchester, United Kingdom
| | - Lucie Dale Cluver
- Department of Psychiatry and Mental Health, University of Cape Town, Cape town, South Africa
- Centre for Evidence–Based Intervention, Department of Social Policy & Social Intervention, University of Oxford, Oxford, United Kingdom
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Pega F, Liu SY, Walter S, Pabayo R, Saith R, Lhachimi SK. Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low- and middle-income countries. Cochrane Database Syst Rev 2017; 11:CD011135. [PMID: 29139110 PMCID: PMC6486161 DOI: 10.1002/14651858.cd011135.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Unconditional cash transfers (UCTs; provided without obligation) for reducing poverty and vulnerabilities (e.g. orphanhood, old age or HIV infection) are a type of social protection intervention that addresses a key social determinant of health (income) in low- and middle-income countries (LMICs). The relative effectiveness of UCTs compared with conditional cash transfers (CCTs; provided so long as the recipient engages in prescribed behaviours such as using a health service or attending school) is unknown. OBJECTIVES To assess the effects of UCTs for improving health services use and health outcomes in vulnerable children and adults in LMICs. Secondary objectives are to assess the effects of UCTs on social determinants of health and healthcare expenditure and to compare to effects of UCTs versus CCTs. SEARCH METHODS We searched 17 electronic academic databases, including the Cochrane Public Health Group Specialised Register, the Cochrane Database of Systematic Reviews (the Cochrane Library 2017, Issue 5), MEDLINE and Embase, in May 2017. We also searched six electronic grey literature databases and websites of key organisations, handsearched key journals and included records, and sought expert advice. SELECTION CRITERIA We included both parallel group and cluster-randomised controlled trials (RCTs), quasi-RCTs, cohort and controlled before-and-after (CBAs) studies, and interrupted time series studies of UCT interventions in children (0 to 17 years) and adults (18 years or older) in LMICs. Comparison groups received either no UCT or a smaller UCT. Our primary outcomes were any health services use or health outcome. DATA COLLECTION AND ANALYSIS Two reviewers independently screened potentially relevant records for inclusion criteria, extracted data and assessed the risk of bias. We tried to obtain missing data from study authors if feasible. For cluster-RCTs, we generally calculated risk ratios for dichotomous outcomes from crude frequency measures in approximately correct analyses. Meta-analyses applied the inverse variance or Mantel-Haenszel method with random effects. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included 21 studies (16 cluster-RCTs, 4 CBAs and 1 cohort study) involving 1,092,877 participants (36,068 children and 1,056,809 adults) and 31,865 households in Africa, the Americas and South-East Asia in our meta-analyses and narrative synthesis. The 17 types of UCTs we identified, including one basic universal income intervention, were pilot or established government programmes or research experiments. The cash value was equivalent to 1.3% to 53.9% of the annualised gross domestic product per capita. All studies compared a UCT with no UCT, and three studies also compared a UCT with a CCT. Most studies carried an overall high risk of bias (i.e. often selection and/or performance bias). Most studies were funded by national governments and/or international organisations.Throughout the review, we use the words 'probably' to indicate moderate-quality evidence, 'may/maybe' for low-quality evidence, and 'uncertain' for very low-quality evidence. UCTs may not have impacted the likelihood of having used any health service in the previous 1 to 12 months, when participants were followed up between 12 and 24 months into the intervention (risk ratio (RR) 1.04, 95% confidence interval (CI) 1.00 to 1.09, P = 0.07, 5 cluster-RCTs, N = 4972, I² = 2%, low-quality evidence). At one to two years, UCTs probably led to a clinically meaningful, very large reduction in the likelihood of having had any illness in the previous two weeks to three months (odds ratio (OR) 0.73, 95% CI 0.57 to 0.93, 5 cluster-RCTs, N = 8446, I² = 57%, moderate-quality evidence). Evidence from five cluster-RCTs on food security was too inconsistent to be combined in a meta-analysis, but it suggested that at 13 to 24 months' follow-up, UCTs could increase the likelihood of having been food secure over the previous month (low-quality evidence). UCTs may have increased participants' level of dietary diversity over the previous week, when assessed with the Household Dietary Diversity Score and followed up 24 months into the intervention (mean difference (MD) 0.59 food categories, 95% CI 0.18 to 1.01, 4 cluster-RCTs, N = 9347, I² = 79%, low-quality evidence). Despite several studies providing relevant evidence, the effects of UCTs on the likelihood of being moderately stunted and on the level of depression remain uncertain. No evidence was available on the effect of a UCT on the likelihood of having died. UCTs probably led to a clinically meaningful, moderate increase in the likelihood of currently attending school, when assessed at 12 to 24 months into the intervention (RR 1.06, 95% CI 1.03 to 1.09, 6 cluster-RCTs, N = 4800, I² = 0%, moderate-quality evidence). The evidence was uncertain for whether UCTs impacted livestock ownership, extreme poverty, participation in child labour, adult employment or parenting quality. Evidence from six cluster-RCTs on healthcare expenditure was too inconsistent to be combined in a meta-analysis, but it suggested that UCTs may have increased the amount of money spent on health care at 7 to 24 months into the intervention (low-quality evidence). The effects of UCTs on health equity (or unfair and remedial health inequalities) were very uncertain. We did not identify any harms from UCTs. Three cluster-RCTs compared UCTs versus CCTs with regard to the likelihood of having used any health services, the likelihood of having had any illness or the level of dietary diversity, but evidence was limited to one study per outcome and was very uncertain for all three. AUTHORS' CONCLUSIONS This body of evidence suggests that unconditional cash transfers (UCTs) may not impact a summary measure of health service use in children and adults in LMICs. However, UCTs probably or may improve some health outcomes (i.e. the likelihood of having had any illness, the likelihood of having been food secure, and the level of dietary diversity), one social determinant of health (i.e. the likelihood of attending school), and healthcare expenditure. The evidence on the relative effectiveness of UCTs and CCTs remains very uncertain.
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Affiliation(s)
- Frank Pega
- University of OtagoPublic Health23A Mein Street, NewtownWellingtonNew Zealand6242
| | - Sze Yan Liu
- Harvard UniversityHarvard Center for Population and Development StudiesCambridgeMAUSA
- Weill Cornell Medical College, Cornell UniversityHealthcare Policy and ResearchNew YorkNYUSA
| | - Stefan Walter
- University of California, San FranciscoEpidemiology and Biostatistics185 Berry StSan FranciscoCAUSA94107
| | - Roman Pabayo
- Harvard TH Chan School of Public HealthSocial and Behavioral Sciences677 Huntington AvenueBostonMAUSA02215
- University of AlbertaSchool of Public HealthEdmontonAlbertaCanada
| | - Ruhi Saith
- New DelhiOxford Policy ManagementNew DelhiIndia
| | - Stefan K Lhachimi
- Leibniz Institute for Prevention Research and EpidemiologyResearch Group for Evidence‐Based Public HealthAchterstr. 30BremenGermany28359
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Hone T, Lee JT, Majeed A, Conteh L, Millett C. Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review. Health Policy Plan 2017; 32:723-731. [PMID: 28453713 DOI: 10.1093/heapol/czw178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/14/2022] Open
Abstract
Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London
| | - John Tayu Lee
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London
| | - Lesong Conteh
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London
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Forster AS, Cornelius V, Rockliffe L, Marlow LAV, Bedford H, Waller J. A cluster randomised feasibility study of an adolescent incentive intervention to increase uptake of HPV vaccination. Br J Cancer 2017; 117:1121-1127. [PMID: 28829766 PMCID: PMC5674104 DOI: 10.1038/bjc.2017.284] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Uptake of human papillomavirus (HPV) vaccination is suboptimal among some groups. We aimed to determine the feasibility of undertaking a cluster randomised controlled trial (RCT) of incentives to improve HPV vaccination uptake by increasing consent form return. METHODS An equal-allocation, two-arm cluster RCT design was used. We invited 60 London schools to participate. Those agreeing were randomised to either a standard invitation or incentive intervention arm, in which Year 8 girls had the chance to win a £50 shopping voucher if they returned a vaccination consent form, regardless of whether consent was provided. We collected data on school and parent participation rates and questionnaire response rates. Analyses were descriptive. RESULTS Six schools completed the trial and only 3% of parents opted out. The response rate was 70% for the girls' questionnaire and 17% for the parents'. In the intervention arm, 87% of girls returned a consent form compared with 67% in the standard invitation arm. The proportion of girls whose parents gave consent for vaccination was higher in the intervention arm (76%) than the standard invitation arm (61%). CONCLUSIONS An RCT of an incentive intervention is feasible. The intervention may improve vaccination uptake but a fully powered RCT is needed.
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Affiliation(s)
- Alice S Forster
- Research Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Lauren Rockliffe
- Research Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Laura AV Marlow
- Research Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, UK
| | - Helen Bedford
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, UCL, Gower Street, London WC1E 6BT, UK
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Fink G, Rockers PC. Financial Incentives, Targeting, and Utilization of Child Health Services: Experimental Evidence from Zambia. HEALTH ECONOMICS 2017; 26:1307-1321. [PMID: 27620009 DOI: 10.1002/hec.3404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 07/19/2016] [Accepted: 08/09/2016] [Indexed: 06/06/2023]
Abstract
To address untreated infections in children, routine health checkups have increasingly been incentivized as part of conditional cash transfer programs targeted at the poor. We conducted a field experiment in Zambia to assess the elasticity of demand for checkups as well as the associated health benefits. We find that relatively small incentives induce substantial increases in uptake among non-farming households and households living farther away from clinics, but not among households in the top wealth quintile. These results suggest that small financial incentives may be an efficient way to target poor populations. However, given the weak socioeconomic gradient in infections observed, small incentives will miss a substantial fraction of exposed children. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Günther Fink
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Garoma DA, Abraha YG, Gebrie SA, Deribe FM, Tefera MH, Morankar S. Impact of conditional cash transfers on child nutritional outcomes among sub-Saharan African countries: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:2295-2299. [PMID: 28902696 DOI: 10.11124/jbisrir-2016-003251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to assess the impact of conditional cash transfers on child nutritional outcomes among sub-Saharan African countries. More specifically, the objectives are to assess the impact of conditional cash transfers on child anthropometry, micro-nutrient, and improvement in dietary diversity of households.
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Affiliation(s)
- Desalegn Ararso Garoma
- 1Technology Transfer and Research Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia 2Ethiopian Evidenced Based Healthcare and Development Centre: a Joanna Briggs Institute Centre of Excellence, Jimma University, Jimma, Ethiopia
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Jahagirdar D, Harper S, Heymann J, Swaminathan H, Mukherji A, Nandi A. The effect of paid maternity leave on early childhood growth in low-income and middle-income countries. BMJ Glob Health 2017; 2:e000294. [PMID: 29988584 PMCID: PMC6027064 DOI: 10.1136/bmjgh-2017-000294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/06/2017] [Accepted: 06/14/2017] [Indexed: 01/05/2023] Open
Abstract
Background Despite recent improvements, low height-for-age, a key indicator of inadequate child nutrition, is an ongoing public health issue in low-income and middle-income countries. Paid maternity leave has the potential to improve child nutrition, but few studies have estimated its impact. Methods We used data from 583 227 children younger than 5 years in 37 countries surveyed as part of the Demographic and Health Surveys (2000–2014) to compare the change in children’s height-for-age z score in five countries that increased their legislated duration of paid maternity leave (Uganda, Zambia, Zimbabwe, Bangladesh and Lesotho) relative to 32 other countries that did not. A quasiexperimental difference-in-difference design involving a linear regression of height-for-age z score on the number of weeks of legislated paid maternity leave was used. We included fixed effects for country and birth year to control for, respectively, fixed country characteristics and shared trends in height-for-age, and adjusted for time-varying covariates such as gross domestic product per capita and the female labour force participation rate. Results The mean height-for-age z scores in the pretreatment period were -1.91 (SD=1.44) and –1.47 (SD=1.57) in countries that did and did not change their policies, respectively. The scores increased in treated and control countries over time. A 1-month increase in legislated paid maternity leave was associated with a decrease of 0.08(95% CI −0.20 to 0.04) in child height-for-age z score. Sensitivity analyses did not support a robust association between paid maternity leave policies and height-for-age z score. Conclusion We found little evidence that recent changes in legislated paid maternity leave have been sufficient to affect child height-for-age z scores. The relatively short durations of leave, the potential for low coverage and the strong increasing trend in children’s growth may explain our findings. Future studies considering longer durations or combined interventions may reveal further insight to support policy.
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Affiliation(s)
- Deepa Jahagirdar
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Jody Heymann
- Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Hema Swaminathan
- Indian Institute of Management Bangalore, Centre for Public Policy, Bangalore, India
| | - Arnab Mukherji
- Indian Institute of Management Bangalore, Centre for Public Policy, Bangalore, India
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, Institute for Health and Social Policy, McGill University, Montreal, Canada
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Abstract
This article looks at both nutrition and early childhood stimulation interventions as part of an integrated life cycle approach to development. We build on recent systematic reviews of child development, which are comprehensive in regard to what is currently known about outcomes reported in key studies. We then focus particularly on implementation, scaling, and economic returns, drawing mainly on experience in low- and middle-income countries where undernutrition and poor child development remain significant public health challenges with implications across the life course.
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Affiliation(s)
- Harold Alderman
- International Food Policy Research Institute, Washington, DC 20006;
| | - Lia Fernald
- Community Health Sciences, School of Public Health, University of California, Berkeley, California 94720;
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Arsenault C, Johri M, Nandi A, Mendoza Rodríguez JM, Hansen PM, Harper S. Country-level predictors of vaccination coverage and inequalities in Gavi-supported countries. Vaccine 2017; 35:2479-2488. [PMID: 28365251 DOI: 10.1016/j.vaccine.2017.03.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Important inequalities in childhood vaccination coverage persist between countries and population groups. Understanding why some countries achieve higher and more equitable levels of coverage is crucial to redress these inequalities. In this study, we explored the country-level determinants of (1) coverage of the third dose of diphtheria-tetanus-pertussis- (DTP3) containing vaccine and (2) within-country inequalities in DTP3 coverage in 45 countries supported by Gavi, the Vaccine Alliance. METHODS We used data from the most recent Demographic and Health Surveys (DHS) conducted between 2005 and 2014. We measured national DTP3 coverage and the slope index of inequality in DTP3 coverage with respect to household wealth, maternal education, and multidimensional poverty. We collated data on country health systems, health financing, governance and geographic and sociocultural contexts from published sources. We used meta-regressions to assess the relationship between these country-level factors and variations in DTP3 coverage and inequalities. To validate our findings, we repeated these analyses for coverage with measles-containing vaccine (MCV). RESULTS We found considerable heterogeneity in DTP3 coverage and in the magnitude of inequalities across countries. Results for MCV were consistent with those from DTP3. Political stability, gender equality and smaller land surface were important predictors of higher and more equitable levels of DTP3 coverage. Inequalities in DTP3 coverage were also lower in countries receiving more external resources for health, with lower rates of out-of-pocket spending and with higher national coverage. Greater government spending on heath and lower linguistic fractionalization were also consistent with better vaccination outcomes. CONCLUSION Improving vaccination coverage and reducing inequalities requires that policies and programs address critical social determinants of health including geographic and social exclusion, gender inequality and the availability of financial protection for health. Further research should investigate the mechanisms contributing to these associations.
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Affiliation(s)
- Catherine Arsenault
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
| | - Mira Johri
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada; Département de gestion, d'évaluation et de politique de santé, École de santé publique de l'Université de Montréal (ESPUM), Montreal, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| | | | | | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
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Forster AS, Cornelius V, Rockliffe L, Marlow LAV, Bedford H, Waller J. A protocol for a cluster randomised feasibility study of an adolescent incentive intervention to increase uptake of HPV vaccination among girls. Pilot Feasibility Stud 2017; 3:13. [PMID: 28286668 PMCID: PMC5338092 DOI: 10.1186/s40814-017-0126-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uptake of the human papillomavirus (HPV) vaccine in the UK is good, but there are pockets of the community who remain unprotected. Immunisation teams usually require written parental consent for a girl to receive the vaccine. Evidence suggests that uptake of the vaccine might be improved by promoting consent form return (if returned, forms are likely to grant consent). Incentivising girls to return consent forms is a promising approach to promoting consent form return. Before testing the efficacy of an incentive intervention in a randomised controlled trial (RCT), we must first establish whether the RCT is feasible. In this randomised feasibility study, we aim to establish the feasibility of conducting a cluster RCT of an adolescent incentive intervention to increase uptake of HPV vaccination. METHODS At least six schools will be randomised to either an incentive intervention arm or a standard invitation arm. Girls in standard invitation arm schools will receive the usual HPV vaccine programme invitation materials. Girls attending schools in the incentive intervention arm will receive the standard invitation and will also be told that they will receive an incentive if they return their consent form (regardless of whether consent is granted or denied). The incentive is being entered into a prize draw to win a retail voucher. Feasibility objectives include estimating the schools' and parents' willingness to participate in the study and be randomised; response rates to questionnaires; the extent of missing data; the girls' and parents' attitudes towards the incentive offered; school staff experiences of participating, fidelity to the trial procedures, data on any unintended consequences and the possible mechanisms of action, and proof-of-concept evidence of the effect of the intervention on consent form return rates and uptake of the vaccine. Analysis of feasibility outcomes will primarily be descriptive. Consent form return rates and uptake of the vaccine will be presented by trial arm without comparison. DISCUSSION Incentivising HPV vaccine consent form return may promote HPV vaccine uptake. This study will provide the evidence needed to establish whether testing this incentive intervention using a RCT design in the future is feasible. TRIAL REGISTRATION ISRCTN72136061.
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Affiliation(s)
- Alice S. Forster
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH UK
| | - Lauren Rockliffe
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
| | - Laura A. V. Marlow
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
| | - Helen Bedford
- Institute of Child Health, UCL, 30 Guilford Street, London, WC1N 1EH UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT UK
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Zombré D, De Allegri M, Ridde V. Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso: A controlled interrupted time-series analysis. Soc Sci Med 2017; 179:27-35. [PMID: 28242542 DOI: 10.1016/j.socscimed.2017.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about the long-term effects of user fee exemption policies on health care use in developing countries. We examined the association between user fee exemption and health care use among children under five in Burkina Faso. We also examined how factors related to characteristics of health facilities and their environment moderate this association. METHOD We used a multilevel controlled interrupted time-series design to examine the strength of effect and long term effects of user fee exemption policy on the rate of health service utilization in children under five between January 2004 and December 2014. RESULTS The initiation of the intervention more than doubled the utilization rate with an immediate 132.596% increase in intervention facilities (IRR: 2.326; 95% CI: 1.980 to 2.672). The effect of the intervention was 32.766% higher in facilities with higher workforce density (IRR: 1.328; 95% CI (1.209-1.446)) and during the rainy season (IRR:1.2001; 95% CI: 1.0953-1.3149), but not significant in facilities with higher dispersed populations (IRR: 1.075; 95% CI: (0.942-1.207)). Although the intervention effect was substantially significant immediately following its inception, the pace of growth, while positive over a first phase, decelerated to stabilize itself three years and 7 months later before starting to decrease slowly towards the end of the study period. CONCLUSION This study provides additional evidence to support user fee exemption policies complemented by improvements in health care quality. Future work should include an assessment of the impact of user fee exemption on infant morbidity and mortality and better discuss factors that could explain the slowdown in this upward trend of utilization rates three and a half years after the intervention onset.
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Affiliation(s)
- David Zombré
- University of Montreal Public Health Research Institute - IRSPUM, Canada; School of Public Health, Montreal, Québec, Canada.
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, Heidelberg University, Germany
| | - Valéry Ridde
- University of Montreal Public Health Research Institute - IRSPUM, Canada; School of Public Health, Montreal, Québec, Canada
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Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, McCoy DC, Fink G, Shawar YR, Shiffman J, Devercelli AE, Wodon QT, Vargas-Barón E, Grantham-McGregor S. Early childhood development coming of age: science through the life course. Lancet 2017; 389:77-90. [PMID: 27717614 PMCID: PMC5884058 DOI: 10.1016/s0140-6736(16)31389-7] [Citation(s) in RCA: 1154] [Impact Index Per Article: 164.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/07/2016] [Accepted: 08/05/2016] [Indexed: 12/19/2022]
Abstract
Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Park, NC, USA.
| | - Susan P Walker
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | | | - Chunling Lu
- Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Dana C McCoy
- Harvard Graduate School of Education, Boston, MA, USA
| | - Günther Fink
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Yusra R Shawar
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, Perez-Escamilla R, Rao N, Ip P, Fernald LCH, MacMillan H, Hanson M, Wachs TD, Yao H, Yoshikawa H, Cerezo A, Leckman JF, Bhutta ZA. Nurturing care: promoting early childhood development. Lancet 2017; 389:91-102. [PMID: 27717615 DOI: 10.1016/s0140-6736(16)31390-3] [Citation(s) in RCA: 698] [Impact Index Per Article: 99.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/12/2016] [Accepted: 08/05/2016] [Indexed: 01/09/2023]
Abstract
The UN Sustainable Development Goals provide a historic opportunity to implement interventions, at scale, to promote early childhood development. Although the evidence base for the importance of early childhood development has grown, the research is distributed across sectors, populations, and settings, with diversity noted in both scope and focus. We provide a comprehensive updated analysis of early childhood development interventions across the five sectors of health, nutrition, education, child protection, and social protection. Our review concludes that to make interventions successful, smart, and sustainable, they need to be implemented as multi-sectoral intervention packages anchored in nurturing care. The recommendations emphasise that intervention packages should be applied at developmentally appropriate times during the life course, target multiple risks, and build on existing delivery platforms for feasibility of scale-up. While interventions will continue to improve with the growth of developmental science, the evidence now strongly suggests that parents, caregivers, and families need to be supported in providing nurturing care and protection in order for young children to achieve their developmental potential.
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Affiliation(s)
| | - Stephen J Lye
- Fraser Mustard Institute for Human Development, University of Toronto, ON, Canada; Departments of Physiology, Obstetrics and Gynecology, and Medicine, University of Toronto, ON, Canada
| | - Kerrie Proulx
- Fraser Mustard Institute for Human Development, University of Toronto, ON, Canada
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Stephen G Matthews
- Fraser Mustard Institute for Human Development, University of Toronto, ON, Canada; Departments of Physiology, Obstetrics and Gynecology, and Medicine, University of Toronto, ON, Canada
| | - Tyler Vaivada
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, CT, USA
| | - Nirmala Rao
- Faculty of Education, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Lia C H Fernald
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Harriet MacMillan
- Department of Psychiatry and Behavioural Neurosciences, and Department of Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Mark Hanson
- Institute of Developmental Sciences and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton, UK
| | - Theodore D Wachs
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Haogen Yao
- Teachers College, Columbia University, New York, NY, USA
| | | | - Adrian Cerezo
- Department of Biology, University of Missouri, St Louis, MO, USA
| | - James F Leckman
- Yale Child Study Centre, Yale School of Medicine, Yale University, CT, USA
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
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Crocker-Buque T, Edelstein M, Mounier-Jack S. Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review. J Epidemiol Community Health 2017; 71:87-97. [PMID: 27535769 PMCID: PMC5256276 DOI: 10.1136/jech-2016-207572] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/13/2016] [Accepted: 07/04/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND In high-income countries, substantial differences exist in vaccine uptake relating to socioeconomic status, gender, ethnic group, geographic location and religious belief. This paper updates a 2009 systematic review on effective interventions to decrease vaccine uptake inequalities in light of new technologies applied to vaccination and new vaccine programmes (eg, human papillomavirus in adolescents). METHODS We searched MEDLINE, Embase, ASSIA, The Campbell Collaboration, CINAHL, The Cochrane Database of Systematic Reviews, Eppi Centre, Eric and PsychINFO for intervention, cohort or ecological studies conducted at primary/community care level in children and young people from birth to 19 years in OECD countries, with vaccine uptake or coverage as outcomes, published between 2008 and 2015. RESULTS The 41 included studies evaluated complex multicomponent interventions (n=16), reminder/recall systems (n=18), outreach programmes (n=3) or computer-based interventions (n=2). Complex, locally designed interventions demonstrated the best evidence for effectiveness in reducing inequalities in deprived, urban, ethnically diverse communities. There is some evidence that postal and telephone reminders are effective, however, evidence remains mixed for text-message reminders, although these may be more effective in adolescents. Interventions that escalated in intensity appeared particularly effective. Computer-based interventions were not effective. Few studies targeted an inequality specifically, although several reported differential effects by the ethnic group. CONCLUSIONS Locally designed, multicomponent interventions should be used in urban, ethnically diverse, deprived populations. Some evidence is emerging for text-message reminders, particularly in adolescents. Further research should be conducted in the UK and Europe with a focus on reducing specific inequalities.
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Affiliation(s)
- Tim Crocker-Buque
- Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Edelstein
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Sandra Mounier-Jack
- Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Taaffe J, Cheikh N, Wilson D. The use of cash transfers for HIV prevention--are we there yet? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016; 15:17-25. [PMID: 27002355 DOI: 10.2989/16085906.2015.1135296] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Poverty and social inequality are significant drivers of the HIV epidemic and are risk factors for acquiring HIV. As such, many individuals worldwide are at risk for new HIV infection, especially young women in East and Southern Africa. By addressing these drivers, social protection programmes may mitigate the impact of poverty and social inequality on HIV risk. There is reason to believe that social protection can be used successfully for HIV prevention; social protection programmes, including cash transfers, have led to positive health outcomes and behaviour in other contexts, and they have been used successfully to promote education and increased income and employment opportunities. Furthermore, cash transfers have influenced sexual behaviour of young women and girls, thereby decreasing sexual risk factors for HIV infection. When HIV outcomes have been measured, several randomised controlled trials have shown that indirectly, cash transfers have led to reduced HIV prevalence and incidence. In these studies, school attendance and safer sexual health were directly incentivised through the cash transfer, yet there was a positive effect on HIV outcomes. In this review, we discuss the growth of social protection programmes, their benefits and impact on health, education and economic potential, and how these outcomes may affect HIV risk. We also review the studies that have shown that cash transfers can lead to reduced HIV infection, including study limitations and what questions still remain with regard to using cash transfers for HIV prevention.
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Silverman K, Jarvis BP, Jessel J, Lopez AA. Incentives and Motivation. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2016; 2:97-100. [PMID: 27917395 DOI: 10.1037/tps0000073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kenneth Silverman
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Brantley P Jarvis
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | | | - Alexa A Lopez
- Department of Psychology, Virginia Commonwealth University
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Owusu-Addo E, Renzaho AMN, Mahal AS, Smith BJ. The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol. Syst Rev 2016; 5:114. [PMID: 27412361 PMCID: PMC4944314 DOI: 10.1186/s13643-016-0295-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing pressure to address the social determinants of health (SDoH) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa (SSA) where health outcomes are generally poor. Available evaluation research on cash transfers (CTs) suggests that the programs may influence the wider determinants of health in SSA; yet, there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities. To date, nearly all the reviews on CTs' impact on health have predominantly featured evidence from Latin America with limited transferability to the social, cultural, and political environments in SSA. Therefore, the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA. METHODS/DESIGN A systematic review of published and unpublished literature on CTs' impact on health and health determinants covering the period 2000-2016 will be undertaken. Studies will be considered for inclusion if they present quantitative or qualitative data, including all relevant study designs. The SDoH conceptual framework will be used to guide the data extraction process. EPPI Reviewer software will be used for data management and analysis. Studies included in the review will be analyzed by narrative synthesis and/or meta-analysis as appropriate for the nature of the data retrieved. DISCUSSION This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy, implementation, and research in SSA. The protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). SYSTEMATIC REVIEW REGISTRATION This protocol has been registered with the PROSPERO international prospective register of systematic reviews, reference CRD42015025015 .
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Affiliation(s)
- Ebenezer Owusu-Addo
- Bureau of Integrated Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ajay S Mahal
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Abstract
Considerable progress has been made towards reducing under-5 childhood mortality in the Millennium Development Goals era. Reduction in newborn mortality has lagged behind maternal and child mortality. Effective implementation of innovative, evidence-based, and cost-effective interventions can reduce maternal and newborn mortality. Interventions aimed at the most vulnerable group results in maximal impact on mortality. Intervention coverage and scale-up remains low, inequitable and uneven in low-income countries due to numerous health-systems bottle-necks. Innovative service delivery strategies, increased integration and linkages across the maternal, newborn, child health continuum of care are vital to accelerate progress towards ending preventable maternal and newborn deaths.
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The dollars and sense of economic incentives to modify HIV-related behaviours. J Int AIDS Soc 2015; 18:20724. [PMID: 26480927 PMCID: PMC4610955 DOI: 10.7448/ias.18.1.20724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/08/2022] Open
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Pega F, Liu SY, Walter S, Lhachimi SK. Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low- and middle-income countries. Cochrane Database Syst Rev 2015; 2015:CD011247. [PMID: 26360970 PMCID: PMC9157652 DOI: 10.1002/14651858.cd011247.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Unconditional cash transfers (UCTs) are a common social protection intervention that increases income, a key social determinant of health, in disaster contexts in low- and middle-income countries (LMICs). OBJECTIVES To assess the effects of UCTs in improving health services use, health outcomes, social determinants of health, health care expenditure, and local markets and infrastructure in LMICs. We also compared the relative effectiveness of UCTs delivered in-hand with in-kind transfers, conditional cash transfers, and UCTs paid through other mechanisms. SEARCH METHODS We searched 17 academic databases, including the Cochrane Public Health Group Specialised Register, the Cochrane Database of Systematic Reviews (The Cochrane Library 2014, Issue 7), MEDLINE, and EMBASE between May and July 2014 for any records published up until 4 May 2014. We also searched grey literature databases, organisational websites, reference lists of included records, and academic journals, as well as seeking expert advice. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs), as well as cohort, interrupted time series, and controlled before-and-after studies (CBAs) on UCTs in LMICs. Primary outcomes were the use of health services and health outcomes. DATA COLLECTION AND ANALYSIS Two authors independently screened all potentially relevant records for inclusion criteria, extracted the data, and assessed the included studies' risk of bias. We requested missing information from the study authors. MAIN RESULTS Three studies (one cluster-RCT and two CBAs) comprising a total of 13,885 participants (9640 children and 4245 adults) as well as 1200 households in two LMICs (Nicaragua and Niger) met the inclusion criteria. They examined five UCTs between USD 145 and USD 250 (or more, depending on household characteristics) that were provided by governmental, non-governmental or research organisations during experiments or pilot programmes in response to droughts. Two studies examined the effectiveness of UCTs, and one study examined the relative effectiveness of in-hand UCTs compared with in-kind transfers and UCTs paid via mobile phone. Due to the methodologic limitations of the retrieved records, which carried a high risk of bias and very serious indirectness, we considered the body of evidence to be of very low overall quality and thus very uncertain across all outcomes.Depending on the specific health services use and health outcomes examined, the included studies either reported no evidence that UCTs had impacted the outcome, or they reported that UCTs improved the outcome. No single outcome was reported by more than one study. There was a very small increase in the proportion of children who received vitamin or iron supplements (mean difference (MD) 0.10 standard deviations (SDs), 95% confidence interval (CI) 0.06 to 0.14) and on the child's home environment, as well as clinically meaningful, very large reductions in the chance of child death (hazard ratio (HR) 0.26, 95% CI 0.10 to 0.66) and the incidence of severe acute malnutrition (HR 0.44, 95% CI 0.24 to 0.80). There was also a moderate reduction in the number of days children spent sick in bed (MD - 0.36 SDs, 95% CI - 0.62 to - 0.10). There was no evidence for any effect on the proportion of children receiving deworming drugs, height for age among children, adults' level of depression, or the quality of parenting behaviour. No adverse effects were identified. The included comparisons did not examine several important outcomes, including food security and equity impacts.With regard to the relative effectiveness of UCTs compared with a food transfer providing a relatively high total caloric value, there was no evidence that a UCT had any effect on the chance of child death (HR 2.27, 95% CI 0.69 to 7.44) or severe acute malnutrition (HR 1.15, 95% CI 0.67 to 1.99). A UCT paid in-hand led to a clinically meaningful, moderate increase in the household dietary diversity score, compared with the same UCT paid via mobile phone (difference-in-differences estimator 0.43 scores, 95% CI 0.06 to 0.80), but there was no evidence for an effect on social determinants of health, health service expenditure, or local markets and infrastructure. AUTHORS' CONCLUSIONS Additional high-quality evidence (especially RCTs of humanitarian disaster contexts other than droughts) is required to reach clear conclusions regarding the effectiveness and relative effectiveness of UCTs for improving health services use and health outcomes in humanitarian disasters in LMICs.
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Affiliation(s)
- Frank Pega
- University of OtagoPublic Health23A Mein Street, NewtownWellingtonNew Zealand6242
| | - Sze Yan Liu
- Harvard UniversityHarvard Center for Population and Development Studies9 Bow StCambridgeMAUSA02138
| | - Stefan Walter
- University of California, San FranciscoEpidemiology and Biostatistics185 Berry StSan FranciscoCAUSA94107
| | - Stefan K Lhachimi
- Leibniz Institute for Prevention Research and EpidemiologyResearch Group for Evidence Based Public HealthAchterstr. 30BremenGermany28359
- University of BremenInstitute for Public Health and Nursing Research, Health Sciences BremenBibliotheksstr. 1BremenGermany28359
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Wilson K, Atkinson KM, Deeks SL, Crowcroft NS. Improving vaccine registries through mobile technologies: a vision for mobile enhanced Immunization information systems. J Am Med Inform Assoc 2015; 23:207-11. [PMID: 26078414 DOI: 10.1093/jamia/ocv055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/05/2015] [Indexed: 11/12/2022] Open
Abstract
Immunization registries or information systems are critical to improving the quality and evaluating the ongoing success of immunization programs. However, the completeness of these systems is challenged by a myriad of factors including the fragmentation of vaccine administration, increasing mobility of individuals, new vaccine development, use of multiple products, and increasingly frequent changes in recommendations. Mobile technologies could offer a solution, which mitigates some of these challenges. Engaging individuals to have more control of their own immunization information using their mobile devices could improve the timeliness and accuracy of data in central immunization information systems. Other opportunities presented by mobile technologies that could be exploited to improve immunization information systems include mobile reporting of adverse events following immunization, the capacity to scan 2D barcodes, and enabling bidirectional communication between individuals and public health officials. Challenges to utilizing mobile solutions include ensuring privacy of data, access, and equity concerns, obtaining consent and ensuring adoption of technology at sufficiently high rates. By empowering individuals with their own health information, mobile technologies can also serve as a mechanism to transfer immunization information as individuals cross local, regional, and national borders. Ultimately, mobile enhanced immunization information systems can help realize the goal of the individual, the healthcare provider, and public health officials always having access to the same immunization information.
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Affiliation(s)
- Kumanan Wilson
- Departments of Medicine and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katherine M Atkinson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Shelley L Deeks
- Public Health Ontario, Toronto, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Toronto, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Canada Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Johri M, Pérez MC, Arsenault C, Sharma JK, Pai NP, Pahwa S, Sylvestre MP. Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ 2015; 93:339-346C. [PMID: 26229205 PMCID: PMC4431517 DOI: 10.2471/blt.14.146951] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/05/2014] [Accepted: 01/23/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and middle-income countries. METHODS We searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis. FINDINGS We identified 11 studies comprising four randomized controlled trials, six cluster randomized controlled trials and one controlled before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an eligible intervention. Six studies demonstrated low risk of bias and five studies had moderate to high risk of bias. We conducted a pooled analysis considering all 11 studies, with data from 11,512 participants. Demand-side interventions were associated with significantly higher receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17-1.44). Subgroup analyses also demonstrated significant effects of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20-1.63) and of four studies which used incentives, RR: 1.28 (95% CI: 1.12-1.45). CONCLUSION Demand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries. Educational approaches and use of incentives were both effective strategies.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Myriam Cielo Pérez
- Département d'administration de la santé, Université de Montréal, Montréal, Canada
| | - Catherine Arsenault
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Jitendar K Sharma
- National Health Systems Resource Centre (NHSRC), Ministry of Health and Family Welfare, New Delhi, India
| | | | - Smriti Pahwa
- Pratham Education Foundation (ASER Centre), New Delhi, India
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
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81
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Kimani-Murage EW, Wekesah F, Wanjohi M, Kyobutungi C, Ezeh AC, Musoke RN, Norris SA, Madise NJ, Griffiths P. Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. MATERNAL AND CHILD NUTRITION 2014; 11:314-32. [PMID: 25521041 PMCID: PMC6860346 DOI: 10.1111/mcn.12161] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poor breastfeeding practices are widely documented in Kenya, where only a third of children are exclusively breastfed for 6 months and only 2% in urban poor settings. This study aimed to better understand the factors that contribute to poor breastfeeding practices in two urban slums in Nairobi, Kenya. In‐depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with women of childbearing age, community health workers, village elders and community leaders and other knowledgeable people in the community. A total of 19 IDIs, 10 FGDs and 11 KIIs were conducted, and were recorded and transcribed verbatim. Data were coded in NVIVO and analysed thematically. We found that there was general awareness regarding optimal breastfeeding practices, but the knowledge was not translated into practice, leading to suboptimal breastfeeding practices. A number of social and structural barriers to optimal breastfeeding were identified: (1) poverty, livelihood and living arrangements; (2) early and single motherhood; (3) poor social and professional support; (4) poor knowledge, myths and misconceptions; (5) HIV; and (6) unintended pregnancies. The most salient of the factors emerged as livelihoods, whereby women have to resume work shortly after delivery and work for long hours, leaving them unable to breastfeed optimally. Women in urban poor settings face an extremely complex situation with regard to breastfeeding due to multiple challenges and risk behaviours often dictated to them by their circumstances. Macro‐level policies and interventions that consider the ecological setting are needed.
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Affiliation(s)
| | - Frederick Wekesah
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Milka Wanjohi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Alex C Ezeh
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Rachel N Musoke
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nyovani J Madise
- Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton, UK
| | - Paula Griffiths
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health and Human Development, Loughborough University, Loughborough, UK
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Sharkey AB, Martin S, Cerveau T, Wetzler E, Berzal R. Demand generation and social mobilisation for integrated community case management (iCCM) and child health: Lessons learned from successful programmes in Niger and Mozambique. J Glob Health 2014; 4:020410. [PMID: 25520800 PMCID: PMC4267098 DOI: 10.7189/jogh.04.020410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM We present the approaches used in and outcomes resulting from integrated community case management (iCCM) programmes in Niger and Mozambique with a strong focus on demand generation and social mobilisation. METHODS We use a case study approach to describe the programme and contextual elements of the Niger and Mozambique programmes. RESULTS Awareness and utilisation of iCCM services and key family practices increased following the implementation of the Niger and Mozambique iCCM and child survival programmes, as did care-seeking within 24 hours and care-seeking from appropriate, trained providers in Mozambique. These approaches incorporated interpersonal communication activities and community empowerment/participation for collective change, partnerships and networks among key stakeholder groups within communities, media campaigns and advocacy efforts with local and national leaders. CONCLUSIONS iCCM programmes that train and equip community health workers and successfully engage and empower community members to adopt new behaviours, have appropriate expectations and to trust community health workers' ability to assess and treat illnesses can lead to improved care-seeking and utilisation, and community ownership for iCCM.
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83
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Ayuku D, Embleton L, Koech J, Atwoli L, Hu L, Ayaya S, Hogan J, Nyandiko W, Vreeman R, Kamanda A, Braitstein P. The government of Kenya cash transfer for orphaned and vulnerable children: cross-sectional comparison of household and individual characteristics of those with and without. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2014; 14:25. [PMID: 25239449 PMCID: PMC4175501 DOI: 10.1186/1472-698x-14-25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/15/2014] [Indexed: 11/16/2022]
Abstract
Background The ‘Cash Transfer to Orphans and Vulnerable Children’ (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people’s health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT. Methods This project analyzes baseline data from a cohort of orphaned and separated children aged <19 years and non-orphaned children living in 300 randomly selected households (HH) in 8 Locations of Uasin Gishu County, Kenya. Baseline data were analyzed using multivariable logistic and Poisson regression comparing children in CT-HH vs. non-CT HH. Odds ratios are adjusted (AOR) with 95% confidence intervals (CI) for guardian age and sex, child age and sex, and intra-HH correlation. Results Included in this analysis were data from 1481 children and adolescents in 300 HH (503 participants in CT, 978 in non-CT households). Overall there were 922 (62.3%) single orphans, 324 (21.9%) double orphans, and 210 (14.2%) participants had both parents alive and were living with them. Participants in CT-HH were less likely to have ≥2 pairs of clothes compared to non-CT HH (AOR: 0.32, 95% CI: 0.16-0.63). Those in CT HH were less likely to have missed any days of school in the preceding month (AOR: 0.62, 95% CI: 0.42-0.94) and those aged <1-18 years in CT-HH were less likely to have height stunting for their age (AOR: 0.65, 95% CI: 0.47-0.89). Participants aged at least 10 years in CT-HH were more likely to have a positive future outlook (AOR: 1.72, 95% CI: 1.12-2.65). Conclusions Children and adolescents in households receiving the CT-OVC appear to have better nutritional status, school attendance, and optimism about the future, compared to those in households not receiving the CT, in spite of some evidence of continued material deprivation. Consideration should be given to expanding the program further.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paula Braitstein
- College of Health Sciences, School of Medicine, Department of Medicine, Moi University, Eldoret, Kenya.
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Pega F, Walter S, Liu SY, Lhachimi SK. Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low- and middle-income countries. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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85
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Pega F, Walter S, Liu SY, Pabayo R, Lhachimi SK, Saith R. Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low- and middle-income countries. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Frank Pega
- University of Otago; Public Health; 23A Mein Street, Newtown Wellington New Zealand 6242
| | - Stefan Walter
- University of California, San Francisco; Epidemiology and Biostatistics; 185 Berry St San Francisco CA USA 94107
- Harvard University; Social and Behavioral Sciences, Harvard School of Public Health; Boston MA USA
| | - Sze Yan Liu
- Harvard University; Harvard Center for Population and Development Studies; 9 Bow St Cambridge MA USA 02138
| | - Roman Pabayo
- Harvard University; Social and Behavioral Sciences, Harvard School of Public Health; Boston MA USA
| | - Stefan K Lhachimi
- Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH; Cooperative Research Group for Evidence Based Public Health; Achterstr. 30 Bremen Germany 28359
- University of Bremen; Health Sciences Bremen; Bremen Germany
| | - Ruhi Saith
- New Delhi; Oxford Policy Management; New Delhi India
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86
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Affiliation(s)
- Zulfiqar A Bhutta
- From the Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto (Z.A.B.); the Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan (Z.A.B.); and the Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (R.E.B.)
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Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013; 382:452-477. [PMID: 23746776 DOI: 10.1016/s0140-6736(13)60996-4] [Citation(s) in RCA: 1538] [Impact Index Per Article: 139.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Maternal undernutrition contributes to 800,000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3·1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the world's children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9·6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches--ie, women's empowerment, agriculture, food systems, education, employment, social protection, and safety nets--they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.
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Affiliation(s)
| | - Jai K Das
- Aga Khan University, Karachi, Pakistan
| | | | | | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, Black RE. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet 2013; 381:1417-1429. [PMID: 23582723 DOI: 10.1016/s0140-6736(13)60648-0] [Citation(s) in RCA: 318] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Global mortality in children younger than 5 years has fallen substantially in the past two decades from more than 12 million in 1990, to 6·9 million in 2011, but progress is inconsistent between countries. Pneumonia and diarrhoea are the two leading causes of death in this age group and have overlapping risk factors. Several interventions can effectively address these problems, but are not available to those in need. We systematically reviewed evidence showing the effectiveness of various potential preventive and therapeutic interventions against childhood diarrhoea and pneumonia, and relevant delivery strategies. We used the Lives Saved Tool model to assess the effect on mortality when these interventions are applied. We estimate that if implemented at present annual rates of increase in each of the 75 Countdown countries, these interventions and packages of care could save 54% of diarrhoea and 51% of pneumonia deaths by 2025 at a cost of US$3·8 billion. However, if coverage of these key evidence-based interventions were scaled up to at least 80%, and that for immunisations to at least 90%, 95% of diarrhoea and 67% of pneumonia deaths in children younger than 5 years could be eliminated by 2025 at a cost of $6·715 billion. New delivery platforms could promote equitable access and community platforms are important catalysts in this respect. Furthermore, several of these interventions could reduce morbidity and overall burden of disease, with possible benefits for developmental outcomes.
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Affiliation(s)
- Zulfiqar A Bhutta
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Jai K Das
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan
| | - Neff Walker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Arjumand Rizvi
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Igor Rudan
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Robert E Black
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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