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Yoshida S, Martines J, Lawn JE, Wall S, Souza JP, Rudan I, Cousens S, Aaby P, Adam I, Adhikari RK, Ambalavanan N, Arifeen SE, Aryal DR, Asiruddin S, Baqui A, Barros AJ, Benn CS, Bhandari V, Bhatnagar S, Bhattacharya S, Bhutta ZA, Black RE, Blencowe H, Bose C, Brown J, Bührer C, Carlo W, Cecatti JG, Cheung PY, Clark R, Colbourn T, Conde-Agudelo A, Corbett E, Czeizel AE, Das A, Day LT, Deal C, Deorari A, Dilmen U, English M, Engmann C, Esamai F, Fall C, Ferriero DM, Gisore P, Hazir T, Higgins RD, Homer CS, Hoque DE, Irgens L, Islam MT, de Graft-Johnson J, Joshua MA, Keenan W, Khatoon S, Kieler H, Kramer MS, Lackritz EM, Lavender T, Lawintono L, Luhanga R, Marsh D, McMillan D, McNamara PJ, Mol BWJ, Molyneux E, Mukasa GK, Mutabazi M, Nacul LC, Nakakeeto M, Narayanan I, Olusanya B, Osrin D, Paul V, Poets C, Reddy UM, Santosham M, Sayed R, Schlabritz-Loutsevitch NE, Singhal N, Smith MA, Smith PG, Soofi S, Spong CY, Sultana S, Tshefu A, van Bel F, Gray LV, Waiswa P, Wang W, Williams SLA, Wright L, Zaidi A, Zhang Y, Zhong N, Zuniga I, Bahl R. Setting research priorities to improve global newborn health and prevent stillbirths by 2025. J Glob Health 2015; 6:010508. [PMID: 26401272 PMCID: PMC4576458 DOI: 10.7189/jogh.06.010508] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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Affiliation(s)
- Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - José Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Norway
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, UK ; Saving Newborn Lives, Save the Children, Washington, USA
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, USA
| | - Joăo Paulo Souza
- Department of Social Medicine, Ribeirăo Preto School of Medicine, University of Săo Paulo, Brazil
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh Medical School, Scotland, UK
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Peter Aaby
- Bandim Health Project, Indepth Network, Guinea-Bissau
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Sudan
| | | | | | - Shams Ei Arifeen
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Dhana Raj Aryal
- Department of Neonatology Paropakar Maternity and women's Hospital, Nepal
| | - Sk Asiruddin
- TRAction Bangladesh Project, University Research Co., LLC
| | | | - Aluisio Jd Barros
- Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Brazil
| | - Christine S Benn
- Research Center for Vitamins and Vaccines, Statens Serum Institut, and University of Southern Denmark/Odense University Hospital, Denmark
| | - Vineet Bhandari
- Program in Perinatal Research, Yale University School of Medicine, USA
| | - Shinjini Bhatnagar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, India
| | | | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Institute of International Programs, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Carl Bose
- The University of North Carolina at Chapel Hill School of Medicine, USA
| | | | - Christoph Bührer
- Department of Neonatology, Charité University Medical Center, Germany
| | | | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Brazil
| | - Po-Yin Cheung
- Departments of Pediatrics, Pharmacology & Surgery, University of Alberta, Canada
| | | | - Tim Colbourn
- University College London Institute for Global Health, UK
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, USA
| | - Erica Corbett
- Independent consultant maternal health research, Rwanda
| | - Andrew E Czeizel
- Foundation for the Community Control of Hereditary Diseases, Hungary
| | - Abhik Das
- Biostatistics and Epidemiology, RTI International, USA
| | | | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases National Institute of Health, USA
| | | | - Uğur Dilmen
- Pediatrics and Neonatology, Yıldırım Beyazıt University Medical Faculty, Turkey
| | - Mike English
- Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, UK and KEMRi-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Cyril Engmann
- Newborn Health, Family Health Division, The Bill & Melinda Gates Foundation and the University of North Carolina Schools of Medicine and Public Health, USA
| | | | - Caroline Fall
- International Paediatric Epidemiology; Affiliations: Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | | | - Peter Gisore
- School of Medicine, Child Health and Pediatrics, Moi University, Kenya
| | - Tabish Hazir
- Children's Hospital, Pakistan Institute of Medical Sciences, Pakistan
| | - Rosemary D Higgins
- Eunice Kennedy Shriver NICHD Neonatal Research Network, Pregnancy and Perinatology, Branch, National Institute of Health, USA
| | - Caroline Se Homer
- Centre for Midwifery, Child and Family Health, University of Technology, Sydney, Australia
| | - D E Hoque
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Lorentz Irgens
- University of Bergen and Norwegian Institute of Public Health, Norway
| | - M T Islam
- Japan International Cooperation Agency (JICA), Bangladesh
| | | | | | | | - Soofia Khatoon
- Paediatrics and Head of Department Shaheed Suhrawardy Medical College, Bangladesh
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institute, Sweden
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Eve M Lackritz
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), USA
| | - Tina Lavender
- University of Manchester School of Nursing Midwifery & Social Work, University of Manchester, UK
| | | | | | | | | | - Patrick J McNamara
- Departments of Paediatrics & Physiology, University of Toronto; Physiology & Experimental Medicine program, Hospital for Sick Children, Toronto, Canada
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, the Netherlands
| | | | - G K Mukasa
- International Baby Food Action Network, Uganda
| | - Miriam Mutabazi
- STRIDES for Family Health, Management Sciences for Health, Uganda
| | - Luis Carlos Nacul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Margaret Nakakeeto
- Kampala Children's Hospital Limited and Childhealth Advocacy International, Uganda
| | - Indira Narayanan
- United States Agency for International Development /Maternal and Child Health Integrated Program, USA
| | | | - David Osrin
- Wellcome Trust Senior Research Fellow in Clinical Science, Institute for Global Health, University College London, UK
| | - Vinod Paul
- All India Institute of Medical Sciences, India
| | | | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | - Mathuram Santosham
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, USA
| | | | | | | | - Mary Alice Smith
- Environmental Health Science Department, University of Georgia, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Sajid Soofi
- Department of Pediatrics & Child Health, Women & Child Health Division, Aga Khan University, Pakistan
| | - Catherine Y Spong
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, USA
| | - Shahin Sultana
- National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare, Bangladesh
| | - Antoinette Tshefu
- Kinshasa School of Public Health, School of Medicine, University of Kinshasa, Democratic Republic of Congo
| | - Frank van Bel
- Department of Neonatology, University of Utrecht, the Netherlands
| | | | - Peter Waiswa
- Division of Global Health, Karolinska Institutet, Sweden
| | - Wei Wang
- School of Medical Sciences, Edith Cowan University, Australia and School of Public Health, Capital Medical University, China
| | | | - Linda Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, USA
| | | | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, China
| | - Nanbert Zhong
- Developmental Genetics Laboratory, New York State Institute for Basic Research in Developmental Disabilities, USA
| | | | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Krishnan A, Amarchand R, Gupta V, Lafond KE, Suliankatchi RA, Saha S, Rai S, Misra P, Purakayastha DR, Wahi A, Sreenivas V, Kapil A, Dawood F, Pandav CS, Broor S, Kapoor SK, Lal R, Widdowson MA. Epidemiology of acute respiratory infections in children - preliminary results of a cohort in a rural north Indian community. BMC Infect Dis 2015; 15:462. [PMID: 26502931 PMCID: PMC4624162 DOI: 10.1186/s12879-015-1188-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 10/07/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite acute respiratory infections being a major cause of death among children in developing countries including India, there is a lack of community-based studies that document its burden and aetiology. METHODS A dynamic cohort of children aged 0-10 years was established in four villages in a north Indian state of Haryana from August 2012 onwards. Trained health workers conducted weekly home visits to screen children for acute respiratory infection (ARI) defined as one of the following: cough, sore throat, nasal congestion, earache/discharge, or breathing difficulty. Nurses clinically assessed these children to grade disease severity based on standard age-specific guidelines into acute upper or lower respiratory infection (AURI or ALRI) and collected nasal/throat swabs for pathogen testing. RESULTS Our first year results show that ARI incidence in 0-10 years of age was 5.9 (5.8-6.0) per child-year with minimal gender difference, the ALRI incidence in the under-five age group was higher among boys (0.43; 0.39-0.49) as compared to girls (0.31; 0.26-0.35) per child year. Boys had 2.4 times higher ARI-related hospitalization rate as compared to girls. CONCLUSION ARI impose a significant burden on the children of this cohort. This study platform aims to provide better evidence for prevention and control of pneumonia in developing countries.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | | | - Vivek Gupta
- The INCLEN Trust International, New Delhi, 110020, India.
| | - Kathryn E Lafond
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | | | - Siddhartha Saha
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | - Sanjay Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Puneet Misra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Debjani Ram Purakayastha
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Abhishek Wahi
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Vishnubhatla Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Fatimah Dawood
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | - Chandrakant S Pandav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Shobha Broor
- The INCLEN Trust International, New Delhi, 110020, India.
| | | | - Renu Lal
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
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Berlan D. Pneumonia's second wind? A case study of the global health network for childhood pneumonia. Health Policy Plan 2015; 31 Suppl 1:i33-47. [PMID: 26438780 DOI: 10.1093/heapol/czv070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 02/03/2023] Open
Abstract
Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood mortality and establish a global health network. This article traces the history of this network's formation and evolution to identify lessons for other global health issues. Through document review and interviews with current, former and potential network members, this case study identifies five distinct eras of activity against childhood pneumonia: a period of isolation (post WWII to 1984), the duration of WHO's Acute Respiratory Infections (ARI) Programme (1984-1995), Integrated Management of Childhood illness's (IMCI) early years (1995-2003), a brief period of network re-emergence (2003-2008) and recent accelerating progress (2008 on). Analysis of these eras reveals the critical importance of building a shared identity in order to form an effective network and take advantage of emerging opportunities. During the ARI era, an initial network formed around a relatively narrow shared identity focused on community-level care. The shift to IMCI led to the partial dissolution of this network, stalled progress on addressing pneumonia in communities and missed opportunities. Frustrated with lack of progress on the issue, actors began forming a network and shared identity that included a broad spectrum of those whose interests overlap with pneumonia. As the network coalesced and expanded, its members coordinated and collaborated on conducting and sharing research on severity and tractability, crafting comprehensive strategies and conducting advocacy. These network activities exerted indirect influence leading to increased attention, funding, policies and some implementation.
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Affiliation(s)
- David Berlan
- Florida State University, 650 Bellamy Building, Tallahassee, FL 32306-2250, USA
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Rudan I, Sridhar D. Structure, function and five basic needs of the global health research system. J Glob Health 2015; 6:010505. [PMID: 26401270 PMCID: PMC4576460 DOI: 10.7189/jogh.06.010505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Two major initiatives that were set up to support and co–ordinate global health research efforts have been largely discontinued in recent years: the Global Forum for Health Research and World Health Organization's Department for Research Policy and Cooperation. These developments provide an interesting case study into the factors that contribute to the sustainability of initiatives to support and co–ordinate global health research in the 21st century. Methods We reviewed the history of attempts to govern, support or co–ordinate research in global health. Moreover, we studied the changes and shifts in funding flows attributed to global health research. This allowed us to map the structure of the global health research system, as it has evolved under the increased funding contributions of the past decade. Bearing in mind its structure, core functions and dynamic nature, we proposed a framework on how to effectively support the system to increase its efficiency. Results Based on our framework, which charted the structure and function of the global health research system and exposed places and roles for many stakeholders within the system, five basic needs emerged: (i) to co–ordinate funding among donors more effectively; (ii) to prioritize among many research ideas; (iii) to quickly recognize results of successful research; (iv) to ensure broad and rapid dissemination of results and their accessibility; and (v) to evaluate return on investments in health research. Conclusion The global health research system has evolved rapidly and spontaneously. It has not been optimally efficient, but it is possible to identify solutions that could improve this. There are already examples of effective responses for the need of prioritization of research questions (eg, the CHNRI method), quick recognition of important research (eg, systems used by editors of the leading journals) and rapid and broadly accessible publication of the new knowledge (eg, PLoS One journal as an example). It is still necessary to develop tools that could assist donors to co–ordinate funding and ensure more equity between areas in the provided support, and to evaluate the value for money invested in health research.
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Affiliation(s)
- Igor Rudan
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Devi Sridhar
- Centre for Global Health Research and WHO Collaborating Centre for Population Health Research and Training, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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Rudan I, Yoshida S, Chan KY, Cousens S, Sridhar D, Bahl R, Martines J. Setting health research priorities using the CHNRI method: I. Involving funders. J Glob Health 2015; 6:010301. [PMID: 26401269 PMCID: PMC4576461 DOI: 10.7189/jogh.06.010301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Igor Rudan
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Scotland, UK
| | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Kit Yee Chan
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Scotland, UK
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
| | - Devi Sridhar
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Scotland, UK
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jose Martines
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Head MG, Fitchett JR, Newell ML, Scott JAG, Harris JN, Clarke SC, Atun R. Mapping pneumonia research: A systematic analysis of UK investments and published outputs 1997-2013. EBioMedicine 2015; 2:1193-9. [PMID: 26501117 PMCID: PMC4588381 DOI: 10.1016/j.ebiom.2015.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 01/09/2023] Open
Abstract
Background The burden of pneumonia continues to be substantial, particularly among the poorest in global society. We describe here the trends for UK pneumonia R&D investment and published outputs, and correlate with 2013 global mortality. Methods Data related to awards to UK institutions for pneumonia research from 1997 to 2013 were systematically sourced and categorised by disease area and type of science. Investment was compared to mortality figures in 2010 and 2013 for pneumonia, tuberculosis and influenza. Investment was also compared to publication data. Results Of all infectious disease research between 2011 and 2013 (£917.0 million), £28.8 million (3.1%) was for pneumonia. This was an absolute and proportionate increase from previous time periods. Translational pneumonia research (33.3%) received increased funding compared with 1997–2010 where funding was almost entirely preclinical (87.5%, here 30.9%), but high-burden areas such as paediatrics, elderly care and antimicrobial resistance received little investment. Annual investment remains volatile; publication temporal trends show a consistent increase. When comparing investment to global burden with a novel ‘investment by mortality observed’ metric, tuberculosis (£48.36) and influenza (£484.21) receive relatively more funding than pneumonia (£43.08), despite investment for pneumonia greatly increasing in 2013 compared to 2010 (£7.39). Limitations include a lack of private sector data and the need for careful interpretation of the comparisons with burden, plus categorisation is subjective. Conclusions There has been a welcome increase for pneumonia funding awarded to UK institutions in 2011–2013 compared with 1997–2010, along with increases for more translational research. Published outputs relating to pneumonia rose steadily from 1997 to 2013. Investment relative to mortality for pneumonia has increased, but it remains low compared to other respiratory infections and clear inequities remain. Analyses that measure investments in pneumonia can provide an insight into funding trends and research gaps. Research in context Pneumonia continues to be a high-burden illness around the globe. This paper shows that although research funding is increasing in the UK (between 1997 and 2013), it remains poorly funded compared to other important respiratory infectious diseases such as tuberculosis and influenza. Publications about pneumonia have been steadily increasing over time, indicating continuing academic and clinical interest in the topic. Though global mortality of pneumonia is declining, it should still be an area of high priority for funders, policymakers and researchers. Pneumonia has historically received little research funding in the UK. Pneumonia-related funding is increasing, particularly in translational research. Compared to global burden, pneumonia remains poorly-funded compared to influenza and tuberculosis.
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Affiliation(s)
- Michael G Head
- University College London, Farr Institution for Health Informatics, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Joseph R Fitchett
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK ; Harvard University, Boston, Massachusetts 02115, USA
| | - Marie-Louise Newell
- Faculty of Medicine and Institute of Life Sciences and Global Health Research Institute, University of Southampton, Southampton, United Kingdom
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, LSHTM, Keppel St, WC1E 7HT, United Kingdom ; Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Stuart C Clarke
- Faculty of Medicine and Institute of Life Sciences and Global Health Research Institute, University of Southampton, Southampton, United Kingdom ; University of Southampton Malaysia Campus, Nusajaya, Malaysia ; Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, United Kingdom
| | - Rifat Atun
- Harvard School of Public Health, Harvard University, Boston, USA
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Angood C, McGrath M, Mehta S, Mwangome M, Lung’aho M, Roberfroid D, Perry A, Wilkinson C, Israel AD, Bizouerne C, Haider R, Seal A, Berkley JA, Kerac M. Research priorities to improve the management of acute malnutrition in infants aged less than six months (MAMI). PLoS Med 2015; 12:e1001812. [PMID: 25898252 PMCID: PMC4405387 DOI: 10.1371/journal.pmed.1001812] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
By engaging expert opinion, Marko Kerac and colleagues set research priorities for the management of acute malnutrition in infants.
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Affiliation(s)
- Chloe Angood
- Emergency Nutrition Network, Oxford, United Kingdom
| | | | - Sagar Mehta
- Washington University School of Medicine, St Louis, Missouri, United States of America
| | | | | | - Dominique Roberfroid
- Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Abigail Perry
- Department for International Development, London, United Kingdom
| | - Caroline Wilkinson
- Public Health Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | | | - Rukhsana Haider
- Training & Assistance for Health & Nutrition (TAHN) Foundation, Dhaka, Bangladesh
| | - Andrew Seal
- Institute for Global Health, University College London, London, United Kingdom
| | - James A. Berkley
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Marko Kerac
- Leonard Cheshire Disability & Inclusive Development Centre, University College London, London, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Muro F, Mtove G, Mosha N, Wangai H, Harrison N, Hildenwall H, Schellenberg D, Todd J, Olomi R, Reyburn H. Effect of context on respiratory rate measurement in identifying non-severe pneumonia in African children. Trop Med Int Health 2015; 20:757-65. [PMID: 25728867 PMCID: PMC4642338 DOI: 10.1111/tmi.12492] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Cough or difficult breathing and an increased respiratory rate for their age are the commonest indications for outpatient antibiotic treatment in African children. We aimed to determine whether respiratory rate was likely to be transiently raised by a number of contextual factors in a busy clinic leading to inaccurate diagnosis. Methods Respiratory rates were recorded in children aged 2–59 months presenting with cough or difficulty breathing to one of the two busy outpatient clinics and then repeated at 10‐min intervals over 1 h in a quiet setting. Results One hundred and sixty‐seven children were enrolled with a mean age of 7.1 (SD ± 2.9) months in infants and 27.6 (SD ± 12.8) months in children aged 12–59 months. The mean respiratory rate declined from 42.3 and 33.6 breaths per minute (bpm) in the clinic to 39.1 and 32.6 bpm after 10 min in a quiet room and to 39.2 and 30.7 bpm (P < 0.001) after 60 min in younger and older children, respectively. This resulted in 11/13 (85%) infants and 2/15 (13%) older children being misclassified with non‐severe pneumonia. In a random effects linear regression model, the variability in respiratory rate within children (42%) was almost as much as the variability between children (58%). Changing the respiratory rates cut‐offs to higher thresholds resulted in a small reduction in the proportion of non‐severe pneumonia mis‐classifications in infants. Conclusion Noise and other contextual factors may cause a transient increase in respiratory rate and consequently misclassification of non‐severe pneumonia. However, this effect is less pronounced in older children than infants. Respiratory rate is a difficult sign to measure as the variation is large between and within children. More studies of the accuracy and utility of respiratory rate as a proxy for non‐severe pneumonia diagnosis in a busy clinic are needed.
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Affiliation(s)
- Florida Muro
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Basnet S, Sharma A, Mathisen M, Shrestha PS, Ghimire RK, Shrestha DM, Valentiner-Branth P, Sommerfelt H, Strand TA. Predictors of duration and treatment failure of severe pneumonia in hospitalized young Nepalese children. PLoS One 2015; 10:e0122052. [PMID: 25798907 PMCID: PMC4370861 DOI: 10.1371/journal.pone.0122052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/07/2015] [Indexed: 11/23/2022] Open
Abstract
Background Pneumonia in young children is still the most frequent cause of death in developing countries. We aimed to identify predictors for recovery and treatment failure in children hospitalized with severe pneumonia. Methods We enrolled 610 Nepalese children, aged 2 – 35 months from February 2006 to June 2008. Study participants were provided with standard treatment for pneumonia and followed up until discharge. Three multiple regression models representing clinical variables, clinical and radiological combined and all variables, including C-reactive protein (CRP) and viral etiology were used to assess the associations. Results The median age of study participants was 6 months with 493 (82%) infants and 367 (61%) males. The median time (IQR) till recovery was 49 (31, 87) hours and treatment failure was experienced by 209 (35%) of the children. Younger age, hypoxia on admission and radiographic pneumonia were independent predictors for both prolonged recovery and risk of treatment failure. While wasting and presence of any danger sign also predicted slower recovery, Parainfluenza type 1 isolated from the nasopharynx was associated with earlier resolution of illness. Gender, being breastfed, stunting, high fever, elevated CRP, presence of other viruses and supplementation with oral zinc did not show any significant association with these outcomes. Conclusion Age, hypoxia and consolidation on chest radiograph were significant predictors for time till recovery and treatment failure in children with severe pneumonia. While chest radiograph is not always needed, detection and treatment of hypoxia is a crucial step to guide the management of hospitalized children with pneumonia.
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Affiliation(s)
- Sudha Basnet
- Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Centre for International Health and Centre for Intervention Science in Maternal and Child health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Arun Sharma
- Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Maria Mathisen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromso, Norway
| | | | - Ram Kumar Ghimire
- Department of Radiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Dhiraj Man Shrestha
- Department of Radiology, Kathmandu Medical College and Teaching Hospital, Kathmandu University, Nepal
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark
| | - Halvor Sommerfelt
- Centre for International Health and Centre for Intervention Science in Maternal and Child health, University of Bergen, Bergen, Norway
- Department of International Public Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - Tor A. Strand
- Centre for International Health and Centre for Intervention Science in Maternal and Child health, University of Bergen, Bergen, Norway
- Division of Medical Services, Innlandet Hospital Trust, Lillehammer, Norway
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Breiman RF, Cosmas L, Njenga M, Williamson J, Mott JA, Katz MA, Erdman DD, Schneider E, Oberste M, Neatherlin JC, Njuguna H, Ondari DM, Odero K, Okoth GO, Olack B, Wamola N, Montgomery JM, Fields BS, Feikin DR. Severe acute respiratory infection in children in a densely populated urban slum in Kenya, 2007-2011. BMC Infect Dis 2015; 15:95. [PMID: 25879805 PMCID: PMC4351931 DOI: 10.1186/s12879-015-0827-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/11/2015] [Indexed: 12/17/2022] Open
Abstract
Background Reducing acute respiratory infection burden in children in Africa remains a major priority and challenge. We analyzed data from population-based infectious disease surveillance for severe acute respiratory illness (SARI) among children <5 years of age in Kibera, a densely populated urban slum in Nairobi, Kenya. Methods Surveillance was conducted among a monthly mean of 5,874 (range = 5,778-6,411) children <5 years old in two contiguous villages in Kibera. Participants had free access to the study clinic and their health events and utilization were noted during biweekly home visits. Patients meeting criteria for SARI (WHO-defined severe or very severe pneumonia, or oxygen saturation <90%) from March 1, 2007-February 28, 2011 had blood cultures processed for bacteria, and naso- and oro- pharyngeal swabs collected for quantitative real-time reverse transcription polymerase chain reaction testing for influenza viruses, parainfluenza viruses (PIV), respiratory syncytial virus (RSV), adenovirus, and human metapneumovirus (hMPV). Swabs collected during January 1, 2009 – February 28, 2010 were also tested for rhinoviruses, enterovirus, parechovirus, Mycoplasma pneumoniae, and Legionella species. Swabs were collected for simultaneous testing from a selected group of control-children visiting the clinic without recent respiratory or diarrheal illnesses. Results SARI overall incidence was 12.4 cases/100 person-years of observation (PYO) and 30.4 cases/100 PYO in infants. When comparing detection frequency in swabs from 815 SARI cases and 115 healthy controls, only RSV and influenza A virus were significantly more frequently detected in cases, although similar trends neared statistical significance for PIV, adenovirus and hMPV. The incidence for RSV was 2.8 cases/100 PYO and for influenza A was 1.0 cases/100 PYO. When considering all PIV, the rate was 1.1 case/100 PYO and the rate per 100 PYO for SARI-associated disease was 1.5 for adenovirus and 0.9 for hMPV. RSV and influenza A and B viruses were estimated to account for 16.2% and 6.7% of SARI cases, respectively; when taken together, PIV, adenovirus, and hMPV may account for >20% additional cases. Conclusions Influenza viruses and RSV (and possibly PIV, hMPV and adenoviruses) are important pathogens to consider when developing technologies and formulating strategies to treat and prevent SARI in children.
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Sonego M, Pellegrin MC, Becker G, Lazzerini M. Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies. PLoS One 2015; 10:e0116380. [PMID: 25635911 PMCID: PMC4312071 DOI: 10.1371/journal.pone.0116380] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/06/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries. DESIGN Systematic review and meta-analysis. STUDY SELECTION Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries. DATA SOURCES Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014. RISK OF BIAS ASSESSMENT Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. RESULTS Out of 10,655 papers retrieved, 77 studies from 39 countries (198,359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37‒13.92); age below two months (5.22, 1.70‒16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67‒8.61), chronic underlying diseases (4.76, 3.27‒6.93); HIV/AIDS (4.68, 3.72‒5.90); and severe malnutrition (OR 4.27, 3.47‒5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03‒3.31); low maternal education (1.43, 1.13‒1.82); low socio-economic status (1.62, 1.32‒2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11‒4.31). Immunisation (0.46, 0.36‒0.58) and good antenatal practices (0.50, 0.31‒0.81) were associated with decreased odds of death. CONCLUSIONS Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.
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Affiliation(s)
- Michela Sonego
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery, and Health Science, University of Trieste, Trieste, Italy
| | - Maria Chiara Pellegrin
- Department of Medicine, Surgery, and Health Science, University of Trieste, Trieste, Italy
| | - Genevieve Becker
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- * E-mail:
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Wazny K, Sadruddin S, Zipursky A, Hamer DH, Jacobs T, Kallander K, Pagnoni F, Peterson S, Qazi S, Raharison S, Ross K, Young M, Marsh DR. Setting global research priorities for integrated community case management (iCCM): Results from a CHNRI (Child Health and Nutrition Research Initiative) exercise. J Glob Health 2014; 4:020413. [PMID: 25520803 PMCID: PMC4267102 DOI: 10.7189/jogh.04.020413] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims To systematically identify global research gaps and resource priorities for integrated community case management (iCCM). Methods An iCCM Child Health and Nutrition Research Initiative (CHNRI) Advisory Group, in collaboration with the Community Case Management Operational Research Group (CCM ORG) identified experts to participate in a CHNRI research priority setting exercise. These experts generated and systematically ranked research questions for iCCM. Research questions were ranked using a “Research Priority Score” (RPS) and the “Average Expert Agreement” (AEA) was calculated for every question. Our groups of experts were comprised of both individuals working in Ministries of Health or Non Governmental Organizations (NGOs) in low– and middle–income countries (LMICs) and individuals working in high–income countries (HICs) in academia or NGO headquarters. A Spearman’s Rho was calculated to determine the correlation between the two groups’ research questions’ ranks. Results The overall RPS ranged from 64.58 to 89.31, with a median score of 81.43. AEA scores ranged from 0.54 to 0.86. Research questions involving increasing the uptake of iCCM services, research questions concerning the motivation, retention, training and supervision of Community Health Workers (CHWs) and concerning adding additional responsibilities including counselling for infant and young child feeding (IYCF) and treatment of severe acute malnutrition (SAM) ranked highly. There was weak to moderate, statistically significant, correlation between scores by representatives of high–income countries and those working in–country or regionally (Spearman’s ρ = 0.35034, P < 0.01). Conclusions Operational research to determine optimal training, supervision and modes of motivation and retention for the CHW is vital for improving iCCM, globally, as is research to motivate caregivers to take advantage of iCCM services. Experts working in–country or regionally in LMICs prioritized different research questions than those working in organization headquarters in HICs. Further exploration is needed to determine the nature of this divergence.
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Affiliation(s)
- Kerri Wazny
- Centre for Global Child Health, the Hospital for Sick Children, Toronto, Canada
| | | | - Alvin Zipursky
- Programme for Global Paediatric Research, the Hospital for Sick Children, Toronto, Canada
| | - Davidson H Hamer
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia ; Center for Global Health and Development, Boston University, Boston, MA, USA ; Department of International Health, Boston University School of Public Health, Boston, MA, USA
| | - Troy Jacobs
- Global Health Bureau, United States Agency for International Development, Washington DC, USA
| | - Karin Kallander
- Malaria Consortium, London, UK ; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden ; Makerere University School of Public Health, Kampala, Uganda
| | - Franco Pagnoni
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Stefan Peterson
- Makerere University School of Public Health, Kampala, Uganda ; International Women's and Children's Health, Uppsala University, Sweden ; Global Health, Karolinska Institutet, Sweden
| | - Shamim Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Serge Raharison
- John Snow, Inc., Washington DC, USA ; Maternal and Child Health Integrated Project (MCHIP), Washington, DC, USA
| | - Kerry Ross
- John Snow, Inc., Washington DC, USA ; Maternal and Child Health Integrated Project (MCHIP), Washington, DC, USA
| | - Mark Young
- Programme Division, United Nations Children's Fund, New York, USA
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Holdsworth M, Kruger A, Nago E, Lachat C, Mamiro P, Smit K, Garimoi-Orach C, Kameli Y, Roberfroid D, Kolsteren P. African stakeholders' views of research options to improve nutritional status in sub-Saharan Africa. Health Policy Plan 2014; 30:863-74. [PMID: 25124084 DOI: 10.1093/heapol/czu087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Setting research priorities for improving nutrition in Africa is currently ad hoc and there is a need to shift the status quo in the light of slow progress in reducing malnutrition. This study explored African stakeholders' views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years. METHODS Using Multi-Criteria Mapping, quantitative and qualitative data were gathered from 91 stakeholders representing 6 stakeholder groups (health professionals, food Industry, government, civil society, academics and research funders) in Benin, Mozambique, South Africa, Tanzania, Togo and Uganda. Stakeholders appraised six research options (ecological nutrition, nutritional epidemiology, community nutrition interventions, behavioural nutrition, clinical nutrition and molecular nutrition) for how well they could address malnutrition in Africa. RESULTS Impact (28.3%), research efficacy (23.6%) and social acceptability (22.4%) were the criteria chosen the most to evaluate the performance of research options. Research on the effectiveness of community interventions was seen as a priority by stakeholders because they were perceived as likely to have an impact relatively quickly, were inexpensive and cost-effective, involved communities and provided direct evidence of what works. Behavioural nutrition research was also highly appraised. Many stakeholders, particularly academics and government were optimistic about the value of ecological nutrition research (the impact of environmental change on nutritional status). Research funders did not share this enthusiasm. Molecular nutrition was least preferred, considered expensive, slow to have an impact and requiring infrastructure. South Africa ranked clinical and molecular nutrition the highest of all countries. CONCLUSION Research funders should redirect research funds in Africa towards the priorities identified by giving precedence to develop the evidence for effective community nutrition interventions. Expanding research funding in behavioural and ecological nutrition was also valued and require multi-disciplinary collaborations between nutritionists, social scientists, agricultural and climate change scientists.
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Affiliation(s)
- Michelle Holdsworth
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK,
| | - Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research, North West University, Potchefstroom, South Africa
| | - Eunice Nago
- Faculté des Sciences Agronomiques, University of Abomey-Calavi, Cotonou, Benin
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium, Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Peter Mamiro
- Department of Food Science and Technology, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Karlien Smit
- Africa Unit for Transdisciplinary Health Research, North West University, Potchefstroom, South Africa
| | | | - Yves Kameli
- Research Unit 'NUTRIPASS', Institute of Research for Development, Montpellier, France
| | - Dominique Roberfroid
- Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium, Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Souza JP, Widmer M, Gülmezoglu AM, Lawrie TA, Adejuyigbe EA, Carroli G, Crowther C, Currie SM, Dowswell T, Hofmeyr J, Lavender T, Lawn J, Mader S, Martinez FE, Mugerwa K, Qureshi Z, Silvestre MA, Soltani H, Torloni MR, Tsigas EZ, Vowles Z, Ouedraogo L, Serruya S, Al-Raiby J, Awin N, Obara H, Mathai M, Bahl R, Martines J, Ganatra B, Phillips SJ, Johnson BR, Vogel JP, Oladapo OT, Temmerman M. Maternal and perinatal health research priorities beyond 2015: an international survey and prioritization exercise. Reprod Health 2014; 11:61. [PMID: 25100034 PMCID: PMC4132282 DOI: 10.1186/1742-4755-11-61] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/22/2014] [Indexed: 11/22/2022] Open
Abstract
Background Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the 2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required. Methods We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international stakeholders constituting a large reference group, and consolidated into a final list of research questions by a technical working group. Questions on this list were then scored by the reference working group according to five independent and equally weighted criteria. Normalized research priority scores (NRPS) were calculated, and research priority questions were ranked accordingly. Results A list of 190 priority research questions for improving maternal and perinatal health was scored by 140 stakeholders. Most priority research questions (89%) were concerned with the evaluation of implementation and delivery of existing interventions, with research subthemes frequently concerned with training and/or awareness interventions (11%), and access to interventions and/or services (14%). Twenty-one questions (11%) involved the discovery of new interventions or technologies. Conclusions Key research priorities in maternal and perinatal health were identified. The resulting ranked list of research questions provides a valuable resource for health research investors, researchers and other stakeholders. We are hopeful that this exercise will inform the post-2015 Development Agenda and assist donors, research-policy decision makers and researchers to invest in research that will ultimately make the most significant difference in the lives of mothers and babies.
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Affiliation(s)
- Joao Paulo Souza
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Affiliation(s)
- Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva 1211, Switzerland
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Edinburgh, UK
| | - Joy E Lawn
- MARCH (Maternal Reproductive & Child Health), London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, DC, USA
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Brazil
| | - José Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva 1211, Switzerland.
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Morof DF, Kerber K, Tomczyk B, Lawn J, Blanton C, Sami S, Amsalu R. Neonatal survival in complex humanitarian emergencies: setting an evidence-based research agenda. Confl Health 2014; 8:8. [PMID: 24959198 PMCID: PMC4057580 DOI: 10.1186/1752-1505-8-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Over 40% of all deaths among children under 5 are neonatal deaths (0-28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Many of the countries with the highest neonatal mortality rates globally are currently or have recently been affected by complex humanitarian emergencies. Despite the global burden of neonatal morbidity and mortality and risks inherent in complex emergency situations, research investments are not commensurate to burden and little is known about the epidemiology or best practices for neonatal survival in these settings. METHODS We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research questions on neonatal health in complex humanitarian emergencies. Experts evaluated 35 questions using four criteria (answerability, feasibility, relevance, equity) with three subcomponents per criterion. Using SAS 9.2, a research prioritization score (RPS) and average expert agreement score (AEA) were calculated for each question. RESULTS Twenty-eight experts evaluated all 35 questions. RPS ranged from 0.846 to 0.679 and the AEA ranged from 0.667 to 0.411. The top ten research priorities covered a range of issues but generally fell into two categories- epidemiologic and programmatic components of neonatal health. The highest ranked question in this survey was "What strategies are effective in increasing demand for, and use of skilled attendance?" CONCLUSIONS In this study, a diverse group of experts used the CHRNI methodology to systematically identify and determine research priorities for neonatal health and survival in complex humanitarian emergencies. The priorities included the need to better understand the magnitude of the disease burden and interventions to improve neonatal health in complex humanitarian emergencies. The findings from this study will provide guidance to researchers and program implementers in neonatal and complex humanitarian fields to engage on the research priorities needed to save lives most at risk.
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Affiliation(s)
- Diane F Morof
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-74, Atlanta, GA 30341, USA
| | - Kate Kerber
- Saving Newborn Lives, Save the Children, 28 Lower Main Road, Observatory 7925, South Africa
- University of the Western Cape, Bellville 7535, South Africa
| | - Barbara Tomczyk
- Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA
| | - Joy Lawn
- Epidemiology, London School of Hygiene and Tropical Medicine, Global Evidence and Policy, Saving Newborn Lives, Save the Children, Keppel Street, London WCIE-7HT, UK
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA
| | - Samira Sami
- Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA
| | - Ribka Amsalu
- Save the Children, 54 Wilton Road, Westport, CT 06880, USA
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Geldsetzer P, Williams TC, Kirolos A, Mitchell S, Ratcliffe LA, Kohli-Lynch MK, Bischoff EJL, Cameron S, Campbell H. The recognition of and care seeking behaviour for childhood illness in developing countries: a systematic review. PLoS One 2014; 9:e93427. [PMID: 24718483 PMCID: PMC3981715 DOI: 10.1371/journal.pone.0093427] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/06/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers. METHODS AND FINDINGS We conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low. CONCLUSIONS Given the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health & Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Thomas Christie Williams
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Amir Kirolos
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Mitchell
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Louise Alison Ratcliffe
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Maya Kate Kohli-Lynch
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Esther Jill Laura Bischoff
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sophie Cameron
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Harry Campbell
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Bruce N, Pope D, Arana B, Shiels C, Romero C, Klein R, Stanistreet D. Determinants of care seeking for children with pneumonia and diarrhea in Guatemala: implications for intervention strategies. Am J Public Health 2014; 104:647-57. [PMID: 24524510 PMCID: PMC4025722 DOI: 10.2105/ajph.2013.301658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We identified barriers to care seeking for pneumonia and diarrhea among rural Guatemalan children. METHODS A population-based survey was conducted twice from 2008 to 2009 among 1605 households with children younger than 5 years. A 14-day calendar recorded episodes of carer-reported pneumonia (n = 364) and diarrhea (n = 481), and formal (health services, public, private) and informal (neighbors, traditional, local shops, pharmacies) care seeking. RESULTS Formal care was sought for nearly half of severe pneumonias but only for 27% within 2 days of onset, with 31% and 18%, respectively, for severe diarrhea. In multivariable analysis, factors independently associated with formal care seeking were knowing the Community Emergency Plan, mother's perception of illness severity, recognition of World Health Organization danger signs, distance from the health center, and having someone to care for family in an emergency. CONCLUSIONS Proximal factors associated with recognizing need for care were important in determining formal care, and were strongly linked to social determinants. In addition to specific action by the health system with an enhanced community health worker role, a systems approach can help ensure barriers are addressed among poorer and more remote homes.
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Affiliation(s)
- Nigel Bruce
- Nigel Bruce, Daniel Pope, Christopher Shiels, and Debbi Stanistreet are with the Department of Public Health and Policy, University of Liverpool, Liverpool, UK. At the time of the study, Byron Arana, Carolina Romero, and Robert Klein were with the Center for Health Studies, University del Valle, Guatemala City, Guatemala
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Goyet S, Vlieghe E, Kumar V, Newell S, Moore CE, Bousfield R, Leang HC, Chuop S, Thong P, Rammaert B, Hem S, van Griensven J, Rachmat A, Fassier T, Lim K, Tarantola A. Etiologies and resistance profiles of bacterial community-acquired pneumonia in Cambodian and neighboring countries' health care settings: a systematic review (1995 to 2012). PLoS One 2014; 9:e89637. [PMID: 24626053 PMCID: PMC3953073 DOI: 10.1371/journal.pone.0089637] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/21/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Community-acquired pneumonia (CAP) is one of the most important causes of morbidity and mortality worldwide. Etiological data for Cambodia is scarce. We aimed to describe the main etiological agents causing CAP, and their resistance patterns in Cambodia and the greater Mekong region. METHODS A review of bacterial etiologies of CAP and antimicrobial resistance in Cambodia and neighboring countries was conducted via: (1) a systematic review of published literature in all NCBI databases using Pubmed, Google scholar, EMBASE, the World Health Organization and the Cambodian Ministry of Health libraries; (2) a review of unpublished data from Cambodia provided by national and international stakeholders working at different tiers of the healthcare system. RESULTS Twenty three articles and five data sources reported etiologies for 5919 CAP patients diagnosed between May 1995 and December 2012, including 1421 (24.0%), 3571 (60.3%) and 927 (15.7%) from Cambodia, Thailand and Vietnam, respectively. Streptococcus pneumoniae and Haemophilus influenzae were the most common pathogens ranking among the five most prevalent in 12 and 10 studies, respectively. Gram-negative bacteria such as Burkholderia pseudomallei and Klebsiella pneumoniae were also frequently diagnosed, particularly in bacteremic CAP in Thai adults and Cambodian children. In Thailand and Vietnam, Mycoplasma pneumoniae and Chlamydia pneumoniae were frequently identified in settings using indirect laboratory testing. CONCLUSIONS Based on this analysis, CAP data in Cambodia seems to present etiological and resistance profiles comparable to those of neighboring countries. Findings have been shared with the national authorities upon the revision of the national therapeutic guidelines and were disseminated using a specially created website.
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Affiliation(s)
- Sophie Goyet
- Epidemiology unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Varun Kumar
- Angkor Hospital for Children, Siem Reap, Cambodia
| | | | - Catrin E. Moore
- Angkor Hospital for Children, Siem Reap, Cambodia
- Wellcome Trust Major Overseas Programme, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom
| | - Rachel Bousfield
- Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom
| | - Heng C. Leang
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Sokheng Chuop
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Phe Thong
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Blandine Rammaert
- Hopital Necker-Enfants malades service des Maladies Infectieuses et Tropicales, APHP, Paris, France
| | - Sopheak Hem
- Epidemiology unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Johan van Griensven
- Institute of Tropical Medicine, Antwerp, Belgium
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Agus Rachmat
- Naval Medical Research Unit2, Phnom Penh, Cambodia
| | - Thomas Fassier
- University of Health Sciences, Faculty of Medicine, Phnom Penh, Cambodia
| | - Kruy Lim
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Arnaud Tarantola
- Epidemiology unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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L-plastin is essential for alveolar macrophage production and control of pulmonary pneumococcal infection. Infect Immun 2014; 82:1982-93. [PMID: 24595139 DOI: 10.1128/iai.01199-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report that mice deficient for the hematopoietic-specific, actin-bundling protein L-plastin (LPL) succumb rapidly to intratracheal pneumococcal infection. The increased susceptibility of LPL(-/-) mice to pulmonary pneumococcal challenge correlated with reduced numbers of alveolar macrophages, consistent with a critical role for this cell type in the immediate response to pneumococcal infection. LPL(-/-) mice demonstrated a very early clearance defect, with an almost 10-fold-higher bacterial burden in the bronchoalveolar lavage fluid 3 h following infection. Clearance of pneumococci from the alveolar space in LPL(-/-) mice was defective compared to that in Rag1(-/-) mice, which lack all B and T lymphocytes, indicating that innate immunity is defective in LPL(-/-) mice. We did not identify defects in neutrophil or monocyte recruitment or in the production of inflammatory cytokines or chemokines that would explain the early clearance defect. However, efficient alveolar macrophage regeneration following irradiation required LPL. We thus identify LPL as being key to alveolar macrophage development and essential to an effective antipneumococcal response. Further analysis of LPL(-/-) mice will illuminate critical regulators of the generation of alveolar macrophages and, thus, effective pulmonary innate immunity.
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Qin Q, Xu B, Liu X, Shen K. Status of <i>Mycoplasma pneumoniae</i> Pneumonia in Chinese Children: A Systematic Review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/aim.2014.411076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ali M, Seuc A, Rahimi A, Festin M, Temmerman M. A global research agenda for family planning: results of an exercise for setting research priorities. Bull World Health Organ 2013; 92:93-8. [PMID: 24623902 DOI: 10.2471/blt.13.122242] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 08/09/2013] [Accepted: 09/23/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To develop a global research agenda that will guide investment in effective interventions to satisfy the large unmet need for modern methods of family planning. METHODS In a global survey, experts on contraception were invited to identify and rank the types of research that would be needed--and the knowledge gaps that would have to be filled--to reduce the unmet need for family planning in the next decade. The experts were then asked to score the research on a given topic in terms of the likelihood of its leading to an intervention that would: (i) be deliverable, affordable and sustainable; (ii) substantially reduce the unmet need for contraceptives; (iii) be effective and efficient in improving health systems; (iv) be ethically implemented; and (v) improve equity in the target population. The overall scores were then ranked. FINDINGS Most of the topics that received the 15 highest scores fell into three categories: implementation of policies in family planning; the integration of services to address barriers to contraceptive use; and interventions targeted at underserved groups, such as adolescents. CONCLUSION Experts on contraception gave top priority ranking to research on improving the implementation and integration of health services and on strengthening the health systems supporting family planning services. The results of the exercise may help decision-makers, researchers and funding agencies to develop a clear and focused approach to satisfying the global need for family planning and reach the target set by the Family Planning 2020 initiative.
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Affiliation(s)
- Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Armando Seuc
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Asma Rahimi
- Charité-Berlin School of Public Health, Berlin, Germany
| | - Mario Festin
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Marleen Temmerman
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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Rudan I, Nair H, Marušić A, Campbell H. Reducing mortality from childhood pneumonia and diarrhoea: The leading priority is also the greatest opportunity. J Glob Health 2013; 3:010101. [PMID: 23826497 PMCID: PMC3700027 DOI: 10.7189/jogh.03.010101] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Pneumonia and diarrhoea have been the leading causes of global child mortality for many decades. The work of Child Health Epidemiology Reference Group (CHERG) has been pivotal in raising awareness that the UN's Millennium Development Goal 4 cannot be achieved without increased focus on preventing and treating the two diseases in low– and middle–income countries. Global Action Plan for Pneumonia (GAPP) and Diarrhoea Global Action Plan (DGAP) groups recently concluded that addressing childhood pneumonia and diarrhoea is not only the leading priority but also the greatest opportunity in global health today: scaling up of existing highly cost–effective interventions could prevent 95% of diarrhoea deaths and 67% of pneumonia deaths in children younger than 5 years by the year 2025. The cost of such effort was estimated at about US$ 6.7 billion.
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Affiliation(s)
- Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, University of Edinburgh Medical School, Scotland, UK
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Bhutta ZA, Zipursky A, Wazny K, Levine MM, Black RE, Bassani DG, Shantosham M, Freedman SB, Grange A, Kosek M, Keenan W, Petri W, Campbell H, Rudan I. Setting priorities for development of emerging interventions against childhood diarrhoea. J Glob Health 2013; 3:010302. [PMID: 23826502 PMCID: PMC3700035 DOI: 10.7189/jogh.03.010302] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Zulfiqar A Bhutta
- Program for Global Pediatric Research, the Hospital for Sick Children, Toronto, Canada ; Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Griffiths UK, Clark A, Hajjeh R. Cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in low- and middle-income countries: regional analysis and assessment of major determinants. J Pediatr 2013; 163:S50-S59.e9. [PMID: 23773595 PMCID: PMC5749634 DOI: 10.1016/j.jpeds.2013.03.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To estimate the cost-effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccine in low- and middle-income countries and identify the model variables, which are most important for the result. STUDY DESIGN A static decision tree model was developed to predict incremental costs and health impacts. Estimates were generated for 4 country groups: countries eligible for funding by the GAVI Alliance in Africa and Asia, lower middle-income countries, and upper middle-income countries. Values, including disease incidence, case fatality rates, and treatment costs, were based on international country estimates and the scientific literature. RESULTS From the societal perspective, it is estimated that the probability of Hib conjugate vaccine cost saving is 34%-53% in Global Alliance for Vaccines and Immunization eligible African and Asian countries, respectively. In middle-income countries, costs per discounted disability adjusted life year averted are between US$37 and US$733. Variation in vaccine prices and risks of meningitis sequelae and mortality explain most of the difference in results. For all country groups, disease incidence cause the largest part of the uncertainty in the result. CONCLUSIONS Hib conjugate vaccine is cost saving or highly cost-effective in low- and middle-income settings. This conclusion is especially influenced by the recent decline in Hib conjugate vaccine prices and new data revealing the high costs of lost productivity associated with meningitis sequelae.
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Affiliation(s)
- Ulla Kou Griffiths
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine London, United Kingdom.
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Respiratory and Systemic Infections in Children with Severe Aplastic Anemia on Immunosuppressive Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 788:417-25. [DOI: 10.1007/978-94-007-6627-3_57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Wazny K, Zipursky A, Black R, Curtis V, Duggan C, Guerrant R, Levine M, Petri WA, Santosham M, Scharf R, Sherman PM, Simpson E, Young M, Bhutta ZA. Setting research priorities to reduce mortality and morbidity of childhood diarrhoeal disease in the next 15 years. PLoS Med 2013; 10:e1001446. [PMID: 23690756 PMCID: PMC3653794 DOI: 10.1371/journal.pmed.1001446] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Zulfi Bhutta and colleagues lay out research priorities for global child diarrheal disease over the next 15 years, which they developed using the Child Health and Nutrition Research Initiative (CHNRI) method. Please see later in the article for the Editors' Summary
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Affiliation(s)
- Kerri Wazny
- Programme for Global Paediatric Research, the Hospital for Sick Children, Toronto, Canada
| | - Alvin Zipursky
- Programme for Global Paediatric Research, the Hospital for Sick Children, Toronto, Canada
| | - Robert Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Valerie Curtis
- Hygiene Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher Duggan
- Center for Nutrition, Division of GI/Nutrition, Boston Children's Hospital, Boston, United States of America
| | - Richard Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, United States of America
| | - Myron Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, United States of America
| | - William A. Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, United States of America
| | - Mathuram Santosham
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Rebecca Scharf
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, United States of America
| | - Philip M. Sherman
- Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes, Toronto, Canada
| | | | - Mark Young
- Programme Division, United Nations Children's Fund, New York, United States of America
| | - Zulfiqar A. Bhutta
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
- Global Child Health, the Hospital for Sick Children, Toronto, Canada
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Chopra M, Mason E, Borrazzo J, Campbell H, Rudan I, Liu L, Black RE, Bhutta ZA. Ending of preventable deaths from pneumonia and diarrhoea: an achievable goal. Lancet 2013; 381:1499-506. [PMID: 23582721 DOI: 10.1016/s0140-6736(13)60319-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Global under-5 mortality has fallen rapidly from 12 million deaths in 1990, to 6·9 million in 2011; however, this number still falls short of the target of a two-thirds reduction or a maximum of 4 million deaths by 2015. Acceleration of reductions in deaths due to pneumonia and diarrhoea, which together account for about 2 million child deaths every year, is essential if the target is to be met. Scaling up of existing interventions against the two diseases to 80% and immunisation to 90% would eliminate more than two-thirds of deaths from these two diseases at a cost of US$6·715 billion by 2025. Modelling in this report shows that if all countries could attain the rates of decline of the regional leaders, then cause-specific death rates of fewer than three deaths per 1000 livebirths from pneumonia and less than one death per 1000 livebirths from diarrhoea could be achieved by 2025. These rates are those at which preventable deaths have been avoided. Increasing of awareness of the size of the problem; strengthening of leadership, intersectoral collaboration, and resource mobilisation; and increasing of efficiency through the selection of the optimum mix of a growing set of cost-effective interventions depending on local contexts are the priority actions needed to achieve the goal of ending preventable deaths from pneumonia and diarrhoea by 2025.
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Affiliation(s)
- Michael S Niederman
- Department of Medicine, State University of New York at Stony Brook, Winthrop-University Hospital, Mineola, NY 11501, USA.
| | - Leonard R Krilov
- Department of Pediatrics, State University of New York at Stony Brook, Winthrop-University Hospital, Mineola, NY 11501, 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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Abstract
This month, on November 12, the world will recognize the fourth annual World Pneumonia Day. First launched in 2009 by a coalition of global health leaders (1), World Pneumonia Day aims to raise awareness about pneumonia's toll on the world's children and to promote interventions to protect against, treat, and prevent the disease. Pneumonia continues to be the leading killer of young children around the world, causing ≈14% of all deaths in children 1 month to 5 years of age (2). It is a critical disease for countries to conquer in order to reach Millennium Development Goal 4: reducing the child mortality rate by two thirds from 1990 to 2015 (3). Most children who die from pneumonia live in developing countries, where such factors as malnutrition, crowding, and lack of access to quality health care increase the risk for death. Pneumonia kills few children in industrialized countries, although it remains among the top 10 causes of deaths in the United States, for example, because of deaths in older adults (4).
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Affiliation(s)
- Rana Hajjeh
- Centers for Disease Control and Prevention, Atlanta,GA 30333, USA.
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Dean S, Rudan I, Althabe F, Webb Girard A, Howson C, Langer A, Lawn J, Reeve ME, Teela KC, Toledano M, Venkatraman CM, Belizan JM, Car J, Chan KY, Chatterjee S, Chitekwe S, Doherty T, Donnay F, Ezzati M, Humayun K, Jack B, Lassi ZS, Martorell R, Poortman Y, Bhutta ZA. Setting research priorities for preconception care in low- and middle-income countries: aiming to reduce maternal and child mortality and morbidity. PLoS Med 2013; 10:e1001508. [PMID: 24019762 PMCID: PMC3760783 DOI: 10.1371/journal.pmed.1001508] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Sohni Dean and colleagues report their CHNRI exercise that developed health research priorities for effective pre-conception care in low- and middle-income countries. Please see later in the article for the Editors' Summary
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Affiliation(s)
- Sohni Dean
- Division of Women & Child Health, the Aga Khan University, Karachi, Pakistan
| | - Igor Rudan
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, United Kingdom
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Aimee Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, United States of America
| | - Christopher Howson
- Global Programs, March of Dimes Foundation, White Plains, United States of America
| | - Ana Langer
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Boston, United States of America
| | - Joy Lawn
- Saving Newborn Lives- Save The Children, Cape Town, South Africa
| | - Mary-Elizabeth Reeve
- Global Programs, March of Dimes Foundation, White Plains, United States of America
| | - Katherine C. Teela
- Global Health Program, Bill and Melinda Gates Foundation, Seattle, United States of America
| | - Mireille Toledano
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | | | - José M. Belizan
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Josip Car
- Global eHealth Unit, Imperial College, London, United Kingdom
| | - Kit Yee Chan
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, United Kingdom
- Nossal Institute of Global Health, University of Melbourne, Melbourne, Australia
| | - Subidita Chatterjee
- Virtual Institute for Advancement of Women, Children and Young People, India and Thailand
| | | | - Tanya Doherty
- Health Systems Research Unit, Medical Research Council, South Africa and School of Public Health, University of the Western Cape, South Africa
| | - France Donnay
- Global Health Program, Bill and Melinda Gates Foundation, Seattle, United States of America
| | - Majid Ezzati
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Khadija Humayun
- Division of Women & Child Health, the Aga Khan University, Karachi, Pakistan
| | - Brian Jack
- Department of Family Medicine, Boston University, Boston, United States of America
| | - Zohra S. Lassi
- Division of Women & Child Health, the Aga Khan University, Karachi, Pakistan
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, United States of America
| | - Ysbrand Poortman
- International Genetic Alliance of parent and patient organizations and Preparing for Life, the Netherlands
| | - Zulfiqar A. Bhutta
- Division of Women & Child Health, the Aga Khan University, Karachi, Pakistan
- * E-mail:
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Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment. PLoS Med 2013; 10:e1001421. [PMID: 23667338 PMCID: PMC3646212 DOI: 10.1371/journal.pmed.1001421] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. Progress in improving the global coverage of antibiotic treatment is monitored through large household surveys such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), which estimate antibiotic treatment rates of pneumonia based on two-week recall of pneumonia by caregivers. However, these survey tools identify children with reported symptoms of pneumonia, and because the prevalence of pneumonia over a two-week period in community settings is low, the majority of these children do not have true pneumonia and so do not provide an accurate denominator of pneumonia cases for monitoring antibiotic treatment rates. In this review, we show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity. However, even at a test specificity of 95% (and a test sensitivity of 80%), the proportion of children with reported symptoms of pneumonia who truly have pneumonia is only 22% (the positive predictive value of the survey tool). Thus, although DHS and MICS survey data on rates of care seeking for children with reported symptoms of pneumonia and other childhood illnesses remain valid and important, DHS and MICS data are not able to give valid estimates of antibiotic treatment rates in children with pneumonia.
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Sreeramareddy CT, Sathyanarayana TN, Kumar HNH. Utilization of health care services for childhood morbidity and associated factors in India: a national cross-sectional household survey. PLoS One 2012; 7:e51904. [PMID: 23284810 PMCID: PMC3526528 DOI: 10.1371/journal.pone.0051904] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 11/07/2012] [Indexed: 11/19/2022] Open
Abstract
Background Information about utilization of health services and associated factors are useful for improving service delivery to achieve universal health coverage. Methods Data on a sample of ever-married women from India Demographic and Health survey 2005–06 was used. Mothers of children aged 0–59 months were asked about child’s illnesses and type of health facilities where treatment was given during 15 days prior to the survey date. Type of health facilities were grouped as informal provider, public provider and private provider. Factors associated with utilization of health services for diarrhea and fever/cough was assessed according to Andersen’s health behavior model. Multinomial logistic regression analyses were done considering sampling weights for complex sampling design. Results A total of 48,679 of ever-married women reported that 9.1% 14.8% and 17.67% of their children had diarrhea, fever and cough respectively. Nearly one-third of the children with diarrhea and fever/cough did not receive any treatment. Two-thirds of children who received treatment were from private health care providers (HCPs). Among predisposing factors, children aged 1–2 years and those born at health facility (public/private) were more likely to be taken to any type of HCP during illness. Among enabling factors, as compared to poorer household, wealthier households were 2.5 times more likely to choose private HCPs for any illness. Children in rural areas were likely to be taken to any type of HCP for diarrhea but rural children were less likely to utilize private HCP for fever/cough. ‘Need’ factors i.e. children having severe symptoms were 2–3 times more likely to be taken to any type of HCP. Conclusion Private HCPs were preferred for treatment of childhood illnesses. Involvement of private HCPs may be considered while planning child health programs. Health insurance scheme for childhood illnesses may to protect economically weaker sections from out-of-pocket health expenditure during child illness.
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Affiliation(s)
- Chandrashekhar T. Sreeramareddy
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Sungai Long, Malaysia
- * E-mail:
| | - T. N. Sathyanarayana
- Indian Institute of Public Health, Bangalore Campus, Public Health Foundation of India, Bangalore, India
| | - H. N. Harsha Kumar
- Department of Community Medicine, Kasturba Medical College, Mangalore, India
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Bahl R, Martines J, Bhandari N, Biloglav Z, Edmond K, Iyengar S, Kramer M, Lawn JE, Manandhar DS, Mori R, Rasmussen KM, Sachdev HPS, Singhal N, Tomlinson M, Victora C, Williams AF, Chan KY, Rudan I. Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015. J Glob Health 2012. [PMID: 23198132 PMCID: PMC3484758 DOI: 10.7189/jogh.02-010403] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW), as set out in the UN's Millennium Development Goal 4. METHODS We applied the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments. In the process coordinated by the World Health Organization in 2007-2008, 21 researchers with interest in child, maternal and newborn health suggested 82 research ideas that spanned across the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions and development of new interventions. The 82 research questions were then assessed for answerability, effectiveness, deliverability, maximum potential for mortality reduction and the effect on equity using the CHNRI method. RESULTS The top 10 identified research priorities were dominated by health systems and policy research questions (eg, identification of LBW infants born at home within 24-48 hours of birth for additional care; approaches to improve quality of care of LBW infants in health facilities; identification of barriers to optimal home care practices including care seeking; and approaches to increase the use of antenatal corticosteriods in preterm labor and to improve access to hospital care for LBW infants). These were followed by priorities for improvement of the existing interventions (eg, early initiation of breastfeeding, including feeding mode and techniques for those unable to suckle directly from the breast; improved cord care, such as chlorhexidine application; and alternative methods to Kangaroo Mother Care (KMC) to keep LBW infants warm in community settings). The highest-ranked epidemiological question suggested improving criteria for identifying LBW infants who need to be cared for in a hospital. Among the new interventions, the greatest support was shown for the development of new simple and effective interventions for providing thermal care to LBW infants, if KMC is not acceptable to the mother. CONCLUSION The context for this exercise was set within the MDG4, requiring an urgent and rapid progress in mortality reduction from low birth weight, rather than identifying long-term strategic solutions of the greatest potential. In a short-term context, the health policy and systems research to improve access and coverage by the existing interventions, coupled with further research to improve effectiveness, deliverability and acceptance of existing interventions, and epidemiological research to address the key gaps in knowledge, were all highlighted as research priorities.
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Affiliation(s)
- Rajiv Bahl
- Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland ; Equal authors' contributions ; Staff of the World Health Organization
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Rudan I, Theodoratou E, Zgaga L, Nair H, Chan KY, Tomlinson M, Tsai A, Biloglav Z, Huda T, El Arifeen S, Chopra M, Campbell H. Setting priorities for development of emerging interventions against childhood pneumonia, meningitis and influenza. J Glob Health 2012. [PMID: 23198129 PMCID: PMC3484764 DOI: 10.7189/jogh.02.010304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Igor Rudan
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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87
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Incidence and epidemiology of hospitalized influenza cases in rural Thailand during the influenza A (H1N1)pdm09 pandemic, 2009-2010. PLoS One 2012; 7:e48609. [PMID: 23139802 PMCID: PMC3490866 DOI: 10.1371/journal.pone.0048609] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 09/27/2012] [Indexed: 11/25/2022] Open
Abstract
Background Data on the burden of the 2009 influenza pandemic in Asia are limited. Influenza A(H1N1)pdm09 was first reported in Thailand in May 2009. We assessed incidence and epidemiology of influenza-associated hospitalizations during 2009–2010. Methods We conducted active, population-based surveillance for hospitalized cases of acute lower respiratory infection (ALRI) in all 20 hospitals in two rural provinces. ALRI patients were sampled 1∶2 for participation in an etiology study in which nasopharyngeal swabs were collected for influenza virus testing by PCR. Results Of 7,207 patients tested, 902 (12.5%) were influenza-positive, including 190 (7.8%) of 2,436 children aged <5 years; 86% were influenza A virus (46% A(H1N1)pdm09, 30% H3N2, 6.5% H1N1, 3.5% not subtyped) and 13% were influenza B virus. Cases of influenza A(H1N1)pdm09 first peaked in August 2009 when 17% of tested patients were positive. Subsequent peaks during 2009 and 2010 represented a mix of influenza A(H1N1)pdm09, H3N2, and influenza B viruses. The estimated annual incidence of hospitalized influenza cases was 136 per 100,000, highest in ages <5 years (477 per 100,000) and >75 years (407 per 100,000). The incidence of influenza A(H1N1)pdm09 was 62 per 100,000 (214 per 100,000 in children <5 years). Eleven influenza-infected patients required mechanical ventilation, and four patients died, all adults with influenza A(H1N1)pdm09 (1) or H3N2 (3). Conclusions Influenza-associated hospitalization rates in Thailand during 2009–10 were substantial and exceeded rates described in western countries. Influenza A(H1N1)pdm09 predominated, but H3N2 also caused notable morbidity. Expanded influenza vaccination coverage could have considerable public health impact, especially in young children.
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Rudan I, Theodoratou E, Zgaga L, Nair H, Chan KY, Tomlinson M, Tsai A, Biloglav Z, Huda T, El Arifeen S, Chopra M, Campbell H. Setting priorities for development of emerging interventions against childhood pneumonia, meningitis and influenza. J Glob Health 2012. [DOI: 10.7189/jogh.01.010304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Igor Rudan
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Lina Zgaga
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Harish Nair
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Kit Yee Chan
- 2Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Mark Tomlinson
- 3Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Alex Tsai
- 5Robert Wood Johnson Health and Society Scholars Program, Harvard University, Cambridge, USA
| | - Zrinka Biloglav
- 7Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tanvir Huda
- 8Child Health and Nutrition Research Initiative, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Shams El Arifeen
- 8Child Health and Nutrition Research Initiative, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | | | - Harry Campbell
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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Bahl R, Martines J, Bhandari N, Biloglav Z, Edmond K, Iyengar S, Kramer M, Lawn JE, Manandhar DS, Mori R, Rasmussen KM, Sachdev HPS, Singhal N, Tomlinson M, Victora C, Williams AF, Chan KY, Rudan I. Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015. J Glob Health 2012. [DOI: 10.7189/jogh.01.010403] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rajiv Bahl
- 1Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
| | - Jose Martines
- 1Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
| | - Nita Bhandari
- 2Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Zrinka Biloglav
- 3Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Croatia
| | - Karen Edmond
- 4London School of Hygiene and Tropical Medicine, London, UK
| | | | - Michael Kramer
- 6Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Canada
| | - Joy E. Lawn
- 7Saving Newborn Lives – Save the Children, Cape Town, South Africa
| | | | - Rintaro Mori
- 9Department of Global Health Policy, Graduate School of Medicine, the University of Tokyo, Japan
| | | | - H. P. S. Sachdev
- 11Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Nalini Singhal
- 12Department of Pediatrics, University of Calgary, Canada
| | - Mark Tomlinson
- 13Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Kit Yee Chan
- 16Nossal Institute for Global Health, Melbourne University, Melbourne, Australia
| | - Igor Rudan
- 17Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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Rudan I. Global health research priorities: mobilizing the developing world. Public Health 2012; 126:237-240. [PMID: 22325672 DOI: 10.1016/j.puhe.2011.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
The paper focuses on two questions: (i) how to set research priorities in a transparent, systematic, fair and legitimate way?; and (ii) how to mobilize low and middle-income countries to take more ownership in defining their own research policies, rather than merely being passive recipients of international aid for research and development? I propose that the recently developed Child Health and Nutrition Research initiative (CHNRI) methodology is becoming widely accepted as a feasible answer to both those questions. In this paper, I review its numerous applications to date and show how it evolved into a practical and systematic tool that can assist priority setting in health research investments in diverse contexts. The CHNRI methodology also addresses support for different instruments of health research to achieve better balance between fundamental research, translation research and implementation research. The wide application of CHNRI methodology is expected to maximise the potential of health research to reduce disease burden and gradually reduce inequities that exist between support for research on the health problems of the rich and the poor. I believe that this tool will find application within many low and middle-income countries and assist them to pull together their own experts and actively define their priorities for research and development in the coming years.
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Affiliation(s)
- I Rudan
- Centre for Population Health Sciences, The University of Edinburgh Medical School, College of Medicine and Veterinary Medicine, Edinburgh, Scotland, UK.
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