101
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Nachiappan N, Koo JM, Chockalingam N, Scott TE. A low-cost field ventilator: An urgent global need. Health Sci Rep 2021; 4:e349. [PMID: 34386615 PMCID: PMC8340924 DOI: 10.1002/hsr2.349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 01/09/2023] Open
Abstract
Modern ventilators are increasingly compact and able to deliver a wide range of ventilator modes and sophisticated monitoring capabilities. However, the global availability of ventilators is woefully short of demand. Data on intensive care units (ICUs), a proxy measure for hospital ventilator capacity in low and middle-income countries (LMIC's), suggest that capacity is extremely limited where it exists at all. In LMIC's, the four most common indications for mechanical ventilation (MV) in ICUs are post-surgical care, sepsis, trauma, and maternal peripartum or neonatal complications. A significant majority of these cases can be managed with intervention involving a short course of MV. Widespread and timely access to MV can thus effectively be used to help patients in these settings and improve outcomes. This paper implores this need and highlights the requirements for a low-cost ventilator or a respiratory support device.
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Affiliation(s)
| | | | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation TechnologiesStaffordshire UniversityStoke on TrentUK
| | - Timothy E Scott
- Adult Intensive Care UnitUniversity Hospitals of North Midlands NHS TrustStoke on TrentUK
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102
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Decouttere C, De Boeck K, Vandaele N. Advancing sustainable development goals through immunization: a literature review. Global Health 2021; 17:95. [PMID: 34446050 PMCID: PMC8390056 DOI: 10.1186/s12992-021-00745-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this. METHODS We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges. RESULTS We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030. CONCLUSIONS In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.
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Affiliation(s)
- Catherine Decouttere
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Kim De Boeck
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Nico Vandaele
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
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103
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Njau J, Silal SP, Kollipara A, Fox K, Balawanth R, Yuen A, White LJ, Moya M, Pillay Y, Moonasar D. Investment case for malaria elimination in South Africa: a financing model for resource mobilization to accelerate regional malaria elimination. Malar J 2021; 20:344. [PMID: 34399767 PMCID: PMC8365569 DOI: 10.1186/s12936-021-03875-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Malaria continues to be a public health problem in South Africa. While the disease is mainly confined to three of the nine provinces, most local transmissions occur because of importation of cases from neighbouring countries. The government of South Africa has reiterated its commitment to eliminate malaria within its borders. To support the achievement of this goal, this study presents a cost-benefit analysis of malaria elimination in South Africa through simulating different scenarios aimed at achieving malaria elimination within a 10-year period. METHODS A dynamic mathematical transmission model was developed to estimate the costs and benefits of malaria elimination in South Africa between 2018 and 2030. The model simulated a range of malaria interventions and estimated their impact on the transmission of Plasmodium falciparum malaria between 2018 and 2030 in the three endemic provinces of Limpopo, Mpumalanga and KwaZulu-Natal. Local financial, economic, and epidemiological data were used to calibrate the transmission model. RESULTS Based on the three primary simulated scenarios: Business as Usual, Accelerate and Source Reduction, the total economic burden was estimated as follows: for the Business as Usual scenario, the total economic burden of malaria in South Africa was R 3.69 billion (USD 223.3 million) over an 11-year period (2018-2029). The economic burden of malaria was estimated at R4.88 billion (USD 295.5 million) and R6.34 billion (~ USD 384 million) for the Accelerate and Source Reduction scenarios, respectively. Costs and benefits are presented in midyear 2020 values. Malaria elimination was predicted to occur in all three provinces if the Source Reduction strategy was adopted to help reduce malaria rates in southern Mozambique. This could be achieved by limiting annual local incidence in South Africa to less than 1 indigenous case with a prediction of this goal being achieved by the year 2026. CONCLUSIONS Malaria elimination in South Africa is feasible and economically worthwhile with a guaranteed positive return on investment (ROI). Findings of this study show that through securing funding for the proposed malaria interventions in the endemic areas of South Africa and neighbouring Mozambique, national elimination could be within reach in an 8-year period.
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Affiliation(s)
- Joseph Njau
- JoDon Consulting Group, 4501 Forest View Court, Lilburn, GA, 30047, USA
| | - Sheetal P Silal
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
- Nuffield Department of Medicine, Centre for Global Health, Oxford University, Oxford, UK.
| | - Aparna Kollipara
- Health Economist and Health Financing Specialist, California Public Health Department, Sacramento, USA
| | - Katie Fox
- Department of Global Health at the School of Medicine and Packard Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Ryleen Balawanth
- Clinton Health Access Initiative (CHAI), South Africa Regional Office, Pretoria, South Africa
| | - Anthony Yuen
- Clinton Health Access Initiative (CHAI), South Africa Regional Office, Pretoria, South Africa
| | - Lisa J White
- Big Data Institute, Nuffield Department of Medicine, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Mandisi Moya
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Yogan Pillay
- Center for Innovation in Global Health, Georgetown University, Georgetown, USA
- Malaria Vector and Zoonotic Disease Directorate, National Department of Health, Pretoria, South Africa
| | - Devanand Moonasar
- Malaria Vector and Zoonotic Disease Directorate, National Department of Health, Pretoria, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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104
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Coates MM, Ezzati M, Robles Aguilar G, Kwan GF, Vigo D, Mocumbi AO, Becker AE, Makani J, Hyder AA, Jain Y, Stefan DC, Gupta N, Marx A, Bukhman G. Burden of disease among the world's poorest billion people: An expert-informed secondary analysis of Global Burden of Disease estimates. PLoS One 2021; 16:e0253073. [PMID: 34398896 PMCID: PMC8366975 DOI: 10.1371/journal.pone.0253073] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background The health of populations living in extreme poverty has been a long-standing focus of global development efforts, and continues to be a priority during the Sustainable Development Goal era. However, there has not been a systematic attempt to quantify the magnitude and causes of the burden in this specific population for almost two decades. We estimated disease rates by cause for the world’s poorest billion and compared these rates to those in high-income populations. Methods We defined the population in extreme poverty using a multidimensional poverty index. We used national-level disease burden estimates from the 2017 Global Burden of Disease Study and adjusted these to account for within-country variation in rates. To adjust for within-country variation, we looked to the relationship between rates of extreme poverty and disease rates across countries. In our main modeling approach, we used these relationships when there was consistency with expert opinion from a survey we conducted of disease experts regarding the associations between household poverty and the incidence and fatality of conditions. Otherwise, no within-country variation was assumed. We compared results across multiple approaches for estimating the burden in the poorest billion, including aggregating national-level burden from the countries with the highest poverty rates. We examined the composition of the estimated disease burden among the poorest billion and made comparisons with estimates for high-income countries. Results The composition of disease burden among the poorest billion, as measured by disability-adjusted life years (DALYs), was 65% communicable, maternal, neonatal, and nutritional (CMNN) diseases, 29% non-communicable diseases (NCDs), and 6% injuries. Age-standardized DALY rates from NCDs were 44% higher in the poorest billion (23,583 DALYs per 100,000) compared to high-income regions (16,344 DALYs per 100,000). Age-standardized DALY rates were 2,147% higher for CMNN conditions (32,334 DALYs per 100,000) and 86% higher for injuries (4,182 DALYs per 100,000) in the poorest billion, compared to high-income regions. Conclusion The disease burden among the poorest people globally compared to that in high income countries is highly influenced by demographics as well as large disparities in burden from many conditions. The comparisons show that the largest disparities remain in communicable, maternal, neonatal, and nutritional diseases, though NCDs and injuries are an important part of the “unfinished agenda” of poor health among those living in extreme poverty.
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Affiliation(s)
- Matthew M. Coates
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, United Kingdom
| | | | - Gene F. Kwan
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | - Daniel Vigo
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana O. Mocumbi
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Anne E. Becker
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health & Allied Sciences, Dar-es-Salaam, Tanzania
- Department of Haematology & Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Adnan A. Hyder
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Yogesh Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
| | - D. Cristina Stefan
- African Medical Research and Innovation Institute, Cape Town, South Africa
- SingHealth Duke-NUS Global Health Institute (SDGHI), Duke-NUS Medical School, Singapore, Singapore
| | - Neil Gupta
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | - Andrew Marx
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gene Bukhman
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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105
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Pacheco Barzallo D, Oña A, Gemperli A. Unmet health care needs and inequality: A cross-country comparison of the situation of people with spinal cord injury. Health Serv Res 2021; 56 Suppl 3:1429-1440. [PMID: 34386981 PMCID: PMC8579205 DOI: 10.1111/1475-6773.13738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To estimate and compare unmet health care needs of persons with spinal cord injury (SCI) across countries, the causes of these shortfalls, and the role of income. Data Sources We analyzed cross‐sectional data of 20 countries from the International Spinal Cord Injury (InSCI) survey, a compendium of comparable data on the living situation of persons with SCI. Data included information on high‐, middle‐, and low‐income countries. The survey comprises information on 12,095 participants. Study Design We used logit regressions to estimate the probability of unmet health care needs of persons with SCI and its causes. We adjusted the results by the individuals' characteristics and countries' fixed effects. We disaggregated the results by income decile of individuals in each country. Data Collection/Extraction Methods The inclusion criteria for the InSCI survey were adults aged 18 years and older with SCI living in the community, who were able to respond to the survey and who provided informed consent. Principal Findings Unmet health care needs are significant for people with long‐term conditions like SCI, where people in low‐income groups tend to be more affected. Among the barriers to meeting health care needs, the foremost is health care cost (in 11 of the 20 countries), followed by transportation and service availability. Persons with SCI in Morocco reported the highest probability of unmet health care needs in the sample, 0.54 (CI: 047–0.59), followed well behind by South Africa, 0.27 (CI: 0.20–0.33), and Brazil, 0.26 (CI: 0.20–0.33). In contrast, persons with SCI in Spain, 0.06 (CI: 0.04–0.08), reported the lowest probability of unmet health care needs, closely followed by Norway, 0.07 (CI: 0.05–0.09), Thailand, 0.08 (CI: 0.05–0.11), France, 0.08 (CI: 0.06–0.11), and Switzerland, 0.09 (CI: 0.07–0.10). Conclusions SCI is a long‐term, irreversible health condition characterized by physical impairment and a series of chronic illness. This makes SCI a high‐need, high‐cost group that faces significant unmet health care needs, which are mainly explained by the costs of health services, transportation, and services availability. This situation is prevalent in low‐, middle‐, and high‐income countries, where persons in lower income groups are disproportionately affected. To improve the situation, a combination of measures from the health and social systems are required.
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Affiliation(s)
- Diana Pacheco Barzallo
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Research, Rehabilitation, Services & Care Unit, Nottwil, Switzerland.,Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, Lucerne, Switzerland
| | - Ana Oña
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Research, Rehabilitation, Services & Care Unit, Nottwil, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Research, Rehabilitation, Services & Care Unit, Nottwil, Switzerland.,Center for Primary and Community Care, Lucerne, Switzerland
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106
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Khadka A, Verguet S. The economic value of changing mortality risk in low- and middle-income countries: a systematic breakdown by cause of death. BMC Med 2021; 19:156. [PMID: 34266420 PMCID: PMC8282406 DOI: 10.1186/s12916-021-02029-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/09/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We develop a framework for quantifying monetary values associated with changes in disease-specific mortality risk in low- and middle-income countries to help quantify trade-offs involved in investing in mortality reduction due to one disease versus another. METHODS We monetized the changes in mortality risk for communicable and non-communicable diseases (CD and NCD, respectively) between 2017 and 2030 for low-income, lower-middle-income, and upper-middle-income countries (LICs, LMICs, and UMICs, respectively). We modeled three mortality trajectories ("base-case", "high-performance", and "low-performance") using Global Burden of Disease study forecasts and estimated disease-specific mortality risk changes relative to the base-case. We assigned monetary values to changes in mortality risk using value of a statistical life (VSL) methods and conducted multiple sensitivity analyses. RESULTS In terms of NCDs, the absolute monetary value associated with changing mortality risk was highest for cardiovascular diseases in older age groups. For example, being on the low-performance trajectory relative to the base-case in 2030 was valued at $9100 (95% uncertainty range $6800; $11,400), $28,300 ($24,200; $32,400), and $30,300 ($27,200; $33,300) for females aged 70-74 years in LICs, LMICs, and UMICs, respectively. Changing the mortality rate from the base-case to the high-performance trajectory was associated with high monetary value for CDs as well, especially among younger age groups. Estimates were sensitive to assumptions made in calculating VSL. CONCLUSIONS Our framework provides a priority setting paradigm to best allocate investments toward the health sector and enables intersectoral comparisons of returns on investments from health interventions.
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Affiliation(s)
- Aayush Khadka
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
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107
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Alsan M, Atella V, Bhattacharya J, Conti V, Mejía-Guevara I, Miller G. Technological Progress and Health Convergence: The Case of Penicillin in Postwar Italy. Demography 2021; 58:1473-1498. [PMID: 34228054 DOI: 10.1215/00703370-9368970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Throughout history, technological progress has transformed population health, but the distributional effects of these gains are unclear. New substitutes for older, more expensive health technologies can produce convergence in population health outcomes but may also be prone to elite capture and thus divergence. We study the case of penicillin using detailed historical mortality statistics and exploiting its abruptly timed introduction in Italy after WWII. We find that penicillin reduced both the mean and standard deviation of infectious disease mortality, leading to substantial convergence across disparate regions of Italy. Our results do not appear to be driven by competing risks or confounded by mortality patterns associated with WWII.
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Affiliation(s)
- Marcella Alsan
- Harvard Kennedy School, Harvard University, Cambridge, MA, USA
| | - Vincenzo Atella
- Department of Economics and Finance, University of Rome Tor Vergata, Rome, Italy
| | | | - Valentina Conti
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Iván Mejía-Guevara
- Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Grant Miller
- School of Medicine, Stanford University, Stanford, CA, USA
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108
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Cookson R, Robson M, Skarda I, Doran T. Equity-informative methods of health services research. J Health Organ Manag 2021; ahead-of-print:665-681. [PMID: 34189877 DOI: 10.1108/jhom-07-2020-0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE We review quantitative methods for analysing the equity impacts of health care and public health interventions: who benefits most and who bears the largest burdens (opportunity costs)? Mainstream health services research focuses on effectiveness and efficiency but decision makers also need information about equity. DESIGN/METHODOLOGY/APPROACH We review equity-informative methods of quantitative data analysis in three core areas of health services research: effectiveness analysis, cost-effectiveness analysis and performance measurement. An appendix includes further readings and resources. FINDINGS Researchers seeking to analyse health equity impacts now have a practical and flexible set of methods at their disposal which builds on the standard health services research toolkit. Some of the more advanced methods require specialised skills, but basic equity-informative methods can be used by any health services researcher with appropriate skills in the three core areas. ORIGINALITY/VALUE We hope that this review will raise awareness of equity-informative methods of health services research and facilitate their entry into the mainstream so that health policymakers are routinely presented with information about who gains and who loses from their decisions.
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Affiliation(s)
| | - Matthew Robson
- Department of Health Sciences, University of York, York, UK
| | - Ieva Skarda
- Centre for Health Economics, University of York, York, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
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109
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Gaudin S, Yazbeck A. Identifying Major Health-System Challenges in Developing Countries Using PERs: Equity is the Elephant in the Room. Health Syst Reform 2021; 7:e1902671. [PMID: 34402393 DOI: 10.1080/23288604.2021.1902671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Despite an unprecedented increase in official development assistance to health in the last 25 years, there is no systematic way to assess dominant patterns in health-system challenges and opportunities in developing countries. Developing a new global instrument for and by donors and development partners would be resource-intensive and cumbersome. In this article, we demonstrate that Public Expenditure Reviews (PERs) can be used to reveal such patterns. PERs are analytical reports financed and conducted by the World Bank that have been used for years to identify and prioritize country-specific health sector reform needs. In order to extend their use beyond the country level, a reading instrument is developed in the form of a questionnaire to systematically identify the different themes addressed in each PER. All PERs published over a period of ten years are reviewed for health sector content. A new database is created with data on 70 PERs, spanning 61 countries. Analysis of the data reveals dominant themes globally, patterns across development levels, and some regional variations. Our main finding is that issues related to equity strongly dominate and are relevant across all regions and income groups. In addition, the article highlights the usefulness of PERs beyond providing country-specific information. Without losing the country-focus and flexibility of PERs, thoughtful and minor investments in how Health PERs are conducted can create a relatively cheap and strongly operational instrument for building global knowledge bases on health sector needs and challenges.
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Affiliation(s)
| | - Abdo Yazbeck
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
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110
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Haacker M, Hallett TB, Atun R. On time horizons in health economic evaluations. Health Policy Plan 2021; 35:1237-1243. [PMID: 33450767 DOI: 10.1093/heapol/czaa073] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2020] [Indexed: 12/23/2022] Open
Abstract
The issue of time horizons has received scant attention in discussions pertaining to health economic evaluations unlike discounting or translation of health outcomes into life-cycle measures (e.g. quality-adjusted life years or disability-adjusted life years). The available guidelines do not offer clear and consistent guidance for many problems addressed in health economic evaluations. In practice, variation of time horizons between studies for the same diseases is a matter of concern, as results on cost-effectiveness depend on the time horizon. Our paper contributes to establishing a consistent approach to setting time horizons across common types of health economic evaluations and mitigating potential bias where the choice of a time horizon may affect results of the evaluation. We find that available guidance is clear only for patient-focused interventions, but not in the presence of population-level effects owing to transmission of infections or other linkages. We distinguish between a policy period-over which an intervention is delivered or initiated-and an evaluation period over which the effects are measured. One important challenge in establishing a time horizon for evaluation is that, at least for infectious diseases, the state of the epidemic at the end of the policy period cannot be evaluated precisely and incorporated in the results of an economic evaluation. While longer policy periods partly mitigate this challenge, they are subject to greater uncertainty, and outcomes may not adequately reflect the cost-effectiveness of current policies because outcomes reflect an average over the policy period. Incremental analysis on interventions implemented in sub-periods of the policy period (especially at the beginning) potentially improves accuracy and helps to identify potential for improving cost-effectiveness by varying the path of implementation or the mix of interventions offered over time.
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Affiliation(s)
- Markus Haacker
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA.,Center for Global Development, 2055 L St NW, Washington, DC 20036, USA.,Centre for Global Health Economics, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Timothy B Hallett
- Imperial College London, MRC Centre for Global Infectious Disease Analysis, School of Public Health, St Mary's Hospital, Norfolk Place, London W2 1PG, London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, 641 Huntington Ave, Boston, MA 02115, USA
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111
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Coates MM, Sliwa K, Watkins DA, Zühlke L, Perel P, Berteletti F, Eiselé JL, Klassen SL, Kwan GF, Mocumbi AO, Prabhakaran D, Habtemariam MK, Bukhman G. An investment case for the prevention and management of rheumatic heart disease in the African Union 2021-30: a modelling study. Lancet Glob Health 2021; 9:e957-e966. [PMID: 33984296 PMCID: PMC9087136 DOI: 10.1016/s2214-109x(21)00199-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/15/2021] [Accepted: 03/31/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite declines in deaths from rheumatic heart disease (RHD) in Africa over the past 30 years, it remains a major cause of cardiovascular morbidity and mortality on the continent. We present an investment case for interventions to prevent and manage RHD in the African Union (AU). METHODS We created a cohort state-transition model to estimate key outcomes in the disease process, including cases of pharyngitis from group A streptococcus, episodes of acute rheumatic fever (ARF), cases of RHD, heart failure, and deaths. With this model, we estimated the impact of scaling up interventions using estimates of effect sizes from published studies. We estimated the cost to scale up coverage of interventions and summarised the benefits by monetising health gains estimated in the model using a full income approach. Costs and benefits were compared using the benefit-cost ratio and the net benefits with discounted costs and benefits. FINDINGS Operationally achievable levels of scale-up of interventions along the disease spectrum, including primary prevention, secondary prevention, platforms for management of heart failure, and heart valve surgery could avert 74 000 (UI 50 000-104 000) deaths from RHD and ARF from 2021 to 2030 in the AU, reaching a 30·7% (21·6-39·0) reduction in the age-standardised death rate from RHD in 2030, compared with no increase in coverage of interventions. The estimated benefit-cost ratio for plausible scale-up of secondary prevention and secondary and tertiary care interventions was 4·7 (2·9-6·3) with a net benefit of $2·8 billion (1·6-3·9; 2019 US$) through 2030. The estimated benefit-cost ratio for primary prevention scale-up was low to 2030 (0·2, <0·1-0·4), increasing with delayed benefits accrued to 2090. The benefit-cost dynamics of primary prevention were sensitive to the costs of different delivery approaches, uncertain epidemiological parameters regarding group A streptococcal pharyngitis and ARF, assumptions about long-term demographic and economic trends, and discounting. INTERPRETATION Increased coverage of interventions to control and manage RHD could accelerate progress towards eradication in AU member states. Gaps in local epidemiological data and particular components of the disease process create uncertainty around the level of benefits. In the short term, costs of secondary prevention and secondary and tertiary care for RHD are lower than for primary prevention, and benefits accrue earlier. FUNDING World Heart Federation, Leona M and Harry B Helmsley Charitable Trust, and American Heart Association.
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Affiliation(s)
- Matthew M Coates
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Karen Sliwa
- Cape Heart Institute and Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; World Heart Federation, Geneva, Switzerland
| | - David A Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Pablo Perel
- World Heart Federation, Geneva, Switzerland; Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Sheila L Klassen
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA
| | - Gene F Kwan
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA; Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ana O Mocumbi
- Instituto Nacional de Saúde, Maputo, Mozambique; Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Dorairaj Prabhakaran
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, Gurgaon, India
| | | | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA.
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Gaskill CE, Gyedu A, Stewart B, Quansah R, Donkor P, Mock C. Improving Global Surgical Oncology Benchmarks: Defining the Unmet Need for Cancer Surgery in Ghana. World J Surg 2021; 45:2661-2669. [PMID: 34152449 DOI: 10.1007/s00268-021-06197-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Lancet Commission on Global Surgery (LCoGS) recommended an annual surgical rate at which low- and middle-income countries (LMICs) could achieve most of the population-wide benefits of surgery. However, condition-specific guidelines were not proposed. To inform rates of surgery for cancer, we sought to assess the current met and unmet need for oncologic surgery in Ghana. METHODS Data on all operations performed in Ghana over a one-year period (2014-15) were obtained from representative samples of 48/124 first-level and 12/16 referral hospitals and scaled-up for nationwide estimates. Procedures for cancer were identified by indication. Using modified LCoGS methodology with disease prevalence, Ghana's annual rate of cancer surgery was compared to that of New Zealand to quantify current unmet needs. RESULTS 232,776 surgical procedures were performed in Ghana; 2,562 procedures (95%UI 1878-3255) were for cancer. Of these, 964 (37%) were surgical biopsies. The annual rate of procedures treating cancer was 2115 surgeries/100,000 cancer cases, or 21% of the New Zealand benchmark. Cervical, breast, and prostate cancer were found to meet 2.1%, 17.2%, and 32.1% of their respective surgical need. CONCLUSIONS There is a large unmet need for cancer surgery in Ghana. Cancer surgery constitutes under 2% of the total surgeries performed in Ghana, an important proportion of which are used for biopsies. Therapeutic operative rate is deficient across most cancer types, and may lag behind improvements in screening efforts. As cancer prevalence and diagnosis increase in LMICs, cancer-specific surgical capacity must be increased to meet these evolving needs.
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Affiliation(s)
- Cameron E Gaskill
- Department of Surgery, University of Washington, Seattle, WA, USA.
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Robert Quansah
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Njiro BJ, Ndumwa HP, Msenga CJ, Kawala T, Matola E, Mhonda J, Corbin H, Ubuguyu O, Likindikoki S. Depression, suicidality and associated risk factors among police officers in urban Tanzania: a cross-sectional study. Gen Psychiatr 2021; 34:e100448. [PMID: 34222794 PMCID: PMC8204155 DOI: 10.1136/gpsych-2020-100448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The WHO has classified depression as a disease of public concern. Police officers are a particular subpopulation group that is at an increased risk for mental health problems. This study examined the prevalence of depression, suicidality and associated risk factors among police officers in urban Tanzania. AIMS The aim of this study was to examine the prevalence of depression, suicidality and associated risk factors among police officers in Tanzania. METHODS A cross-sectional study was conducted between April 2019 and October 2020 among 550 participants in Dar es Salaam recruited using a multistage cluster sampling technique. The Patient Health Questionnaire-9 was used to screen for depression and suicidality. The Interpersonal Support Evaluation List-12 tool was used to measure perceived social support. Descriptive statistics were summarised using frequencies and percentages. Bivariate and multivariate analyses were used to establish associations between predictors of interest, depression and suicidality. RESULTS There were 497 participants in the study. Of these, 76.6% (376 of 491) were men, and the median (IQR) age was 37.0 (17) years. Around 19.8% (96 of 486) of the police officers screened positive for depression and 15.4% (75 of 413) for suicidality. A significant proportion was either moderately (29 of 96, 30.2%) or severely depressed (8 of 75, 10.7 %). Of those who experienced suicidal thoughts, 10.7% (8 of 75) reported having daily suicidal thoughts. Perceiving low social support was associated with an increased risk of reporting depression (adjusted OR (aOR): 28.04, 95% CI: 8.42 to 93.37, p<0.001) and suicidality (aOR: 10.85, 95% CI: 3.56 to 33.08, p<0.001) as compared with those with high perceived social support. CONCLUSION The magnitude of depression and suicidality among police officers in urban Tanzania is alarmingly high. The study findings indicate the need for routine screening for depression and suicidality among police officers and design appropriate mental health responsive services in this population.
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Affiliation(s)
- Belinda Jackson Njiro
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Harrieth Peter Ndumwa
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | | | - Thomas Kawala
- Medical Unit, Tanzania Police Force, Dar es Salaam, Tanzania, United Republic of
| | - Ezekiel Matola
- Medical Unit, Tanzania Police Force, Dar es Salaam, Tanzania, United Republic of
| | - Juhudi Mhonda
- Medical Unit, Tanzania Police Force, Dar es Salaam, Tanzania, United Republic of
| | - Hillary Corbin
- Medical Unit, Tanzania Police Force, Dar es Salaam, Tanzania, United Republic of
| | - Omary Ubuguyu
- National NCD Prevention and Control Program, Ministry of Health, Community, Development, Gender, Elderly and Children, Dodoma, Tanzania, United Republic of
| | - Samuel Likindikoki
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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Achieving global mortality reduction targets and universal health coverage: The impact of COVID-19. PLoS Med 2021; 18:e1003675. [PMID: 34166391 PMCID: PMC8270396 DOI: 10.1371/journal.pmed.1003675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Wenhui Mao and coauthors discuss possible implications of the COVID-19 pandemic for health aspirations in low- and middle-income countries.
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115
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Briggs AM, Huckel Schneider C, Slater H, Jordan JE, Parambath S, Young JJ, Sharma S, Kopansky-Giles D, Mishrra S, Akesson KE, Ali N, Belton J, Betteridge N, Blyth FM, Brown R, Debere D, Dreinhöfer KE, Finucane L, Foster HE, Gimigliano F, Haldeman S, Haq SA, Horgan B, Jain A, Joshipura M, Kalla AA, Lothe J, Matsuda S, Mobasheri A, Mwaniki L, Nordin MC, Pattison M, Reis FJJ, Soriano ER, Tick H, Waddell J, Wiek D, Woolf AD, March L. Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health. BMJ Glob Health 2021; 6:e006045. [PMID: 37904582 PMCID: PMC8215245 DOI: 10.1136/bmjgh-2021-006045] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health. METHODS Design: mixed-methods, three-phase design.Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response.Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci.Phase 3: informed by phases 1-2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions. RESULTS Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action.Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening. CONCLUSION An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives.
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Affiliation(s)
- Andrew M Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Slater
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | | | - Sarika Parambath
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - James J Young
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Swatee Mishrra
- Sydney Musculoskeletal, Bone and Joint Health Alliance. Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kristina E Akesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
- Department of Orthopedics, Skane University Hospital, Malmö, Sweden
| | - Nuzhat Ali
- Health Improvement, Public Health England, London, UK
| | - Joletta Belton
- Global Alliance of Partners for Pain Advocacy, International Association for the Study of Pain, Washington, DC, USA
| | | | - Fiona M Blyth
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Brown
- World Federation of Chiropractic, Toronto, Ontario, Canada
| | - Demelash Debere
- Rehabilitation International (Africa Region), Addis Ababa, Ethiopia
| | - Karsten E Dreinhöfer
- Medical Park Berlin Humboldtmühle, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
- Global Alliance for Musculoskeletal Health, Berlin, Germany
| | - Laura Finucane
- International Federation of Orthopaedic Manipulative Physical Therapists Incorporated (IFOMPT), World Physiotherapy, London, UK
- Sussex MSK Partnership, Physiotherapy Department, National Health Service, Brighton, UK
| | - Helen E Foster
- Population Health Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Scott Haldeman
- Department of Neurology, University of California, Irvine, California, USA
- Southern California University of Health Sciences, Whittier, California, USA
- Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, Ontario, Canada
- World Spine Care, Santa Ana, California, USA
| | - Syed A Haq
- Rheumatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ben Horgan
- Consumer and Community Involvement Program, West Australian Health Translation Network, Perth, Western Australia, Australia
| | - Anil Jain
- Department of Physical Medicine and Rehabilitation, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | | | - Asgar A Kalla
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jakob Lothe
- Norwegian Council for Musculoskeletal Health, Oslo, Norway
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Guangzhou, Guangdong, People's Republic of China
| | | | - Margareta C Nordin
- Department of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York City, NY, USA
- Department of Occupational and Industrial Orthopedic Center, NYU Grossman School of Medicine, New York University, New York City, NY, USA
| | - Marilyn Pattison
- World Federation of Occupational Therapists (WFOT), London, UK
- MPOT/Access Fitness and Talking Matters, Adelaide, South Australia, Australia
| | - Felipe J J Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
- Clinical Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Services and University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Pan-American League of Associations for Rheumatology, Miami, Florida, USA
| | - Heather Tick
- Department of Family Medicine and Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Academic Consortium for Integrative Medicine and Health, New Buffalo, Michigan, USA
| | - James Waddell
- Saint Michael's Hospital Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Dieter Wiek
- People with Arthritis and Rheumatism, European Alliance for Associations for Rheumatology (EULAR), Kilchberg, Switzerland
| | - Anthony D Woolf
- Bone and Joint Research Group, Royal Cornwall Hospitals Trust, Truro, UK
| | - Lyn March
- Sydney Musculoskeletal, Bone and Joint Health Alliance. Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
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Briggs AM, Jordan JE, Kopansky-Giles D, Sharma S, March L, Schneider CH, Mishrra S, Young JJ, Slater H. The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants. Glob Health Res Policy 2021; 6:24. [PMID: 34256865 PMCID: PMC8277526 DOI: 10.1186/s41256-021-00201-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response. METHODS An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1-4 of the logic model. RESULTS Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived. CONCLUSION KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.
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Affiliation(s)
- Andrew M Briggs
- Curtin School of Allied Health, Curtin University, Perth, Australia.
| | | | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
- Sydney Musculoskeletal, Bone & Joint Health Alliance, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Swatee Mishrra
- Sydney Musculoskeletal, Bone & Joint Health Alliance, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - James J Young
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Helen Slater
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Liu J, Yin H, Tang X, Zhu T, Zhang Q, Liu Z, Tang X, Yi H. Transition in air pollution, disease burden and health cost in China: A comparative study of long-term and short-term exposure. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 277:116770. [PMID: 33640815 DOI: 10.1016/j.envpol.2021.116770] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/13/2021] [Accepted: 02/13/2021] [Indexed: 05/22/2023]
Abstract
Ambient air pollution is one of the leading environmental risk factors to human health, largely offsetting economic growth. This study evaluated health burden and cost associated with the short-term and long-term exposure of major air pollutants (fine particulate matter [PM2.5] and ozone [O3]) during 2013-2018. We developed a database of gridded daily and annual PM2.5 and O3 exposure in China at 15 km × 15 km resolution. Then, we estimated the age- and cause-specific premature deaths and quantified related health damage with an age-adjusted value of statistical life (VSL) measure. The health cost estimated in this study captured direct cost, indirect cost and intangible cost of the premature death attributable to ambient PM2.5 and O3. We found that the national premature deaths attributable to long-term and short-term exposure to PM2.5 decreased by 15% and 59%, whereas the national premature deaths attributable to long-term and short-term exposure to O3 increased by 36% and 94%. Despite a 15% reduction of attributable deaths, the health cost attributable to long-term exposure to PM2.5 did not change significantly as a result of GDP growth and population aging. On the other hand, the long-term O3 related health cost in 2018 doubled that in 2013. Our study suggests that while premature deaths fell as a result of China's clean air actions, the health costs of air pollution remained high. The growing trends of O3 highlighted the needs for strategies to reduce both PM2.5 and O3 emissions, for the sake of public health and social well-being in China.
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Affiliation(s)
- Jun Liu
- Department of Environmental Engineering, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, PR China; Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, University of Science and Technology Beijing, Beijing, 100083, PR China; Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, 100084, PR China
| | - Hao Yin
- School of Population and Public Health, The University of British Columbia, Vancouver BC, Canada; Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, 100084, PR China; Energy and Resources Group, University of California, Berkeley, CA, USA
| | - Xiao Tang
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, 100029, China.
| | - Tong Zhu
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, 100871, China
| | - Qiang Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, 100084, PR China
| | - Zhu Liu
- Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, 100084, PR China
| | - XiaoLong Tang
- Department of Environmental Engineering, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, PR China; Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, University of Science and Technology Beijing, Beijing, 100083, PR China
| | - HongHong Yi
- Department of Environmental Engineering, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, PR China; Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, University of Science and Technology Beijing, Beijing, 100083, PR China.
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Zheng XY, Yi Q, Xu YJ, Zeng XY, Xu XJ, Chen G, Ma SL, Tang SL, Lin LF. Health transition of the causes of mortality between 2005 and 2015 in Guangdong, China. Postgrad Med J 2021; 98:346-353. [PMID: 33990394 DOI: 10.1136/postgradmedj-2020-139269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To analyse the patterns of transition of health burden for 110 causes of death by stratification of age, sex and geographic regions in Guangdong between 2005 and 2015. METHODS We analysed the age-specific, sex-specific, region-specific mortality in Guangdong based on assembled databases. County-level surveillance data were calculated to inform city-level changes. RESULTS The age-standardised mortality of all causes, non-communicable diseases (NCDs), communicable diseases, maternal diseases, neonatal diseases, malnutrition and injury declined progressively. Despite declining mortality of NCDs, the overall burden of disease was dominated by NCDs (ie, cerebrovascular disease, chronic obstructive pulmonary disease) that still accounted for 86.93% and 88.12% of death in 2005 and 2015, respectively. Considerable variations across geographic regions were observed (lowest in Pearl River Delta and highest in west Guangdong). There was a modest shift to transport injuries at younger ages and unintentional injuries in the elderly. CONCLUSIONS We have documented a dramatic change in the overall mortality and age-specific, sex-specific and cause-specific mortality in Guangdong province between 2005 and 2015. The significant burden of NCDs remains a major healthcare issue despite the notable progress in reducing mortality in Guangdong, China. Our findings highlight important unmet needs to refine healthcare services by taking into account the inequity of age, sex and geographic regions. Identification of the 'treatable' risk factors and improved disease surveillance should be continuously improved to minimised the overall and cause-specific mortality.
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Affiliation(s)
- Xue-Yan Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Qian Yi
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.,Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yan-Jun Xu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xin-Ying Zeng
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao-Jun Xu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Ge Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Shu-Li Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Si-Li Tang
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Li-Feng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
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Khor SK, Heymann DL. Pandemic preparedness in the 21st century: which way forward? LANCET PUBLIC HEALTH 2021; 6:e357-e358. [PMID: 33964228 PMCID: PMC8099566 DOI: 10.1016/s2468-2667(21)00101-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Swee Kheng Khor
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - David L Heymann
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
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Nayagam S, Chan P, Zhao K, Sicuri E, Wang X, Jia J, Wei L, Walsh N, Rodewald LE, Zhang G, Ailing W, Zhang L, Chang JH, Hou W, Qiu Y, Sui B, Xiao Y, Zhuang H, Thursz MR, Scano F, Low-Beer D, Schwartländer B, Wang Y, Hallett TB. Investment Case for a Comprehensive Package of Interventions Against Hepatitis B in China: Applied Modeling to Help National Strategy Planning. Clin Infect Dis 2021; 72:743-752. [PMID: 32255486 PMCID: PMC7935389 DOI: 10.1093/cid/ciaa134] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background In 2016, the first global viral hepatitis elimination targets were endorsed. An estimated one-third of the world’s population of individuals with chronic hepatitis B virus (HBV) infection live in China and liver cancer is the sixth leading cause of mortality, but coverage of first-line antiviral treatment was low. In 2015, China was one of the first countries to initiate a consultative process for a renewed approach to viral hepatitis. We present the investment case for the scale-up of a comprehensive package of HBV interventions. Methods A dynamic simulation model of HBV was developed and used to simulate the Chinese HBV epidemic. We evaluated the impact, costs, and return on investment of a comprehensive package of prevention and treatment interventions from a societal perspective, incorporating costs of management of end-stage liver disease and lost productivity costs. Results Despite the successes of historical vaccination scale-up since 1992, there will be a projected 60 million people still living with HBV in 2030 and 10 million HBV-related deaths, including 5.7 million HBV-related cancer deaths between 2015 and 2030. This could be reduced by 2.1 million by highly active case-finding and optimal antiviral treatment regimens. The package of interventions is likely to have a positive return on investment to society of US$1.57 per US dollar invested. Conclusions Increases in HBV-related deaths for the next few decades pose a major public health threat in China. Active case-finding and access to optimal antiviral treatment are required to mitigate this risk. This investment case approach provides a real-world example of how applied modeling can support national dialog and inform policy planning.
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Affiliation(s)
- Shevanthi Nayagam
- Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom.,MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London,UK
| | - Polin Chan
- World Health Organization China office, Beijing, China
| | - Kun Zhao
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Elisa Sicuri
- Health Economics Group, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Xiaochun Wang
- National Center for AIDS Control and Prevention (NCAIDS), China Center for Disease Control and Prevention, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Beijing, China
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China
| | - Nick Walsh
- World Health Organization regional office for the Western Pacific, Manila, Philippines
| | | | - Guomin Zhang
- National Immunization Programme, China Center for Disease Control and Prevention, Beijing, China
| | - Wang Ailing
- National Center for Women and Children's Health, China Center for Disease Control and Prevention, Beijing, China
| | - Lan Zhang
- World Health Organization China office, Beijing, China
| | - Joo H Chang
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - WeiWei Hou
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Yingpeng Qiu
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Binyan Sui
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Yue Xiao
- China National Health Development Research Center, National Health and Family Planning Commission, Beijing, China
| | - Hui Zhuang
- Department of Microbiology and Infectious Disease Center, Peking University Health Science Center, Beijing, China
| | - M R Thursz
- Section of Hepatology and Gastroenterology, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom
| | - Fabio Scano
- World Health Organization China office, Beijing, China
| | | | | | - Yu Wang
- China Center for Disease Control and Prevention, Beijing, China
| | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London,UK
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121
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Niang M, Dupéré S, Alami H, Gagnon MP. Why is repositioning public health innovation towards a social paradigm necessary? A reflection on the field of public health through the examples of Ebola and Covid-19. Global Health 2021; 17:46. [PMID: 33853631 PMCID: PMC8045578 DOI: 10.1186/s12992-021-00695-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/29/2021] [Indexed: 01/01/2023] Open
Abstract
Health innovations are generally oriented on a techno-economic vision. In this perspective, technologies are seen as an end in themselves, and there is no arrangement between the technical and the social values of innovation. This vision prevails in sanitary crises, in which management is carried out based on the search for punctual, reactive, and technical solutions to remedy a specific problem without a systemic/holistic, sustainable, or proactive approach. This paper attempts to contribute to the literature on the epistemological orientation of innovations in the field of public health. Taking the Covid-19 and Ebola crises as examples, the primary objective is to show how innovation in health is oriented towards a techno-economic paradigm. Second, we propose a repositioning of public health innovation towards a social paradigm that will put more emphasis on the interaction between social and health dimensions in the perspective of social change. We will conclude by highlighting the roles that public health could play in allowing innovations to have more social value, especially during sanitary crises.
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Affiliation(s)
- Marietou Niang
- Faculty of Nursing Science, Université Laval, 1050, Avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, QC G1V 0A6 Canada
| | - Sophie Dupéré
- Faculty of Nursing Science, Université Laval, 1050, Avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, QC G1V 0A6 Canada
| | - Hassane Alami
- Center for Public Health Research, Université de Montréal, Montreal, Québec Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing Science, Université Laval, 1050, Avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, QC G1V 0A6 Canada
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García JI, Allué-Guardia A, Tampi RP, Restrepo BI, Torrelles JB. New Developments and Insights in the Improvement of Mycobacterium tuberculosis Vaccines and Diagnostics Within the End TB Strategy. CURR EPIDEMIOL REP 2021; 8:33-45. [PMID: 33842192 PMCID: PMC8024105 DOI: 10.1007/s40471-021-00269-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW The alignment of sustainable development goals (SDGs) with the End Tuberculosis (TB) strategy provides an integrated roadmap to implement key approaches towards TB elimination. This review summarizes current social challenges for TB control, and yet, recent developments in TB diagnosis and vaccines in the context of the End TB strategy and SDGs to transform global health. RECENT FINDINGS Advances in non-sputum based TB biomarkers and whole genome sequencing technologies could revolutionize TB diagnostics. Moreover, synergistic novel technologies such as mRNA vaccination, nanovaccines and promising TB vaccine models are key promising developments for TB prevention and control. SUMMARY The End TB strategy depends on novel developments in point-of-care TB diagnostics and effective vaccines. However, despite outstanding technological developments in these fields, TB elimination will be unlikely achieved if TB social determinants are not fully addressed. Indeed, the End TB strategy and SDGs emphasize the importance of implementing sustainable universal health coverage and social protection.
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Affiliation(s)
- Juan Ignacio García
- Population Health Program, Tuberculosis Group, Texas Biomedical Research Institute, 8715 W. Military Dr, San Antonio, TX 78227 USA
| | - Anna Allué-Guardia
- Population Health Program, Tuberculosis Group, Texas Biomedical Research Institute, 8715 W. Military Dr, San Antonio, TX 78227 USA
| | - Radhika P. Tampi
- PhD Program in Health Policy, Harvard University, Cambridge, MA 02138 USA
| | - Blanca I. Restrepo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX 78520 USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX 78539 USA
| | - Jordi B. Torrelles
- Population Health Program, Tuberculosis Group, Texas Biomedical Research Institute, 8715 W. Military Dr, San Antonio, TX 78227 USA
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123
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Hricak H, Abdel-Wahab M, Atun R, Lette MM, Paez D, Brink JA, Donoso-Bach L, Frija G, Hierath M, Holmberg O, Khong PL, Lewis JS, McGinty G, Oyen WJG, Shulman LN, Ward ZJ, Scott AM. Medical imaging and nuclear medicine: a Lancet Oncology Commission. Lancet Oncol 2021; 22:e136-e172. [PMID: 33676609 PMCID: PMC8444235 DOI: 10.1016/s1470-2045(20)30751-8] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.
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Affiliation(s)
- Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - May Abdel-Wahab
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria; Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Diana Paez
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Lluís Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jason S Lewis
- Department of Radiology and Molecular Pharmacology Programme, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Pharmacology and Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Geraldine McGinty
- Departments of Radiology and Population Science, Weill Cornell Medical College, New York, NY, USA; American College of Radiology, Reston, VA, USA
| | - Wim J G Oyen
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, Netherlands; Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lawrence N Shulman
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Andrew M Scott
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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Gyedu A, Stewart B, Gaskill C, Salia E, Wadie R, Abantanga F, Donkor P, Mock C. A Nationwide Enumeration of Operations Performed for Pediatric Patients in Ghana. Eur J Pediatr Surg 2021; 31:199-205. [PMID: 32242327 DOI: 10.1055/s-0040-1705130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Currently, there are no existing benchmarks for evaluating a nation's pediatric surgical capacity in terms of met and unmet needs. MATERIALS AND METHODS Data on pediatric operations performed from 2014 to 2015 were obtained from a representative sample of hospitals in Ghana, then scaled up for national estimates. Operations were categorized as "essential" (most cost-effective, highest population impact) as designated by the World Bank's Disease Control Priorities versus "other." Estimates were then compared with pediatric operation rates in New Zealand to determine unmet pediatric surgery need in Ghana. RESULTS A total of 29,884 operations were performed for children <15 years, representing an annual operation rate of 284/100,000 (95% uncertainty interval: 205-364). Essential procedures constituted 66% of all pediatric operations; 12,397 (63%) were performed at district hospitals. General surgery (8,808; 29%) and trauma (6,302; 21%) operations were most common. Operations for congenital conditions were few (826; 2.8%). Tertiary hospitals performed majority (55%) of operations outside of the essential category. Compared with the New Zealand benchmark (3,806 operations/100,000 children <15 years), Ghana is meeting only 7% of its pediatric surgical needs. CONCLUSION Ghana has a large unmet need for pediatric surgical care. Pediatric-specific benchmarking is needed to guide surgical capacity efforts in low- and middle-income country healthcare systems.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, Kwame Nkrumah University of Science and Technology College of Health Sciences, Kumasi, Ghana
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, United States
| | - Cameron Gaskill
- Department of Surgery, University of Washington, Seattle, Washington, United States
| | - Emmanuella Salia
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Raymond Wadie
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Francis Abantanga
- Department of Surgery, University for Development Studies, Tamale, Northern, Ghana
| | - Peter Donkor
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, Washington, United States
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Ward ZJ, Scott AM, Hricak H, Atun R. Global costs, health benefits, and economic benefits of scaling up treatment and imaging modalities for survival of 11 cancers: a simulation-based analysis. Lancet Oncol 2021; 22:341-350. [PMID: 33662286 DOI: 10.1016/s1470-2045(20)30750-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND In addition to increased availability of treatment modalities, advanced imaging modalities are increasingly recommended to improve global cancer care. However, estimates of the costs and benefits of investments to improve cancer survival are scarce, especially for low-income and middle-income countries (LMICs). In this analysis, we aimed to estimate the costs and lifetime health and economic benefits of scaling up imaging and treatment modality packages on cancer survival, both globally and by country income group. METHODS Using a previously developed model of global cancer survival, we estimated stage-specific cancer survival and life-years gained (accounting for competing mortality) in 200 countries and territories for patients diagnosed with one of 11 cancers (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate) representing 60% of all cancer diagnoses between 2020 and 2030 (inclusive of full years). We evaluated the costs and health and economic benefits of scaling up packages of treatment (chemotherapy, surgery, radiotherapy, and targeted therapy), imaging modalities (ultrasound, x-ray, CT, MRI, PET, single-photon emission CT), and quality of care to the mean level of high-income countries, separately and in combination, compared with no scale-up. Costs and benefits are presented in 2018 US$ and discounted at 3% annually. FINDINGS For the 11 cancers studied, we estimated that without scale-up (ie, with current availability of treatment, imaging, and quality of care) there will be 76·0 million cancer deaths (95% UI 73·9-78·6) globally for patients diagnosed between 2020 and 2030, with more than 70% of these deaths occurring in LMICs. Comprehensive scale-up of treatment, imaging, and quality of care could avert 12·5% (95% UI 9·0-16·3) of these deaths globally, ranging from 2·8% (1·8-4·3) in high-income countries to 38·2% (32·6-44·5) in low-income countries. Globally, we estimate that comprehensive scale-up would cost an additional $232·9 billion (95% UI 85·9-422·0) between 2020 and 2030 (representing a 6·9% increase in cancer treatment costs), but produce $2·9 trillion (1·8-4·0) in lifetime economic benefits, yielding a return of $12·43 (6·47-33·23) per dollar invested. Scaling up treatment and quality of care without imaging would yield a return of $6·15 (2·66-16·71) per dollar invested and avert 7·0% (3·9-10·3) of cancer deaths worldwide. INTERPRETATION Simultaneous investment in cancer treatment, imaging, and quality of care could yield substantial health and economic benefits, especially in LMICs. These results provide a compelling rationale for the value of investing in the global scale-up of cancer care. FUNDING Harvard TH Chan School of Public Health and National Cancer Institute.
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Affiliation(s)
- Zachary J Ward
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
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126
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Nachega JB, Borre ED, Dowdy DW, Chanda-Kapata P, Cleary S, Geng EH. Cost-effectiveness of universal HIV testing and treatment: where next? LANCET GLOBAL HEALTH 2021; 9:e573-e574. [PMID: 33721567 PMCID: PMC8295732 DOI: 10.1016/s2214-109x(21)00089-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Jean B Nachega
- Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Global Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Medicine and Centre for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town 7505, South Africa; Department of Epidemiology and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ethan D Borre
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - David W Dowdy
- Department of Epidemiology and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, Washington University, St Louis, MO, USA; Center for Dissemination and Implementation, Institute for Public Health, Washington University, St Louis, MO, USA
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127
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Callander EJ, Topp SM. Health inequality in the tropics and its costs: a Sustainable Development Goals alert. Int Health 2021; 12:395-410. [PMID: 31951257 PMCID: PMC7443734 DOI: 10.1093/inthealth/ihz112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/10/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background It is known that health impacts economic performance. This article aims to assess the current state of health inequality in the tropics, defined as the countries located between the Tropic of Cancer and the Tropic of Capricorn, and estimate the impact of this inequality on gross domestic product (GDP). Methods We constructed a series of concentration indices showing between-country inequalities in disability-adjusted life years (DALYs), taken from the Global Burden of Disease Study. We then utilized a non-linear least squares model to estimate the influence of health on GDP and counterfactual analysis to assess the GDP for each country had there been no between-country inequality. Results The poorest 25% of the tropical population had 68% of the all-cause DALYs burden in 2015; 82% of the communicable, maternal, neonatal and nutritional DALYs burden; 55% of the non-communicable disease DALYs burden and 61% of the injury DALYs burden. An increase in the all-cause DALYs rate of 1/1000 resulted in a 0.05% decrease in GDP. If there were no inequality between countries in all-cause DALY rates, most high-income countries would see a modest increase in GDP, with low- and middle-income countries estimated to see larger increases. Conclusions There are large and growing inequalities in health in the tropics and this has significant economic cost for lower-income countries.
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Affiliation(s)
- Emily J Callander
- School of Medicine, Griffith University Gold Coast Campus, G05 Room 2.44, Southport Queensland 4125 Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville Queensland 4811, Australia
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Abu-Akel A, Spitz A, West R. The effect of spokesperson attribution on public health message sharing during the COVID-19 pandemic. PLoS One 2021; 16:e0245100. [PMID: 33534800 PMCID: PMC7857592 DOI: 10.1371/journal.pone.0245100] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022] Open
Abstract
It is urgent to understand how to effectively communicate public health messages during the COVID-19 pandemic. Previous work has focused on how to formulate messages in terms of style and content, rather than on who should send them. In particular, little is known about the impact of spokesperson selection on message propagation during times of crisis. We report on the effectiveness of different public figures at promoting social distancing among 12,194 respondents from six countries that were severely affected by the COVID-19 pandemic at the time of data collection. Across countries and demographic strata, immunology expert Dr. Anthony Fauci achieved the highest level of respondents' willingness to reshare a call to social distancing, followed by a government spokesperson. Celebrity spokespersons were least effective. The likelihood of message resharing increased with age and when respondents expressed positive sentiments towards the spokesperson. These results contribute to the development of evidence-based knowledge regarding the effectiveness of prominent official and non-official public figures in communicating public health messaging in times of crisis. Our findings serve as a reminder that scientific experts and governments should not underestimate their power to inform and persuade in times of crisis and underscore the crucial importance of selecting the most effective messenger in propagating messages of lifesaving information during a pandemic.
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Affiliation(s)
- Ahmad Abu-Akel
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Andreas Spitz
- School of Computer and Communication Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Robert West
- School of Computer and Communication Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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129
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Thomas S, Johnston B, Barry S, Siersbaek R, Burke S. Sláintecare implementation status in 2020: Limited progress with entitlement expansion. Health Policy 2021; 125:277-283. [PMID: 33531170 DOI: 10.1016/j.healthpol.2021.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/04/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
The Sláintecare report developed by political consensus sets out a ten year plan for achieving Universal Health Care (UHC) in Ireland. This paper evaluates the design and progress of the report to mid 2020, but with some reflection on the new COVID 19 era, particularly as it relates to the expansion of entitlements to achieve UHC. The authors explore how close Sláintecare is to the UHC ideal. They also review the phased strategy of implementation in Sláintecare that utilises a systems-thinking approach with interlinkages between entitlements, funding, capacity and implementation. Finally the authors review the Sláintecare milestones against the reality of implementation since the publication of the report in 2017, cognisant of government policy and practice. Some of the initial assumptions around the context of Sláintecare were not realised and there has been limited progress made toward expanding entitlements, and certainly short of the original plan. Nevertheless there have been positive developments in that there is evidence that Government's Implementation Strategy and Action Plans are focussing on reforming a complex adaptive system rather than implementing a blueprint with such initiatives as integrated care pilots and citizen engagement. The authors find that this may help the system change but it risks losing some of the essential elements of entitlement expansion in favour of organisational change.
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Affiliation(s)
- Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, Ireland.
| | - Bridget Johnston
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
| | - Sarah Barry
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
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Costa JC, Victora CG. A scoping review of methods for assessment of sex differentials in early childhood mortality. BMC Pediatr 2021; 21:55. [PMID: 33499809 PMCID: PMC7836200 DOI: 10.1186/s12887-021-02503-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While assessment of sex differentials in child mortality is straightforward, their interpretation must consider that, in the absence of gender bias, boys are more likely to die than girls. The expected differences are also influenced by levels and causes of death. However, there is no standard approach for determining expected sex differences. METHODS We performed a scoping review of studies on sex differentials in under-five mortality, using PubMed, Web of Science, and Scopus databases. Publication characteristics were described, and studies were grouped according to their methodology. RESULTS From the 17,693 references initially retrieved we included 154 studies published since 1929. Indian, Bangladeshi, and Chinese populations were the focus of 44% of the works, and most studies addressed infant mortality. Fourteen publications were classified as reference studies, as these aimed to estimate expected sex differentials based upon the demographic experience of selected populations, either considered as gender-neutral or not. These studies used a variety of methods - from simple averages to sophisticated modeling - to define values against which observed estimates could be compared. The 21 comparative studies mostly used life tables from European populations as standard for expected values, but also relied on groups without assuming those values as expected, otherwise, just as comparison parameters. The remaining 119 studies were categorized as narrative and did not use reference values, being limited to reporting observed sex-specific estimates or used a variety of statistical models, and in general, did not account for mortality levels. CONCLUSION Studies aimed at identifying sex differentials in child mortality should consider overall mortality levels, and report on more than one age group. The comparison of results with one or more reference values, and the use of statistical testing, are strongly recommended. Time trends analyses will help understand changes in population characteristics and interpret findings from a historical perspective.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas. Marechal Deodoro, 1160, 3rd floor, Pelotas, 96020-220 Brazil
| | - Cesar G. Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas. Marechal Deodoro, 1160, 3rd floor, Pelotas, 96020-220 Brazil
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131
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Severe hypoglycaemia under abemaciclib administration in a patient with breast cancer: A case report. Mol Clin Oncol 2021; 14:61. [PMID: 33604051 PMCID: PMC7849062 DOI: 10.3892/mco.2021.2223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 01/11/2021] [Indexed: 01/22/2023] Open
Abstract
The current study reports the case of an 80-year-old woman who experienced severe hypoglycaemia after abemaciclib administration, with a recovery time of ~46 h. Abemaciclib is a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor that is used to treat metastatic breast cancer. A side effect of abemaciclib administration is an increase in creatinine levels. The half-life (t1/2) of 150 mg abemaciclib in patients with breast cancer was reported to be 17.5 h (nearly lower limit), and the time to reach Cmax was ~5 h (Tmax, 4-6 h). Therefore, the total time to reach half the maximum blood concentration after abemaciclib administration is ~24 h (Tmax + t1/2=5+17.5=22.5 h). As abemaciclib is administered twice daily, a considerable amount (Cmax = 123 ng/ml) may persist in the blood following the initial dose. Upon repeated administration, the blood abemaciclib concentration in patients with metastatic liver tumours might increase, although their liver function remains normal. The patient described in the current study had a creatinine level of 1.05 mg/dl at the start of abemaciclib administration. At the time of emergency hospitalisation (on day 5 of abemaciclib administration), the creatinine level was 1.40 mg/dl; however, dehydration was not observed. The patient had been administered the same dose of glimepiride for >1 year and had not experienced hypoglycaemia previously. It can be speculated that the increase in blood creatinine level had some effect on glimepiride metabolism. It is thought that administered abemaciclib enhances metabolic delay in the blood in the same way as in patients with impaired liver function, and as a result, the creatinine level increases in patients with liver metastases. This causes a decrease in renal function, which in turn results in an increase in blood concentration of glimepiride, consequently leading to severe hypoglycaemia. Therefore, clinicians must be careful when using abemaciclib in patients with liver metastases, diabetes and poor renal function.
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132
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Cookson R, Griffin S, Norheim OF, Culyer AJ, Chalkidou K. Distributional Cost-Effectiveness Analysis Comes of Age. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:118-120. [PMID: 33431145 PMCID: PMC7813213 DOI: 10.1016/j.jval.2020.10.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/06/2020] [Indexed: 05/23/2023]
Affiliation(s)
- Richard Cookson
- Centre for Health Economics, University of York, York, England, UK.
| | - Susan Griffin
- Centre for Health Economics, University of York, York, England, UK
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Anthony J Culyer
- Centre for Health Economics, University of York, York, England, UK
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health, Imperial College London, London, England, UK
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Callaghan-Koru JA, Islam M, Khan M, Sowe A, Islam J, Mannan II, George J. Factors that influence the scale up of new interventions in low-income settings: a qualitative case study of the introduction of chlorhexidine cleansing of the umbilical cord in Bangladesh. Health Policy Plan 2020; 35:440-451. [PMID: 32068867 DOI: 10.1093/heapol/czz156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 11/14/2022] Open
Abstract
There is a well-recognized need for empirical study of processes and factors that influence scale up of evidence-based interventions in low-income countries to address the 'know-do' gap. We undertook a qualitative case study of the scale up of chlorhexidine cleansing of the umbilical cord (CHX) in Bangladesh to identify and compare facilitators and barriers for the institutionalization and expansion stages of scale up. Data collection and analysis for this case study were informed by the Consolidated Framework for Implementation Research (CFIR) and the WHO/ExpandNet model of scale up. At the national level, we interviewed 20 stakeholders involved in CHX policy or implementation. At the district level, we conducted interviews with 31 facility-based healthcare providers in five districts and focus group discussions (FGDs) with eight community-based providers and eight programme managers. At the community level, we conducted 7 FGDs with 53 mothers who had a baby within the past year. Expanded interview notes were thematically coded and analysed following an adapted Framework approach. National stakeholders identified external policy and incentives, and the engagement of stakeholders in policy development through the National Technical Working Committee for Newborn Health, as key facilitators for policy and health systems changes. Stakeholders, providers and families perceived the intervention to be simple, safe and effective, and more consistent with family preferences than the prior policy of dry cord care. The major barriers that delayed or decreased the public health impact of the scale up of CHX in Bangladesh's public health system related to commodity production, procurement and distribution. Bangladesh's experience scaling up CHX suggests that scale up should involve early needs assessments and planning for institutionalizing new drugs and commodities into the supply chain. While the five CFIR domains were useful for categorizing barriers and facilitators, additional constructs are needed for common health systems barriers in low-income settings.
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Affiliation(s)
- Jennifer A Callaghan-Koru
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, 1000 Hilltop Circle, Baltimore County, Baltimore, MD 21250, USA.,Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Munia Islam
- MaMoni Health Systems Strengthening Project, Save the Children International, House CWN (A) 35, Road 43, Gulshan 2, Dhaka- 1212, Bangladesh
| | - Marufa Khan
- MaMoni Health Systems Strengthening Project, Save the Children International, House CWN (A) 35, Road 43, Gulshan 2, Dhaka- 1212, Bangladesh.,Pathfinder International, 32 Gulshan Avenue, Gulshan- 2, Dhaka- 1212, Bangladesh
| | - Ardy Sowe
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, 1000 Hilltop Circle, Baltimore County, Baltimore, MD 21250, USA.,Howard University College of Medicine, 520 W Street NW Washington, DC, USA
| | - Jahrul Islam
- Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Imteaz Ibne Mannan
- MaMoni Health Systems Strengthening Project, Save the Children International, House CWN (A) 35, Road 43, Gulshan 2, Dhaka- 1212, Bangladesh.,Jhpiego, House 71, Road 4, Ansari Watt, Shahre Naw, District 4, Kabul, Afghanistan
| | - Joby George
- MaMoni Health Systems Strengthening Project, Save the Children International, House CWN (A) 35, Road 43, Gulshan 2, Dhaka- 1212, Bangladesh
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Belete H, Ergetie T, Ali T, Birhanu S, Belete T. Work-Related Stress and Associated Factors Among Textile Factory Employees in Northwest Ethiopia: A Cross-Sectional Study. Psychol Res Behav Manag 2020; 13:1071-1078. [PMID: 33273870 PMCID: PMC7708313 DOI: 10.2147/prbm.s282061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Work-related stress is becoming an alarmingly growing public health concern worldwide. Textile factories are among the most common manufacturing industries that have a higher rate of work-related stress. Investigating the prevalence and factors associated with work-related stress will help planners and decision-makers at every level in planning, managing, and evaluating the health status of the employees. Research evidence is limited for work-related stress in Northwest Ethiopia. Therefore, this study was aimed to assess work-related stress and associated factors among textile factory employees in Northwest Ethiopia. Methods A cross-sectional study design was employed among 403 employees in Bahir Dar Textile Factory. Data were collected using an interviewer administered questionnaire, then entered into EpiData version 3.1, and analyzed using SPSS version 22 software. Descriptive statistics, bivariate and multivariate logistic regressions were carried out. In logistic regression analysis, adjusted odds ratio (AOR), along with 95% confidence interval (CI), was used to identify the associated factors of work-related stress. A P-value<0.05 was considered as statistically significant. Results The prevalence of work-related stress was 45.2%, with 95% CI=40.0–50.1%. Working in rotational shifts (AOR=2.33, 95% CI=1.34–4.03), current substance use (AOR=5.67, 95% CI=3.38–9.52), poor and medium social support (AOR=3.75, 95% CI=1.71–8.21 and AOR=3.26, 95% CI=1.39–7.64) were significantly associated factors with work-related stress, respectively. Conclusion and Recommendation Near to half of the study participants had work-related stress. Work shift, substance use, and social support were among the factors which affect work-related stress. Thus, interventions that could reduce work-related stress such as stress management programs should be considered.
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Affiliation(s)
- Habte Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Temesgen Ergetie
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Ali
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Simon Birhanu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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135
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Atim C, Arthur E, Achala DM, Novignon J. An Assessment of Domestic Financing for Reproductive, Maternal, Neonatal and Child Health in Sub-Saharan Africa: Potential Gains and Fiscal Space. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:789-799. [PMID: 31512085 PMCID: PMC7716850 DOI: 10.1007/s40258-019-00508-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Reproductive, maternal, neonatal and child health (RMNCH) remains an important public health objective. In sub-Saharan Africa (SSA), inadequate financial commitment continues to pose a major challenge to improving RMNCH outcomes. Understanding financing gains and potential fiscal space for RMNCH can therefore not be overemphasized. OBJECTIVE This study sought to analyse the potential gains from increased domestic financing as a source for improving RMNCH outcomes in SSA. We also assessed, in addition to the potential gains, the potential fiscal space available for financing RMNCH in SSA. METHODS Our study used panel econometric techniques to estimate gains from increased health financing in terms of RMNCH. We also reviewed tax system performance as well as debt sustainability to identify fiscal space potentials across countries. RESULTS We found significant gains from both domestic and external financing. The estimated elasticities suggest that the gains from domestic public financing were much stronger. The fiscal space options identified include tax revenue performance improvements, improved public financial management, and borrowing, at least in the short to medium term. The results show that fiscal space from improved tax systems ranged from US$34.6 per capita in Uganda to US$310.6 per capita in Nigeria. CONCLUSION This result reinforces calls for increased domestic financing for health through innovations in domestic resource mobilization. Improving the performance of tax systems will be a step in the right direction, with possible long-term gains to the health sector.
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Affiliation(s)
- Chris Atim
- African Health Economics and Policy Association (AfHEA), Accra, Ghana
| | - Eric Arthur
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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136
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Mahé C. Publicly provided healthcare and migration. ECONOMICS AND HUMAN BIOLOGY 2020; 39:100924. [PMID: 32966954 DOI: 10.1016/j.ehb.2020.100924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
Publicly provided healthcare has received growing attention. Debates have been fuelled by evidence on improved health and reduced poverty, and concerns over adverse labour market effects; concerns that are, to date, only supported by mixed empirical findings. This article examines whether publicly provided healthcare influences the decision to migrate. The spatial and temporal variation in the expansion of a non-contributory health insurance programme in Mexico, combined with the panel dimension and the timing of household survey data allows causal identification of the effect of increased coverage on migration. Difference-in-differences estimates reveal that accessing healthcare for free raises internal migration. The effect on international migration, costlier by nature, is statistically insignificant. Potential mechanisms include better health, the alleviation of financial constraints and a greater propensity to work. Results point to the relevance of including household members who have migrated in assessing the impacts of social health policies. They suggest that publicly provided healthcare could have multiplier effects on economic development and welfare by enabling labour force detachment of working-age members in affiliated households.
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Affiliation(s)
- Clotilde Mahé
- Department of Economics and Management, University of Luxembourg, 6, rue Richard Coudenhove-Kalergi, L-1359 Luxembourg, Luxembourg
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137
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Carrasco H, Fuentes P, Eguiluz I, Lucio-Ramírez C, Cárdenas S, Leyva Barrera IM, Pérez-Jiménez M. Evaluation of a multidisciplinary global health online course in Mexico. Glob Health Res Policy 2020; 5:48. [PMID: 33292748 PMCID: PMC7670103 DOI: 10.1186/s41256-020-00179-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/29/2020] [Indexed: 11/14/2022] Open
Abstract
Background Global Health Education (GHE) focuses on training proactive global citizens to tackle health challenges in an increasingly interconnected and interdependent world. Studies show that health professionals in training have reported that GHE has improved their teamwork, responsiveness to contextual factors that impact health, and understanding of health systems; however, there is little research on the impact of GHE courses in undergraduate settings, especially in low and middle-income countries (LMICs). Methods Our study analyzes a multidisciplinary online global health course at Tecnologico de Monterrey, México. We conducted a cross-sectional study with pre- and post-design. Students who took the multidisciplinary course of Global Health for Leaders in the Fall of 2019 (n = 153) and Spring of 2020 (n = 348) were selected for this study. Using a five-point Likert scale (strongly agree to strongly disagree), the survey assessed seven competencies as well as questions about course expectations, takeaways, and recommendations to improve the course. We performed descriptive statistical analyses comparing the combined pre-tests (from Fall and Spring cohorts) to the combined post-tests. Fisher’s exact test was used to compare the samples. Results Of the 501 pre-course surveys administered, 456 responses were completed in the pre-course and 435 in the post-course (91% overall response rate). Only 8.7% of the respondents in the pre-course survey strongly agreed that they could describe fundamental aspects of global health such as the Millennium Development Goals or Sustainable Development Goals, in contrast to a 56% of the students who strongly agreed in the post-course survey (p < 0.001). Similar differences were captured in understanding the global burden of disease, social determinants of health, the effects of globalization in health, health systems’ goals and functions, and human rights. 38% felt that the course helped them develop a more empathetic perception of the suffering of others experiencing global health-related issues. Conclusion In this study, we have presented our experience in teaching an online global health course for multidisciplinary undergraduates in a LMIC. The competencies reported by our students indicate that the course prepared them to confront complex global health issues. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-020-00179-8.
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Affiliation(s)
- Héctor Carrasco
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.
| | - Patricia Fuentes
- History of Science and Global Health and Health Policy, Harvard University, Cambridge, USA
| | - Itzel Eguiluz
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Cesar Lucio-Ramírez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Sandra Cárdenas
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Ilse Mariana Leyva Barrera
- Vice-Rectory of Academic and Educational Innovation, Tecnológico de Monterrey, Monterrey Campus, Monterrey, Mexico
| | - Manuel Pérez-Jiménez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
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Abstract
Using infectious diseases sensitive to climate as indicators of climate change helps stimulate and inform public health responses, write Kris A Murray and colleagues
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Affiliation(s)
- Kris A Murray
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK
- Grantham Institute-Climate Change and the Environment, Imperial College, London, UK
- MRC Unit, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, the Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Luis E Escobar
- Department of Fish and Wildlife Conservation, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, 24061 USA
| | - Rachel Lowe
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jan C Semenza
- Scientific Assessment Section, European Centre for Disease Prevention and Control, 169 73 Solna, Sweden
| | - Nick Watts
- Institute for Global Health, University College London, London W1T 4TJ, UK
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139
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Patel SA, Sharma H, Mohan S, Weber MB, Jindal D, Jarhyan P, Gupta P, Sharma R, Ali M, Ali MK, Narayan KMV, Prabhakaran D, Gupta Y, Roy A, Tandon N. The Integrated Tracking, Referral, and Electronic Decision Support, and Care Coordination (I-TREC) program: scalable strategies for the management of hypertension and diabetes within the government healthcare system of India. BMC Health Serv Res 2020; 20:1022. [PMID: 33168004 PMCID: PMC7652581 DOI: 10.1186/s12913-020-05851-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023] Open
Abstract
Background Hypertension and diabetes are among the most common and deadly chronic conditions globally. In India, most adults with these conditions remain undiagnosed, untreated, or poorly treated and uncontrolled. Innovative and scalable approaches to deliver proven-effective strategies for medical and lifestyle management of these conditions are needed. Methods The overall goal of this implementation science study is to evaluate the Integrated Tracking, Referral, Electronic decision support, and Care coordination (I-TREC) program. I-TREC leverages information technology (IT) to manage hypertension and diabetes in adults aged ≥30 years across the hierarchy of Indian public healthcare facilities. The I-TREC program combines multiple evidence-based interventions: an electronic case record form (eCRF) to consolidate and track patient information and referrals across the publicly-funded healthcare system; an electronic clinical decision support system (CDSS) to assist clinicians to provide tailored guideline-based care to patients; a revised workflow to ensure coordinated care within and across facilities; and enhanced training for physicians and nurses regarding non-communicable disease (NCD) medical content and lifestyle management. The program will be implemented and evaluated in a predominantly rural district of Punjab, India. The evaluation will employ a quasi-experimental design with mixed methods data collection. Evaluation indicators assess changes in the continuum of care for hypertension and diabetes and are grounded in the Reach, Effectiveness, Adoption Implementation, and Maintenance (RE-AIM) framework. Data will be triangulated from multiple sources, including community surveys, health facility assessments, stakeholder interviews, and patient-level data from the I-TREC program’s electronic database. Discussion I-TREC consolidates previously proven strategies for improved management of hypertension and diabetes at single-levels of the healthcare system into a scalable model for coordinated care delivery across all levels of the healthcare system hierarchy. Findings have the potential to inform best practices to ultimately deliver quality public-sector hypertension and diabetes care across India. Trial registration The study is registered with Clinical Trials Registry of India (registration number CTRI/2020/01/022723). The study was registered prior to the launch of the intervention on 13 January 2020. The current version of protocol is version 2 dated 6 June 2018.
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Affiliation(s)
- Shivani A Patel
- Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA.
| | | | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | - Mary Beth Weber
- Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA
| | - Devraj Jindal
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Priti Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - Rakshit Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Mumtaj Ali
- Centre for Chronic Disease Control, New Delhi, India
| | - Mohammed K Ali
- Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA.,Department of Family and Preventive Medicine, Emory University, Atlanta, USA
| | - K M Venkat Narayan
- Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | - Yashdeep Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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140
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Beneath the Surface: A Comparison of Methods for Assessment of Quality of Care for Maternal and Neonatal Health Care in Rural Uganda. Matern Child Health J 2020; 24:328-339. [PMID: 31894511 DOI: 10.1007/s10995-019-02862-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Efforts to improve access to healthcare in low-income countries will not achieve the maternal and child health (MCH) Sustainable Development Goals unless a concomitant improvement in the quality of care (QoC) occurs. This study measures infrastructure and QoC indicators in rural Ugandan health facilities. Valid measure of the quality of current clinical practices in resource-limited settings are critical for effectively intervening to reduce adverse maternal and neonatal outcomes. METHODS Facility-based assessments of infrastructure and clinical quality during labor and delivery were conducted in six primary care health facilities in the greater Masaka area, Uganda in 2017. Data were collected using direct observation of clinical encounters and facility checklists. Direct observation comprised the entire delivery process, from initial client assessment to discharge, and included emergency management (e.g. postpartum hemorrhage, neonatal resuscitation). Health providers were assessed on their adherence to best practice standards of care. RESULTS The quality of facility infrastructure was relatively high in facilities, with little variation in availability of equipment and supplies. However, heterogeneity in adherence to best clinical practices was noted across procedure type and facility. Adherence to crude measures of clinical quality were relatively high but more sensitive measures of the same clinical practice were found to be much lower. CONCLUSIONS FOR PRACTICE Standard indicators of clinical practice may be insufficient to validly measure clinical quality for maternal and newborn care if we want to document evidence of impact.
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Mamiya KT, John C, Alnahar SA, Bader L, Bates I. Achieving Sustainable Developments Goal 3 on health from global pharmacy workforce. J Glob Health 2020; 10:020350. [PMID: 33110547 PMCID: PMC7562730 DOI: 10.7189/jogh.10.020350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kayoko Takeda Mamiya
- Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Sapporo, Hokkaido, Japan
| | - Christopher John
- International Pharmaceutical Federation, The Hague, the Netherlands
| | | | - Lina Bader
- International Pharmaceutical Federation, The Hague, the Netherlands
| | - Ian Bates
- School of Pharmacy, University College London, London, UK
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142
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Vijayasingham L, Govender V, Witter S, Remme M. Employment based health financing does not support gender equity in universal health coverage. BMJ 2020; 371:m3384. [PMID: 33109510 PMCID: PMC7587231 DOI: 10.1136/bmj.m3384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health financing and entitlement systems linked to employment can disadvantage women, argue Lavanya Vijayasingham and colleagues
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Affiliation(s)
- Lavanya Vijayasingham
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | | | - Sophie Witter
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Michelle Remme
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
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143
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144
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Forsythe SS, McGreevey W, Whiteside A, Shah M, Cohen J, Hecht R, Bollinger LA, Kinghorn A. Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits. Health Aff (Millwood) 2020; 38:1163-1172. [PMID: 31260344 DOI: 10.1377/hlthaff.2018.05391] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Since the introduction of azidothymidine in 1987, significant improvements in treatment for people living with HIV have yielded substantial improvements in global health as a result of the unique benefits of antiretroviral therapy (ART). ART averted 9.5 million deaths worldwide in 1995-2015, with global economic benefits of $1.05 trillion. For every $1 spent on ART, $3.50 in benefits accrued globally. If treatment scale-up achieves the global 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS, a total of 34.9 million deaths are projected to be averted between 1995 and 2030. Approximately 40.2 million new HIV infections could also be averted by ART, and economic gains could reach $4.02 trillion in 2030. Having provided ART to 19.5 million people represents a major human achievement. However, 15.2 million infected people are currently not receiving treatment, which represents a significant lost opportunity. Further treatment scale-up could yield even greater health and economic benefits.
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Affiliation(s)
- Steven S Forsythe
- Steven S. Forsythe is deputy director for economics and costing at Avenir Health, in Glastonbury, Connecticut
| | - William McGreevey
- William McGreevey is an associate professor of international health at Georgetown University, in Washington, D.C
| | - Alan Whiteside
- Alan Whiteside is the CIGI Chair in Global Health Policy at the School of International Policy and Governance, Wilfrid Laurier University, in Waterloo, Ontario
| | - Maunank Shah
- Maunank Shah is an associate professor in the Division of Infectious Diseases, Johns Hopkins University, in Baltimore, Maryland
| | - Joshua Cohen
- Joshua Cohen is an independent health care analyst in Boston, Massachusetts
| | - Robert Hecht
- Robert Hecht is president of Pharos Global Health, in Boston
| | | | - Anthony Kinghorn
- Anthony Kinghorn ( ) is a health economist in the Perinatal HIV Research Unit, University of the Witwatersrand, in Soweto, South Africa
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145
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Ranabhat CL, Subedi R, Karn S. Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study. Cost Eff Resour Alloc 2020. [PMID: 33013204 DOI: 10.1186/s12962‐020‐00227‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Compared to other countries in the South Asia Nepal has seen a slow progress in the coverage of health insurance. Despite of a long history of the introduction of health insurance (HI) and a high priority of the government of Nepal it has not been able to push rapidly its social health insurance to its majority of the population. There are many challenges while to achieve universal health insurance in Nepal ranging from existing policy paralysis to program operation. This study aims to identify the enrollment and dropout rates of health insurance and its determinants in selected districts of Nepal. Methods The study was conducted while using a mixed method including both quantitative and qualitative approaches. Numerical data related to enrollment and dropout rates were taken from Health Insurance Board (HIB) of Nepal. For the qualitative data, three districts, Bardiya, Chitwan, and Gorkha of Nepal were selected purposively. Enrollment assistants (EA) of social health insurance program were taken as the participants of study. Focus group discussions (FGD) were arranged with the selected EAs using specific guidelines along with unstructured questions. The results from numerical data and focus group discussions are synthesized and presented accordingly. Results The findings of the study suggested variation in enrollment and dropout of health insurance in the districts. Enrollment coverage was 13,545 (1%), 249,104 (5%), 1,159,477 (9%) and 1,676,505 (11%) from 2016 to 2019 among total population and dropout rates were 9121(67%), 110,885 (44%) and 444,967 (38%) among total enrollment from 2016 to 2018 respectively. Of total coverage, more than one-third proportion was subsidy enrollment-free enrollment for vulnerable groups. The population characteristics of unwilling and dropout in social health insurance came from relatively well-off families, government employees, businessman, migrants' people, some local political leaders as well as the poor class families. The major determinants of poor enrollment and dropout were mainly due to unavailability of enough drugs, unfriendly behavior of health workers, and indifferent behavior of the care personnel to the insured patients in health care facilities and prefer to take health service in private clinic for their own benefits. The long maturation time to activate health service, limited health package and lack of copayment in different types of health care were the factors related to inefficient program and policy implementation. Conclusion There is a high proportion of dropout and subsidy enrollment, the key challenge for sustainability of health insurance program in Nepal. Revisiting of existing HI policy on health care packages, more choices on copayment, capacity building of enrollment assistants and better coordination between health insurance board and health care facilities can increase the enrollment and minimize the dropout.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Policy Research Institute, Sanogaucharan, Kathmandu, Nepal.,Manmohan Memorial Institute of Health Sciences, Solteemod, Kathmandu, Nepal.,Global Center for Research and Development, Kathmandu, Nepal
| | - Radha Subedi
- Policy Research Institute, Sanogaucharan, Kathmandu, Nepal
| | - Sujeet Karn
- Policy Research Institute, Sanogaucharan, Kathmandu, Nepal.,Global Center for Research and Development, Kathmandu, Nepal
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146
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Bukhman G, Mocumbi AO, Atun R, Becker AE, Bhutta Z, Binagwaho A, Clinton C, Coates MM, Dain K, Ezzati M, Gottlieb G, Gupta I, Gupta N, Hyder AA, Jain Y, Kruk ME, Makani J, Marx A, Miranda JJ, Norheim OF, Nugent R, Roy N, Stefan C, Wallis L, Mayosi B. The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion. Lancet 2020; 396:991-1044. [PMID: 32941823 PMCID: PMC7489932 DOI: 10.1016/s0140-6736(20)31907-3] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Gene Bukhman
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne E Becker
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Kids, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Institute for Global Health & Development, Aga Khan University, South-Central Asia, East Africa, and UK
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew M Coates
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Gary Gottlieb
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Indrani Gupta
- Health Policy Research Unit, Institute of Economic Growth, Delhi, India
| | - Neil Gupta
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yogesh Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew Marx
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ole F Norheim
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, HBNI University, Government of India, Mumbai, India; Field Health Systems Laboratory, Bihar Technical Support Programme, CARE India, Madhubani, Bihar, India
| | - Cristina Stefan
- SingHealth Duke-NUS Global Health Institute (SDGHI), Duke-NUS Medical School, Singapore; African Medical Research and Innovation Institute, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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147
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Ranabhat CL, Subedi R, Karn S. Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:40. [PMID: 33013204 PMCID: PMC7528465 DOI: 10.1186/s12962-020-00227-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Compared to other countries in the South Asia Nepal has seen a slow progress in the coverage of health insurance. Despite of a long history of the introduction of health insurance (HI) and a high priority of the government of Nepal it has not been able to push rapidly its social health insurance to its majority of the population. There are many challenges while to achieve universal health insurance in Nepal ranging from existing policy paralysis to program operation. This study aims to identify the enrollment and dropout rates of health insurance and its determinants in selected districts of Nepal. Methods The study was conducted while using a mixed method including both quantitative and qualitative approaches. Numerical data related to enrollment and dropout rates were taken from Health Insurance Board (HIB) of Nepal. For the qualitative data, three districts, Bardiya, Chitwan, and Gorkha of Nepal were selected purposively. Enrollment assistants (EA) of social health insurance program were taken as the participants of study. Focus group discussions (FGD) were arranged with the selected EAs using specific guidelines along with unstructured questions. The results from numerical data and focus group discussions are synthesized and presented accordingly. Results The findings of the study suggested variation in enrollment and dropout of health insurance in the districts. Enrollment coverage was 13,545 (1%), 249,104 (5%), 1,159,477 (9%) and 1,676,505 (11%) from 2016 to 2019 among total population and dropout rates were 9121(67%), 110,885 (44%) and 444,967 (38%) among total enrollment from 2016 to 2018 respectively. Of total coverage, more than one-third proportion was subsidy enrollment-free enrollment for vulnerable groups. The population characteristics of unwilling and dropout in social health insurance came from relatively well-off families, government employees, businessman, migrants' people, some local political leaders as well as the poor class families. The major determinants of poor enrollment and dropout were mainly due to unavailability of enough drugs, unfriendly behavior of health workers, and indifferent behavior of the care personnel to the insured patients in health care facilities and prefer to take health service in private clinic for their own benefits. The long maturation time to activate health service, limited health package and lack of copayment in different types of health care were the factors related to inefficient program and policy implementation. Conclusion There is a high proportion of dropout and subsidy enrollment, the key challenge for sustainability of health insurance program in Nepal. Revisiting of existing HI policy on health care packages, more choices on copayment, capacity building of enrollment assistants and better coordination between health insurance board and health care facilities can increase the enrollment and minimize the dropout.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Policy Research Institute, Sanogaucharan, Kathmandu, Nepal.,Manmohan Memorial Institute of Health Sciences, Solteemod, Kathmandu, Nepal.,Global Center for Research and Development, Kathmandu, Nepal
| | - Radha Subedi
- Policy Research Institute, Sanogaucharan, Kathmandu, Nepal
| | - Sujeet Karn
- Policy Research Institute, Sanogaucharan, Kathmandu, Nepal.,Global Center for Research and Development, Kathmandu, Nepal
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148
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Briggs AM, Shiffman J, Shawar YR, Åkesson K, Ali N, Woolf AD. Global health policy in the 21st century: Challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions. Best Pract Res Clin Rheumatol 2020; 34:101549. [PMID: 32713802 PMCID: PMC7377715 DOI: 10.1016/j.berh.2020.101549] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The profound burden of disease associated with musculoskeletal health conditions is well established. Despite the unequivocal disability burden and personal and societal consequences, relative to other non-communicable diseases (NCDs), system-level responses for musculoskeletal conditions that are commensurate with their burden have been lacking nationally and globally. Health policy priorities and responses in the 21st century have evolved significantly from the 20th century, with health systems now challenged by an increasing prevalence and impact of NCDs and an unprecedented rate of global population ageing. Further, health policy priorities are now strongly aligned to the 2030 Sustainable Development Goals. With this background, what are the challenges and opportunities available to influence global health policy to support high-value care for musculoskeletal health conditions and persistent pain? This paper explores these issues by considering the current global health policy landscape, the role of global health networks, and progress and opportunities since the 2000-2010 Bone and Joint Decade for health policy to support improved musculoskeletal health and high-value musculoskeletal health care.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box 1987, Perth, WA, 6845, Australia.
| | - Jeremy Shiffman
- Johns Hopkins Bloomberg School of Public Health, John Hopkins University, 615 N. Wolfe St., E8539, Baltimore, MD, 21205, United States.
| | - Yusra Ribhi Shawar
- Johns Hopkins Bloomberg School of Public Health, John Hopkins University, 615 N. Wolfe St., E8539, Baltimore, MD, 21205, United States.
| | - Kristina Åkesson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Geriatrics, Skåne University Hospital, Malmö, Sweden.
| | - Nuzhat Ali
- Priority and Programmes Division, Health Improvement Directorate, Public Health England, Wellington House, 133- 155 Waterloo Road, Waterloo, SE1 8UG, United Kingdom.
| | - Anthony D Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, TR1 3HD, United Kingdom.
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149
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Hatefi A, Marten R, Smith RD. Global-scale action in health: a common language is a critical starting point to bolster global health financing. Health Policy Plan 2020; 35:1133-1136. [PMID: 32860681 DOI: 10.1093/heapol/czaa090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Arian Hatefi
- Department of Medicine and Institute for Global Health Sciences, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA 94143, USA
| | - Robert Marten
- The Alliance for Health Policy and Systems Research and
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150
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Economic Case for Scale-up of the WHO Surgical Safety Checklist at the National Level in Sub-Saharan Africa. Ann Surg 2020; 275:1018-1024. [PMID: 32941283 DOI: 10.1097/sla.0000000000004498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the economic case for nationwide scale-up of the World Health Organisation (WHO) Surgical Safety Checklist using cost-effectiveness and benefit-cost analyses. BACKGROUND The Checklist improves surgical outcomes but the economic case for widespread use remains uncertain. For perioperative quality improvement interventions to compete successfully against other worthwhile health and non-health interventions for limited government resources they must demonstrate cost-effectiveness and positive societal benefit. METHODS Using data from three countries, we estimated the benefits as the total years of life lost (YLL) due to post-operative mortality averted over a 3 year period; converted the benefits to dollar equivalent values using estimates of the economic value of an additional year of life expectancy; estimated total implementation costs; and determined incremental cost-effectiveness ratios (ICER) and benefit-cost-ratios (BCR). Costs are reported in international dollars using Word Bank purchasing power parity conversion factors at 2016 price-levels. RESULTS In Benin, Cameroon and Madagascar ICERs were: $31, $138 and $118 per additional YLL averted; and BCRs were 62, 29, and 9, respectively. Sensitivity analysis demonstrated that the associated mortality reduction and increased usage due to Checklist scale-up would need to deviate approximately 10-fold from published data to change our main interpretations. CONCLUSIONS According to WHO criteria, Checklist scale-up is considered "very cost-effective" and for every $1 spent the potential return on investment is $9-62. These results compare favourably with other health and non-health interventions and support the economic argument for investing in Checklist scale-up as part of a national strategy for improving surgical outcomes.
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