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Octavius GS, Daleni VA, Sagala YDS. An Insight into Indonesia's Challenges in Implementing Newborn Screening Programs and Their Future Implications. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1216. [PMID: 37508713 PMCID: PMC10378005 DOI: 10.3390/children10071216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
Due to high entry barriers, countries might find it daunting to implement the NBS program, especially those just trying to start it. This review aims to discuss Indonesia's barriers that hinder newborn screening (NBS) implementation while discussing the future implications. Literature in Pubmed and Google Scholar was scoured with keywords such as "Newborn Screening", "Neonatal Screening", "Indonesia", "Asia Pacific", "Barriers", and "Challenges". We also searched for relevant references in those published articles. Grey literature, such as state regulations, informative webinars on the topics by experts regarding current situations, and press releases by the Indonesian Minister of Health (MoH), was also searched. Newborn screening is no longer considered just a laboratory test but an array of well-harmonized systems that must be orchestrated well. Some of the barriers Indonesia faces in implementing NBS are a lack of prevalence data, ethical issues, infrastructure, cost-benefit analysis, logistical issues, government support, patient issues, a lack of commitments, and a lack of healthcare workers, specialization, and training. Government support with professional advocates and support groups, proper infrastructure, and a single-payer system for NBS programs are necessary to accelerate NBS programs in Indonesia.
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Affiliation(s)
- Gilbert Sterling Octavius
- Department of Pediatrics, Universitas Pelita Harapan, Tangerang 15811, Indonesia
- St. Theresia Hospital, Jambi 36123, Indonesia
| | - Vamela Adman Daleni
- Department of Pediatrics, Universitas Pelita Harapan, Tangerang 15811, Indonesia
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Karamagi HC, Berhane A, Ngusbrhan Kidane S, Nyawira L, Ani-Amponsah M, Nyanjau L, Maoulana K, Seydi ABW, Nzinga J, Dangou JM, Nkurunziza T, K Bisoborwa G, Sillah JS, W Muriithi A, Nirina Razakasoa H, Bigirimana F. High impact health service interventions for attainment of UHC in Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000945. [PMID: 36962639 PMCID: PMC10021619 DOI: 10.1371/journal.pgph.0000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022]
Abstract
African countries have prioritized the attainment of targets relating to Universal Health Coverage (UHC), Health Security (HSE) and Coverage of Health Determinants (CHD)to attain their health goals. Given resource constraints, it is important to prioritize implementation of health service interventions with the highest impact. This is important to be identified across age cohorts and public health functions of health promotion, disease prevention, diagnostics, curative, rehabilitative and palliative interventions. We therefore explored the published evidence on the effectiveness of existing health service interventions addressing the diseases and conditions of concern in the Africa Region, for each age cohort and the public health functions. Six public health and economic evaluation databases, reports and grey literature were searched. A total of 151 studies and 357 interventions were identified across different health program areas, public health functions and age cohorts. Of the studies, most were carried out in the African region (43.5%), on communicable diseases (50.6%), and non-communicable diseases (36.4%). Majority of interventions are domiciled in the health promotion, disease prevention and curative functions, covering all age cohorts though the elderly cohort was least represented. Neonatal and communicable conditions dominated disease burden in the early years of life and non-communicable conditions in the later years. A menu of health interventions that are most effective at averting disease and conditions of concern across life course in the African region is therefore consolidated. These represent a comprehensive evidence-based set of interventions for prioritization by decision makers to attain desired health goals. At a country level, we also identify principles for identifying priority interventions, being the targeting of higher implementation coverage of existing interventions, combining interventions across all the public health functions-not focusing on a few functions, provision of subsidies or free interventions and prioritizing early identification of high-risk populations and communities represent these principles.
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Affiliation(s)
- Humphrey Cyprian Karamagi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Araia Berhane
- Conmmunicable Diseases Control Division, Ministry of Health, Asmara, Eritrea
| | - Solyana Ngusbrhan Kidane
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Lizah Nyawira
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Koulthoume Maoulana
- Ministry of Health, Solidarity, Social Protection and Gender Promotion, Moroni, Comoros
| | - Aminata Binetou Wahebine Seydi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Cacciatore P, Visser LA, Buyukkaramikli N, van der Ploeg CPB, van den Akker-van Marle ME. The Methodological Quality and Challenges in Conducting Economic Evaluations of Newborn Screening: A Scoping Review. Int J Neonatal Screen 2020; 6:ijns6040094. [PMID: 33238605 PMCID: PMC7712813 DOI: 10.3390/ijns6040094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cost-effectiveness (CEA) and cost-utility analyses (CUA) have become popular types of economic evaluations (EE) used for evidence-based decision-making in healthcare resource allocation. Newborn screening programs (NBS) can have significant clinical benefits for society, and cost-effectiveness analysis may help to select the optimal strategy among different screening programs, including the no-screening option, on different conditions. These economic analyses of NBS, however, are hindered by several methodological challenges. This study explored the methodological quality in recent NBS economic evaluations and analyzed the main challenges and strategies adopted by researchers to deal with them. METHODS A scoping review was conducted according to PRISMA methodology to identify CEAs and CUAs of NBS. The methodological quality of the retrieved studies was assessed quantitatively using a specific guideline for the quality assessment of NBS economic evaluations, by calculating a general score for each EE. Challenges in the studies were then explored using thematic analysis as a qualitative synthesis approach. RESULTS Thirty-five studies met the inclusion criteria. The quantitative analysis showed that the methodological quality of NBS economic evaluations was heterogeneous. Lack of clear description of items related to results, discussion, and discounting were the most frequent flaws. Methodological challenges in performing EEs of neonatal screenings include the adoption of a long time horizon, the use of quality-adjusted life years as health outcome measure, and the assessment of costs beyond the screening interventions. CONCLUSIONS The results of this review can support future economic evaluation research, aiding researchers to develop a methodological guidance to perform EEs aimed at producing solid results to inform decisions for resource allocation in neonatal screening.
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Affiliation(s)
- Pasquale Cacciatore
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Laurenske A. Visser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (L.A.V.); (N.B.)
| | - Nasuh Buyukkaramikli
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (L.A.V.); (N.B.)
| | | | - M. Elske van den Akker-van Marle
- Unit Medical Decision Making, Department of Biomedical Datasciences, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
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Cost-Effectiveness Analysis of Pulse Oximetry Screening in the Full-Term Neonates for Diagnosis of Congenital Heart Disease: A Systematic Review. IRANIAN JOURNAL OF PEDIATRICS 2020. [DOI: 10.5812/ijp.105393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Congenital heart disease (CHD) is a leading cause of mortality by birth defects with significant social and economic burden. Pulse oximetry as a safe and non-invasive screening method, and with its potential for early detection of CHD has improved neonatal health outcomes. Objectives: The aim of this study was to systematically review economic evaluation studies that compared pulse oximetry with current programs to diagnose early detection of CHD in full-term newborns. Data Sources: A systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and related articles published from 1995 up to March 2020 were searched in different databases (MEDLINE, EMBASE, PubMed, Science Direct, Google Scholar, Scopus, NHS EED, Science Citation Index, MagIran, Cochrane Library, EconLit and SID). The articles were selected based on inclusion and exclusion criteria. Consolidated health economic evaluation reporting standards (CHEERS) statement checklist was used to qualitatively evaluate the papers. Overall, 7 articles were included in the study. Results: Timely diagnosis was considered as main effectiveness health outcome in most studies. The highest and lowest values of incremental cost-effectiveness ratio (in two-phase studies) were €139,000 and $100 per infant in the Netherlands and Colombia respectively; and (in one-phase studies) were £24,000 and £1,489 per infant both belonging to the UK. Implementing pulse oximetry method concurrent with the clinical examination is more cost-effective. The reviewed studies had been conducted in high-income and upper middle-income countries; therefore, when the results are generalizing by policy makers in different health systems, a substantial precaution approach is needed.
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Mardani A, Gheytanchi E, Mousavie SH, Madjd Jabari Z, Shooshtarizadeh T. Clinical Significance of Cancer Stem Cell Markers CD133 and CXCR4 in Osteosarcomas. Asian Pac J Cancer Prev 2020; 21:67-73. [PMID: 31983166 PMCID: PMC7294029 DOI: 10.31557/apjcp.2020.21.1.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: Osteosarcomas (OS) is one the most common primary bone malignancy in humans with the lungs metastasis in most cases. Metastasis and recurrence of OS is attributed to cancer stem cells (CSCs). Our study aimed to evaluate the clinical significance of CD133 and C-X-C chemokine receptor type 4 (CXCR4) as the frequently applied markers for CSCs in OS patients. Methods: In this cross-sectional, a total of 50 tissue samples from the patients with primary OS were immunohistochemically examined to detect the expression of CD133 and CXCR4. The associations of the relative expression and clinical significance of each marker were also evaluated. Results: High level expression of CD133 was detected in 26% of OS patient tissues. Of the 12 patients who showed lung metastasis, 5 cases showed high expression of CD133 with marginal trend correlation (P=0.06). No significant correlation was observed between CD133 expression and clinicopathological factors. Only 36% of cases showed CXCR4 expression which was not significantly correlated with gender, age, tumor size, necrosis, stage and metastasis (P>0.05). Clinically, patients with concomitant CD133/CXCR4 expression had significant association with lung metastasis (P=0.05). Conclusion: Our findings showed that concomitant expression of CSC markers CD133/CXCR4 might had a synergistic effect on the OS poor prognosis. These markers could be considered as potential therapeutic candidates of OS targeted therapy.
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Affiliation(s)
- Azam Mardani
- Department of Pathology, Iran University of Medical Science, Tehran, Iran
| | - Elmira Gheytanchi
- Oncopathology Research Center, Iran University of Medical Science, Tehran, Iran
| | - Seyed Hamzeh Mousavie
- Department of Surgery, Rasool-Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Zahra Madjd Jabari
- Oncopathology Research Center, Iran University of Medical Science, Tehran, Iran
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Liu X, Xu W, Yu J, Shu Q. Screening for congenital heart defects: diversified strategies in current China. WORLD JOURNAL OF PEDIATRIC SURGERY 2019. [DOI: 10.1136/wjps-2019-000051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BackgroundCongenital heart defects (CHD) is the most common type of birth defect and a leading cause of infant mortality in China. Detection of CHD during newborn is still challenging. The contradiction between the increasingly mature technology of diagnosis and treatment and the inability of early detection is the biggest current dilemma. A few pilot studies attempt to establish the universal screening for CHD in newborns; however, the rate of misdiagnosis is still high in most Chinese hospitals, especially in some undeveloped middle-western regions.Data sourcesBased on the recent publications on screening of congenital heart diseases in China. We reviewed the use of diversified screening strategies in current China.ResultsPrenatal diagnosis by fetal echocardiography and postnatal detection by pulse oximetry combined with clinical assessment are the useful methods for CHD screening in most areas. The altitude should be taken into account when using pulse oximetry in the middle-western areas of China, where the incidence of CHD maybe higher. Echocardiography is suitable for CHD screening in almost all areas but it could add to financial burden in the developing regions. Genetic analysis could assist clinical doctors to perform more earlier screening and give better counseling regarding the outcome. Due to disparities in economic and medical resources, the screening system should be carried out from multiple perspectives according to the present economic development. Notably, follow-up is an important issue in the screening of CHD, especially for the asymptomatic babies who discharged home. Policies should be formulated to address the epidemiology of CHD in deprived areas to better allocate medical resources and to develop local training programmes to screen and diagnose CHD.ConclusionsDiversified strategies are available in current China. The two-indicator method for CHD screening is recommended to be implemented in routine postnatal care. We can do more in screening for CHD in the future.
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Huang Q, Geng Z, Chen T, Cheng X, Gu H, Li Q, Li D, Liu R. Comparative proteomic analysis of plasma of children with congenital heart disease. Electrophoresis 2019; 40:1848-1854. [DOI: 10.1002/elps.201900098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Qiong Huang
- The First Affiliated HospitalNanjing Medical University Nanjing P. R. China
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrializationand National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative MedicineNanjing University of Chinese Medicine Nanjing P. R. China
| | - Zhi Geng
- Cardiovascular Center of the Second Affiliated Hospital of Nanjing Medical University Nanjing P. R. China
| | - Tao Chen
- The First Affiliated HospitalNanjing Medical University Nanjing P. R. China
| | - Xiangjun Cheng
- The First Affiliated HospitalNanjing Medical University Nanjing P. R. China
| | - Haitao Gu
- The First Affiliated HospitalNanjing Medical University Nanjing P. R. China
| | - Qingguo Li
- Cardiovascular Center of the Second Affiliated Hospital of Nanjing Medical University Nanjing P. R. China
| | - Dianfu Li
- The First Affiliated HospitalNanjing Medical University Nanjing P. R. China
| | - Rui Liu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrializationand National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative MedicineNanjing University of Chinese Medicine Nanjing P. R. China
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Abstract
PURPOSE OF REVIEW We review newborn screening (NBS) publications from the developing countries to identify global progress in improving child health. RECENT FINDINGS Many developing countries do not yet have national NBS. As infant mortality rates decline, NBS gains in public health priority. Local incidence and outcome data are used to persuade health officials to include screening in priority health spending. Congenital hypothyroidism is the most cost-effective screened condition in most countries. In sub-Saharan Africa, India and some parts of Asia, screening for hemoglobinopathies and glucose-6-dehydrogenase deficiency are also important. Expanded screening for metabolic conditions is most needed in areas of high consanguinity. Screening for hearing disorders and critical congenital heart defects is increasing globally. The largest birth cohorts are India and China, but only China has successful NBS. Reports from completed government research projects in India support initiation of NBS. SUMMARY Government activities around NBS are increasing in India and there is increased emphasis on pilot programs for sickle cell NBS in sub-Saharan Africa. Genetic counseling training in Asia and Africa is increasing and will be helpful as part of NBS. To build successful screening programs, partnerships among health professionals, parents, policy makers and industry stakeholders are essential.
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