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Villalpando-Carrión S, Henao-Martínez AF, Franco-Paredes C. Epidemiology and Clinical Outcomes of Bacterial Meningitis in Children and Adults in Low- and Middle-Income Countries. CURRENT TROPICAL MEDICINE REPORTS 2024; 11:60-67. [PMID: 39006487 PMCID: PMC11244613 DOI: 10.1007/s40475-024-00316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 07/16/2024]
Abstract
Purpose of Review Despite the availability of effective vaccines against the three primary pathogens (Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis) that cause bacterial meningitis, this condition remains a significant cause of morbidity, neurologic sequelae, and mortality among children and adults living in low-income and middle-income countries. Recent Findings Bacterial meningitis represents a significant public health challenge for national and global health systems. Since vaccine-preventable meningitis remains highly prevalent in low-income and middle-income countries, the World Health Organization (WHO) recently developed a global roadmap to defeating meningitis by 2030 and ameliorating its associated neurological sequelae. Summary There is a need for a global approach to surveillance and prevention of bacterial meningitis. Increasing vaccination coverage with conjugate vaccines against pneumococcus and meningococcus with optimal immunization schedules are high-value healthcare interventions. Additionally, overcoming diagnostic challenges and the early institution of empirical antibiotic therapy and, when feasible, adjunctive steroid therapy constitutes the pillars of reducing the disease burden of bacterial meningitis in resource-limited settings.
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Affiliation(s)
- Salvador Villalpando-Carrión
- Hospital Infantil de México, Federico Gómez, Doctor Marquéz No. 162, Col. Doctores, Delegación Cuauhtémoc, 06720 CDMX, Mexico City, CP, Mexico
| | | | - Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, Doctor Marquéz No. 162, Col. Doctores, Delegación Cuauhtémoc, 06720 CDMX, Mexico City, CP, Mexico
- Division of Microbiology, Immunology, and Pathology, Colorado State University, Aurora, CO, USA
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Inam M, Ladak LA, Janjua M, Malik M, Ali F, Akmal Malik M. Health related quality of life in adults after late repair of tetralogy of fallot: experience from a low-middle income country. Qual Life Res 2023; 32:3063-3074. [PMID: 37318695 DOI: 10.1007/s11136-023-03453-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Without neonatal screening in low middle-income countries like Pakistan, Tetralogy of Fallot (TOF) is a congenital heart disease which frequently remains untreated beyond infancy. The purpose of this study is to determine and assess outcomes and health related quality of life (HRQOL) in patients who undergo complete repair of TOF as adults. METHODS 56 patients who underwent complete TOF repair after 16 years of age were included. Patient data was collected via retrospective chart review, and a semi structured interview along with Short-Form 36 (SF-36) questionnaire were used to assess HRQOL. RESULTS 66.1% of patients were male with the mean age at surgery of 22.3 ± 6.00. All patients had a post-operative NYHA Classification of I or II, 94.6% had an ejection fraction of ≥ 50% and 28.6% showed small residual lesions in follow-up echocardiograms. 32.1% of patients suffered post-operative morbidity. For the quantitative assessment using SF-36 scores, patients showed good scores of median 95 (65-100). A major cause of delay to treatment was lack of consensus between treatments offered by doctors in different parts of Pakistan. There was a pattern of 'inability to fit in' among patients who had had late TOF repair, despite self- reported improved HRQOL. CONCLUSION Our results indicate that even with a delayed diagnosis, surgical repair of TOF produces good functional results. However, these patients face significant psychosocial issues. While early diagnosis remains the ultimate goal, patients undergoing late repair should be managed in more holistic manner with attention to psychological impact of the disease as well.
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Affiliation(s)
- Maha Inam
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Laila Akbar Ladak
- School of Nursing and Midwifery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mahin Janjua
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Maarij Malik
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Fatima Ali
- Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Mahim Akmal Malik
- Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.
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Bahuguna P, Masaki E, Jeet G, Prinja S. Financing Comprehensive Immunization Services in Lao PDR: A Fiscal Space Analysis From a Public Policy Perspective. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:131-140. [PMID: 36136264 PMCID: PMC9492462 DOI: 10.1007/s40258-022-00763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION A comprehensive package of immunization services is an internal component of the Essential Health Service Package (ESP) implemented by Government of Lao People's Democratic Republic (Lao PDR). Thus, the cost of delivering the immunization program and its feasibility given the fiscal space emerges as an important policy question. The present analysis was undertaken to estimate the total cost of implementing the immunization program under ESP, determinants of total cost and the program's fiscal implications from the government's perspective. METHODOLOGY We employed a normative costing approach for costing of immunization services under ESP. Standard treatment guidelines (STGs) from both within and outside Lao PDR were considered to identify the resource use for each vaccine delivery. Subsequently, cost per dose administered and fully immunized beneficiary were computed. We assessed the fiscal space for financing immunization services in Lao PDR by adapting the decomposition method given by Tandon et al. RESULTS: In 2019, the estimated total cost of financing immunization in Lao PDR was US$12 million, which will increase in 2025 by 1.75 times, to US$21 million. The per capita budget for immunization needs to increase from about US$2 to US$7. Introduction of newer vaccines in the immunization schedule accounts for the major share (60%) of the increased cost for financing immunization. In view of current fiscal space, the government immunization expenditure (GIE) allocations will be adequate only in a scenario where no new vaccine is introduced under ESP in future years. CONCLUSION The current fiscal space would fall short of meeting the aspirational goals of ESP-Immunization for the introduction of newer vaccines in Lao PDR. The present analysis of the fiscal space provides important evidence to support a greater role for the Global Alliance for Vaccine Initiative (GAVI) to continue to finance immunization in Lao PDR. A publicly financed immunization model in Lao PDR would require significant strategic amendments with low short-term viability.
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Affiliation(s)
- Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Emiko Masaki
- Health, Nutrition and Population, World Bank, Vientiane, Lao PDR
| | - Gursimer Jeet
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Wang R, Li X, Hu Z, Jing W, Zhao Y. Spatial Heterogeneity and Its Influencing Factors of Syphilis in Ningxia, Northwest China, from 2004 to 2017: A Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10541. [PMID: 36078254 PMCID: PMC9518519 DOI: 10.3390/ijerph191710541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Syphilis remains a growing and resurging infectious disease in China. However, exploring the influence of environmental factors on the spatiotemporal distribution of syphilis remains under explore. This study aims to analyze the spatiotemporal distribution characteristics of syphilis in Ningxia, Northwest China, and its potential environmental influencing factors. Based on the standardized incidence ratio of syphilis for 22 administrative areas in Ningxia from 2004 to 2017, spatiotemporal autocorrelation and scan analyses were employed to analyze the spatial and temporal distribution characteristics of syphilis incidence, while a fixed-effect spatial panel regression model identified the potential factors affecting syphilis incidence. Syphilis incidence increased from 3.78/100,000 in 2004 to 54.69/100,000 in 2017 with significant spatial clustering in 2007 and 2009-2013. The "high-high" and "low-low" clusters were mainly distributed in northern and southern Ningxia, respectively. The spatial error panel model demonstrated that the syphilis incidence may be positively correlated with the per capita GDP and tertiary industry GDP and negatively correlated with the number of health facilities and healthcare personnel. Sex ratio and meteorological factors were not significantly associated with syphilis incidence. These results show that the syphilis incidence in Ningxia is still increasing and has significant spatial distribution differences and clustering. Socio-economic and health-resource factors could affect the incidence; therefore, strengthening syphilis surveillance of migrants in the economically developed region and allocating health resources to economically underdeveloped areas may effectively help prevent and control syphilis outbreaks in high-risk cluster areas of Ningxia.
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Affiliation(s)
- Ruonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
| | - Xiaolong Li
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
| | - Zengyun Hu
- State Key Laboratory of Desert and Oasis Ecology, Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences, Urumqi 830011, China
| | - Wenjun Jing
- School of Statistics, Shanxi University of Finance and Economics, Taiyuan 030006, China
| | - Yu Zhao
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control, 1160 Shengli Street, Xingqing District, Yinchuan 750001, China
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Implications of Oncology Trial Design and Uncertainties in Efficacy-Safety Data on Health Technology Assessments. Curr Oncol 2022; 29:5774-5791. [PMID: 36005193 PMCID: PMC9406873 DOI: 10.3390/curroncol29080455] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Advances in cancer medicines have resulted in tangible health impacts, but the magnitude of benefits of approved cancer medicines could vary greatly. Health Technology Assessment (HTA) is a multidisciplinary process used to inform resource allocation through a systematic value assessment of health technology. This paper reviews the challenges in conducting HTA for cancer medicines arising from oncology trial designs and uncertainties of safety-efficacy data. Methods: Multiple databases (PubMed, Scopus and Google Scholar) and grey literature (public health agencies and governmental reports) were searched to inform this policy narrative review. Results: A lack of robust efficacy-safety data from clinical trials and other relevant sources of evidence has made HTA for cancer medicines challenging. The approval of cancer medicines through expedited pathways has increased in recent years, in which surrogate endpoints or biomarkers for patient selection have been widely used. Using these surrogate endpoints has created uncertainties in translating surrogate measures into patient-centric clinically (survival and quality of life) and economically (cost-effectiveness and budget impact) meaningful outcomes, with potential effects on diverting scarce health resources to low-value or detrimental interventions. Potential solutions include policy harmonization between regulatory and HTA authorities, commitment to generating robust post-marketing efficacy-safety data, managing uncertainties through risk-sharing agreements, and using value frameworks. Conclusion: A lack of robust efficacy-safety data is a central problem for conducting HTA of cancer medicines, potentially resulting in misinformed resource allocation.
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Pandya A, Khanal N, Upadhyaya M. Workplace Mental Health Interventions in India: A Rapid Systematic Scoping Review. Front Public Health 2022; 10:800880. [PMID: 35592077 PMCID: PMC9110774 DOI: 10.3389/fpubh.2022.800880] [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: 10/24/2021] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
The mental health initiatives at the workplace are growing in numbers over the past few years. Public and private sectors continue to explore avenues to navigate and adapt initiatives to promote employee's mental wellbeing. However, such initiatives in the Indian context are not thoroughly studied. We attempted to review existing literature on workplace mental health interventions in the Indian context. The scoping review was conducted following the standard process as recommended by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews. We searched in the databases such as PubMed, Google Scholar and Scopus. Scientific literature including gray literature of the past decade was searched to synthesize evidence on types of mental health interventions and their unique features. Of the 1,311 records, 30 records that met the inclusion criteria were included for the final review. The review highlights evidence on stress and mental health problems faced by the working population and various strategies adopted by organizations to address mental health problems. However, very few interventions were accompanied by comprehensive needs assessment, impact evaluation and workplace policy initiatives. Most interventions were curative–provisioning counseling services, limiting the scope of mental health promotion activities. Addressing mental health wellbeing comprehensively and aligning an organization's policies are crucial. Research on employee mental health, its risk factors, and cost-effectiveness analysis of workplace mental health interventions in the Indian context need to be prioritized.
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Affiliation(s)
- Apurvakumar Pandya
- Parul Institute of Public Health, Faculty of Medicine, Parul University, Vadodara, India
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Makaula P, Kayuni SA, Mamba KC, Bongololo G, Funsanani M, Musaya J, Juziwelo LT, Furu P. An assessment of implementation and effectiveness of mass drug administration for prevention and control of schistosomiasis and soil-transmitted helminths in selected southern Malawi districts. BMC Health Serv Res 2022; 22:517. [PMID: 35439991 PMCID: PMC9016207 DOI: 10.1186/s12913-022-07925-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Mass drug administration (MDA) is one of the key interventions recommended by WHO for prevention and control of neglected tropical diseases (NTD). In Malawi, MDA is widely carried out annually since 2009 for prevention and control of schistosomiasis and soil-transmitted helminths (STH). No study has been carried out to assess effectiveness of the MDA approach and to document perceptions of health providers and beneficiaries regarding use of MDA. This study was done to understand how well MDA is being implemented and to identify opportunities for improvement in MDA delivery in Malawi. Methods Designed as a cross-sectional and multi-methods research, the study was carried out in three southern Malawi districts of Chiradzulu, Mangochi and Zomba. In each district, four health centres and 16 villages were randomly selected to participate. A mixed-methods approach to data collection focusing on quantitative data for coverage and knowledge, attitudes and practices assessments; and qualitative data for assessing perceptions of health providers and beneficiaries regarding MDA was used. Quantitative data were processed and analyzed using IBM SPSS software version 26 while qualitative data were analysed using NVivo 12 for Windows. Results Knowledge levels about schistosomiasis and STH in the districts varied according to disease aspects asked about. Majority are more knowledgeable about what schistosomiasis is (78%) and whether STH are treatable with drugs (97%); with least knowledgeable about the organism that transmits schistosomiasis (18%), types of schistosomiasis (11%) and what causes STH (20%). In 2018 and 2019 the districts registered high coverage rates for praziquantel and albendazole using community-based MDA (73–100%) and using school-based MDA (75–91%). Both the health authorities and community members perceived the MDA approach as good because it brings treatment closer to people. Conclusion With the high MDA coverage obtained in communities and schools, the effectiveness of MDA in the target districts is satisfactory. There are, however, several challenges including disproportionate knowledge levels, which are hampering progress towards attainment of the 2030 global NTD goals. There is a need for promotion of community participation and partnerships as well as implementation of other recommended interventions for sustainable prevention and control of schistosomiasis and STH. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07925-3.
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Ozaltin A, Vaughan K, Tani K, Manzi F, Mai VQ, Van Minh H, Kosen S, Shimp L, Brenzel L, Boonstoppel L. Key Factors Influencing Use of Immunization Cost Evidence in Country Planning and Budgeting Processes: Experiences From Indonesia, Tanzania, and Vietnam. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00264. [PMID: 35294377 PMCID: PMC8885341 DOI: 10.9745/ghsp-d-21-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Vu Quynh Mai
- Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Soewarta Kosen
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | - Logan Brenzel
- Bill & Melinda Gates Foundation, Washington, DC, USA
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Avanceña AL, Prosser LA. Innovations in cost-effectiveness analysis that advance equity can expand its use in health policy. BMJ Glob Health 2022; 7:bmjgh-2021-008140. [PMID: 35173023 PMCID: PMC8852660 DOI: 10.1136/bmjgh-2021-008140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/29/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anton L.V. Avanceña
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA,Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
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Cost analysis of negative-pressure wound therapy versus standard treatment of acute conflict-related extremity wounds within a randomized controlled trial. World J Emerg Surg 2022; 17:9. [PMID: 35144650 PMCID: PMC8832805 DOI: 10.1186/s13017-022-00415-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/30/2022] [Indexed: 11/15/2022] Open
Abstract
Background Clinical outcomes after negative-pressure wound therapy (NPWT) and standard treatment of conflict-related extremity wounds are similar. In resource-limited settings, cost affects the choice of treatment. We aimed to estimate treatment-related costs of NPWT in comparison with standard treatment for conflict-related extremity wounds. Methods We derived outcome data from a randomized, controlled superiority trial that enrolled adult (≥ 18 years) patients with acute (≤ 72 h) conflict-related extremity wounds at two civilian hospitals in Jordan and Iraq. Primary endpoint was mean treatment-related healthcare costs (adjusted to 2019 US dollars).
Results Patients were enrolled from June 9, 2015, to October 24, 2018. A total of 165 patients (155 men [93.9%]; 10 women [6.1%]; and median [IQR] age, 28 [21–34] years) were included in the analysis. The cost per patient treated with NPWT was $142 above that of standard treatment. Overall, results were robust in a sensitivity analysis. Conclusions With similar clinical outcomes compared to standard care, our results do not support the use of NPWT in routine treatment of conflict-related extremity wounds at civilian hospitals in resource scarce settings. Trial registration NCT02444598.
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Bickton FM, Shannon H. Barriers and Enablers to Pulmonary Rehabilitation in Low- and Middle-Income Countries: A Qualitative Study of Healthcare Professionals. Int J Chron Obstruct Pulmon Dis 2022; 17:141-153. [PMID: 35046649 PMCID: PMC8763198 DOI: 10.2147/copd.s348663] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/24/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Low- and middle-income countries bear a disproportionately high burden of global morbidity and mortality caused by chronic respiratory diseases. Pulmonary rehabilitation is recommended as a core intervention in the management of people with chronic respiratory diseases. However, the intervention remains poorly accessed/utilised globally, especially in low- and middle-income countries. Aim This qualitative study explored barriers and enablers to pulmonary rehabilitation in low- and middle-income countries from the perspective of healthcare professionals with pulmonary rehabilitation experience in these settings. Methods Online-based semi-structured in-depth interviews with healthcare professionals were undertaken to data saturation, exploring lived barriers and enablers to pulmonary rehabilitation in their low- or middle-income country. Anonymised interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results A total of seven healthcare professionals from seven low- and middle-income countries representing Africa, Asia, and South America were interviewed. They included five physiotherapists (four females), one family physician (male), and one pulmonologist (female). Themes for barriers to pulmonary rehabilitation included limited resources, low awareness, coronavirus disease 2019, and patient access-related costs. Themes for enablers included local adaptation, motivated patients, coronavirus disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Conclusion Barriers to pulmonary rehabilitation in low- and middle-income countries include limited resources, low awareness, coronavirus disease 2019, and patient access-related costs. Enablers include local adaptation, motivated patients, coronavirus disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Successful implementation of these enablers will require engagement with multiple stakeholders. The findings of this study are a necessary step towards developing strategies that can overcome the existing pulmonary rehabilitation evidence-practice gap in low- and middle-income countries and alleviating the burden of chronic respiratory diseases in these countries.
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Affiliation(s)
- Fanuel Meckson Bickton
- UCL Great Ormond Street Institute of Child Health, London, UK
- Lung Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Harriet Shannon
- UCL Great Ormond Street Institute of Child Health, London, UK
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Holtzhausen JDV, Downing C, Poggenpoel M, Ndawo G. Concept Analysis: The Scope of Practice of a Nurse Anesthetist in South Africa. J Perianesth Nurs 2021; 36:672-677. [PMID: 34548239 DOI: 10.1016/j.jopan.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this article is to propose a definition for the concept "scope of practice" as it applies to a nurse anesthetist in South Africa. DESIGN Concept analysis. METHODS Walker and Avant's procedure of concept analysis was followed. The actions included "Select a concept"; "Determine the purpose of analysis"; "Identifying uses of the concept"; "Determining the defining attributes"; "Identifying antecedents and consequences"; "Define empirical referents"; "Identify model case"; and "Identifying additional cases." FINDINGS The concept 'scope of practice' as it applies to the nurse anesthetist in South Africa can be defined as the individual's competence, accountability, and responsibility as a health professional. The nurse anesthetist is (1) competent: ready to use skills and judgement in practice; (2) accountable: able to be registered as a nurse anesthetist and willing to abide by the regulations; and (3) responsible: upholding professionalism and demanding recognition from the public and peers. CONCLUSIONS A definition (revealing the concept's structure) and it's uses (revealing the concept's function) for "scope of practice" of a South African nurse anesthetist is proposed for the consideration of introducing nurse anesthesia to provide safe and affordable anesthesia services in South Africa. This article forms part of a larger study titled "A Model for Nurse Anaesthesia Practice in South Africa."
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Affiliation(s)
- Jan Dirk Visagie Holtzhausen
- Doctor of Nursing Science candidate, Department of Nursing, University of Johannesburg, Johannesburg, South Africa
| | - Charlené Downing
- Department of Nursing, University of Johannesburg, Johannesburg, South Africa.
| | - Marie Poggenpoel
- Department of Nursing, University of Johannesburg, Johannesburg, South Africa
| | - Gugu Ndawo
- Department of Nursing, University of Johannesburg, Johannesburg, South Africa
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Galaurchi A, Chatio ST, Beeri P, Oduro AR, Ofosu W, Hanson M, Newell ML, Norris SA, Ward KA, Nonterah EA, Biesma R. Stakeholder Perspectives on Barriers and Facilitators on the Implementation of the 1000 Days Plus Nutrition Policy Activities in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105317. [PMID: 34067735 PMCID: PMC8156632 DOI: 10.3390/ijerph18105317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/08/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
Optimizing nutrition in the preconception and 1000 days periods have long-term benefits such as higher economic productivity, reduced risk of related non-communicable diseases and increased health and well-being. Despite Ghana's recent progress in reducing malnutrition, the situation is far from optimal. This qualitative study analyzed the maternal and child health nutrition policy framework in Ghana to identify the current barriers and facilitators to the implementation of nutrition policies and programs relating to the first 1000 days plus. Data analyzed included in-depth interviews and focus group discussions conducted in Ghana between March and April 2019. Participants were composed of experts from government agencies, civil society organizations, community-based organizations and international partners at national and subnational levels. Seven critical areas were identified: planning policy implementation, resources, leadership and stakeholders' engagement, implementation guidance and ongoing communication, organizational culture, accountability and governance and coverage. The study showed that, to eradicate malnutrition in Ghana, priorities of individual stakeholders have to be merged and aligned into a single 1000 days plus nutrition policy framework. Furthermore, this study may support stakeholders in implementing successfully the 1000 days plus nutrition policy activities in Ghana.
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Affiliation(s)
- Anne Galaurchi
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands;
- Correspondence:
| | - Samuel T. Chatio
- Navrongo Health Research Centre, Ghana Health Service, Navrongo 00233, Ghana; (S.T.C.); (P.B.); (A.R.O.); (E.A.N.)
| | - Paula Beeri
- Navrongo Health Research Centre, Ghana Health Service, Navrongo 00233, Ghana; (S.T.C.); (P.B.); (A.R.O.); (E.A.N.)
| | - Abraham R. Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo 00233, Ghana; (S.T.C.); (P.B.); (A.R.O.); (E.A.N.)
| | - Winfred Ofosu
- Upper East Regional Health Directorate, Ghana Health Service, PMB, Bolgatanga 00233, Ghana;
| | - Mark Hanson
- Institute of Developmental Sciences and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton, Southampton SO17 1 BJ, UK;
| | - Marie-Louise Newell
- Department of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO17 1 BJ, UK;
| | - Shane A. Norris
- SAMRC Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (S.A.N.); (K.A.W.)
- Global Health Research Institute, School of Health and Human Development, University of Southampton, Southampton SO17 1 BJ, UK
| | - Kate A. Ward
- SAMRC Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (S.A.N.); (K.A.W.)
- Global Health Research Institute, School of Health and Human Development, University of Southampton, Southampton SO17 1 BJ, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton SO17 1 BJ, UK
| | - Engelbert A. Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo 00233, Ghana; (S.T.C.); (P.B.); (A.R.O.); (E.A.N.)
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands;
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