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Kaufman J, Rak A, Vasiliadis S, Brar N, Atif E, White J, Danchin M, Durrheim DN. The Case for Assessing the Drivers of Measles Vaccine Uptake. Vaccines (Basel) 2024; 12:692. [PMID: 38932421 PMCID: PMC11209301 DOI: 10.3390/vaccines12060692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
Global measles cases are on the rise following disruptions to routine immunisation programs during the COVID-19 pandemic, with devastating consequences. According to the World Health Organization, the behavioural and social drivers of vaccination include what people think and feel about vaccines, social processes, motivation to vaccinate and practical barriers to vaccination. However, the drivers of measles vaccine uptake are not necessarily the same as those for other childhood vaccines, and we lack data on how these drivers specifically have changed during and since the COVID-19 pandemic. Without accurately measuring the behavioural and social drivers for measles vaccination, and ideally measuring them serially over time, countries cannot design, target and implement interventions that effectively increase and sustain measles vaccine coverage. This paper outlines what is and is not known about the behavioural and social drivers of measles vaccination and provides recommendations for improving their post-pandemic assessment.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.R.); (S.V.); (M.D.)
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Ashleigh Rak
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.R.); (S.V.); (M.D.)
| | - Sophia Vasiliadis
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.R.); (S.V.); (M.D.)
| | - Navrit Brar
- Melbourne Medical School, The University of Melbourne, Melbourne, CIV 3052, Australia; (N.B.); (E.A.)
| | - Eeman Atif
- Melbourne Medical School, The University of Melbourne, Melbourne, CIV 3052, Australia; (N.B.); (E.A.)
| | - Jennifer White
- Health Protection, Hunter New England Local Health District, Booth Building, Wallsend Health Services Longworth Avenue, Newcastle, NSW 2287, Australia; (J.W.); (D.N.D.)
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.R.); (S.V.); (M.D.)
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- Department of General Medicine, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - David N. Durrheim
- Health Protection, Hunter New England Local Health District, Booth Building, Wallsend Health Services Longworth Avenue, Newcastle, NSW 2287, Australia; (J.W.); (D.N.D.)
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
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Vinals L, Radhakrishnan A, Sarri G. Opportunity and accessibility: an environmental scan of publicly available data repositories to address disparities in healthcare decision-making. Int J Equity Health 2024; 23:93. [PMID: 38720282 PMCID: PMC11080201 DOI: 10.1186/s12939-024-02187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Health disparities, starkly exposed and exacerbated by coronavirus disease 2019, pose a significant challenge to healthcare system access and health outcomes. Integrating health inequalities into health technology assessment calls for robust analytical methodologies utilizing disaggregated data to investigate and quantify the scope of these disparities. However, a comprehensive summary of population datasets that can be used for this purpose is lacking. The objective of this review was to identify publicly accessible health inequalities data repositories that are potential resources for healthcare decision-making and future health technology assessment submissions. METHODS An environmental scan was conducted in June of 2023 of six international organizations (World Health Organization, Organisation for Economic Co-operation and Development, Eurostat, United Nations Inter-agency Group for Child Mortality Estimation, the United Nations Sustainable Development Goals, and World Bank) and 38 Organisation for Economic Co-operation and Development countries. The official websites of 42 jurisdictions, excluding non-English websites and those lacking English translations, were reviewed. Screening and data extraction were performed by two reviewers for each data repository, including health indicators, determinants of health, and health inequality metrics. The results were narratively synthesized. RESULTS The search identified only a limited number of country-level health inequalities data repositories. The World Health Organization Health Inequality Data Repository emerged as the most comprehensive source of health inequality data. Some country-level data repositories, such as Canada's Health Inequality Data Tool and England's Health Inequality Dashboard, offered rich local insights into determinants of health and numerous health status indicators, including mortality. Data repositories predominantly focused on determinants of health such as age, sex, social deprivation, and geography. CONCLUSION Interactive interfaces featuring data exploration and visualization options across diverse patient populations can serve as valuable tools to address health disparities. The data they provide may help inform complex analytical methodologies that integrate health inequality considerations into healthcare decision-making. This may include assessing the feasibility of transporting health inequality data across borders.
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Affiliation(s)
- Lydia Vinals
- Cytel Inc, 1 University Avenue, 3rd Floor, Toronto, M5J 2P1, Canada.
| | | | - Grammati Sarri
- Cytel Inc, Hamilton House, Mabledon Place, London, WC1H 9BB, UK
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Sharma S, Campbell OMR, Oswald WE, Adhikari D, Paudel P, Lal B, Penn-Kekana L. Increased utilisation and quality: a focus on inequality and a learning health system approach-explaining Nepal's success in reducing maternal and newborn mortality 2000-2020. BMJ Glob Health 2024; 9:e011836. [PMID: 38770807 PMCID: PMC11085885 DOI: 10.1136/bmjgh-2023-011836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/31/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Maternal mortality in Nepal dropped from 553 to 186 per 100 000 live births during 2000-2017 (66% decline). Neonatal mortality dropped from 40 to 21 per 1000 live births during 2000-2018 (48% decline). Stillbirths dropped from 28 to 18 per 1000 births during 2000-2019 (34% decline). Nepal outperformed other countries in these mortality improvements when adjusted for economic growth, making Nepal a 'success'. Our study describes mechanisms which contributed to these achievements. METHODS A mixed-method case study was used to identify drivers of mortality decline. Methods used included a literature review, key-informant interviews, focus-group discussions, secondary analysis of datasets, and validation workshops. RESULTS Despite geographical challenges and periods of political instability, Nepal massively increased the percentage of women delivering in health facilities with skilled birth attendance between 2000 and 2019. Although challenges remain, there was also evidence in improved quality and equity-of-access to antenatal care and childbirth services. The study found policymaking and implementation processes were adaptive, evidence-informed, made use of data and research, and involved participants inside and outside government. There was a consistent focus on reducing inequalities. CONCLUSION Policies and programmes Nepal implemented between 2000 and 2020 to improve maternal and newborn health outcomes were not unique. In this paper, we argue that Nepal was able to move rapidly from stage 2 to stage 3 in the mortality transition framework not because of what they did, but how they did it. Despite its achievements, Nepal still faces many challenges in ensuring equal access to quality-care for all women and newborns.
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Affiliation(s)
| | - Oona Maeve Renee Campbell
- Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
| | - William Edward Oswald
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Global Health Division, RTI International, Research Triangle Park, North Carolina, USA
| | - Dadhi Adhikari
- South Asian Institute for Policy Analysis and Leadership, Kathmandu, Nepal
| | | | - Bibek Lal
- Family Welfare Division, Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | - Loveday Penn-Kekana
- Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
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Campbell OMR, Amouzou A, Blumenberg C, Boerma T. Learning from success: the main drivers of the maternal and newborn health transition in seven positive-outlier countries and implications for future policies and programmes. BMJ Glob Health 2024; 9:e012126. [PMID: 38770812 PMCID: PMC11085707 DOI: 10.1136/bmjgh-2023-012126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/06/2023] [Indexed: 05/22/2024] Open
Abstract
Currently, about 8% of deaths worldwide are maternal or neonatal deaths, or stillbirths. Maternal and neonatal mortality have been a focus of the Millenium Development Goals and the Sustainable Development Goals, and mortality levels have improved since the 1990s. We aim to answer two questions: What were the key drivers of maternal and neonatal mortality reductions seen in seven positive-outlier countries from 2000 to the present? How generalisable are the findings?We identified positive-outlier countries with respect to maternal and neonatal mortality reduction since 2000. We selected seven, and synthesised experience to assess the contribution of the health sector to the mortality reduction, including the roles of access, uptake and quality of services, and of health system strengthening. We explored the wider context by examining the contribution of fertility declines, and the roles of socioeconomic and human development, particularly as they affected service use, the health system and fertility. We analysed government levers, namely policies and programmes implemented, investments in data and evidence, and political commitment and financing, and we examined international inputs. We contextualised these within a mortality transition framework.We found that strategies evolved over time as the contacts women and neonates had with health services increased. The seven countries tended to align with global recommendations but could be distinguished in that they moved progressively towards implementing their goals and in scaling-up services, rather than merely adopting policies. Strategies differed by phase in the transition framework-one size did not fit all.
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Affiliation(s)
- Oona Maeve Renee Campbell
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Agbessi Amouzou
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cauane Blumenberg
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Ties Boerma
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Brittz K, Botma Y, Heyns T. Twelve tips for creating online learning units for the health professions in low-and middle-income countries. MEDICAL TEACHER 2024; 46:626-632. [PMID: 37976372 DOI: 10.1080/0142159x.2023.2280144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Health professions educators in low-and middle-income countries are often sceptical about developing online learning units. This scepticism stems from the belief that online programmes are limited in developing clinical competence, and there are concerns about digital proficiency and resource availability. A social constructivist approach in designing online work-based learning units may overcome such scepticism. In this article, we use our experience in developing an online learning unit for healthcare education to suggest 12 tips for developing online learning units in a low-and middle-income context. The tips are nested in a 'promoting theory-practice integration framework' and include context, establishing communities of learning and practice, establishing foundational knowledge, practise in a work-based environment, and showcasing attainment of learning outcomes. By integrating the guidelines and framework, healthcare educators will be better equipped to develop online learning units and contribute to learning.
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Affiliation(s)
- Karli Brittz
- School of the Arts, University of Gauteng, Pretoria South Africa
| | - Yvonne Botma
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Tanya Heyns
- Department of Nursing Sciences, School of Health Care Sciences, University of Pretoria, South Africa
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Belrhiti Z, Bigdeli M, Lakhal A, Kaoutar D, Zbiri S, Belabbes S. Unravelling collaborative governance dynamics within healthcare networks: a scoping review. Health Policy Plan 2024; 39:412-428. [PMID: 38300250 PMCID: PMC11005841 DOI: 10.1093/heapol/czae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/02/2024] Open
Abstract
In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalized healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges and enablers for effective inter-organizational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organizational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews, we searched four databases [PubMed (n = 114), Web of Science (n = 171), Google Scholar (n = 153) and Scopus (n = 52)] and used snowballing (n = 22). A total of 37 papers addressing HN including hospitals were included. We used a framework synthesis informed by the collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g. strategic vs steering committees), formal procedural arrangements and strategic governing bodies in stimulating participative decision-making, collaboration and sense of ownership. In a highly institutionalized context, the inter-organizational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualizing resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems To promote the effectiveness of HN, more bottom-up participative decision-making, formalization of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.
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Affiliation(s)
- Zakaria Belrhiti
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
| | - Maryam Bigdeli
- World Health Organization, 3 Av. S.A.R. Sidi Mohamed, Rabat, Geneva 10170, Morocco
| | - Aniss Lakhal
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Directorate of Hospitals and Ambulatory Care, Ministry of Health and Social Protection, Route d’El Jadida, Agdal, Rabat 10100, Morocco
| | - Dib Kaoutar
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Directorate of Hospitals and Ambulatory Care, Ministry of Health and Social Protection, Route d’El Jadida, Agdal, Rabat 10100, Morocco
| | - Saad Zbiri
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
| | - Sanaa Belabbes
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
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Wong KA, Moskalewicz A, Nathan PC, Gupta S, Denburg A. Physical late effects of treatment among survivors of childhood cancer in low- and middle-income countries: a systematic review. J Cancer Surviv 2024:10.1007/s11764-023-01517-8. [PMID: 38183576 DOI: 10.1007/s11764-023-01517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Physical late effects of treatment are well-documented among childhood cancer survivors in high-income countries, but whether prevalence and risk factors are comparable in low- and middle-income countries (LMICs) is unclear. We conducted a systematic review to assess physical late effect outcomes among childhood cancer survivors in LMICs. METHODS Five health sciences databases were searched from inception to November 2022 in all languages. We included observational studies conducted in LMICs that evaluated physical late effects of treatment in childhood cancer survivors. Mean or median cohort follow-up must have been ≥ 5 years from original cancer diagnosis. RESULTS Sixteen full articles and five conference abstracts were included. Studies were conducted in lower-middle (n = 12, 57%) or upper-middle income (n = 9, 43%) countries; nearly half (n = 9, 43%) were conducted in India. Five cohorts (24%) were comprised entirely of 5-year survivors. Subsequent malignant neoplasms were reported in 0-11% of survivors (n = 10 studies). Hypothyroidism and metabolic syndrome prevalence ranged from 2-49% (n = 4 studies) and 4-17% (n = 5 studies), respectively. Gonadal dysfunction ranged from 3-47% (n = 4 studies). Cardiac dysfunction ranged from 1-16% (n = 3 studies). Late effects of the musculoskeletal and urinary systems were least investigated. CONCLUSIONS Substantial knowledge gaps exist in LMIC childhood cancer survivorship. No low-income country data were found. In middle-income countries, late effects were defined and assessed variably and limited by selection bias and small sample sizes. IMPLICATIONS FOR CANCER SURVIVORS Survivors in LMICs can experience physical late effects of treatment, though additionally systematically collected data from survivor cohorts are needed to fill knowledge gaps.
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Affiliation(s)
- Kevin A Wong
- Faculty of Health Sciences, McMaster University, Hamilton, L8S 4K1, Canada
| | | | - Paul C Nathan
- The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
| | - Sumit Gupta
- The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
| | - Avram Denburg
- The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada.
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Keshri VR, Parveen S, Abimbola S, Mishra B, Khurram MF, Peden M, Norton R, Jagnoor J. The health workforce conundrum for burn care in Uttar Pradesh, India: a qualitative exploration. Glob Public Health 2024; 19:2345370. [PMID: 38686925 DOI: 10.1080/17441692.2024.2345370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
Delivering specialised care for major burns requires a multidisciplinary health workforce. While health systems 'hardware' issues, such as shortages of the healthcare workforce and training gaps in burn care are widely acknowledged, there is limited evidence around the systems 'software' aspects, such as interest, power dynamics, and relationships that impact the healthcare workforce performance. This study explored challenges faced by the health workforce in burn care to identify issues affecting their performance. Qualitative in-depth interviews were conducted with a purposively selected sample (n = 31, 18 women and 13 men) of various cadres of the burn care health workforce in Uttar Pradesh, India. Inductive coding and thematic analysis identified three major themes. First, the dynamics within the multidisciplinary team where complex relations, power and normative hierarchy hampered performance. Second, the dynamics between health workers and patients due to the clinical and emotional challenges of dealing with burn injuries and multitasking. Third, dynamics between specialised burn units and broader health systems are narrated in challenges due to inadequate first response and delayed referral from primary care facilities. These findings indicate that burn care health workers in India face multiple challenges that need systemic intervention with a multipronged human resource for health framework.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, New Delhi, India
| | - Samina Parveen
- The George Institute for Global Health, New Delhi, India
- Ipas Development Foundation, New Delhi, India
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Brijesh Mishra
- Department of Plastic Surgery, King George's Medical University, Lucknow, India
| | - Mohammed Fahad Khurram
- Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Margie Peden
- The George Institute for Global Health, New Delhi, India
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Robyn Norton
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, New Delhi, India
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Ahsan N, Malik FA, Mughis W, Jabeen R, Mehboob S, Allana R, Quratulain S, Jamal S, Paganelli CR, Goco N, Parlberg L, Omer SB, Kazi AM. Postmortem minimally invasive tissue sampling in communities: exploring perceptions of families, funeral workers, religious and community leaders and healthcare providers from Pakistan. BMC Health Serv Res 2023; 23:1402. [PMID: 38093318 PMCID: PMC10720140 DOI: 10.1186/s12913-023-10438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS) has increasingly been used to improve the diagnosis of disease and identification of the cause of death, particularly in underserved areas. However, there are multiple barriers to accessing those who die within the community, our study aimed to explore the perceptions and insights of community members and healthcare providers regarding the feasibility of implementing MITS in community settings. METHODS A qualitative exploratory study was conducted. A total of twenty one in-depth interviews were conducted with deceased infants' parents, elders of the family, religious leaders, community leaders, and funeral workers. Focus group discussions were conducted with health care providers (n = 14) in two peri-urban slum areas of Karachi, Pakistan. The duration of this study was from August to October 2020. Data was analyzed using thematic analysis and was coded and merged into categories forming eight major themes. RESULTS In general, participants viewed minimally invasive tissue sampling (MITS) as beneficial for improving child health, though some had concerns about disrespecting the deceased during sample collection. Misinformation, fear of needles, and medical procedures were major barriers to MITS implementation. To enhance acceptance, community and religious leaders suggested using religious rulings, obtaining parental consent, ensuring confidentiality, and increasing efforts of community engagement. Community healthcare providers, along with funeral workers, recommended providing community members with grief counseling to increase study participation. Besides concerns about sampling interfering with respect for the decease, community members also raised concerns about misinformation. Further, participants provided feedback on the design and appearance of the mobile van used to collect MITS samples from children under the age of five. CONCLUSION This study is critical for understanding the challenges associated with implementation of community-based MITS sampling in Pakistan. Integrating the use of a mobile van for sample collection, grief counseling along with community engagement sessions and advocacy will help address community-based misinformation and develop community trust.
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Affiliation(s)
- Nazia Ahsan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fauzia Aman Malik
- Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Waliyah Mughis
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rawshan Jabeen
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shaheen Mehboob
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Raheel Allana
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syeda Quratulain
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saima Jamal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Christina R Paganelli
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, Seattle Washington, NC, USA
| | - Norman Goco
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, Seattle Washington, NC, USA
| | - Lindsay Parlberg
- Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, Seattle Washington, NC, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA
| | - Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Youkee D, Lahai M, Mansaray AR, Samura S, Bunn J, Lakoh S, Sevalie S. Improving the quality of COVID-19 care in Sierra Leone: A modified Delphi process and serial nationwide assessments of quality of COVID-19 care in Sierra Leone. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002670. [PMID: 38055688 PMCID: PMC10699596 DOI: 10.1371/journal.pgph.0002670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Improving the quality of care that patients receive is paramount to improving patient outcomes and engendering trust during infectious disease outbreaks. Whilst Quality Improvement (QI) is well established to drive improvement in routine care and in health systems, there are fewer reports of its use during infectious disease outbreaks. METHODS A modified Delphi process was undertaken to create a standardized assessment tool for the quality of COVID-19 care in Sierra Leone. Four rounds of assessment were undertaken between July 2020 and July 2021. To assess change across the four assessment periods compared to baseline we used a mixed effects model and report coefficients and p values. RESULTS During the Delphi process, 12/14 participants selected the domains to be assessed within the tool. The final 50 questions included 13 outcome questions, 17 process questions and 20 input questions. A total of 94 assessments were undertaken over four assessment periods at 27 facilities. An increase of 8.75 (p = <0.01) in total score was seen in round 2, 10.67 (p = <0.01) in round 3 and 2.17 (p = 0.43) in round 4 compared to baseline. Mean cumulative scores for COVID-19 Treatment Centres were higher than Hospital Isolation Units (p<0.02) at all four timepoints. Significant improvements were reported in coordination, diagnostics, staffing, infection prevention and control (IPC), nutrition, and vulnerable populations domains, but not in the oxygen, care processes, infrastructure and drugs domains. CONCLUSION We demonstrate the feasibility of creating a quality of care assessment tool and conducting sequential nationwide assessments during an infectious disease outbreak. We report significant improvements in quality-of-care scores in round 2 and round 3 compared to baseline, however, these improvements were not sustained. We recommend the use of QI and the creation of standardised assessment tools to improve quality of care during outbreak responses.
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Affiliation(s)
- Daniel Youkee
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- King’s College London, King’s Global Health Partnerships, School of Life Course and Population Health Sciences, London, United Kingdom
| | - Michael Lahai
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdul R. Mansaray
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sorie Samura
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - James Bunn
- Foreign Commonwealth and Development Office, British High Commission, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Stephen Sevalie
- National COVID-19 Emergency Response Centre, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- 34th Military Hospital, Wilberforce, Freetown, Sierra Leone
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Witter S, Thomas S, Topp SM, Barasa E, Chopra M, Cobos D, Blanchet K, Teddy G, Atun R, Ager A. Health system resilience: a critical review and reconceptualisation. Lancet Glob Health 2023; 11:e1454-e1458. [PMID: 37591591 DOI: 10.1016/s2214-109x(23)00279-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 08/19/2023]
Abstract
This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and-as amply shown during the COVID-19 pandemic-relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities-what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance.
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Affiliation(s)
- Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK; ReBUILD for Resilience, Queen Margaret University, Edinburgh, UK.
| | - Steve Thomas
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Stephanie M Topp
- Centre for Health Policy & Management, James Cook University, Townsville, QLD, Australia
| | - Edwine Barasa
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Daniel Cobos
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Geneva, Switzerland
| | - Gina Teddy
- Ghana Institute of Management and Public Affairs, Accra, Ghana
| | - Rifat Atun
- Harvard School of Public Health, Boston, MA, USA
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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12
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Millimouno TM, Meessen B, Put WVD, Garcia M, Camara BS, Christou A, Delvaux T, Sidibé S, Beavogui AH, Delamou A. How has Guinea learnt from the response to outbreaks? A learning health system analysis. BMJ Glob Health 2023; 8:bmjgh-2022-010996. [PMID: 36854489 PMCID: PMC9980363 DOI: 10.1136/bmjgh-2022-010996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea's health system has learnt from the response to outbreaks between 2014 and 2021. METHODS We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022. RESULTS The 70 reports included in the evidence synthesis were about the 2014-2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts' opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents' commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system. CONCLUSION Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.
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Affiliation(s)
- Tamba Mina Millimouno
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea .,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Bruno Meessen
- Health Systems Governance and Financing Department, World Health Organization, Geneva, Switzerland
| | - Willem Van De Put
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Marlon Garcia
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bienvenu Salim Camara
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Aliki Christou
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Therese Delvaux
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Sidikiba Sidibé
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Abdoul Habib Beavogui
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Alexandre Delamou
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
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