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Brubacher LJ, Lau LL, Bustos M, Kelly Mijares M, Lim Mar K, Dodd W. Exploring the Use of Multiple Participatory Tools to Engage Community Health Workers in Program Evaluation and Implementation: A Case Study From the Philippines. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241280353. [PMID: 39241210 DOI: 10.1177/2752535x241280353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
This study explored the use of three participatory tools within a Philippines-based case study with community health workers (CHWs) by comparing and contrasting the process and data generated across the tools, and critically reflecting on adaptations and facilitation considerations that affected the tools' use. Facilitator notes and audio-recordings of discussions were integrated and analyzed thematically. Tools differed by the type of data generated: program-specific data related to CHWs' roles and responsibilities or data on broader structural factors. A stepwise approach within each tool facilitated focused, in-depth sharing, as did initial paired discussions that allowed exchange of knowledge and experiences among CHWs. Facilitators required topic- and context-specific knowledge to guide discussion effectively. CHWs discussed challenges and successes in their roles; program recommendations; and broader challenges related to healthcare delivery in their communities. This study contributes critical insights on the use of participatory tools to promote the inclusion of implementer perspectives in health program co-design, implementation, and evaluation.
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Affiliation(s)
- Laura J Brubacher
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
| | - Lincoln L Lau
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
- International Care Ministries, Metro Manila, Philippines
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Monica Bustos
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
| | | | - Krisha Lim Mar
- International Care Ministries, Metro Manila, Philippines
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Ontario, Canada
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Domingo A, Little M, Beggs B, Brubacher LJ, Lau LL, Dodd W. Examining the role of community health workers amid extreme weather events in low- and middle-income countries: a scoping review. Public Health 2024; 236:133-143. [PMID: 39182471 DOI: 10.1016/j.puhe.2024.07.023] [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: 11/28/2023] [Revised: 05/29/2024] [Accepted: 07/12/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES The increased frequency and severity of extreme weather events (EWEs) have underscored the need to strengthen climate-resilient health systems and capacity. Community health workers (CHWs) are integral health systems actors with the potential to protect and improve population health in a changing climate. The aim of this review was to synthesize the literature on the roles of CHWs amid EWEs in low- and middle-income countries, the barriers and facilitators to implement these roles, and program supports to strengthen CHW capacity and health system functions. STUDY DESIGN Scoping review. METHODS Four academic databases and gray literature published between January 2000 and June 2023 were searched. Data were thematically analyzed using a deductive-inductive approach guided by the World Health Organization's (WHO's) Operational framework for building climate-resilient health systems. RESULTS Thirty sources were included. Amid EWEs, CHW roles included: 1) delivery of diagnostic, treatment, and other clinical services; 2) support with access, utilization, or navigation of health services and/or referrals; 3) community education and health promotion; 4) data collection and health surveillance; 5) psychosocial supports; and 6) weather-related health emergency response. Facilitators and barriers to the provision of CHW supports amid EWEs were categorized within WHO's building blocks of health systems. Considerations for strengthening CHW programs to enhance climate-resilient health systems are also discussed. CONCLUSIONS CHWs are uniquely positioned to provide health-related supports amid EWEs that extend to emergency preparedness and response to climate-health challenges. These efforts can contribute to the community and health systems resilience to climate change.
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Affiliation(s)
- A Domingo
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada; Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Rd East, Guelph, Ontario N1G 2W1, Canada
| | - M Little
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada; School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Rd, Victoria, BC V8P 5C2, Canada
| | - B Beggs
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - L J Brubacher
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada
| | - L L Lau
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7 Toronto, ON, Canada; International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605 Pasig City, Philippines
| | - W Dodd
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, Ontario N2L 3G1, Canada.
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Dodd W, Brubacher LJ, Speers S, Servano D, Go DJ, Lau LL. The contributions of religious leaders in addressing food insecurity during the COVID-19 pandemic in the Philippines: A realist evaluation of the Rapid Emergencies and Disasters Intervention (REDI). INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2023; 86:103545. [PMID: 36686058 PMCID: PMC9842389 DOI: 10.1016/j.ijdrr.2023.103545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 06/17/2023]
Abstract
To address the unintended consequences of public health measures during the COVID-19 pandemic (e.g., emergency food insecurity, income loss), non-governmental organizations (NGOs) have partnered with diverse actors, including religious leaders, to provide humanitarian relief in resource-constrained communities. One such example is the Rapid Emergencies and Disasters Intervention (REDI), which is an NGO-led program in the Philippines that leverages a network of volunteer religious leaders to identify and address emergency food insecurity among households experiencing poverty. Guided by a realist evaluation approach, the objectives of this study were to identify the facilitators and barriers to effective implementation of REDI by religious leaders during the COVID-19 pandemic and to explore the context and mechanisms that influenced REDI implementation. In total, we conducted 25 virtual semi-structured interviews with religious leaders actively engaged in REDI implementation across 17 communities in Negros Occidental, Philippines. Interviews were audio recorded, transcribed, and thematically analyzed. Three main context-mechanism configurations were identified in shaping effective food aid distribution by religious leaders, including program infrastructure (e.g., technical and relational support from partner NGO), social infrastructure (e.g., social networks), and community infrastructure (e.g., community assets as well as a broader enabling environment). Overall, this study contributes insight into how the unique positionality of religious leaders in combination with organizational structures and guidance from a partner NGO shapes the implementation of a disaster response initiative across resource-constrained communities. Further, this study describes how intersectoral collaboration (involving religious leaders, NGOs, and local governments) can be facilitated through an NGO-led disaster response network.
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Affiliation(s)
- Warren Dodd
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, Ontario, Canada, N2L 3G1
| | - Laura Jane Brubacher
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, Ontario, Canada, N2L 3G1
| | - Shoshannah Speers
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, Ontario, Canada, N2L 3G1
| | - Danilo Servano
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Ortigas Center, Pasig City, Metro Manila, 1605, Philippines
| | - Daryn J Go
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Ortigas Center, Pasig City, Metro Manila, 1605, Philippines
| | - Lincoln L Lau
- School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, Ontario, Canada, N2L 3G1
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Ortigas Center, Pasig City, Metro Manila, 1605, Philippines
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M7, Canada
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Haldane V, Dodd W, Kipp A, Ferrolino H, Wilson K, Servano D, Lau LL, Wei X. Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines. BMC Health Serv Res 2022; 22:1385. [PMID: 36411439 PMCID: PMC9677893 DOI: 10.1186/s12913-022-08734-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Amidst ongoing calls for increased health systems resilience, gaps remain in our understanding of how health systems can reach further into communities to ensure resilient service delivery. Indeed, public health emergencies caused by infectious hazards reveal both the value and vulnerability of the workforce delivering health services in communities. This study explores ways in which a non-governmental organization (NGO) in the Philippines protected their frontline workforce during the first year of the COVID-19 pandemic. METHODS Guided by a qualitative descriptive approach, 34 in-depth interviews were conducted with community-based health actors employed by the NGO between June 2020 and February 2021. Data analysis was guided by an iterative deductive and inductive approach. RESULTS We identified four key activities that enabled the NGO and their staff to provide health and social services in communities in a safe and consistent manner as part of the organization's pandemic response. These include (1) ensuring adequate personal protective equipment (PPE) and hygiene supplies; (2) providing contextualized and role-specific infection prevention and control (IPC) training; (3) ensuring access to testing for all staff; and (4) providing support during quarantine or isolation. CONCLUSION Learning from the implementation of these activities offers a way forward toward health emergency preparedness and response that is crucially needed for NGOs to safely leverage their workforce during pandemics. Further, we describe how community-based health actors employed by NGOs can contribute to broader health systems resilience in the context of health emergency preparedness and response.
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Affiliation(s)
- Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7, Toronto, ON, Canada
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1, Waterloo, ON, Canada
| | - Amy Kipp
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1, Waterloo, ON, Canada
| | - Hannah Ferrolino
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605, Pasig City, Philippines
| | - Kendall Wilson
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605, Pasig City, Philippines
| | - Danilo Servano
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1, Waterloo, ON, Canada
| | - Lincoln L Lau
- Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7, Toronto, ON, Canada.
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, N2L 3G1, Waterloo, ON, Canada.
- International Care Ministries, Unit 1701, 17th Floor, West Tower, Philippine Stock Exchange Centre, Exchange Road, Metro Manila, 1605, Pasig City, Philippines.
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7, Toronto, ON, Canada.
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Jaminola LI, Negre JM, Pepito VCF, Loreche AM, Dayrit MM. The policy environment of self-care: a case study of the Philippines. Health Policy Plan 2022; 38:205-217. [PMID: 36331518 PMCID: PMC9923374 DOI: 10.1093/heapol/czac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/04/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022] Open
Abstract
Self-care is the ability and empowerment of individuals to maintain health through informed health-care decisions, with or without the support of a health provider. High-income countries have made advances to their conceptualization, research and institutionalization of self-care, given its reported benefits to patients, the health system and economy. A similar undertaking in low- and middle-income countries (LMICs) with already fragile health systems is warranted as highlighted by the coronavirus disease 2019 pandemic. Our article therefore aimed to describe and analyse the policy environment of self-care using the Philippines as a case study, which may have relevance to other similar countries and settings that are transitioning towards Universal Health Care (UHC) to reform and strengthen their primary care systems. We conducted 13 key informant interviews and 2 focus group discussions among representatives from the government, the pharmaceutical retail/industry, community retail pharmacy, primary health physicians and health workers, an infirmary administrator and patients and/or patient advocates. We triangulated our qualitative data with findings from our policy review. We found a total of 13 relevant policies on self-care in the Philippines recently drafted and/or implemented from 2016 to 2021 that fall under the broad categories of unifying frameworks and road maps, capacity building and institutional streamlining, regulations and disease guidelines. Our case study highlights the role of the UHC Law as a driver for self-care and patient empowerment towards better health outcomes with its passage resulting in the promulgation of self-care-related policies. Our findings also suggest that changes in the local policy and built environment, and the formal educational and health systems, are needed to foster a culture of responsible self-care. There are notable exemplars in advancing self-care in the region, including Thailand, from which LMICs like the Philippines can draw lessons to make progress on institutionalizing self-care and, ultimately, realizing UHC and Health For All.
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Affiliation(s)
| | | | - Veincent Christian F Pepito
- School of Medicine and Public Health, Ateneo de Manila University, Ortigas Ave., Pasig City 1604, Philippines
| | - Arianna Maever Loreche
- *Corresponding author. School of Medicine and Public Health, Ateneo de Manila University, Ortigas Ave., Pasig City 1604, Philippines. E-mail:
| | - Manuel M Dayrit
- School of Medicine and Public Health, Ateneo de Manila University, Ortigas Ave., Pasig City 1604, Philippines
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Lau LL, Hung N, Go DJ, Choi M, Dodd W, Wei X. Dramatic increases in knowledge, attitudes and practices of COVID-19 observed among low-income households in the Philippines: A repeated cross-sectional study in 2020. J Glob Health 2022; 12:05015. [PMID: 35596944 PMCID: PMC9123942 DOI: 10.7189/jogh.12.05015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has severely impacted populations globally, and knowledge, attitudes and practices (KAPs) surrounding the virus have necessarily evolved. This study was conducted in partnership with International Care Ministries (ICM), a Philippine-based non-governmental organization that runs the “Transform” poverty alleviation program. The main objective of this study was to describe the changes in COVID-19 KAPs among households experiencing extreme poverty in the Philippines over an 8-month period. Methods A KAP questionnaire was integrated into the household survey collected as part of ICM’s regular monitoring and evaluation of “Transform”. Data collection for the first survey was conducted between February 20 and March 13, 2020, and the second survey was conducted between November 12 and December 12, 2020. Frequencies and proportions were calculated to describe the respondents’ responses and the Kruskal-Wallis test was used to assess if there were significant differences in KAP identification between the two time points. Results We observed a distinct increase across all KAP domains. Over 90% of study participants were able to correctly identify COVID-19 transmission modes and preventive measures, and an even higher percentage reported adopting these measures. However, the intention to seek care from public hospitals for COVID-19 symptoms dropped from 43.6% to 28.4%, while reports of self-treatment using stored medicines or antibiotics increased. Trust in community members and local health authorities was correlated with higher knowledge and practice scores. Conclusions Our study results reflect the extraordinary speed of information dissemination and behaviour change globally over the course of the pandemic, but they also highlight the changes in KAP that show the additional challenges faced by populations experiencing poverty in the Philippines. Prioritization of reducing inequities in the implementation and adoption of the evolving public health measures will be integral as the pandemic continues.
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Affiliation(s)
- Lincoln L Lau
- International Care Ministries Inc., Manila, Philippines.,School of Public Health Sciences, University of Waterloo, Waterloo, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Natalee Hung
- International Care Ministries Inc., Manila, Philippines
| | - Daryn J Go
- International Care Ministries Inc., Manila, Philippines
| | - Mia Choi
- International Care Ministries Inc., Manila, Philippines
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Luu K, Brubacher LJ, Lau LL, Liu JA, Dodd W. Exploring the Role of Social Networks in Facilitating Health Service Access Among Low-Income Women in the Philippines: A Qualitative Study. Health Serv Insights 2022; 15:11786329211068916. [PMID: 35095277 PMCID: PMC8793367 DOI: 10.1177/11786329211068916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Despite efforts to implement universal health care coverage (UHC) in the Philippines, income poor households continue to face barriers to health care access and use. In light of recent UHC legislation, the aim of this study was to explore how gender and social networks shape health care access and use among women experiencing poverty in Negros Occidental, Philippines. Semi-structured interviews were conducted with women (n = 35) and health care providers (n = 15). Descriptive statistical analyses were performed to report demographic information. Interview data were analyzed thematically using a hybrid deductive-inductive approach and guided by the Patient-Centred Access to Health Care framework. Women’s decisions regarding health care access were influenced by their perceptions of illness severity, their trust in health care facilities, and their available financial resources. Experiences of health care use were shaped by interactions with health professionals, resource availability at facilities, health care costs, and health insurance acquisition. Women drew upon social networks throughout their lifespan for social and financial support to facilitate healthcare access and use. These findings indicate that social networks may be an important complement to formal supports (eg, UHC) in improving access to health care for women experiencing poverty in the Philippines.
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Affiliation(s)
- Kathy Luu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Lincoln L Lau
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- International Care Ministries, Manila, Philippines
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jennifer A Liu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Anthropology, University of Waterloo, Waterloo, ON, Canada
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Haldane V, Ratnapalan S, Perera N, Zhang Z, Ge S, Choi M, Lau LL, Samaraweera S, Dodd W, Walley J, Wei X. Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the 'SPRINT' principles. BMJ Glob Health 2021; 6:bmjgh-2021-006406. [PMID: 34452942 PMCID: PMC8406459 DOI: 10.1136/bmjgh-2021-006406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with fewer examples that can be implemented in resource-constrained settings. This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs). Methods We used a collaborative autoethnographic approach to explore the process of developing COVID-19 guidelines. In this approach, multiple researchers contributed their reflections, conducted joint analysis through dialogue, reflection and with consideration of experiential knowledge and multidisciplinary perspectives to identify and synthesise enablers, challenges and key lessons learnt. Results We describe the guideline development process in the Philippines and the adaptation process in Sri Lanka. We offer key enablers identified through this work, including flexible leadership that aimed to empower the team to bring their expertise to the process; shared responsibility through equitable ownership; an interdisciplinary team; and collaboration with local experts. We then elaborate on challenges including interpreting other guidelines to the country context; tensions between the ideal compared with the feasible and user-friendly; adapting and updating with evolving information; and coping with pandemic-related challenges. Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency. Conclusions Guideline development during a pandemic requires a robust and time sensitive paradigm. We summarise the learning in the ‘SPRINT principles’ for adapting guidelines in an epidemic context in LMICs. We emphasise that these principles must be grounded in a collaborative or codesign process and add value to existing national responses.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Savithiri Ratnapalan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Emergency Medicine, SickKids, Toronto, Ontario, Canada
| | - Niranjala Perera
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Emergency Medicine, SickKids, Toronto, Ontario, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shiliang Ge
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mia Choi
- International Care Ministries Inc, Manila, Philippines
| | - Lincoln L Lau
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,International Care Ministries Inc, Manila, Philippines
| | | | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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