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Corboz J, Dartnall E, Brown C, Fulu E, Gordon S, Tomlinson M. Co-creating a global shared research agenda on violence against women in low- and middle-income countries. Health Res Policy Syst 2024; 22:71. [PMID: 38914999 DOI: 10.1186/s12961-024-01153-3] [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: 05/21/2023] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Despite a large growth in evidence on violence against women (VAW) over the last 25 years, VAW persists, as do gaps in the field's knowledge of how to prevent and respond to it. To ensure that research on VAW in low- and middle-income countries (LIMCs) is addressing the most significant gaps in knowledge, and to prioritise evidence needs to reduce VAW and better support victims/survivors, the Sexual Violence Research Initiative (SVRI) and Equality Institute (EQI) led a process of developing a global shared research agenda (GSRA) on VAW in LMICs. METHODS The GSRA was developed through a six-stage adaptation of the Child Health and Nutrition Research Initiative (CHNRI) method, which draws on the principle of the 'wisdom of the crowd'. These steps included: a review of the literature on VAW in LMICs and development of domains; the generation of research questions within four domains by an Advisory Group; the consolidation of research questions; scoring of research questions by a Global Expert Group and the Advisory Group according to three criteria (applicability, effectiveness and equity); consultation and validation of the findings with the Advisory Group; and wide dissemination of the findings. RESULTS The highest ranked research questions in the GSRA pertain to the domain of Intervention research, with some highly ranked questions also pertaining to the domain of Understanding VAW in its multiple forms. Questions under the other two domains, Improving existing interventions, and Methodological and measurement gaps, were not prioritised as highly by experts. There was strong consistency in top ranked research questions according to experts' characteristics, albeit with some important differences according to experts' gender, occupation and geographical location. CONCLUSIONS The GSRA findings suggest that currently the VAW field is shifting towards intervention research after several decades of building evidence on understanding VAW, including prevalence, drivers and impacts of violence. The findings also suggest a strong emphasis on under-served populations, and under-researched forms of VAW. Future priority setting exercises in LMICs that seek to decolonise knowledge should ensure that methodologies, and modalities of engagement, put diverse voices at the centre of engagement. Trial registration Not applicable.
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Affiliation(s)
| | | | - Chay Brown
- The Equality Institute, Melbourne, Australia
| | - Emma Fulu
- The Equality Institute, Melbourne, Australia
| | - Sarah Gordon
- Stellenbosch University, Stellenbosch, South Africa
| | - Mark Tomlinson
- Stellenbosch University, Stellenbosch, South Africa
- Queens University, Belfast, United Kingdom
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Kelly MM, DeMuri GP, Barton HJ, Nacht CL, Butteris SM, Katz B, Burns R, Koval S, Ehlenbach ML, Stanley J, Wald ER, Warner G, Wilson LF, Myrah GE, Parker DE, Coller RJ. Priorities for Safer In-Person School for Children With Medical Complexity During COVID-19. Pediatrics 2022; 149:184886. [PMID: 35199167 PMCID: PMC9647557 DOI: 10.1542/peds.2021-054434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To establish statewide consensus priorities for safer in-person school for children with medical complexity (CMC) during the coronavirus disease 2019 (COVID-19) pandemic using a rapid, replicable, and transparent priority-setting method. METHODS We adapted the Child Health and Nutrition Research Initiative Method, which allows for crowdsourcing ideas from diverse stakeholders and engages technical experts in prioritizing these ideas using predefined scoring criteria. Crowdsourcing surveys solicited ideas from CMC families, school staff, clinicians and administrators through statewide distribution groups/listservs using the prompt: "It is safe for children with complex health issues and those around them (families, teachers, classmates, etc.) to go to school in-person during the COVID-19 pandemic if/when…" Ideas were aggregated and synthesized into a unique list of candidate priorities. Thirty-four experts then scored each candidate priority against 5 criteria (equity, impact on COVID-19, practicality, sustainability, and cost) using a 5-point Likert scale. Scores were weighted and predefined thresholds applied to identify consensus priorities. RESULTS From May to June 2021, 460 stakeholders contributed 1166 ideas resulting in 87 candidate priorities. After applying weighted expert scores, 10 consensus CMC-specific priorities exceeded predetermined thresholds. These priorities centered on integrating COVID-19 safety and respiratory action planning into individualized education plans, educating school communities about CMC's unique COVID-19 risks, using medical equipment safely, maintaining curricular flexibility, ensuring masking and vaccination, assigning seats during transportation, and availability of testing and medical staff at school. CONCLUSIONS Priorities for CMC, identified by statewide stakeholders, complement and extend existing recommendations. These priorities can guide implementation efforts to support safer in-person education for CMC.
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Affiliation(s)
- Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,Address correspondence to Michelle M. Kelly, MD, MS Department of Pediatrics, University of Wisconsin, H4/419 CSC, 600 Highland Ave., Madison, WI 53792. E-mail:
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hanna J. Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carrie L. Nacht
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sabrina M. Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Rebecca Burns
- Children and Youth with Special Health Care Needs, State of Wisconsin Department of Health Services, Madison, Wisconsin
| | - Shawn Koval
- Children and Youth with Special Health Care Needs, State of Wisconsin Department of Health Services, Madison, Wisconsin
| | - Mary L. Ehlenbach
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Julia Stanley
- Healthy Kids Collaborative, UW Health, Madison, Wisconsin
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Gary E. Myrah
- Wisconsin Council of Administrators and Special Services, Wisconsin
| | | | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Kobeissi L, Nair M, Evers ES, Han MD, Aboubaker S, Say L, Rollins N, Darmstadt GL, Blanchet K, Garcia DM, Hagon O, Ashorn P. Setting research priorities for sexual, reproductive, maternal, newborn, child and adolescent health in humanitarian settings. Confl Health 2021; 15:16. [PMID: 33771212 PMCID: PMC7995567 DOI: 10.1186/s13031-021-00353-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background An estimated 70.8 million people are forcibly displaced worldwide, 75% of whom are women and children. Prioritizing a global research agenda to inform guidance, service delivery, access to and quality of services is essential to improve the survival and health of women, children and adolescents in humanitarian settings. Method A mixed-methods design was adapted from the Child Health and Nutrition Research Initiative (CHNRI) methodology to solicit priority research questions across the sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) domains in humanitarian settings. The first step (CHNRI) involved data collection and scoring of perceived priority questions, using a web-based survey over two rounds (first, to generate the questions and secondly, to score them). Over 1000 stakeholders from across the globe were approached; 177 took part in the first survey and 69 took part in the second. These research questions were prioritized by generating a research prioritization score (RPP) across four dimensions: answerability, program feasibility, public health relevance and equity. A Delphi process of 29 experts followed, where the 50 scored and prioritized CHRNI research questions were shortlisted. The top five questions from the CHNRI scored list for each SRMNCAH domain were voted on, rendering a final list per domain. Results A total of 280 questions were generated. Generated questions covered sexual and reproductive health (SRH) (n = 90, 32.1%), maternal health (n = 75, 26.8%), newborn health (n = 42, 15.0%), child health (n = 43, 15.4%), and non-SRH aspects of adolescent health (n = 31, 11.1%). A shortlist of the top ten prioritized questions for each domain were generated on the basis of the computed RPPs. During the Delphi process, the prioritized questions, based on the CHNRI process, were further refined. Five questions from the shortlist of each of the SRMNCAH domain were formulated, resulting in 25 priority questions across SRMNCAH. For example, one of the prioritized SRH shortlisted and prioritized research question included: “What are effective strategies to implement good quality comprehensive contraceptive services (long-acting, short-acting and EC) for women and girls in humanitarian settings?” Conclusion Data needs, effective intervention strategies and approaches, as well as greater efficiency and quality during delivery of care in humanitarian settings were prioritized. The findings from this research provide guidance for researchers, program implementers, as well as donor agencies on SRMNCAH research priorities in humanitarian settings. A global research agenda could save the lives of those who are at greatest risk and vulnerability as well as increase opportunities for translation and innovation for SRMNCAH in humanitarian settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00353-w.
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Affiliation(s)
- Loulou Kobeissi
- SRH Integration in Health Systems (SHS), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization (WHO), Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland.
| | - Mahalakshmi Nair
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Egmond Samir Evers
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Mansuk Daniel Han
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | | | - Lale Say
- SRH Integration in Health Systems (SHS), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization (WHO), Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Gary L Darmstadt
- Maternal and Child Health, Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, the Graduate Institute, Geneva, Switzerland
| | - Daniel Martinez Garcia
- Women and Child Health Unit, Medical Department of Médecins Sans Frontières (MSF), Geneva, Switzerland
| | - Olivier Hagon
- Center for Humanitarian Medicine and Disaster Management (CHMDM), WHO Collaborative center, Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Callaghan-Koru JA, Islam M, Khan M, Sowe A, Islam J, Mannan II, George J. Factors that influence the scale up of new interventions in low-income settings: a qualitative case study of the introduction of chlorhexidine cleansing of the umbilical cord in Bangladesh. Health Policy Plan 2020; 35:440-451. [PMID: 32068867 DOI: 10.1093/heapol/czz156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 11/14/2022] Open
Abstract
There is a well-recognized need for empirical study of processes and factors that influence scale up of evidence-based interventions in low-income countries to address the 'know-do' gap. We undertook a qualitative case study of the scale up of chlorhexidine cleansing of the umbilical cord (CHX) in Bangladesh to identify and compare facilitators and barriers for the institutionalization and expansion stages of scale up. Data collection and analysis for this case study were informed by the Consolidated Framework for Implementation Research (CFIR) and the WHO/ExpandNet model of scale up. At the national level, we interviewed 20 stakeholders involved in CHX policy or implementation. At the district level, we conducted interviews with 31 facility-based healthcare providers in five districts and focus group discussions (FGDs) with eight community-based providers and eight programme managers. At the community level, we conducted 7 FGDs with 53 mothers who had a baby within the past year. Expanded interview notes were thematically coded and analysed following an adapted Framework approach. National stakeholders identified external policy and incentives, and the engagement of stakeholders in policy development through the National Technical Working Committee for Newborn Health, as key facilitators for policy and health systems changes. Stakeholders, providers and families perceived the intervention to be simple, safe and effective, and more consistent with family preferences than the prior policy of dry cord care. The major barriers that delayed or decreased the public health impact of the scale up of CHX in Bangladesh's public health system related to commodity production, procurement and distribution. Bangladesh's experience scaling up CHX suggests that scale up should involve early needs assessments and planning for institutionalizing new drugs and commodities into the supply chain. While the five CFIR domains were useful for categorizing barriers and facilitators, additional constructs are needed for common health systems barriers in low-income settings.
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Affiliation(s)
- Jennifer A Callaghan-Koru
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, 1000 Hilltop Circle, Baltimore County, Baltimore, MD 21250, USA.,Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Munia Islam
- MaMoni Health Systems Strengthening Project, Save the Children International, House CWN (A) 35, Road 43, Gulshan 2, Dhaka- 1212, Bangladesh
| | - Marufa Khan
- MaMoni Health Systems Strengthening Project, Save the Children International, House CWN (A) 35, Road 43, Gulshan 2, Dhaka- 1212, Bangladesh.,Pathfinder International, 32 Gulshan Avenue, Gulshan- 2, Dhaka- 1212, Bangladesh
| | - Ardy Sowe
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, 1000 Hilltop Circle, Baltimore County, Baltimore, MD 21250, USA.,Howard University College of Medicine, 520 W Street NW Washington, DC, USA
| | - Jahrul Islam
- Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Imteaz Ibne Mannan
- MaMoni Health Systems Strengthening Project, Save the Children International, House CWN (A) 35, Road 43, Gulshan 2, Dhaka- 1212, Bangladesh.,Jhpiego, House 71, Road 4, Ansari Watt, Shahre Naw, District 4, Kabul, Afghanistan
| | - Joby George
- MaMoni Health Systems Strengthening Project, Save the Children International, House CWN (A) 35, Road 43, Gulshan 2, Dhaka- 1212, Bangladesh
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Callaghan-Koru JA, Khan M, Islam M, Sowe A, Islam J, Billah SM, Mannan II, George J. Implementation outcomes of the national scale up of chlorhexidine cord cleansing in Bangladesh's public health system. J Glob Health 2019; 9:020410. [PMID: 31656605 PMCID: PMC6793170 DOI: 10.7189/jogh.09.020410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Chlorhexidine (CHX) cleansing of the umbilical cord stump is an evidence-based intervention that reduces newborn infections and is recommended for high-mortality settings. Bangladesh is one of the first countries to adopt and scale up CHX nationally. This study evaluates the implementation outcomes for the CHX scale up in Bangladesh and identifies and describes key milestones and processes for the scale up. Methods We adapted the RE-AIM framework for this study, incorporating the WHO/ExpandNet model of Scale Up. Adoption and incorporation milestones were assessed through program documents and interviews with national stakeholders (n = 25). Provider training records served as a measure of reach. Implementation was assessed through a survey of readiness to provide CHX at public facilities (n = 4479) and routine data on the proportion of all live births at public facilities (n = 813 607) that received CHX from December 2016 to November 2017. Six rounds of a rolling household survey with recently-delivered women in four districts (n = 6000 to 8000 per round) measured the effectiveness and maintenance of the scale up in increasing population-level coverage of CHX in those districts. Results More than 80 000 providers, supervisors, and managers across all 64 districts received a half-day training on CHX and essential newborn care between July 2015 and September 2016. Seventy-four percent of facilities had at least 70% of maternal and newborn health providers with CHX training, while only 46% had CHX in stock on the day of the assessment. The provision of CHX to newborns delivered at facilities steadily increased from 15 059 newborns (24%) in December 2016 to 71 704 (72%) in November 2017. In the final household survey of four districts, 33% of newborns were reported to receive CHX, and babies delivered at public facilities had 5.04 times greater odds (95% CI = 4.45, 5.72) of receiving CHX than those delivered at home. Conclusions The scale up of CHX in Bangladesh achieved sustained national implementation in public health facilities. Institutionalization barriers, such as changes to supply logistics systems, had to be addressed before expansion was achieved. For greater public health impact, implementation must reach deliveries that take place at home and in the private sector.
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Affiliation(s)
- Jennifer A Callaghan-Koru
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Marufa Khan
- Save the Children International, Bangladesh, Dhaka, Bangladesh.,MaMoni Health Systems Strenghtening Project
| | - Munia Islam
- Save the Children International, Bangladesh, Dhaka, Bangladesh.,MaMoni Health Systems Strenghtening Project
| | - Ardy Sowe
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Jahurul Islam
- Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh
| | | | - Imteaz Ibne Mannan
- MaMoni Health Systems Strenghtening Project.,Jhpiego (formerly, Save the Children, Bangladesh), Kabul, Afghanistan
| | - Joby George
- Save the Children International, Bangladesh, Dhaka, Bangladesh.,MaMoni Health Systems Strenghtening Project
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Wazny K, Anderson N, Bassani DG, Ravenscroft J, Chan KY, Rudan I. Exploring individual and demographic characteristics and their relation to CHNRI Criteria from an international public stakeholder group: an analysis using random intercept and logistic regression modelling. J Glob Health 2019; 9:010701. [PMID: 30820318 PMCID: PMC6377795 DOI: 10.7189/jogh.09.010701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Child Health and Nutrition Research Initiative (CHNRI) method for health research prioritisation relies on stakeholders weighting criteria used to assess research options. These weights in turn impact on the final scores and ranks assigned to research options. Three quarters of CHNRI studies published to date have not involved stakeholders in criteria weighting. Of those that have, few incorporated members of the public into stakeholder groups. Those that have compared different stakeholder groups, such as donors, researchers, or policy makers, showed that different groups place different values upon CHNRI criteria. When choosing the composition of a stakeholder group, it may be important to understand factors that may influence weighting. Drawing upon a group of international public stakeholders, this study explores some of the effects of individual and demographic characteristics has on the weights assigned to the most commonly used CHNRI criteria, with the aim of informing future researchers on avoiding future biases. METHODS Individual and demographic information and 5-point Likert scale responses to questions about the importance of 15 CHNRI criteria were collected from 1031 "Turkers" (Amazon Mechanical Turk workers) via Amazon Mechanical Turk (AMT), which is an online crowdsourcing platform. Thirteen of the fifteen criteria were analysed using random-intercept models and the remaining two were analysed through logistic regression. RESULTS Self-reported health status explained most of the variability in participants' responses across criteria (11/15 criteria), followed by being female (10/15), ethnicity (9/15), employment (8/15), and religion (7/15). Differences across criteria indicate that when choosing stakeholder groups, researchers need to consider these factors to minimise bias. CONCLUSION Researchers should collect and report more detailed information from stakeholders, including individual and demographic characteristics, and ensure participation from both genders, multiple ethnicities, religious beliefs, and people with differing health statuses to be transparent regarding possible biases in health research prioritisation. Our analyses indicate that these factors do influence the relative importance of these values, even when the data appears fairly homogeneous.
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Affiliation(s)
- Kerri Wazny
- Centre for Global Health Research, Usher Institute of Informatics and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Niall Anderson
- Centre of Population Health Sciences, Usher Institute of Informatics and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Diego G Bassani
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - John Ravenscroft
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research, Usher Institute of Informatics and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Informatics and Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Wazny K, Ravenscroft J, Chan KY, Bassani DG, Anderson N, Rudan I. Setting weights for fifteen CHNRI criteria at the global and regional level using public stakeholders: an Amazon Mechanical Turk study. J Glob Health 2019; 9:010702. [PMID: 30992986 PMCID: PMC6445564 DOI: 10.7189/jogh.09.010702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Stakeholder involvement has been described as an indispensable part of health research priority setting. Yet, more than 75% of the exercises using the Child Health and Nutrition Research Initiative (CHNRI) methodology have omitted the step involving stakeholders in priority setting. Those that have used stakeholders have rarely used the public, possibly due to the difficulty of assembling and/or accessing a public stakeholder group. In order to strengthen future exercises using the CHNRI methodology, we have used a public stakeholder group to weight 15 CHNRI criteria, and have explored regional differences or being a health stakeholder is influential, and whether the criteria are collapsible. Methods Using Amazon Mechanical Turk (AMT), an online crowdsourcing platform, we collected demographic information and conducted a Likert-scale format survey about the importance of the CHNRI criteria from 1051 stakeholders. The Kruskal-Wallis test, with Dunn's test for posthoc comparisons, was used to examine regional differences and Wilcoxon rank-sum test was used to analyse differences between stakeholders with health training/background and stakeholders without a health background and by region. A Factor Analysis (FA) was conducted on the criteria to identify the main domains connecting them. Criteria means were converted to weights. Results There were regional differences in thirteen of fifteen criteria according to the Kruskal-Wallis test and differences in responses from health stakeholders vs those who were not in eleven of fifteen criteria using the Wilcoxon rank-sum test. Three components were identified: improve and impact results; implementation and affordability; and, study design and dissemination. A formula is provided to convert means to weights for future studies. Conclusion In future CHNRI studies, researchers will need to ensure adequate representation from stakeholders to undue bias of CHNRI results. These results should be used in combination with other stakeholder groups, including government, donors, policy makers, and bilateral agencies. Global and regional stakeholder groups scored CHNRI criteria differently; due to this, researchers should consider which group to use in their CHNRI exercises.
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Affiliation(s)
- Kerri Wazny
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Ravenscroft
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Diego G Bassani
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Niall Anderson
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Kapiriri L. Stakeholder involvement in health research priority setting in low income countries: the case of Zambia. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:41. [PMID: 30460042 PMCID: PMC6234591 DOI: 10.1186/s40900-018-0121-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
SUMMARY While there is increasing recognition of the importance of stakeholder involvement in health research priority setting there is a paucity of literature reporting on stakeholder involvement in health research priority setting in low income countries. This paper fills this gap by identifying and discussing the roles and legitimacy of different stakeholders (including the public and patients) involved in the health research priority setting process in Zambia; identifying the barriers to public participation and proposing improvement strategies.We interviewed 28 policy makers and practitioners who had participated in the national level health research priority setting in Zambia. Reported participants in health research priority setting included research users, researchers, research funders and the community/ public. Research funders were thought to have undue influence while the public and patients were not effectively involved. This could be due to the public's lack of education, lack of resources to facilitate public involvement and limited skills to meaningfully engage the public. Participation of people from rural areas, women and young professionals was also limited.While there is a commitment to broad stakeholder involvement in health research priority setting, there's limited public/patient involvement. Public education, availing more resources, and skills to meaningfully engage the public need to be explored. The undue influence of research funders should be mitigated and incentives availed to ensure that they align their research funding with the national priorities. These efforts would strengthen meaningful stakeholder engagement in health research prioritization within Zambia and other similar contexts. ABSTRACT Background Stakeholder involvement in health research priority setting contributes to the legitimacy and acceptability of the priorities. Hence legitimate priority setting should involve a broad representation of stakeholders including the public. While there is a growing body of literature on health research prioritization in low income countries, there is a paucity of literature reporting on stakeholder involvement in the process. The objectives of this paper are to; 1) identify the stakeholders who were involved in the health research priority setting process in Zambia; 2) discuss the roles and perceived legitimacy of the stakeholders and analyze the degree to which patients/ public was involved; 3) To discuss some of the barriers to stakeholder participation in Zambia and similar contexts and to propose improvement strategies.Methods This was a qualitative study involving 28 in-depth interviews with stakeholders who had participated in the national level health research priority setting exercises in Zambia. An interview guide was used. Audio recorded interviews were transcribed and analyzed using INVIVO 10. Analysis of the Stakeholders' theme involved identifying the different dimensions of stakeholder involvement as discussed in the interviews.Results Identified stakeholders included; research users, researchers, research funders and the community/ public. We found that health research priority setting involved research users, researchers, research funders and the community/ public. However, research funders were thought to have undue influence while the public and patients were not effectively involved. While the respondents recognized the advantages of involving the public and patients, they were not effectively involved. This could be due to the public's limited understanding of the technicalities of priority setting, lack of resources to facilitate public involvement and limited skills to meaningfully engage the public. Participation from rural areas, women, and young professionals was also limited.Conclusions While there is a commitment to broad stakeholder involvement in health research priority setting, the public is left out. Efforts such as public education, availing more resources, and skills to meaningfully engage the public need to be explored. The undue influence of research funders should be mitigated through their direct involvement in the prioritization process and incentives to ensure that they align their research funding with the national priorities. These efforts would strengthen meaningful stakeholder engagement in health research prioritization within Zambia and other similar contexts.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health and Aging, McMaster University, 1280 Main Street West, Hamilton, ON Canada
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Kiwanuka Henriksson D, Fredriksson M, Waiswa P, Selling K, Swartling Peterson S. Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda. Glob Health Action 2018; 10:1327256. [PMID: 28581379 PMCID: PMC5496050 DOI: 10.1080/16549716.2017.1327256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Poor quality of care and access to effective and affordable interventions have been attributed to constraints and bottlenecks within and outside the health system. However, there is limited understanding of health system barriers to utilization and delivery of appropriate, high-impact, and cost-effective interventions at the point of service delivery in districts and sub-districts in low-income countries. In this study we illustrate the use of the bottleneck analysis approach, which could be used to identify bottlenecks in service delivery within the district health system. Methods: A modified Tanahashi model with six determinants for effective coverage was used to determine bottlenecks in service provision for maternal and newborn care. The following interventions provided during antenatal care were used as tracer interventions: use of iron and folic acid, intermittent presumptive treatment for malaria, HIV counseling and testing, and syphilis testing. Data from cross-sectional household and health facility surveys in Mayuge and Namayingo districts in Uganda were used in this study. Results: Effective coverage and human resource gaps were identified as the biggest bottlenecks in both districts, with coverage ranging from 0% to 66% for effective coverage and from 46% to 58% for availability of health facility staff. Our findings revealed a similar pattern in bottlenecks in both districts for particular interventions although the districts are functionally independent. Conclusion: The modified Tanahashi model is an analysis tool that can be used to identify bottlenecks to effective coverage within the district health system, for instance, the effective coverage for maternal and newborn care interventions. However, the analysis is highly dependent on the availability of data to populate all six determinants and could benefit from further validation analysis for the causes of bottlenecks identified.
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Affiliation(s)
- Dorcus Kiwanuka Henriksson
- a Institution of International Maternal and Child Health, Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.,b Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Mio Fredriksson
- c Department of Public Health and Caring Sciences , Uppsala University , Uppsala , Sweden
| | - Peter Waiswa
- b Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,d Makerere University College of Health Sciences , School of Public Health , Kampala , Uganda
| | - Katarina Selling
- a Institution of International Maternal and Child Health, Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Stefan Swartling Peterson
- a Institution of International Maternal and Child Health, Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.,d Makerere University College of Health Sciences , School of Public Health , Kampala , Uganda
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Arora NK, Mohapatra A, Gopalan HS, Wazny K, Thavaraj V, Rasaily R, Das MK, Maheshwari M, Bahl R, Qazi SA, Black RE, Rudan I. Setting research priorities for maternal, newborn, child health and nutrition in India by engaging experts from 256 indigenous institutions contributing over 4000 research ideas: a CHNRI exercise by ICMR and INCLEN. J Glob Health 2018; 7:011003. [PMID: 28686749 PMCID: PMC5481897 DOI: 10.7189/jogh.07.011003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Health research in low– and middle– income countries (LMICs) is often driven by donor priorities rather than by the needs of the countries where the research takes place. This lack of alignment of donor’s priorities with local research need may be one of the reasons why countries fail to achieve set goals for population health and nutrition. India has a high burden of morbidity and mortality in women, children and infants. In order to look forward toward the Sustainable Development Goals, the Indian Council of Medical Research (ICMR) and the INCLEN Trust International (INCLEN) employed the Child Health and Nutrition Research Initiative’s (CHNRI) research priority setting method for maternal, neonatal, child health and nutrition with the timeline of 2016–2025. The exercise was the largest to–date use of the CHNRI methodology, both in terms of participants and ideas generated and also expanded on the methodology. Methods CHNRI is a crowdsourcing–based exercise that involves using the collective intelligence of a group of stakeholders, usually researchers, to generate and score research options against a set of criteria. This paper reports on a large umbrella CHNRI that was divided into four theme–specific CHNRIs (maternal, newborn, child health and nutrition). A National Steering Group oversaw the exercise and four theme–specific Research Sub–Committees technically supported finalizing the scoring criteria and refinement of research ideas for the respective thematic areas. The exercise engaged participants from 256 institutions across India – 4003 research ideas were generated from 498 experts which were consolidated into 373 research options (maternal health: 122; newborn health: 56; child health: 101; nutrition: 94); 893 experts scored these against five criteria (answerability, relevance, equity, innovation and out–of–box thinking, investment on research). Relative weights to the criteria were assigned by 79 members from the Larger Reference Group. Given India’s diversity, priorities were identified at national and three regional levels: (i) the Empowered Action Group (EAG) and North–Eastern States; (ii) States and Union territories in Northern India (including West Bengal); and (iii) States and Union territories in Southern and Western parts of India. Conclusions The exercise leveraged the inherent flexibility of the CHNRI method in multiple ways. It expanded on the CHNRI methodology enabling analyses for identification of research priorities at national and regional levels. However, prioritization of research options are only valuable if they are put to use, and we hope that donors will take advantage of this prioritized list of research options.
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Affiliation(s)
| | | | | | - Kerri Wazny
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | | | - Reeta Rasaily
- The Indian Council of Medical Research, New Delhi, India
| | - Manoj K Das
- The INCLEN Trust International, New Delhi, India
| | | | - Rajiv Bahl
- World Health Organization, Geneva, Switzerland
| | | | - Robert E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions. Reprod Health 2018; 15:39. [PMID: 29506534 PMCID: PMC5838932 DOI: 10.1186/s12978-018-0484-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/20/2018] [Indexed: 12/02/2022] Open
Abstract
Background In-country research capacity is key to creating improvements in local implementation of health programs and can help prioritize health issues in a landscape of limited funding. Research prioritization has shown to be particularly useful to help answer strategic and programmatic issues in health care, including sexual and reproductive health (SRH). The purpose of this paper is to present the results of a priority setting exercise that brought together researchers and program managers from the WHO Africa and Eastern Mediterranean regions to identify key SRH issues. Methods In June 2015, researchers and program managers from the WHO Africa and Eastern Mediterranean regions met for a three-day meeting to discuss strategies to strengthen research capacity in the regions. A prioritization exercise was carried out to identify key priority areas for research in SRH. The process included five criteria: answerability, effectiveness, deliverability and acceptability, potential impact of the intervention/program to improve reproductive, maternal and newborn health substantially, and equity. Results The six main priorities identified include: creation and investment in multipurpose prevention technologies, addressing adolescent violence and early pregnancy (especially in the context of early marriage), improved maternal and newborn emergency care, increased evaluation and improvement of adolescent health interventions including contraception, further focus on family planning uptake and barriers, and improving care for mothers and children during childbirth. Conclusion The setting of priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. The key elements identified in this exercise provides guidance for decision makers to focus action on identified research priorities and goals. Prioritization and identifying/acting on research gaps can have great impact across multiple sectors in the regions for improved reproductive, maternal and children health.
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Rotheram-Fuller EJ, Tomlinson M, Scheffler A, Weichle TW, Rezvan PH, Comulada WS, Rotheram-Borus MJ. Maternal patterns of antenatal and postnatal depressed mood and the impact on child health at 3-years postpartum. J Consult Clin Psychol 2018; 86:218-230. [PMID: 29504791 PMCID: PMC5842813 DOI: 10.1037/ccp0000281] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The consequences of maternal depressed mood on children's growth, health, and cognitive and language development are examined over the first 3 years of life. METHOD Pregnant women in 24 periurban township neighborhoods in Cape Town, South Africa (N = 1,238 mothers) were randomized by neighborhood to a home visiting intervention or a standard care condition. Reassessments were conducted for 93%-85% of mothers at 2-weeks, 6-, 18-, and 36-months postbirth. Regressions were conducted on measures of children's growth, behavior, language, and cognition to examine the impact of four patterns of depressed mood: antenatal only (n = 154, 13.8%), postnatal only (n = 272, 24.3%), antenatal and postnatal (n = 220, 19.7%), and no depressed mood on any assessment (n = 473, 42.3%). RESULTS Patterns of depressed mood were similar across intervention conditions. Depressed mothers were significantly less educated, had lower incomes, were less likely to be employed or to have electricity; were more likely to report problematic drinking of alcohol, experience food insecurity, interpersonal partner violence, and to be HIV seropositive. At 36 months, the pattern of maternal depressed mood over time was significantly associated with children's compromised physical growth, both in weight and height, and more internalizing and externalizing symptoms of behavior problems. Measures of language and cognition were similar across maternal patterns of depressed mood. CONCLUSIONS Mothers who report depressed mood face significantly more life challenges, both environmental stressors related to poverty and other problematic behaviors. More proximal, postnatal depressed mood appears to have a larger influence on their children, compared with antenatal depressed mood. (PsycINFO Database Record
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Affiliation(s)
- Erin J. Rotheram-Fuller
- Division of Education Leadership and Innovation, Mary Lou Fulton Teacher’s College, Arizona State University
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Private Bag X1 Matieland, 7602 South Africa
| | - Aaron Scheffler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024
| | - Thomas W. Weichle
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024
| | - Panteha Hayati Rezvan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024
| | - Warren Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90024
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Kapiriri L, Chanda-Kapata P. The quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia. Health Res Policy Syst 2018; 16:11. [PMID: 29452602 PMCID: PMC5816391 DOI: 10.1186/s12961-017-0268-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 11/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background Priority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-setting institutions to identify and fund their own research priorities, since most of the priority-setting initiatives are driven by experts. This paper reports findings from a pilot project whose aim was to develop a systematic process to identify components of a locally desirable and feasible health research priority-setting approach and to contribute to capacity strengthening for the Zambia National Health Research Authority. Methods Synthesis of the current literature on the approaches to health research prioritisations. The results of the synthesis were presented and discussed with a sample of Zambian researchers and decision-makers who are involved in health research priority-setting. The ultimate aim was for them to explore the different approaches available for guiding health research priority-setting and to identify an approach that would be relevant and feasible to implement and sustain within the Zambian context. Results Based on the evidence that was presented, the participants were unable to identify one approach that met the criteria. They identified attributes from the different approaches that they thought would be most appropriate and proposed a process that they deemed feasible within the Zambian context. Conclusion While it is easier to implement prioritisation based on one approach that the initiator might be interested in, researchers interested in capacity-building for health research priority-setting organisations should expose the low-income country participants to all approaches. Researchers ought to be aware that sometimes one shoe may not fit all, as in the case of Zambia, instead of choosing one approach, the stakeholders may select desirable attributes from the different approaches and piece together an approach that would be feasible and acceptable within their context. An approach that builds on the decision-makers’ understanding of their contexts and their input to its development would foster local ownership and has a greater potential for sustainability. Electronic supplementary material The online version of this article (10.1186/s12961-017-0268-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health and Aging, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada.
| | - Pascalina Chanda-Kapata
- Department of Diseases Surveillance Control and Research, Ministry of Health, Lusaka, Zambia
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Yoshida S, Wazny K, Cousens S, Chan KY. Setting health research priorities using the CHNRI method: III. Involving stakeholders. J Glob Health 2018; 6:010303. [PMID: 27303649 PMCID: PMC4894379 DOI: 10.7189/jogh.06.010303] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sachiyo Yoshida
- Department for Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland; These authors contributed equally to the work
| | - Kerri Wazny
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK; These authors contributed equally to the work
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kit Yee Chan
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK; Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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Gordon S, Rotheram-Borus MJ, Skeen S, Parry C, Bryant K, Tomlinson M. Research Priorities for the Intersection of Alcohol and HIV/AIDS in Low and Middle Income Countries: A Priority Setting Exercise. AIDS Behav 2017; 21:262-273. [PMID: 28975440 PMCID: PMC5660137 DOI: 10.1007/s10461-017-1921-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The harmful use of alcohol is a component cause for more than 200 diseases. The association between alcohol consumption, risk taking behavior and a range of infectious diseases such as HIV/AIDS is well established. The prevalence of HIV/AIDS as well as harmful alcohol use in low and middle income countries is high. Alcohol has been identified as a modifiable risk factor in the prevention and treatment of HIV/AIDS. The objective of this paper is to define research priorities for the interaction of alcohol and HIV/AIDS in low and middle income countries. The Child Health and Nutrition Research Initiative (CHNRI) priority setting methodology was applied in order to assess research priorities of the interaction of alcohol and HIV/AIDS. A group of 171 global and local experts in the field of alcohol and or HIV/AIDS related research were identified and invited to generate research questions. This resulted in 205 research questions which have been categorized and refined by senior researchers into 48 research questions to be evaluated using five criteria: answerability, effectiveness, feasibility, applicability and impact, as well as equity. A total of 59 experts participated independently in the voluntary scoring exercise (a 34% response rate). There was substantial consensus among experts on priorities for research on alcohol and HIV. These tended to break down into two categories, those focusing on better understanding the nexus between alcohol and HIV and those directed towards informing practical interventions to reduce the impact of alcohol use on HIV treatment outcomes, which replicates what Bryant (Subst Use Misuse 41:1465–1507, 2006) and Parry et al. (Addiction 108:1–2, 2012) found. Responses from experts were stratified by location in order to determine any differences between groups. On average experts in the LMIC gave higher scores than the HIC experts. Recent research has shown the causal link between alcohol consumption and the incidence of HIV/AIDS including a better understanding of the pathways through which alcohol use affects ARV adherence (and other medications to treat opportunistic infections) and CD4 counts. The results of this process clearly indicated that the important priorities for future research related to the development and assessment of interventions focusing on addressing alcohol and HIV/AIDS, addressing and exploring the impact of HIV risk and comorbid alcohol use, as well as exploring the risk and protective factors in the field of alcohol and HIV/AIDS. The findings from this priority setting exercise could guide international research agenda and make research funding more effective in addressing the research on intersection of alcohol and HIV/AIDS
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Affiliation(s)
- Sarah Gordon
- The Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
- Global Center for Children and Families, Semel Institute and the Department of Psychiatry, University of California at Los Angeles, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024-6521, USA.
| | - Sarah Skeen
- The Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Charles Parry
- South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, South Africa
| | - Kendall Bryant
- National Institute of Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Bethesda, MD, 20892-7003, USA
| | - Mark Tomlinson
- The Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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Tomlinson M, Jordans M, MacMillan H, Betancourt T, Hunt X, Mikton C. Research priority setting for integrated early child development and violence prevention (ECD+) in low and middle income countries: An expert opinion exercise. CHILD ABUSE & NEGLECT 2017; 72:131-139. [PMID: 28802211 DOI: 10.1016/j.chiabu.2017.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
Child development in low and middle income countries (LMIC) is compromised by multiple risk factors. Reducing children's exposure to harmful events is essential for early childhood development (ECD). In particular, preventing violence against children - a highly prevalent risk factor that negatively affects optimal child development - should be an intervention priority. We used the Child Health and Nutrition Initiative (CHNRI) method for the setting of research priorities in integrated Early Childhood Development and violence prevention programs (ECD+). An expert group was identified and invited to systematically list and score research questions. A total of 186 stakeholders were asked to contribute five research questions each, and contributions were received from 81 respondents. These were subsequently evaluated using a set of five criteria: answerability; effectiveness; feasibility and/or affordability; applicability and impact; and equity. Of the 400 questions generated, a composite group of 50 were scored by 55 respondents. The highest scoring research questions related to the training of Community Health Workers (CHW's) to deliver ECD+ interventions effectively and whether ECD+ interventions could be integrated within existing delivery platforms such as HIV, nutrition or mental health platforms. The priority research questions can direct new research initiatives, mainly in focusing on the effectiveness of an ECD+ approach, as well as on service delivery questions. To the best of our knowledge, this is the first systematic exercise of its kind in the field of ECD+. The findings from this research priority setting exercise can help guide donors and other development actors towards funding priorities for important future research related to ECD and violence prevention.
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Affiliation(s)
| | - Mark Jordans
- War Child Holland, Netherlands & King's College London, UK
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McNeely CA, Morland L, Doty SB, Meschke LL, Awad S, Husain A, Nashwan A. How Schools Can Promote Healthy Development for Newly Arrived Immigrant and Refugee Adolescents: Research Priorities. THE JOURNAL OF SCHOOL HEALTH 2017; 87:121-132. [PMID: 28076923 DOI: 10.1111/josh.12477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/05/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The US education system must find creative and effective ways to foster the healthy development of the approximately 2 million newly arrived immigrant and refugee adolescents, many of whom contend with language barriers, limited prior education, trauma, and discrimination. We identify research priorities for promoting the school success of these youth. METHODS The study used the 4-phase priority-setting method of the Child Health and Nutrition Research Initiative. In the final stage, 132 researchers, service providers, educators, and policymakers based in the United States were asked to rate the importance of 36 research options. RESULTS The highest priority research options (range 1 to 5) were: evaluating newcomer programs (mean = 4.44, SD = 0.55), identifying how family and community stressors affect newly arrived immigrant and refugee adolescents' functioning in school (mean = 4.40, SD = 0.56), identifying teachers' major stressors in working with this population (mean = 4.36, SD = 0.72), and identifying how to engage immigrant and refugee families in their children's education (mean = 4.35, SD = 0.62). CONCLUSION These research priorities emphasize the generation of practical knowledge that could translate to immediate, tangible benefits for schools. Funders, schools, and researchers can use these research priorities to guide research for the highest benefit of schools and the newly arrived immigrant and refugee adolescents they serve.
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Affiliation(s)
- Clea A McNeely
- Department of Public Health, University of Tennessee, Knoxville, 1914 Andy Holt Avenue, Suite 390, Knoxville, TN 37919
| | - Lyn Morland
- Innovation, Policy and Research, Bank Street College of Education, 610 West 112th Street, New York, NY 10025
| | - S Benjamin Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205
| | - Laurie L Meschke
- Department of Public Health, University of Tennessee, Knoxville, 1914 Andy Holt Avenue, Suite 390, Knoxville, TN 37919
| | - Summer Awad
- Department of Public Health, University of Tennessee, Knoxville, 1212 Wallingford Road, Knoxville, TN 32923
| | - Altaf Husain
- Department of Social Work, Howard University, 601 Howard Place, NW, Washington, DC 20059
| | - Ayat Nashwan
- Yarmouk University, Shafiq Irshidat St, Irbid 21163, Jordan
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Sharma R, Buccioni M, Gaffey MF, Mansoor O, Scott H, Bhutta ZA. Setting an implementation research agenda for Canadian investments in global maternal, newborn, child and adolescent health: a research prioritization exercise. CMAJ Open 2017; 5:E82-E89. [PMID: 28401123 PMCID: PMC5378526 DOI: 10.9778/cmajo.20160088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Improving global maternal, newborn, child and adolescent health (MNCAH) is a top development priority in Canada, as shown by the $6.35 billion in pledges toward the Muskoka Initiative since 2010. To guide Canadian research investments, we aimed to systematically identify a set of implementation research priorities for MNCAH in low- and middle-income countries. METHODS We adapted the Child Health and Nutrition Research Initiative method. We scanned the Child Health and Nutrition Research Initiative literature and extracted research questions pertaining to delivery of interventions, inviting Canadian experts on MNCAH to generate additional questions. The experts scored a combined list of 97 questions against 5 criteria: answerability, feasibility, deliverability, impact and effect on equity. These questions were ranked using a research priority score, and the average expert agreement score was calculated for each question. RESULTS The overall research priority score ranged from 40.14 to 89.25, with a median of 71.84. The average expert agreement scores ranged from 0.51 to 0.82, with a median of 0.64. Highly-ranked research questions varied across the life course and focused on improving detection and care-seeking for childhood illnesses, overcoming barriers to intervention uptake and delivery, effectively implementing human resources and mobile technology, and increasing coverage among at-risk populations. Children were the most represented target population and most questions pertained to interventions delivered at the household or community level. INTERPRETATION Investing in implementation research is critical to achieving the Sustainable Development Goal of ensuring health and well-being for all. The proposed research agenda is expected to drive action and Canadian research investments to improve MNCAH.
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Affiliation(s)
- Renee Sharma
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Matthew Buccioni
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Michelle F Gaffey
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Omair Mansoor
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Helen Scott
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
| | - Zulfiqar A Bhutta
- Centre for Global Child Health (Sharma, Buccioni, Gaffey, Mansoor, Bhutta), The Hospital for Sick Children, Toronto, Ont.; Canadian Partnership for Women and Children's Health (Scott), Ottawa, Ont
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Tudor Car L, Papachristou N, Gallagher J, Samra R, Wazny K, El-Khatib M, Bull A, Majeed A, Aylin P, Atun R, Rudan I, Car J, Bell H, Vincent C, Franklin BD. Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study. BMC FAMILY PRACTICE 2016; 17:160. [PMID: 27852240 PMCID: PMC5112691 DOI: 10.1186/s12875-016-0552-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. METHODS We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. RESULTS The top three problems were incomplete reconciliation of medication during patient 'hand-overs', inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. CONCLUSIONS Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.
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Affiliation(s)
- Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Nikolaos Papachristou
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Joseph Gallagher
- UCD Conway Institute, gHealth Research Group, The University College Dublin School of Medicine, Dublin, Ireland
| | - Rajvinder Samra
- Faculty of Health & Social Care, Health & Social Care Programme, The Open University, Milton Keynes, UK
| | - Kerri Wazny
- Usher Institute of Population Health Sciences and Informatics, Centre for Global Health Research, The University of Edinburgh Medical School, Edinburgh, UK
| | - Mona El-Khatib
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Adrian Bull
- Imperial College Health Partners, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Rifat Atun
- Department of Global Health and Population & Department of Health Policy and Management, Harvard, Boston USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, Centre for Global Health Research, The University of Edinburgh Medical School, Edinburgh, UK
| | - Josip Car
- Health Services and Outcomes Research Programme, LKCMedicine, Nanyang Technological University, Singapore, Singapore
| | - Helen Bell
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust/UCL School of Pharmacy, London, UK
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Car LT, Papachristou N, Bull A, Majeed A, Gallagher J, El-Khatib M, Aylin P, Rudan I, Atun R, Car J, Vincent C. Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study. BMC FAMILY PRACTICE 2016; 17:131. [PMID: 27613564 PMCID: PMC5017013 DOI: 10.1186/s12875-016-0530-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/01/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Delayed diagnosis in primary care is a common, harmful and costly patient safety incident. Its measurement and monitoring are underdeveloped and underutilised. We created and implemented a novel approach to identify problems leading to and solutions for delayed diagnosis in primary care. METHODS We developed a novel priority-setting method for patient safety problems and solutions called PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their suggestions which were thematically grouped and synthesized into a composite list of 33 distinct problems and 27 solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the Average Expert Agreement. RESULTS The top ranked problems were poor communication between secondary and primary care and the inverse care law, i.e. a mismatch between patients' medical needs and healthcare supply. The highest ranked solutions included: a more rigorous system of communicating abnormal results of investigations to patients, direct hotlines to specialists for GPs to discuss patient problems and better training of primary care clinicians in relevant areas. A priority highlighted throughout the findings is a need to improve communication between clinicians as well as with patients. The highest ranked suggestions had the highest consensus between experts. CONCLUSIONS The novel method we have developed is highly feasible, informative and scalable, and merits wider exploration with a view of becoming part of a routine pro-active and preventative system for patient safety assessment. Clinicians proposed a range of concrete suggestions with an emphasis on improving communication among clinicians and with patients and better GP training. In their view, delayed diagnosis can be largely prevented with interventions requiring relatively minor investment. Rankings of identified problems and solutions can serve as an aid to policy makers and commissioners of care in prioritization of scarce healthcare resources.
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Affiliation(s)
- Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Nikolaos Papachristou
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Adrian Bull
- Imperial College Health Partners, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Joseph Gallagher
- gHealth Research Group, UCD Conway Institute, University College Dublin School of Medicine, Dublin, Ireland
| | - Mona El-Khatib
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, USA
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, USA
| | - Josip Car
- Health Services and Outcomes Research Programme, LKCMedicine, Nanyang Technological University, Singapore, Singapore
| | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK
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21
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Mador RL, Kornas K, Simard A, Haroun V. Using the Nine Common Themes of Good Practice checklist as a tool for evaluating the research priority setting process of a provincial research and program evaluation program. Health Res Policy Syst 2016; 14:22. [PMID: 27006075 PMCID: PMC4804477 DOI: 10.1186/s12961-016-0092-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the context-specific nature of health research prioritization and the obligation to effectively allocate resources to initiatives that will achieve the greatest impact, evaluation of priority setting processes can refine and strengthen such exercises and their outcomes. However, guidance is needed on evaluation tools that can be applied to research priority setting. This paper describes the adaption and application of a conceptual framework to evaluate a research priority setting exercise operating within the public health sector in Ontario, Canada. METHODS The Nine Common Themes of Good Practice checklist, described by Viergever et al. (Health Res Policy Syst 8:36, 2010) was used as the conceptual framework to evaluate the research priority setting process developed for the Locally Driven Collaborative Projects (LDCP) program in Ontario, Canada. Multiple data sources were used to inform the evaluation, including a review of selected priority setting approaches, surveys with priority setting participants, document review, and consultation with the program advisory committee. RESULTS The evaluation assisted in identifying improvements to six elements of the LDCP priority setting process. The modifications were aimed at improving inclusiveness, information gathering practices, planning for project implementation, and evaluation. In addition, the findings identified that the timing of priority setting activities and level of control over the process were key factors that influenced the ability to effectively implement changes. CONCLUSIONS The findings demonstrate the novel adaptation and application of the 'Nine Common Themes of Good Practice checklist' as a tool for evaluating a research priority setting exercise. The tool can guide the development of evaluation questions and enables the assessment of key constructs related to the design and delivery of a research priority setting process.
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Affiliation(s)
- Rebecca L Mador
- Public Health Ontario, Santé publique Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
| | - Kathy Kornas
- Public Health Ontario, Santé publique Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Anne Simard
- Public Health Ontario, Santé publique Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Vinita Haroun
- Ontario Long-Term Care Association, 425 University Avenue, Suite 500, Toronto, ON, M5G 1T6, Canada
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22
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Kruk ME, Yamey G, Angell SY, Beith A, Cotlear D, Guanais F, Jacobs L, Saxenian H, Victora C, Goosby E. Transforming Global Health by Improving the Science of Scale-Up. PLoS Biol 2016; 14:e1002360. [PMID: 26934704 PMCID: PMC4775018 DOI: 10.1371/journal.pbio.1002360] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In its report Global Health 2035, the Commission on Investing in Health proposed that health investments can reduce mortality in nearly all low- and middle-income countries to very low levels, thereby averting 10 million deaths per year from 2035 onward. Many of these gains could be achieved through scale-up of existing technologies and health services. A key instrument to close this gap is policy and implementation research (PIR) that aims to produce generalizable evidence on what works to implement successful interventions at scale. Rigorously designed PIR promotes global learning and local accountability. Much greater national and global investments in PIR capacity will be required to enable the scaling of effective approaches and to prevent the recycling of failed ideas. Sample questions for the PIR research agenda include how to close the gap in the delivery of essential services to the poor, which population interventions for non-communicable diseases are most applicable in different contexts, and how to engage non-state actors in equitable provision of health services in the context of universal health coverage.
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Affiliation(s)
- Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Gavin Yamey
- Evidence to Policy Initiative, Global Health Group, University of California San Francisco, San Francisco, California, United States of America
| | - Sonia Y. Angell
- New York City Department of Health and Mental Hygiene, Long Island City, New York, United States of America
| | - Alix Beith
- Independent global health consultant, Arlington, Virginia, United States of America
| | - Daniel Cotlear
- Health, Nutrition and Population, World Bank Group, Washington, District of Columbia, United States of America
| | - Frederico Guanais
- Social Protection and Health Division, Inter-American Development Bank, Lima, Peru
| | - Lisa Jacobs
- Independent global health consultant, San Francisco, California, United States of America
| | - Helen Saxenian
- Results for Development, Washington, District of Columbia, United States of America
| | - Cesar Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Eric Goosby
- Global Health Delivery and Diplomacy, Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
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Kruk ME, Yamey G, Angell SY, Beith A, Cotlear D, Guanais F, Jacobs L, Saxenian H, Victora C, Goosby E. Transforming Global Health by Improving the Science of Scale-Up. PLoS Biol 2016. [PMID: 26934704 DOI: 10.1371/journal.pbio.1002360.t002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
In its report Global Health 2035, the Commission on Investing in Health proposed that health investments can reduce mortality in nearly all low- and middle-income countries to very low levels, thereby averting 10 million deaths per year from 2035 onward. Many of these gains could be achieved through scale-up of existing technologies and health services. A key instrument to close this gap is policy and implementation research (PIR) that aims to produce generalizable evidence on what works to implement successful interventions at scale. Rigorously designed PIR promotes global learning and local accountability. Much greater national and global investments in PIR capacity will be required to enable the scaling of effective approaches and to prevent the recycling of failed ideas. Sample questions for the PIR research agenda include how to close the gap in the delivery of essential services to the poor, which population interventions for non-communicable diseases are most applicable in different contexts, and how to engage non-state actors in equitable provision of health services in the context of universal health coverage.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Gavin Yamey
- Evidence to Policy Initiative, Global Health Group, University of California San Francisco, San Francisco, California, United States of America
| | - Sonia Y Angell
- New York City Department of Health and Mental Hygiene, Long Island City, New York, United States of America
| | - Alix Beith
- Independent global health consultant, Arlington, Virginia, United States of America
| | - Daniel Cotlear
- Health, Nutrition and Population, World Bank Group, Washington, District of Columbia, United States of America
| | - Frederico Guanais
- Social Protection and Health Division, Inter-American Development Bank, Lima, Peru
| | - Lisa Jacobs
- Independent global health consultant, San Francisco, California, United States of America
| | - Helen Saxenian
- Results for Development, Washington, District of Columbia, United States of America
| | - Cesar Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Eric Goosby
- Global Health Delivery and Diplomacy, Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
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Prioritizing the PMTCT implementation research agenda in 3 African countries: INtegrating and Scaling up PMTCT through Implementation REsearch (INSPIRE). J Acquir Immune Defic Syndr 2014; 67 Suppl 2:S108-13. [PMID: 25310115 DOI: 10.1097/qai.0000000000000358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Countries with high HIV prevalence face the challenge of achieving high coverage of antiretroviral drug regimens interventions including for the prevention of mother-to-child transmission of HIV (PMTCT). In 2011, the World Health Organization and the Department of Foreign Affairs, Trade and Development, Canada, launched a joint implementation research (IR) initiative to increase access to effective PMTCT interventions. Here, we describe the process used for prioritizing PMTCT IR questions in Malawi, Nigeria, and Zimbabwe. Policy makers, district health workers, academics, implementing partners, and persons living with HIV were invited to 2-day workshops in each country. Between 42 and 70 representatives attended each workshop. Using the Child Health Nutrition Research Initiative process, stakeholder groups systematically identified programmatic barriers and formulated IR questions that addressed these challenges. IR questions were scored by individual participants according to 6 criteria: (1) answerable by research, (2) likely to reduce pediatric HIV infections, (3) addresses main barriers to scaling-up, (4) innovation and originality, (5) improves equity among underserved populations, and (6) likely value to policy makers. Highest scoring IR questions included health system approaches for integrating and decentralization services, ways of improving retention-in-care, bridging gaps between health facilities and communities, and increasing male partner involvement. The prioritized questions reflect the diversity of health care settings, competing health challenges and local and national context. The differing perspectives of policy makers, researchers, and implementers illustrate the value of inclusive research partnerships. The participatory Child Health Nutrition Research Initiative approach effectively set national PMTCT IR priorities, promoted country ownership, and strategically allocated research resources.
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Tomlinson M, Yasamy MT, Emerson E, Officer A, Richler D, Saxena S. Setting global research priorities for developmental disabilities, including intellectual disabilities and autism. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:1121-30. [PMID: 24397279 PMCID: PMC4556421 DOI: 10.1111/jir.12106] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2013] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The prevalence of intellectual disabilities (ID) has been estimated at 10.4/1000 worldwide with higher rates among children and adolescents in lower income countries. The objective of this paper is to address research priorities for development disabilities, notably ID and autism, at the global level and to propose the more rational use of scarce funds in addressing this under-investigated area. METHODS An expert group was identified and invited to systematically list and score research questions. They applied the priority setting methodology of the Child Health and Nutrition Research Initiative (CHNRI) to generate research questions and to evaluate them using a set of five criteria: answerability, feasibility, applicability and impact, support within the context and equity. FINDINGS The results of this process clearly indicated that the important priorities for future research related to the need for effective and efficient approaches to early intervention, empowerment of families supporting a person with developmental disability and to address preventable causes of poor health in people with ID and autism. CONCLUSIONS For the public health and other systems to become more effective in delivering appropriate support to persons with developmental disabilities, greater (and more targeted) investment in research is required to produce evidence of what works consistent with international human rights standards.
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Affiliation(s)
- M Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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26
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Holdsworth M, Kruger A, Nago E, Lachat C, Mamiro P, Smit K, Garimoi-Orach C, Kameli Y, Roberfroid D, Kolsteren P. African stakeholders' views of research options to improve nutritional status in sub-Saharan Africa. Health Policy Plan 2014; 30:863-74. [PMID: 25124084 DOI: 10.1093/heapol/czu087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Setting research priorities for improving nutrition in Africa is currently ad hoc and there is a need to shift the status quo in the light of slow progress in reducing malnutrition. This study explored African stakeholders' views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years. METHODS Using Multi-Criteria Mapping, quantitative and qualitative data were gathered from 91 stakeholders representing 6 stakeholder groups (health professionals, food Industry, government, civil society, academics and research funders) in Benin, Mozambique, South Africa, Tanzania, Togo and Uganda. Stakeholders appraised six research options (ecological nutrition, nutritional epidemiology, community nutrition interventions, behavioural nutrition, clinical nutrition and molecular nutrition) for how well they could address malnutrition in Africa. RESULTS Impact (28.3%), research efficacy (23.6%) and social acceptability (22.4%) were the criteria chosen the most to evaluate the performance of research options. Research on the effectiveness of community interventions was seen as a priority by stakeholders because they were perceived as likely to have an impact relatively quickly, were inexpensive and cost-effective, involved communities and provided direct evidence of what works. Behavioural nutrition research was also highly appraised. Many stakeholders, particularly academics and government were optimistic about the value of ecological nutrition research (the impact of environmental change on nutritional status). Research funders did not share this enthusiasm. Molecular nutrition was least preferred, considered expensive, slow to have an impact and requiring infrastructure. South Africa ranked clinical and molecular nutrition the highest of all countries. CONCLUSION Research funders should redirect research funds in Africa towards the priorities identified by giving precedence to develop the evidence for effective community nutrition interventions. Expanding research funding in behavioural and ecological nutrition was also valued and require multi-disciplinary collaborations between nutritionists, social scientists, agricultural and climate change scientists.
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Affiliation(s)
- Michelle Holdsworth
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK,
| | - Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research, North West University, Potchefstroom, South Africa
| | - Eunice Nago
- Faculté des Sciences Agronomiques, University of Abomey-Calavi, Cotonou, Benin
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium, Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Peter Mamiro
- Department of Food Science and Technology, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Karlien Smit
- Africa Unit for Transdisciplinary Health Research, North West University, Potchefstroom, South Africa
| | | | - Yves Kameli
- Research Unit 'NUTRIPASS', Institute of Research for Development, Montpellier, France
| | - Dominique Roberfroid
- Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium, Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Morof DF, Kerber K, Tomczyk B, Lawn J, Blanton C, Sami S, Amsalu R. Neonatal survival in complex humanitarian emergencies: setting an evidence-based research agenda. Confl Health 2014; 8:8. [PMID: 24959198 PMCID: PMC4057580 DOI: 10.1186/1752-1505-8-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Over 40% of all deaths among children under 5 are neonatal deaths (0-28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Many of the countries with the highest neonatal mortality rates globally are currently or have recently been affected by complex humanitarian emergencies. Despite the global burden of neonatal morbidity and mortality and risks inherent in complex emergency situations, research investments are not commensurate to burden and little is known about the epidemiology or best practices for neonatal survival in these settings. METHODS We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research questions on neonatal health in complex humanitarian emergencies. Experts evaluated 35 questions using four criteria (answerability, feasibility, relevance, equity) with three subcomponents per criterion. Using SAS 9.2, a research prioritization score (RPS) and average expert agreement score (AEA) were calculated for each question. RESULTS Twenty-eight experts evaluated all 35 questions. RPS ranged from 0.846 to 0.679 and the AEA ranged from 0.667 to 0.411. The top ten research priorities covered a range of issues but generally fell into two categories- epidemiologic and programmatic components of neonatal health. The highest ranked question in this survey was "What strategies are effective in increasing demand for, and use of skilled attendance?" CONCLUSIONS In this study, a diverse group of experts used the CHRNI methodology to systematically identify and determine research priorities for neonatal health and survival in complex humanitarian emergencies. The priorities included the need to better understand the magnitude of the disease burden and interventions to improve neonatal health in complex humanitarian emergencies. The findings from this study will provide guidance to researchers and program implementers in neonatal and complex humanitarian fields to engage on the research priorities needed to save lives most at risk.
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Affiliation(s)
- Diane F Morof
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-74, Atlanta, GA 30341, USA
| | - Kate Kerber
- Saving Newborn Lives, Save the Children, 28 Lower Main Road, Observatory 7925, South Africa
- University of the Western Cape, Bellville 7535, South Africa
| | - Barbara Tomczyk
- Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA
| | - Joy Lawn
- Epidemiology, London School of Hygiene and Tropical Medicine, Global Evidence and Policy, Saving Newborn Lives, Save the Children, Keppel Street, London WCIE-7HT, UK
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA
| | - Samira Sami
- Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA
| | - Ribka Amsalu
- Save the Children, 54 Wilton Road, Westport, CT 06880, USA
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Lachat C, Nago E, Roberfroid D, Holdsworth M, Smit K, Kinabo J, Pinxten W, Kruger A, Kolsteren P. Developing a sustainable nutrition research agenda in sub-Saharan Africa--findings from the SUNRAY project. PLoS Med 2014; 11:e1001593. [PMID: 24492348 PMCID: PMC3904839 DOI: 10.1371/journal.pmed.1001593] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Patrick Kolsteren and colleagues present the findings of a collaborative effort by stakeholders in sub-Saharan Africa to identify priorities for nutrition research. They propose a new approach that stimulates demand from policy makers for research and holds them accountable for incorporating research into policy and practice. Please see later in the article for the Editors' Summary
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Affiliation(s)
- Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium ; Unit of Nutrition and Child Health, Institute for Tropical Medicine, Antwerp, Belgium
| | - Eunice Nago
- Department of Nutrition and Food Science, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Dominique Roberfroid
- Unit of Nutrition and Child Health, Institute for Tropical Medicine, Antwerp, Belgium
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Karlien Smit
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Joyce Kinabo
- Department of Food Science and Technology, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Wim Pinxten
- Faculty of Medicine & Life Sciences, Hasselt University, Diepenbeek, Belgium ; Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium ; Unit of Nutrition and Child Health, Institute for Tropical Medicine, Antwerp, Belgium
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Ali M, Seuc A, Rahimi A, Festin M, Temmerman M. A global research agenda for family planning: results of an exercise for setting research priorities. Bull World Health Organ 2013; 92:93-8. [PMID: 24623902 DOI: 10.2471/blt.13.122242] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 08/09/2013] [Accepted: 09/23/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To develop a global research agenda that will guide investment in effective interventions to satisfy the large unmet need for modern methods of family planning. METHODS In a global survey, experts on contraception were invited to identify and rank the types of research that would be needed--and the knowledge gaps that would have to be filled--to reduce the unmet need for family planning in the next decade. The experts were then asked to score the research on a given topic in terms of the likelihood of its leading to an intervention that would: (i) be deliverable, affordable and sustainable; (ii) substantially reduce the unmet need for contraceptives; (iii) be effective and efficient in improving health systems; (iv) be ethically implemented; and (v) improve equity in the target population. The overall scores were then ranked. FINDINGS Most of the topics that received the 15 highest scores fell into three categories: implementation of policies in family planning; the integration of services to address barriers to contraceptive use; and interventions targeted at underserved groups, such as adolescents. CONCLUSION Experts on contraception gave top priority ranking to research on improving the implementation and integration of health services and on strengthening the health systems supporting family planning services. The results of the exercise may help decision-makers, researchers and funding agencies to develop a clear and focused approach to satisfying the global need for family planning and reach the target set by the Family Planning 2020 initiative.
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Affiliation(s)
- Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Armando Seuc
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Asma Rahimi
- Charité-Berlin School of Public Health, Berlin, Germany
| | - Mario Festin
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Marleen Temmerman
- Department of Reproductive Health and Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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Nair H, Lau ESM, Brooks WA, Seong AC, Theodoratou E, Zgaga L, Huda T, Jadhav SS, Rudan I, Campbell H. An evaluation of the emerging vaccines against influenza in children. BMC Public Health 2013; 13 Suppl 3:S14. [PMID: 24564565 PMCID: PMC3847180 DOI: 10.1186/1471-2458-13-s3-s14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Influenza is an under-appreciated cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 20 million new episodes of ALRI in children annually, 97% of these occurring in developing countries. It is also estimated to result in 28000 to 112000 deaths annually in young children. Apart from hospitalisations and deaths, influenza has significant economic consequences. The current egg-based inactivated influenza vaccines have several limitations: annual vaccination, high production costs, and cannot respond adequately to meet the demand during pandemics. METHODS We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging cross-protective vaccines against influenza relevant to several criteria of interest: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). They answered questions from the CHNRI framework and their "collective optimism" towards each criterion was documented on a scale from 0 to 100%. RESULTS The experts expressed very high level of optimism for deliverability, impact on equity, and acceptability to health workers and end users. However, they expressed concerns over the criteria of answerability, low development cost, low product cost, low implementation cost, affordability and, to a lesser extent sustainability. In addition they felt that the vaccine would have higher efficacy and impact on disease burden reduction on overall influenza-associated disease rather than specifically influenza-associated pneumonia. CONCLUSION Although the landscape of emerging influenza vaccines shows several promising candidates, it is unlikely that the advancements in the newer vaccine technologies will be able to progress through to large scale production in the near future. The combined effects of continued investments in researching new vaccines and improvements of available vaccines will hopefully shorten the time needed to the development of an effective seasonal and pandemic influenza vaccine suitable for large scale production.
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Affiliation(s)
- Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
- Public Health Foundation of India, New Delhi, India
| | - Eva Shi May Lau
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - W Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ang Choon Seong
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Evropi Theodoratou
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Lina Zgaga
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Tanvir Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | | | - Igor Rudan
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Harry Campbell
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
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Rudan I. Global health research priorities: mobilizing the developing world. Public Health 2012; 126:237-240. [PMID: 22325672 DOI: 10.1016/j.puhe.2011.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
The paper focuses on two questions: (i) how to set research priorities in a transparent, systematic, fair and legitimate way?; and (ii) how to mobilize low and middle-income countries to take more ownership in defining their own research policies, rather than merely being passive recipients of international aid for research and development? I propose that the recently developed Child Health and Nutrition Research initiative (CHNRI) methodology is becoming widely accepted as a feasible answer to both those questions. In this paper, I review its numerous applications to date and show how it evolved into a practical and systematic tool that can assist priority setting in health research investments in diverse contexts. The CHNRI methodology also addresses support for different instruments of health research to achieve better balance between fundamental research, translation research and implementation research. The wide application of CHNRI methodology is expected to maximise the potential of health research to reduce disease burden and gradually reduce inequities that exist between support for research on the health problems of the rich and the poor. I believe that this tool will find application within many low and middle-income countries and assist them to pull together their own experts and actively define their priorities for research and development in the coming years.
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Affiliation(s)
- I Rudan
- Centre for Population Health Sciences, The University of Edinburgh Medical School, College of Medicine and Veterinary Medicine, Edinburgh, Scotland, UK.
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Abstract
Eliana Jimenez Soto and colleagues describe the Investment Case framework, a health systems research approach for planning and budgeting, and detail the implementation of the framework in four Asian countries to improve maternal, newborn and child health.
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Tol WA, Patel V, Tomlinson M, Baingana F, Galappatti A, Panter-Brick C, Silove D, Sondorp E, Wessells M, van Ommeren M. Research priorities for mental health and psychosocial support in humanitarian settings. PLoS Med 2011; 8:e1001096. [PMID: 21949644 PMCID: PMC3176752 DOI: 10.1371/journal.pmed.1001096] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Wietse Tol and colleagues lay out a a consensus-based research agenda for mental health and psychosocial support in humanitarian settings.
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Affiliation(s)
- Wietse A Tol
- Global Health Initiative, MacMillan Center, Yale University, New Haven, Connecticut, United States of America.
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Tomlinson M, Chopra M, Hoosain N, Rudan I. A review of selected research priority setting processes at national level in low and middle income countries: towards fair and legitimate priority setting. Health Res Policy Syst 2011; 9:19. [PMID: 21575144 PMCID: PMC3115910 DOI: 10.1186/1478-4505-9-19] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 05/15/2011] [Indexed: 11/10/2022] Open
Abstract
Background It is estimated that more than $130 billion is invested globally into health research each year. Increasingly, there is a need to set priorities in health research investments in a fair and legitimate way, using a sound and transparent methodology. In this paper we review selected priority setting processes at national level in low and middle income countries. We outline a set of criteria to assess the process of research priority setting and use these to describe and evaluate priority setting exercises that have taken place at country level. Based on these insights, recommendations are made regarding the constituents of a good priority setting process. Methods Data were gathered from presentations at a meeting held at the World Health Organization (WHO) in 2008 and a web-based search. Based on this literature review a number of criteria were developed to evaluate the priority setting processes. Results Across the countries surveyed there was a relative lack of genuine stakeholder engagement; countries varied markedly in the extent to which the priority setting processes were documented; none of the countries surveyed had a systematic or operational appeals process for outlined priorities; and in all countries (except South Africa) the priorities that were outlined described broad disease categories rather than specific research questions. Conclusions Country level priority setting processes differed significantly in terms of the methods used. We argue that priority setting processes must have in-built mechanisms for publicizing results, effective procedures to enforce decisions as well as processes to ensure that the revision of priorities happens in practice.
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Affiliation(s)
- Mark Tomlinson
- Department of Psychology, Stellenbosch University, South Africa.
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Choudhuri D, Huda T, Theodoratou E, Nair H, Zgaga L, Falconer R, Luksic I, Johnson HL, Zhang JSF, El Arifeen S, Nelson CB, Borrow R, Campbell H, Rudan I. An evaluation of emerging vaccines for childhood meningococcal disease. BMC Public Health 2011; 11 Suppl 3:S29. [PMID: 21501447 PMCID: PMC3231902 DOI: 10.1186/1471-2458-11-s3-s29] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Meningococcal meningitis is a major cause of disease worldwide, with frequent epidemics particularly affecting an area of sub-Saharan Africa known as the “meningitis belt”. Neisseria meningitidis group A (MenA) is responsible for major epidemics in Africa. Recently W-135 has emerged as an important pathogen. Currently, the strategy for control of such outbreaks is emergency use of meningococcal (MC) polysaccharide vaccines, but these have a limited ability to induce herd immunity and elicit an adequate immune response in infant and young children. In recent times initiatives have been taken to introduce meningococcal conjugate vaccine in these African countries. Currently there are two different types of MC conjugate vaccines at late stages of development covering serogroup A and W-135: a multivalent MC conjugate vaccine against serogroup A,C,Y and W-135; and a monovalent conjugate vaccine against serogroup A. We aimed to perform a structured assessment of these emerging meningococcal vaccines as a means of reducing global meningococal disease burden among children under 5 years of age. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In the first stage we systematically reviewed the literature related to emerging MC vaccines relevant to 12 criteria of interest. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). They answered questions from CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results For MenA conjugate vaccine the experts showed very high level of optimism (~ 90% or more) for 7 out of the 12 criteria. The experts felt that the likelihood of efficacy on meningitis was very high (~ 90%). Deliverability, acceptability to health workers, end users and the effect on equity were all seen as highly likely (~ 90%). In terms of the maximum potential impact on meningitis disease burden, the median potential effectiveness of the vaccines in reduction of overall meningitis mortality was estimated to be 20%; (interquartile range 20-40% and min. 8%, max 50 %). For the multivalent meningococcal vaccines the experts had similar optimism for most of the 12 CHNRI criteria with slightly lower optimism in answerability and low development cost criteria. The main concern was expressed over the cost of product, its affordability and cost of implementation. Conclusions With increasing recognition of the burden of meningococcal meningitis, especially during epidemics in Africa, it is vitally important that strategies are taken to reduce the morbidity and mortality attributable to this disease. Improved MC vaccines are a promising investment that could substantially contribute to reduction of child meningitis mortality world-wide.
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Affiliation(s)
- Debajeet Choudhuri
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
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Catto AG, Zgaga L, Theodoratou E, Huda T, Nair H, Arifeen SE, Rudan I, Duke T, Campbell H. An evaluation of oxygen systems for treatment of childhood pneumonia. BMC Public Health 2011; 11 Suppl 3:S28. [PMID: 21501446 PMCID: PMC3231901 DOI: 10.1186/1471-2458-11-s3-s28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Oxygen therapy is recommended for all of the 1.5 - 2.7 million young children who consult health services with hypoxemic pneumonia each year, and the many more with other serious conditions. However, oxygen supplies are intermittent throughout the developing world. Although oxygen is well established as a treatment for hypoxemic pneumonia, quantitative evidence for its effect is lacking. This review aims to assess the utility of oxygen systems as a method for reducing childhood mortality from pneumonia. METHODS Aiming to improve priority setting methods, The Child Health and Nutrition Research Initiative (CHNRI) has developed a common framework to score competing interventions into child health. That framework involves the assessment of 12 different criteria upon which interventions can be compared. This report follows the proposed framework, using a semi-systematic literature review and the results of a structured exercise gathering opinion from experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies), to assess and score each criterion as their "collective optimism" towards each, on a scale from 0 to 100%. RESULTS A rough estimate from an analysis of the literature suggests that global strengthening of oxygen systems could save lives of up to 122,000 children from pneumonia annually. Following 12 CHNRI criteria, the experts expressed very high levels of optimism (over 80%) for answerability, low development cost and low product cost; high levels of optimism (60-80%) for low implementation cost, likelihood of efficacy, deliverability, acceptance to end users and health workers; and moderate levels of optimism (40-60%) for impact on equity, affordability and sustainability. The median estimate of potential effectiveness of oxygen systems to reduce the overall childhood pneumonia mortality was ~20% (interquartile range: 10-35%, min. 0%, max. 50%). However, problems with oxygen systems in terms of affordability, sustainability and impact on equity are noted in both expert opinion scores and on review. CONCLUSION Oxygen systems are likely to be an effective intervention in combating childhood mortality from pneumonia. However, a number of gaps in the evidence base exist that should be addressed to complete the investment case and research addressing these issues merit greater funding attention.
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Affiliation(s)
- Alastair G Catto
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Lina Zgaga
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Evropi Theodoratou
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Tanvir Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Harish Nair
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
- Public Health Foundation of India, New Delhi, India
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Igor Rudan
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
- Croatian Centre for Global Health, University of Split Medical School, Split, Croatia
| | - Trevor Duke
- Centre for International Child Health, Melbourne University Department of Paediatrics, Royal Children's Hospital, Parkville, 3052, Victoria, Australia
| | - Harry Campbell
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
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Webster J, Theodoratou E, Nair H, Seong AC, Zgaga L, Huda T, Johnson HL, Madhi S, Rubens C, Zhang JSF, El Arifeen S, Krause R, Jacobs TA, Brooks AW, Campbell H, Rudan I. An evaluation of emerging vaccines for childhood pneumococcal pneumonia. BMC Public Health 2011; 11 Suppl 3:S26. [PMID: 21501444 PMCID: PMC3231900 DOI: 10.1186/1471-2458-11-s3-s26] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumonia is the leading cause of child mortality worldwide. Streptococcus pneumoniae (SP) or pneumococcus is estimated to cause 821,000 child deaths each year. It has over 90 serotypes, of which 7 to 13 serotypes are included in current formulations of pneumococcal conjugate vaccines that are efficacious in young children. To further reduce the burden from SP pneumonia, a vaccine is required that could protect children from a greater diversity of serotypes. Two different types of vaccines against pneumococcal pneumonia are currently at varying stages of development: a multivalent pneumococcal conjugate vaccine covering additional SP serotypes; and a conserved common pneumococcal protein antigen (PPA) vaccine offering protection for all serotypes. METHODS We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging SP vaccines relevant to several criteria of interest: answerability; efficacy and effectiveness; cost of development, production and implementation; deliverability, affordability and sustainability; maximum potential for disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their "collective optimism" towards each criterion was documented on a scale from 0 to 100%. RESULTS The experts expressed very high level of optimism (over 80%) that low-cost polysaccharide conjugate SP vaccines would satisfy each of the 9 relevant CHNRI criteria. The median potential effectiveness of conjugate SP vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 25% (interquartile range 20-38%, min. 15%, max 45%). For low cost, cross-protective common protein vaccines for SP the experts expressed concerns over answerability (72%) and the level of development costs (50%), while the scores for all other criteria were over 80%. The median potential effectiveness of common protein vaccines in reduction of overall childhood pneumonia mortality was predicted to be about 30% (interquartile range 26-40%, min. 20%, max 45%). CONCLUSIONS Improved SP vaccines are a very promising investment that could substantially contribute to reduction of child mortality world-wide.
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Affiliation(s)
- Julia Webster
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Evropi Theodoratou
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
- Public Health Foundation of India, New Delhi, India
| | - Ang Choon Seong
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Lina Zgaga
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Tanvir Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Hope L Johnson
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shabir Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases & Medical Research Council Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, South Africa
| | - Craig Rubens
- Center for Childhood Infections and Prematurity Research, Seattle Children's Met Park West, Seattle, USA
| | - Jian Shayne F Zhang
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ryoko Krause
- International Federation of Pharmaceutical Manufacturers & Associations, Geneva, Switzerland
| | | | - Abdullah W Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Harry Campbell
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
| | - Igor Rudan
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
- Croatian Centre for Global Health, University of Split Medical School, Croatia
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Huda T, Nair H, Theodoratou E, Zgaga L, Fattom A, El Arifeen S, Rubens C, Campbell H, Rudan I. An evaluation of the emerging vaccines and immunotherapy against staphylococcal pneumonia in children. BMC Public Health 2011; 11 Suppl 3:S27. [PMID: 21501445 PMCID: PMC3239838 DOI: 10.1186/1471-2458-11-s3-s27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Staphylococcus aureus is a commensal of human skin and nares. It is also one of the leading nosocomial pathogens in both developed and developing countries and is responsible for a wide range of life threatening infections, especially in patients who are immunocompromised, post-surgery, undergoing haemodialysis and those who are treated with catheters and ventilators. Over the past two decades, the incidence of nosocomial staphylococcal infections has increased dramatically. Currently there are at least seven vaccine and immunotherapy candidates against S. aureus in the developmental phase targeting both active and passive immunization. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging vaccines against Staphylococcus aureus relevant to several criteria of interest: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies) to participate. The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to sensitive nature of their involvement in such exercises. They answered questions from CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results The panel of experts expressed low levels of optimism (score around or below 50%) on the criteria of answerability, efficacy, maximum disease burden reduction potential, low cost of production, low cost of implementation and affordability; moderate levels of optimism (scores around 60 to 80%) that these vaccines could be developed at a low cost, and thus on the deliverability, sustainability and impact on equity; and high levels of optimism (scores above 80%) regarding acceptable of such a product to both the end-users and health workers. While assessing the candidates for passive immunization against S.aureus, the experts were poorly optimistic regarding low production cost, low implementation cost, efficacy, deliverability, sustainability, affordability and equity; moderately optimistic regarding answerability and acceptability to health workers and end-users. They were of the opinion that these interventions would have only a modest impact (3 to 5%) on the burden of childhood pneumonia. . Conclusion In order to provide an effective vaccine against S. aureus, a number of unresolved issues in vaccine development relating to optimal antigenic target identification, criteria for acceptable efficacy, identification of target population, commercial development limitations, optimal timing of immunization strategy, storage, cold chain requirements and cost need to be addressed properly. There is still a great deal unknown about the complex interaction between S. aureus and the human host. However, given the nature of S. aureus and the lessons learned from the recent failure of two emerging vaccines, it is clear that a multi-component vaccine is essential. Combating only one virulence factor is not sufficient in the human host but finding the right combination of factors will be very challenging.
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Affiliation(s)
- Tanvir Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Higginson D, Theodoratou E, Nair H, Huda T, Zgaga L, Jadhav SS, Omer SB, Rudan I, Campbell H. An evaluation of respiratory administration of measles vaccine for prevention of acute lower respiratory infections in children. BMC Public Health 2011; 11 Suppl 3:S31. [PMID: 21501450 PMCID: PMC3231905 DOI: 10.1186/1471-2458-11-s3-s31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Measles was responsible for an estimated 100,000 deaths worldwide in 2008. Despite being a vaccine-preventable disease, measles remains a major cause of morbidity and mortality in young children. Although a safe and effective injectable measles vaccine has been available for over 50 years it has not been possible to achieve the uniformly high levels of coverage (required to achieve measles eradication) in most parts of the developing world. Aerosolised measles vaccines are now under development with the hope of challenging the delivery factors currently limiting the coverage of the existing vaccine. Methods We used a modified CHNRI methodology for setting priorities in health research investments to assess the strengths and weaknesses of this emerging intervention to decrease the burden of childhood pneumonia. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging aerosol vaccines against measles relevant to several criteria of interest. Although there are a number of different aerosol vaccine approaches under development, for the purpose of this exercise, all were considered as one intervention. The criteria of interest were: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results The panel of experts expressed mixed feelings about an aerosol measles vaccine. The group expressed low levels of optimism regarding the criteria of likelihood of efficacy and low cost of development (scores around 50%); moderate levels of optimism regarding answerability, low cost of production, low cost of implementation and affordability (score around 60%); and high levels of optimism regarding deliverability, impact on equity and acceptability to health workers and end-users (scores over 80%). Finally, the experts felt that this intervention will have a modest but nevertheless important impact on reduction of burden of disease due to childhood pneumonia (median: 5%, interquartile range 1-15%, minimum 0%, maximum 45%). Conclusion Aerosol measles vaccine is at an advanced stage of development, with evidence of good immunogenicity. This new intervention will be presented as a feasible candidate strategy in the campaign for global elimination of measles. It also presents an unique opportunity to decrease the overall burden of disease due to severe pneumonia in young children.
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Affiliation(s)
- Daisy Higginson
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
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Nair H, Verma VR, Theodoratou E, Zgaga L, Huda T, Simões EAF, Wright PF, Rudan I, Campbell H. An evaluation of the emerging interventions against Respiratory Syncytial Virus (RSV)-associated acute lower respiratory infections in children. BMC Public Health 2011; 11 Suppl 3:S30. [PMID: 21501449 PMCID: PMC3231904 DOI: 10.1186/1471-2458-11-s3-s30] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Respiratory Syncytial Virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 33.8 million new episodes of ALRI in children annually, 96% of these occurring in developing countries. It is also estimated to result in about 53,000 to 199,000 deaths annually in young children. Currently there are several vaccine and immunoprophylaxis candidates against RSV in the developmental phase targeting active and passive immunization. Methods We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging vaccines against RSV relevant to 12 criteria of interest. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%. Results In the case of candidate vaccines for active immunization of infants against RSV, the experts expressed very low levels of optimism for low product cost, affordability and low cost of development; moderate levels of optimism regarding the criteria of answerability, likelihood of efficacy, deliverability, sustainability and acceptance to end users for the interventions; and high levels of optimism regarding impact on equity and acceptance to health workers. While considering the candidate vaccines targeting pregnant women, the panel expressed low levels of optimism for low product cost, affordability, answerability and low development cost; moderate levels of optimism for likelihood of efficacy, deliverability, sustainability and impact on equity; high levels of optimism regarding acceptance to end users and health workers. The group also evaluated immunoprophylaxis against RSV using monoclonal antibodies and expressed no optimism towards low product cost; very low levels of optimism regarding deliverability, affordability, sustainability, low implementation cost and impact on equity; moderate levels of optimism against the criteria of answerability, likelihood of efficacy, acceptance to end-users and health workers; and high levels of optimism regarding low development cost. They felt that either of these vaccines would have a high impact on reducing burden of childhood ALRI due to RSV and reduce the overall childhood ALRI burden by a maximum of about 10%. Conclusion Although monoclonal antibodies have proven to be effective in providing protection to high-risk infants, their introduction in resource poor settings might be limited by high cost associated with them. Candidate vaccines for active immunization of infants against RSV hold greatest promise. Introduction of a low cost vaccine against RSV would reduce the inequitable distribution of burden due to childhood ALRI and will most likely have a high impact on morbidity and mortality due to severe ALRI.
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Affiliation(s)
- Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK
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Lawn JE, Bahl R, Bergstrom S, Bhutta ZA, Darmstadt GL, Ellis M, English M, Kurinczuk JJ, Lee ACC, Merialdi M, Mohamed M, Osrin D, Pattinson R, Paul V, Ramji S, Saugstad OD, Sibley L, Singhal N, Wall SN, Woods D, Wyatt J, Chan KY, Rudan I. Setting research priorities to reduce almost one million deaths from birth asphyxia by 2015. PLoS Med 2011; 8:e1000389. [PMID: 21305038 PMCID: PMC3019109 DOI: 10.1371/journal.pmed.1000389] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Joy Lawn and colleagues used a systematic process developed by the Child Health Nutrition Research Initiative (CHNRI) to define and rank research options to reduce mortality from intrapartum-related neonatal deaths (birth asphyxia) by the year 2015.
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Affiliation(s)
- Joy E. Lawn
- Saving Newborn Lives/Save the Children, Cape Town, South Africa
- * E-mail:
| | - Rajiv Bahl
- Department for Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
| | - Staffan Bergstrom
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden, and Averting Maternal Death and Disability Program, Columbia University, New York, New York, United States of America
| | - Zulfiqar A. Bhutta
- Division of Women & Child Health, the Aga Khan University, Karachi, Pakistan
| | - Gary L. Darmstadt
- Family Health Division, Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Matthew Ellis
- Community Child Health Partnership, Southmead Hospital, Bristol, United Kingdom
| | - Mike English
- KEMRI–Wellcome Trust Programme, Centre for Geographic Medicine Research–Coast, Nairobi, Kenya, and Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- The National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Anne C. C. Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mario Merialdi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mohamed Mohamed
- George Washington University, Washington, D.C., United States of America
| | - David Osrin
- Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom
| | - Robert Pattinson
- MRC Maternal and Infant Heath Care Strategies Research Unit at the University of Pretoria, Pretoria, South Africa
| | - Vinod Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddarth Ramji
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Ola D. Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Norway
| | - Lyn Sibley
- Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America
| | - Nalini Singhal
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Steven N. Wall
- Saving Newborn Lives/Save the Children, Washington, D.C., United States of America
| | - Dave Woods
- University of Cape Town and the Perinatal Education Programme, Observatory, South Africa
| | - John Wyatt
- Centre for Philosophy, Justice and Health, University College of London, London, United Kingdom, and Center for Women's Health, University College of London, London, United Kingdom
| | - Kit Yee Chan
- Nossal Institute of Global Health, University of Melbourne, Melbourne, Australia
| | - Igor Rudan
- Croatian Centre for Global Health, University of Split Medical School, Split, Croatia, and the Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, United Kingdom
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George A, Young M, Bang A, Chan KY, Rudan I, Victora CG, Chopra M, Rubens C. Setting implementation research priorities to reduce preterm births and stillbirths at the community level. PLoS Med 2011; 8:e1000380. [PMID: 21245907 PMCID: PMC3014929 DOI: 10.1371/journal.pmed.1000380] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Asha George and colleagues from the GAPPS group report the implementation research priorities to address prematurity and stillbirths at the community level that resulted from their recent expert consensus exercise.
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Affiliation(s)
- Asha George
- Health Section, UNICEF, New York, New York, United States of America
- * E-mail:
| | - Mark Young
- Health Section, UNICEF, New York, New York, United States of America
| | - Abhay Bang
- Society for Education, Action and Research in Community Health, Gadchiroli, India
| | - Kit Yee Chan
- Nossal Institute of Global Health, University of Melbourne, Melbourne, Australia
| | - Igor Rudan
- Croatian Centre for Global Health, University of Split Medical School, Split, Croatia
- Centre of Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, United Kingdom
| | | | - Mickey Chopra
- Health Section, UNICEF, New York, New York, United States of America
| | - Craig Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle Children's Hospital, Seattle, Washington, United States of America
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Rudan I, Kapiriri L, Tomlinson M, Balliet M, Cohen B, Chopra M. Evidence-based priority setting for health care and research: tools to support policy in maternal, neonatal, and child health in Africa. PLoS Med 2010; 7:e1000308. [PMID: 20644640 PMCID: PMC2903581 DOI: 10.1371/journal.pmed.1000308] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
As part of a series on maternal, neonatal, and child health in sub-Saharan Africa, Igor Rudan and colleagues discuss various priority-setting tools for health care and research that can help develop evidence-based policy.
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Affiliation(s)
- Igor Rudan
- Global Health Academy and Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, United Kingdom.
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Affiliation(s)
- Stefan Peterson
- Karolinska Institutet, Global Health (IHCAR), 17177 Stockholm, Sweden.
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Placing emergency care on the global agenda. Ann Emerg Med 2010; 56:142-9. [PMID: 20138398 DOI: 10.1016/j.annemergmed.2010.01.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 11/26/2009] [Accepted: 01/11/2010] [Indexed: 11/20/2022]
Abstract
Emergency care serves a key function within health care systems by providing an entry point to health care and by decreasing morbidity and mortality. Although primarily focused on evaluation and treatment for acute conditions, emergency care also serves as an important locus of provision for preventive care with regard to injuries and disease progression. Despite its important and increasing role, however, emergency care has been frequently overlooked in the discussion of health systems and delivery platforms, particularly in developing countries. Little research has been done in lower- and middle-income countries on the burden of disease reduction attributable to emergency care, whether through injury treatment and prevention, urgent and emergency treatment of acute conditions, or emergency treatment of complications from chronic conditions. There is a critical need for research documenting the role of emergency care services in reducing the global burden of disease. In addition to applying existing methodologies toward this aim, new methodologies should be developed to determine the cost-effectiveness of these interventions and how to effectively cover the costs of and demands for emergency care needs. These analyses could be used to emphasize the public health and clinical importance of emergency care within health systems as policymakers determine health and budgeting priorities in resource-limited settings.
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Ranson MK, Bennett SC. Priority setting and health policy and systems research. Health Res Policy Syst 2009; 7:27. [PMID: 19961591 PMCID: PMC2796654 DOI: 10.1186/1478-4505-7-27] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 12/04/2009] [Indexed: 11/10/2022] Open
Abstract
Health policy and systems research (HPSR) has been identified as critical to scaling-up interventions to achieve the millennium development goals, but research priority setting exercises often do not address HPSR well. This paper aims to (i) assess current priority setting methods and the extent to which they adequately include HPSR and (ii) draw lessons regarding how HPSR priority setting can be enhanced to promote relevant HPSR, and to strengthen developing country leadership of research agendas. Priority setting processes can be distinguished by the level at which they occur, their degree of comprehensiveness in terms of the topic addressed, the balance between technical versus interpretive approaches and the stakeholders involved. When HPSR is considered through technical, disease-driven priority setting processes it is systematically under-valued. More successful approaches for considering HPSR are typically nationally-driven, interpretive and engage a range of stakeholders. There is still a need however for better defined approaches to enable research funders to determine the relative weight to assign to disease specific research versus HPSR and other forms of cross-cutting health research. While country-level research priority setting is key, there is likely to be a continued need for the identification of global research priorities for HPSR. The paper argues that such global priorities can and should be driven by country level priorities.
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Affiliation(s)
- Michael K Ranson
- Alliance for Health Policy and Systems Research, World Health Organization, 20 Avenue Appia-1211 Geneva 27, Switzerland.
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Tomlinson M, Swartz L, Officer A, Chan KY, Rudan I, Saxena S. Research priorities for health of people with disabilities: an expert opinion exercise. Lancet 2009; 374:1857-62. [PMID: 19944866 DOI: 10.1016/s0140-6736(09)61910-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
International evidence shows that people with disabilities have many unmet health and rehabilitation needs, face barriers in accessing mainstream health-care services, and consequently have poor health. Inadequate specific information is available about the prevalence and patterns of health conditions of people with disabilities, effective interventions, and policy-relevant research about what works to improve health and functioning of people with disabilities. In view of the urgency of the issues at stake and scarcity of resources, research contributing to improvement of health of people with disabilities needs to be prioritised. We invited 82 stakeholders to list and score research options, with the priority-setting method of the Child Health and Nutrition Research Initiative. 83 research questions were assessed for answerability, applicability, sensitivity, support within the context, and equity. The leading research priority was identification of barriers that people with disabilities have in accessing health services at different levels, and finding the best possible strategies to integrate their needs into primary health-care systems and ensure local delivery. Results showed that addressing specific impairments is secondary to ensuring that health systems provide adequately for all people with disabilities. Our findings are a call for urgent attention to the issue of access to appropriate health care for people with disabilities, especially in low-income and middle-income countries.
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Affiliation(s)
- Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
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Tomlinson M, Rudan I, Saxena S, Swartz L, Tsai AC, Patel V. Setting priorities for global mental health research. Bull World Health Organ 2009; 87:438-46. [PMID: 19565122 PMCID: PMC2686213 DOI: 10.2471/blt.08.054353] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 09/03/2008] [Accepted: 09/09/2008] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To set investment priorities in global mental health research and to propose a more rational use of funds in this under-resourced and under-investigated area. METHODS Members of the Lancet Mental Health Group systematically listed and scored research investment options on four broad classes of disorders: schizophrenia and other major psychotic disorders, major depressive disorder and other common mental disorders, alcohol abuse and other substance abuse disorders, and the broad class of child and adolescent mental disorders. Using the priority-setting approach of the Child Health and Nutrition Research Initiative, the group listed various research questions and evaluated them using the criteria of answerability, effectiveness, deliverability, equity and potential impact on persisting burden of mental health disorders. Scores were then weighted according to the system of values expressed by a larger group of stakeholders. FINDINGS The research questions that scored highest were related to health policy and systems research, where and how to deliver existing cost-effective interventions in a low-resource context, and epidemiological research on the broad categories of child and adolescent mental disorders or those pertaining to alcohol and drug abuse questions. The questions that scored lowest related to the development of new interventions and new drugs or pharmacological agents, vaccines or other technologies. CONCLUSION In the context of global mental health and with a time frame of the next 10 years, it would be best to fill critical knowledge gaps by investing in research into health policy and systems, epidemiology and improved delivery of cost-effective interventions.
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Affiliation(s)
- Mark Tomlinson
- Department of Psychology, Stellenbosch University, Matieland, South Africa.
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Kosek M, Lanata CF, Black RE, Walker DG, Snyder JD, Salam MA, Mahalanabis D, Fontaine O, Bhutta ZA, Bhatnagar S, Rudan I. Directing diarrhoeal disease research towards disease-burden reduction. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2009; 27:319-331. [PMID: 19507747 PMCID: PMC2761799 DOI: 10.3329/jhpn.v27i3.3374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions; the efficacy and effectiveness of the intervention resulting from the research; the maximal potential for disease-burden reduction of the interventions derived from the research; the affordability, deliverability, and sustainability of the intervention supported by the research; and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015.
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Affiliation(s)
- Margaret Kosek
- Department of International Health, Joins Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Abstract
BACKGROUND Little published evidence supports the widely held contention that research in pregnancy is underfunded compared with other disease areas. OBJECTIVES To assess absolute and relative government and charitable funding for maternal and perinatal research in the UK and internationally. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION, AND ANALYSIS: Major research funding bodies and alliances were identified from an Internet search and discussions with opinion leaders/senior investigators. Websites and annual reports were reviewed for details of strategy, research spend, grants awarded, and allocation to maternal and/or perinatal disease using generic and disease-specific search terms. MAIN RESULTS Within the imprecision in the data sets, < or =1% of health research spend in the UK was on maternal/perinatal health. Other countries fared better with 1-4% investment, although nonexclusive categorisation may render this an overestimate. In low-resource settings, government funders focused on infectious disease but not maternal and perinatal health despite high relative disease burden, while global philanthropy concentrated on service provision rather than research. Although research expenditure has been deemed as appropriate for 'reproductive health' disease burden in the UK, there are no data on the equity of maternal/perinatal research spend against disease burden, which globally may justify a manyfold increase. AUTHOR'S CONCLUSIONS This systematic review of research expenditure and priorities from national and international funding bodies suggests relative underinvestment in maternal/perinatal health. Contributing factors include the low political priority given to women's health, the challenging nature of clinical research in pregnancy, and research capacity dearth as a consequence of chronic underinvestment.
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Affiliation(s)
- N M Fisk
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.
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