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Ssegujja E, Andipatin M. Translating lessons to reinforce national stillbirth response; multi-stakeholder perspectives regarding priorities and opportunities to deliver quality evidence-based interventions within a limited-resource context in Uganda. BMC Health Serv Res 2024; 24:715. [PMID: 38858756 PMCID: PMC11165756 DOI: 10.1186/s12913-024-11180-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/05/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND There is noted increase in attention towards implementation of evidence-based interventions in response to the stillbirth burden in low- and middle-income countries including Uganda. Recent results reporting some of the strategies adopted have tended to focus much attention towards their overall effect on the stillbirth burden. More is needed regarding stakeholder reflections on priorities and opportunities for delivering quality services within a limited resource setting like Uganda. This paper bridges this knowledge gap. METHODS Data collection occurred between March and June 2019 at the national level. Qualitative interviews were analysed using a thematic analysis technique. RESULTS Identified priorities included; a focus on supportive functions such as the referral system, attention to the demand side component of maternal health services, and improvements in the support supervision particularly focusing on empowering subnational level actors. The need to strengthen the learning for better implementation of strategies which are compatible with context was also reported. A comprehensive and favourable policy environment with the potential to direct implementation of strategies, harnessing the private sector contribution as well as the role of national level champions and patient advocates to amplify national stillbirth reduction efforts for continued visibility and impact were recommended. CONCLUSION Great potential exists within the current strategies to address the national stillbirth burden. However, priorities such as improving the supportive functions of MCH service delivery and attention to the demand side need to be pursued more for better service delivery with opportunities including a favourable policy environment primed to better serve the current strategies. This calls for dedicated efforts targeted at addressing gaps within the existing priorities and opportunities for better delivery of national strategies to address the stillbirth burden in Uganda.
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Affiliation(s)
- Eric Ssegujja
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7076, Kampala, Uganda.
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, Republic of South Africa.
| | - Michelle Andipatin
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
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Salam SS, Ameen S, Balen J, Nahar Q, Jabeen S, Ahmed A, Gillespie B, Chauke L, Mannan A, Hoque M, Dey SK, Islam J, Ashrafee S, Alam HMS, Saberin A, Saha PK, Sarkar S, Alim A, Islam MS, Gray C, El Arifeen S, Rahman AE, Anumba DOC. Research prioritisation on prevention and management of preterm birth in low and middle-income countries (LMICs) with a special focus on Bangladesh using the Child Health and Nutrition Research Initiative (CHNRI) method. J Glob Health 2023; 13:07004. [PMID: 37651640 PMCID: PMC10472017 DOI: 10.7189/jogh.13.07004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background Fifteen million babies are born preterm globally each year, with 81% occurring in low- and middle-income countries (LMICs). Preterm birth complications are the leading cause of newborn deaths and significantly impact health, quality of life, and costs of health services. Improving outcomes for newborns and their families requires prioritising research for developing practical, scalable solutions, especially in low-resource settings such as Bangladesh. We aimed to identify research priorities related to preventing and managing preterm birth in LMICs for 2021-2030, with a special focus on Bangladesh. Methods We adopted the Child Health and Nutrition Research Initiative (CHNRI) method to set research priorities for preventing and managing preterm birth. Seventy-six experts submitted 490 research questions online, which we collated into 95 unique questions and sent for scoring to all experts. A hundred and nine experts scored the questions using five pre-selected criteria: answerability, effectiveness, deliverability, maximum potential for burden reduction, and effect on equity. We calculated weighted and unweighted research priority scores and average expert agreement to generate a list of top-ranked research questions for LMICs and Bangladesh. Results Health systems and policy research dominated the top 20 identified priorities for LMICs, such as understanding and improving uptake of the facility and community-based Kangaroo Mother Care (KMC), promoting breastfeeding, improving referral and transport networks, evaluating the impact of the use of skilled attendants, quality improvement activities, and exploring barriers to antenatal steroid use. Several of the top 20 questions also focused on screening high-risk women or the general population of women, understanding the causes of preterm birth, or managing preterm babies with illnesses (jaundice, sepsis and retinopathy of prematurity). There was a high overlap between research priorities in LMICs and Bangladesh. Conclusions This exercise, aimed at identifying priorities for preterm birth prevention and management research in LMICs, especially in Bangladesh, found research on improving the care of preterm babies to be more important in reducing the burden of preterm birth and accelerating the attainment of Sustainable Development Goal 3 target of newborn deaths, by 2030.
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Affiliation(s)
| | - Shafiqul Ameen
- The University of Sheffield, Sheffield, UK
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Julie Balen
- The University of Sheffield, Sheffield, UK
- Canterbury Christ Church University, Canterbury, UK
| | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anisuddin Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Abdul Mannan
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | | | - Sanjoy Kumer Dey
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Jahurul Islam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Sabina Ashrafee
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Husam Md Shah Alam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Ashfia Saberin
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Palash Kumar Saha
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Supriya Sarkar
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Azizul Alim
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Clive Gray
- Stellenbosch University, Stellenbosch, South Africa
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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Hamm RF, Moniz MH, Wahid I, Breman RB, Callaghan-Koru JA. Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers. Implement Sci Commun 2023; 4:83. [PMID: 37480135 PMCID: PMC10360260 DOI: 10.1186/s43058-023-00461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/21/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA. METHODS This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures. RESULTS Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. CONCLUSIONS Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.
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Affiliation(s)
- Rebecca F Hamm
- Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michelle H Moniz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Inaya Wahid
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rachel Blankstein Breman
- Department of Partnerships, Professional Education and Practice, School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Jennifer A Callaghan-Koru
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Springdale, AR, USA.
- Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Koivu AM, Haapaniemi T, Askari S, Bhandari N, Black RE, Chico RM, Dewey KG, Duggan CP, Klein N, Kumar S, Lawn JE, Manji K, Näsänen-Gilmore PK, Salasibew M, Semrau KEA, Ashorn U, Ashorn P. What more can be done? Prioritizing the most promising antenatal interventions to improve birth weight. Am J Clin Nutr 2023; 117 Suppl 2:S107-S117. [PMID: 37331758 PMCID: PMC10447483 DOI: 10.1016/j.ajcnut.2022.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/13/2022] [Accepted: 10/28/2022] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) is associated with neonatal mortality and sequelae of lifelong health problems; prioritizing the most promising antenatal interventions may guide resource allocation and improve health outcomes. OBJECTIVE We sought to identify the most promising interventions that are not yet included in the policy recommendations of the World Health Organization (WHO) but could complement antenatal care and reduce the prevalence of LBW and related adverse birth outcomes in low- and middle-income settings. METHODS We utilized an adapted Child Health and Nutrition Research Initiative (CHNRI) prioritization method. RESULTS In addition to procedures already recommended by WHO for the prevention of LBW, we identified six promising antenatal interventions that are not currently recommended by WHO with an indication for LBW prevention, namely: (1) provision of multiple micronutrients; (2) low-dose aspirin; (3) high-dose calcium; (4) prophylactic cervical cerclage; (5) psychosocial support for smoking cessation; and (6) other psychosocial support for targeted populations and settings. We also identified seven interventions for further implementation research and six interventions for efficacy research. CONCLUSION These promising interventions, coupled with increasing coverage of currently recommended antenatal care, could accelerate progress toward the global target of a 30% reduction in the number of LBW infants born in 2025 compared to 2006-10.
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Affiliation(s)
- Annariina M Koivu
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Tiia Haapaniemi
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sufia Askari
- Children's Investment Fund Foundation, London, United Kingdom
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - R Matthew Chico
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Christopher P Duggan
- Center for Nutrition, Boston Children's Hospital/Harvard Medical School; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Pieta K Näsänen-Gilmore
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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George AS, Lopes CA, Vijayasingham L, Mothupi MC, Musizvingoza R, Mishra G, Stevenson J, Remme M. A shared agenda for gender and COVID-19 research: priorities based on broadening engagement in science. BMJ Glob Health 2023; 8:bmjgh-2022-011315. [PMID: 37217235 DOI: 10.1136/bmjgh-2022-011315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
While the acute and collective crisis from the pandemic is over, an estimated 2.5 million people died from COVID-19 in 2022, tens of millions suffer from long COVID and national economies still reel from multiple deprivations exacerbated by the pandemic. Sex and gender biases deeply mark these evolving experiences of COVID-19, impacting the quality of science and effectiveness of the responses deployed. To galvanise change by strengthening evidence-informed inclusion of sex and gender in COVID-19 practice, we led a virtual collaboration to articulate and prioritise gender and COVID-19 research needs. In addition to standard prioritisation surveys, feminist principles mindful of intersectional power dynamics underpinned how we reviewed research gaps, framed research questions and discussed emergent findings. The collaborative research agenda-setting exercise engaged over 900 participants primarily from low/middle-income countries in varied activities. The top 21 research questions included the importance of the needs of pregnant and lactating women and information systems that enable sex-disaggregated analysis. Gender and intersectional aspects to improving vaccine uptake, access to health services, measures against gender-based violence and integrating gender in health systems were also prioritised. These priorities are shaped by more inclusive ways of working, which are critical for global health as it faces further uncertainties in the aftermath of COVID-19. It remains imperative to address the basics in gender and health (sex-disaggregated data and sex-specific needs) and also advance transformational goals to advance gender justice across health and social policies, including those related to global research.
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Affiliation(s)
- Asha S George
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Claudia A Lopes
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Lavanya Vijayasingham
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mamothena Carol Mothupi
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Ronald Musizvingoza
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Gita Mishra
- School of Public Health, Centre for Longitudinal and Life Course Studies, University of Queensland, Brisbane, Queensland, Australia
| | - Jacqui Stevenson
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Michelle Remme
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
- The Global Fund to Fights AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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Research priorities for maternal and perinatal health clinical trials and methods used to identify them: A systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 280:120-131. [PMID: 36455392 DOI: 10.1016/j.ejogrb.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Research prioritisation helps to target research resources to the most pressing health and healthcare needs of a population. This systematic review aimed to report research priorities in maternal and perinatal health and to assess the methods that were used to identify them. METHODS A systematic review was undertaken. Projects that aimed to identify research priorities that were considered to be amenable to clinical trials research were eligible for inclusion. The search, limited to the last decade and publications in English, included MEDLINE, EMBASE, CINHAL, relevant Cochrane priority lists, Cochrane Priority Setting Methods Group homepage, James Lind Alliance homepage, Joanna Brigg's register, PROSPERO register, reference lists of all included articles, grey literature, and the websites of relevant professional bodies, until 13 October 2020. The methods used for prioritisation were appraised using the Reporting Guideline for Priority Setting of Health Research (REPRISE). FINDINGS From the 62 included projects, 757 research priorities of relevance to maternal and perinatal health were identified. The most common priorities related to healthcare systems and services, pregnancy care and complications, and newborn care and complications. The least common priorities related to preconception and postpartum health, maternal mental health, contraception and pregnancy termination, and fetal medicine and surveillance. The most commonly used prioritisation methods were Delphi (20, 32%), Child Health Nutrition Research Initiative (17, 27%) and the James Lind Alliance (10, 16%). The fourteen projects (23%) that reported on at least 80% of the items included in the REPRISE guideline all used an established research prioritisation method. CONCLUSIONS There are a large number of diverse research priorities in maternal and perinatal health that are amenable to future clinical trials research. These have been identified by a variety of research prioritisation methods.
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Ssegujja E, Mulumba Y, Guttmacher S, Andipatin M. The role and attributes of social networks in the provision of support to women after stillbirth: experiences from Uganda. BMC Womens Health 2021; 21:352. [PMID: 34615502 PMCID: PMC8496046 DOI: 10.1186/s12905-021-01498-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/17/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Communities exert stigma on mothers after stillbirth despite their potential to offer social support to the grieving family. Maternal healthcare-seeking behaviors are socially reinforced rendering a social network approach vital in understanding support dynamics which when utilized can improve community response to mothers experiencing stillbirth. However, the form and direction of social support for women when in need is not clear. The study explored the role and attributes of women's social networks in the provision of support to mothers who have experienced a stillbirth in Uganda. METHODS An exploratory cross-sectional study design adopting a social network approach was conducted. Data collection following established procedures was conducted on a convenient sample of 17 mothers who had experienced a stillbirth six months before the study. Frequencies and bivariate analysis were conducted to determine the factors influencing the provision of social support from 293 network members elicited during the alter generation. We then performed a Poisson regression on each of the social support forms and the explanatory variables. Network structure variables were calculated using UCINET version 6 while Netdraw facilitated the visualization of networks. RESULTS Overall, social support was available from all network relations mentioned by the respondents. No major variations were observed between the two time periods during pregnancy and following a stillbirth. The most common support received was in form of intangible support such as emotional and information support, mainly from females who were married and from the naturally occurring networks such as family and friends. We also observed that social support followed patterns of network relational characteristics including trust, frequency of contact and alters counted on for support more likely to provide the same. CONCLUSIONS A great potential for social support exists within women's social networks to help address stillbirth risk factors during pregnancy and cope after experiencing the same. Alter characteristics like being female, married, and from naturally occurring networks together with relational characteristics such as trust, frequency of contact, and count on alter for support were predictors of eventual social support. Interventions aiming at addressing stillbirth risks at the community level ought to harness these network characteristics for benefits to the mothers.
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Affiliation(s)
- Eric Ssegujja
- Makerere University School of Public Health, Kampala, Uganda.
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
| | - Yusuf Mulumba
- Uganda Cancer Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Sally Guttmacher
- School of Global Public Health, New York University, New York, NY, USA
| | - Michelle Andipatin
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
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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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Long C, Tang S, Wang R, Ji L, Wang Y, Wu T, Li Z, Feng Z. The migrating mediators and the interaction associated with the use of essential public health services: a cross-sectional study in Chinese older migrants. BMC Geriatr 2020; 20:475. [PMID: 33198656 PMCID: PMC7670818 DOI: 10.1186/s12877-020-01878-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite the incremental implementation of the essential public health services (EPHS) during the last decade, the goal of EPHS’s equalization is impossible to cannot be achieved without appropriate policies targeting older migrants. Therefore, this study aims to examine whether the supply side meets the needs of older migrants and to explore the relationships among health status, the use of health services, and diverse factors. Methods The data were derived from a national cross-sectional dataset (N = 11,161) of the 2015 Chinese Migrant Dynamic Monitoring Survey. Mediating effects analysis and moderating effects analysis were conducted to explore the interactions between physical status and the use of EPHS in older migrants such as physical examination, health record, and follow-up services. Results The use of physical examination, health record, and follow-up services were correlated with each other. Household income, migrating for employment, and migrating for offspring were negatively associated with the use of EPHS. A positive association was observed between the use of EPHS and willingness for long-stay. The mediating effects of household income, migrating for employment, migrating for offspring, and willingness for long-stay were observed on the relationship between physical status and the use of EPHS. The moderating effects of household income and migrating for employment were discovered. Conclusion Public health policies that may be worthy of consideration include further enhancing the delivery capacity of primary health institutions, integrating professional clinical resources into the primary health system, and launching the target policies to improve the accessibility of EPHS in older migrants.
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Affiliation(s)
- Chengxu Long
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Lu Ji
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yang Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Tailai Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Zhifei Li
- China National Center for Biotechnology Development, 16 West Sihuan Middle Road, Beijing, 100039, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
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10
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Tomlinson M, Darmstadt GL, Yousafzai AK, Daelmans B, Britto P, Gordon SL, Tablante E, Dua T. Global research priorities to accelerate programming to improve early childhood development in the sustainable development era: a CHNRI exercise. J Glob Health 2019; 9:020703. [PMID: 31673352 PMCID: PMC6815874 DOI: 10.7189/jogh.09.020703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Approximately 250 million children under the age of five in low and middle-income countries (LMICs) will not achieve their developmental potential due to poverty and stunting alone. Investments in programming to improve early childhood development (ECD) have the potential to disrupt the cycle of poverty and therefore should be prioritised. Support for ECD has increased in recent years. Nevertheless, donors and policies continue to neglect ECD, in part from lack of evidence to guide policy makers and donors about where they should focus policies and programmes. Identification and investment in research is needed to overcome these constraints and in order to achieve high quality implementation of programmes to improve ECD. Methods The Child Health and Nutrition Research Initiative (CHNRI) priority setting methodology was applied in order to assess research priorities for improving ECD. A group of 348 global and local experts in ECD-related research were identified and invited to generate research questions. This resulted in 406 research questions which were categorised and refined by study investigators into 54 research questions across six thematic goals which were evaluated using five criteria: answerability, effectiveness, feasibility, impact, and effect on equity. Research options were ranked by their final research priority score multiplied by 100. Results The top three research priority options from the LMIC experts came from the third thematic goal of improving the impact of interventions, whereas the top three research priority options from high-income country experts came from different goals: improving the integration of interventions, increasing the understanding of health economics and social protection strategies, and improving the impact of interventions. Conclusion The results of this process highlight that priorities for future research should focus on the need for services and support to parents to provide nurturing care, and the training of health workers and non-specialists in implementation of interventions to improve ECD. Three of the six thematic goals of the present priority setting centred on interventions (ie, improving impact, implementation of interventions and improving the integration of interventions). In order to achieve higher coverage through sustainable interventions to improve ECD with equitable reach, interventions should be integrated and not be sector driven.
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Affiliation(s)
- Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Pia Britto
- Early Childhood Development Unit, UNICEF, New York, New York, USA
| | - Sarah L Gordon
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Tarun Dua
- World Health Organization, Geneva, Switzerland
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11
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George AS, LeFevre AE, Schleiff M, Mancuso A, Sacks E, Sarriot E. Hubris, humility and humanity: expanding evidence approaches for improving and sustaining community health programmes. BMJ Glob Health 2018; 3:e000811. [PMID: 29946489 PMCID: PMC6014224 DOI: 10.1136/bmjgh-2018-000811] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/16/2022] Open
Abstract
Community-based approaches are a critical foundation for many health outcomes, including reproductive, maternal, newborn and child health (RMNCH). Evidence is a vital part of strengthening that foundation, but largely focuses on the technical content of what must be done, rather than on how disparate community actors continuously interpret, implement and adapt interventions in dynamic and varied community health systems. We argue that efforts to strengthen evidence for community programmes must guard against the hubris of relying on a single approach or hierarchy of evidence for the range of research questions that arise when sustaining community programmes at scale. Moving forward we need a broader evidence agenda that better addresses the implementation realities influencing the scale and sustainability of community programmes and the partnerships underpinning them if future gains in community RMNCH are to be realised. This will require humility in understanding communities as social systems, the complexity of the interventions they engage with and the heterogeneity of evidence needs that address the implementation challenges faced. It also entails building common ground across epistemological word views to strengthen the robustness of implementation research by improving the use of conceptual frameworks, addressing uncertainty and fostering collaboration. Given the complexity of scaling up and sustaining community RMNCH, ensuring that evidence translates into action will require the ongoing brokering of relationships to support the human creativity, scepticism and scaffolding that together build layers of evidence, critical thinking and collaborative learning to effect change.
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Affiliation(s)
- Asha S George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Amnesty E LeFevre
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Emma Sacks
- Johns Hopkins University, Baltimore, Maryland, USA.,Maternal and Child Survival Program, USAID, Washington, District of Columbia, USA
| | - Eric Sarriot
- Maternal and Child Survival Program, USAID, Washington, District of Columbia, USA.,Save the Children, Washington, District of Columbia, USA
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12
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Sharma R, Gaffey MF, Alderman H, Bassani DG, Bogard K, Darmstadt GL, Das JK, de Graft-Johnson JE, Hamadani JD, Horton S, Huicho L, Hussein J, Lye S, Pérez-Escamilla R, Proulx K, Marfo K, Mathews-Hanna V, Mclean MS, Rahman A, Silver KL, Singla DR, Webb P, Bhutta ZA. Prioritizing research for integrated implementation of early childhood development and maternal, newborn, child and adolescent health and nutrition platforms. J Glob Health 2018; 7:011002. [PMID: 28685048 PMCID: PMC5481896 DOI: 10.7189/jogh.07.011002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Existing health and nutrition services present potential platforms for scaling up delivery of early childhood development (ECD) interventions within sensitive windows across the life course, especially in the first 1000 days from conception to age 2 years. However, there is insufficient knowledge on how to optimize implementation for such strategies in an integrated manner. In light of this knowledge gap, we aimed to systematically identify a set of integrated implementation research priorities for health, nutrition and early child development within the 2015 to 2030 timeframe of the Sustainable Development Goals (SDGs). Methods We applied the Child Health and Nutrition Research Initiative method, and consulted a diverse group of global health experts to develop and score 57 research questions against five criteria: answerability, effectiveness, 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. Findings The research priority scores ranged from 61.01 to 93.52, with a median of 82.87. The average expert agreement scores ranged from 0.50 to 0.90, with a median of 0.75. The top–ranked research question were: i) “How can interventions and packages to reduce neonatal mortality be expanded to include ECD and stimulation interventions?”; ii) “How does the integration of ECD and MNCAH&N interventions affect human resource requirements and capacity development in resource–poor settings?”; and iii) “How can integrated interventions be tailored to vulnerable refugee and migrant populations to protect against poor ECD and MNCAH&N outcomes?”. Most highly–ranked research priorities varied across the life course and highlighted key aspects of scaling up coverage of integrated interventions in resource–limited settings, including: workforce and capacity development, cost–effectiveness and strategies to reduce financial barriers, and quality assessment of programs. Conclusions Investing in ECD is critical to achieving several of the SDGs, including SDG 2 on ending all forms of malnutrition, SDG 3 on ensuring health and well–being for all, and SDG 4 on ensuring inclusive and equitable quality education and promotion of life–long learning opportunities for all. The generated research agenda is expected to drive action and investment on priority approaches to integrating ECD interventions within existing health and nutrition services.
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Affiliation(s)
- Renee Sharma
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Harold Alderman
- International Food Policy Research Institute, Washington, DC, USA
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kimber Bogard
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jai K Das
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Jena D Hamadani
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Luis Huicho
- Centro de Investigación para el Desarrollo Integral y Sostenible, Centro de Investigación en Salud Materna e Infantil, and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julia Hussein
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Stephen Lye
- Fraser Mustard Institute for Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Kerrie Proulx
- Fraser Mustard Institute for Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Kofi Marfo
- Aga Khan University (South-Central Asia, East Africa, UK), Nairobi, Kenya
| | | | - Mireille S Mclean
- The Sackler Institute for Nutrition Science at the New York Academy of Sciences, New York, New York, USA
| | - Atif Rahman
- Institute Of Psychology, Health And Society, University of Liverpool, Liverpool, UK
| | | | - Daisy R Singla
- Sinai Health System; Lunenfeld Tanenbaum Research Institute; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,Patan Academy of Health Sciences, Patan, Nepal
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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13
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Yoshida S, Cousens S, Wazny K, Chan KY. Setting health research priorities using the CHNRI method: II. Involving researchers. J Glob Health 2018; 6:010302. [PMID: 27350870 PMCID: PMC4920006 DOI: 10.7189/jogh.06.010302] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sachiyo Yoshida
- Department for Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerri Wazny
- Centre for Global Health Research, the Usher Institute for Population Health Sciences and Informatics, the University of Edinburgh, Edinburgh, Scotland, 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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14
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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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15
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Round Up: Research. REPRODUCTIVE HEALTH MATTERS 2017. [DOI: 10.1016/s0968-8080(11)37568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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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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17
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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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18
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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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Velayutham B, Nair D, Ramalingam S, Perez-Velez CM, Becerra MC, Swaminathan S. Setting priorities for a research agenda to combat drug-resistant tuberculosis in children. Public Health Action 2016; 5:222-35. [PMID: 26767175 DOI: 10.5588/pha.15.0047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
SETTING Numerous knowledge gaps hamper the prevention and treatment of childhood drug-resistant tuberculosis (TB). Identifying research priorities is vital to inform and develop strategies to address this neglected problem. OBJECTIVE To systematically identify and rank research priorities in childhood drug-resistant TB. DESIGN Adapting the Child Health and Nutrition Research Initiative (CHNRI) methodology, we compiled 53 research questions in four research areas, then classified the questions into three research types. We invited experts in childhood drug-resistant TB to score these questions through an online survey. RESULTS A total of 81 respondents participated in the survey. The top-ranked research question was to identify the best combination of existing diagnostic tools for early diagnosis. Highly ranked treatment-related questions centred on the reasons for and interventions to improve treatment outcomes, adverse effects of drugs and optimal treatment duration. The prevalence of drug-resistant TB was the highest-ranked question in the epidemiology area. The development type questions that ranked highest focused on interventions for optimal diagnosis, treatment and modalities for treatment delivery. CONCLUSION This is the first effort to identify and rank research priorities for childhood drug-resistant TB. The result is a resource to guide research to improve prevention and treatment of drug-resistant TB in children.
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Affiliation(s)
- B Velayutham
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Chennai, India
| | - D Nair
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Chennai, India
| | - S Ramalingam
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Chennai, India
| | - C M Perez-Velez
- Banner Good Samaritan Medical Center, The University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - M C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - S Swaminathan
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), Chennai, India
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George A, Rodríguez DC, Rasanathan K, Brandes N, Bennett S. iCCM policy analysis: strategic contributions to understanding its character, design and scale up in sub-Saharan Africa. Health Policy Plan 2015; 30 Suppl 2:ii3-ii11. [DOI: 10.1093/heapol/czv096] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McDonald CR, Darling AM, Conroy AL, Tran V, Cabrera A, Liles WC, Wang M, Aboud S, Urassa W, Fawzi WW, Kain KC. Inflammatory and Angiogenic Factors at Mid-Pregnancy Are Associated with Spontaneous Preterm Birth in a Cohort of Tanzanian Women. PLoS One 2015; 10:e0134619. [PMID: 26247200 PMCID: PMC4527774 DOI: 10.1371/journal.pone.0134619] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/11/2015] [Indexed: 01/08/2023] Open
Abstract
Research Question Preterm birth (PTB) is the leading cause of perinatal mortality worldwide, with the greatest burden occurring in resource-constrained settings. Based on the hypothesis that altered placental angiogenesis and inflammation early in pregnancy lead to PTB, we examined whether levels of inflammatory and angiogenic mediators, measured early in pregnancy, were predictive of spontaneous PTB (sPTB). Study Design Plasma samples were collected from a prospective cohort of primigravid Tanzanian women between 12–27 weeks gestation. A panel of 18 markers was screened on a training cohort of 426 women. Markers associated with sPTB in the training cohort were repeated in a test cohort of 628 women. All markers were measured by ELISA. Findings In both the training and test cohorts plasma levels of IL-18BP, sICAM-1, sEndoglin and CHI3L1 were elevated and Leptin was lower at enrollment in women who subsequently experienced sPTB. In multivariate analysis women with plasma levels of CHI3L1, C5a, sICAM-1, AngptL3, sEndgolin, sFlt-1 and IL-18BP in the highest quartile had an increased risk of sPTB compared with those in the lowest quartile. Women with Leptin and Ang2 in the highest quartile had a reduced risk of sPTB compared with women in the lowest quartile. Implications Levels of angiogenic and inflammatory mediators measured at mid-pregnancy were associated with subsequent sPTB. These findings provide insight into mechanisms underlying sPTB and suggest biomarkers that may have clinical utility in risk-stratifying pregnancies.
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Affiliation(s)
- Chloe R. McDonald
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Anne M. Darling
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Andrea L. Conroy
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Vanessa Tran
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Ana Cabrera
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada
| | - W. Conrad Liles
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Molin Wang
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Kevin C. Kain
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
- * E-mail:
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Duarte-Gómez MB, Núñez-Urquiza RM, Restrepo-Restrepo JA, Richardson-López-Collada VL. [Social determinants of infant mortality in socioeconomic deprived rural areas in Mexico]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:181-189. [PMID: 29421500 DOI: 10.1016/j.bmhimx.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/01/2015] [Accepted: 06/15/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to identify determinants of infant mortality in rural areas in Mexico and recommend strategies for its decrease. METHODS A study was conducted in a sample of 16 municipalities among those with the lowest index of human development. Infant deaths were identified through official data, records and through interviews with civil authorities, health workers and community leaders. Mothers of children who died were also interviewed. RESULTS In most cases, deaths were related with intermediate social determinants (living conditions and health services converged). The most important critical factors were the prevention programs and delays in receiving healthcare. Deficiencies in intersectorial policies to guarantee effective access to health services were found. CONCLUSIONS To decrease infant mortality in rural areas of Mexico, geographic access has to be improved as well as investment in resources and training health personnel in intercultural competence and primary health care skills.
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Wazny K, Sadruddin S, Zipursky A, Hamer DH, Jacobs T, Kallander K, Pagnoni F, Peterson S, Qazi S, Raharison S, Ross K, Young M, Marsh DR. Setting global research priorities for integrated community case management (iCCM): Results from a CHNRI (Child Health and Nutrition Research Initiative) exercise. J Glob Health 2014; 4:020413. [PMID: 25520803 PMCID: PMC4267102 DOI: 10.7189/jogh.04.020413] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims To systematically identify global research gaps and resource priorities for integrated community case management (iCCM). Methods An iCCM Child Health and Nutrition Research Initiative (CHNRI) Advisory Group, in collaboration with the Community Case Management Operational Research Group (CCM ORG) identified experts to participate in a CHNRI research priority setting exercise. These experts generated and systematically ranked research questions for iCCM. Research questions were ranked using a “Research Priority Score” (RPS) and the “Average Expert Agreement” (AEA) was calculated for every question. Our groups of experts were comprised of both individuals working in Ministries of Health or Non Governmental Organizations (NGOs) in low– and middle–income countries (LMICs) and individuals working in high–income countries (HICs) in academia or NGO headquarters. A Spearman’s Rho was calculated to determine the correlation between the two groups’ research questions’ ranks. Results The overall RPS ranged from 64.58 to 89.31, with a median score of 81.43. AEA scores ranged from 0.54 to 0.86. Research questions involving increasing the uptake of iCCM services, research questions concerning the motivation, retention, training and supervision of Community Health Workers (CHWs) and concerning adding additional responsibilities including counselling for infant and young child feeding (IYCF) and treatment of severe acute malnutrition (SAM) ranked highly. There was weak to moderate, statistically significant, correlation between scores by representatives of high–income countries and those working in–country or regionally (Spearman’s ρ = 0.35034, P < 0.01). Conclusions Operational research to determine optimal training, supervision and modes of motivation and retention for the CHW is vital for improving iCCM, globally, as is research to motivate caregivers to take advantage of iCCM services. Experts working in–country or regionally in LMICs prioritized different research questions than those working in organization headquarters in HICs. Further exploration is needed to determine the nature of this divergence.
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Affiliation(s)
- Kerri Wazny
- Centre for Global Child Health, the Hospital for Sick Children, Toronto, Canada
| | | | - Alvin Zipursky
- Programme for Global Paediatric Research, the Hospital for Sick Children, Toronto, Canada
| | - Davidson H Hamer
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia ; Center for Global Health and Development, Boston University, Boston, MA, USA ; Department of International Health, Boston University School of Public Health, Boston, MA, USA
| | - Troy Jacobs
- Global Health Bureau, United States Agency for International Development, Washington DC, USA
| | - Karin Kallander
- Malaria Consortium, London, UK ; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden ; Makerere University School of Public Health, Kampala, Uganda
| | - Franco Pagnoni
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Stefan Peterson
- Makerere University School of Public Health, Kampala, Uganda ; International Women's and Children's Health, Uppsala University, Sweden ; Global Health, Karolinska Institutet, Sweden
| | - Shamim Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Serge Raharison
- John Snow, Inc., Washington DC, USA ; Maternal and Child Health Integrated Project (MCHIP), Washington, DC, USA
| | - Kerry Ross
- John Snow, Inc., Washington DC, USA ; Maternal and Child Health Integrated Project (MCHIP), Washington, DC, USA
| | - Mark Young
- Programme Division, United Nations Children's Fund, New York, USA
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24
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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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25
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Lawn JE, Davidge R, Paul VK, Xylander SV, de Graft Johnson J, Costello A, Kinney MV, Segre J, Molyneux L. Born too soon: care for the preterm baby. Reprod Health 2013; 10 Suppl 1:S5. [PMID: 24625233 PMCID: PMC3828583 DOI: 10.1186/1742-4755-10-s1-s5] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As part of a supplement entitled “Born Too Soon”, this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable. For health systems in low and middle income settings with increasing facility births, district hospitals are the key frontier for improving obstetric and neonatal care, and some large scale programmes now include specific newborn care strategies. However there are still around 50 million births outside facilities, hence home visits for mothers and newborns, as well as women’s groups are crucial for reaching these families, often the poorest. A fundamental challenge is improving programmatic tracking data for coverage and quality, and measuring disability-free survival. The power of parent’s voices has been important in high-income countries in bringing attention to preterm newborns, but is still missing from the most affected countries.
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Affiliation(s)
- Joy E Lawn
- MARCH, London School Hygiene & Tropical Medicine, UK
- Saving Newborn Lives, Save the Children, Cape Town, South Africa
| | - Ruth Davidge
- Kwa-Zulu Natal Dept. of Health, Pietermartizburg, South Africa
- NNASA-Neonatal Nurses Association of Southern Africa, Durban, South Africa
- Congress of International Neonatal Nurses (COINN
| | - Vinod K Paul
- All India Institute for Medical Sciences, New Delhi, India
| | | | | | | | - Mary V Kinney
- Saving Newborn Lives, Save the Children, Cape Town, South Africa
| | - Joel Segre
- Consultant to Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Liz Molyneux
- Queen Elizabeth Hospital, College of Medicine, Blantyre, Malawi
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26
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Bhutta ZA, Zipursky A, Wazny K, Levine MM, Black RE, Bassani DG, Shantosham M, Freedman SB, Grange A, Kosek M, Keenan W, Petri W, Campbell H, Rudan I. Setting priorities for development of emerging interventions against childhood diarrhoea. J Glob Health 2013; 3:010302. [PMID: 23826502 PMCID: PMC3700035 DOI: 10.7189/jogh.03.010302] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Zulfiqar A Bhutta
- Program for Global Pediatric Research, the Hospital for Sick Children, Toronto, Canada ; Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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27
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Hindin MJ, Christiansen CS, Ferguson BJ. Setting research priorities for adolescent sexual and reproductive health in low- and middle-income countries. Bull World Health Organ 2013; 91:10-8. [PMID: 23397346 PMCID: PMC3537249 DOI: 10.2471/blt.12.107565] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To conduct an expert-led process for identifying research priorities in adolescent sexual and reproductive health in low- and middle-income countries. METHODS The authors modified the priority-setting method of the Child Health and Nutrition Research Initiative (CHNRI) to obtain input from nearly 300 researchers, health programme managers and donors with wide-ranging backgrounds and experiences and from all geographic regions. In a three-Phase process, they asked these experts to: (i) rank outcome areas in order of importance; (ii) formulate research questions within each area, and (iii) rank the formulated questions. FINDINGS seven areas of adolescent sexual and reproductive health were identified as important: (i) maternal health; (ii) contraception; (iii) gender-based violence; (iv) treatment and care of patients with human immunodeficiency virus (HIV) infection; (v) abortion; (vi) integration of family planning and HIV-related services and (vii) sexually transmitted infections. Experts generated from 30 to 40 research questions in each area, and to prioritize these questions, they applied five criteria focused on: clarity, answerability, impact, implementation and relevance for equity. Rankings were based on overall mean scores derived by averaging the scores for individual criteria. Experts agreed strongly on the relative importance of the questions in each area. CONCLUSION Research questions on the prevalence of conditions affecting adolescents are giving way to research questions on the scale-up of existing interventions and the development of new ones. CHNRI methods can be used by donors and health programme managers to prioritize research on adolescent sexual and reproductive health.
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Affiliation(s)
- Michelle J Hindin
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America.
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28
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Rudan I, Theodoratou E, Zgaga L, Nair H, Chan KY, Tomlinson M, Tsai A, Biloglav Z, Huda T, El Arifeen S, Chopra M, Campbell H. Setting priorities for development of emerging interventions against childhood pneumonia, meningitis and influenza. J Glob Health 2012. [PMID: 23198129 PMCID: PMC3484764 DOI: 10.7189/jogh.02.010304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Igor Rudan
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
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29
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Pitt C, Lawn JE, Ranganathan M, Mills A, Hanson K. Donor funding for newborn survival: an analysis of donor-reported data, 2002-2010. PLoS Med 2012; 9:e1001332. [PMID: 23118619 PMCID: PMC3484125 DOI: 10.1371/journal.pmed.1001332] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/19/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Neonatal mortality accounts for 43% of global under-five deaths and is decreasing more slowly than maternal or child mortality. Donor funding has increased for maternal, newborn, and child health (MNCH), but no analysis to date has disaggregated aid for newborns. We evaluated if and how aid flows for newborn care can be tracked, examined changes in the last decade, and considered methodological implications for tracking funding for specific population groups or diseases. METHODS AND FINDINGS We critically reviewed and categorised previous analyses of aid to specific populations, diseases, or types of activities. We then developed and refined key terms related to newborn survival in seven languages and searched titles and descriptions of donor disbursement records in the Organisation for Economic Co-operation and Development's Creditor Reporting System database, 2002-2010. We compared results with the Countdown to 2015 database of aid for MNCH (2003-2008) and the search strategy used by the Institute for Health Metrics and Evaluation. Prior to 2005, key terms related to newborns were rare in disbursement records but their frequency increased markedly thereafter. Only two mentions were found of "stillbirth" and only nine references were found to "fetus" in any spelling variant or language. The total value of non-research disbursements mentioning any newborn search terms rose from US$38.4 million in 2002 to US$717.1 million in 2010 (constant 2010 US$). The value of non-research projects exclusively benefitting newborns fluctuated somewhat but remained low, at US$5.7 million in 2010. The United States and the United Nations Children's Fund (UNICEF) provided the largest value of non-research funding mentioning and exclusively benefitting newborns, respectively. CONCLUSIONS Donor attention to newborn survival has increased since 2002, but it appears unlikely that donor aid is commensurate with the 3.0 million newborn deaths and 2.7 million stillbirths each year. We recommend that those tracking funding for other specific population groups, diseases, or activities consider a key term search approach in the Creditor Reporting System along with a detailed review of their data, but that they develop their search terms and interpretations carefully, taking into account the limitations described. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Catherine Pitt
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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30
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Rudan I, Theodoratou E, Zgaga L, Nair H, Chan KY, Tomlinson M, Tsai A, Biloglav Z, Huda T, El Arifeen S, Chopra M, Campbell H. Setting priorities for development of emerging interventions against childhood pneumonia, meningitis and influenza. J Glob Health 2012. [DOI: 10.7189/jogh.01.010304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Igor Rudan
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Lina Zgaga
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Harish Nair
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Kit Yee Chan
- 2Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Mark Tomlinson
- 3Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Alex Tsai
- 5Robert Wood Johnson Health and Society Scholars Program, Harvard University, Cambridge, USA
| | - Zrinka Biloglav
- 7Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tanvir Huda
- 8Child Health and Nutrition Research Initiative, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | - Shams El Arifeen
- 8Child Health and Nutrition Research Initiative, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka, Bangladesh
| | | | - Harry Campbell
- 1Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, 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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32
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Neonatal mortality risk associated with preterm birth in East Africa, adjusted by weight for gestational age: individual participant level meta-analysis. PLoS Med 2012; 9:e1001292. [PMID: 22904691 PMCID: PMC3419185 DOI: 10.1371/journal.pmed.1001292] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 07/06/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Low birth weight and prematurity are amongst the strongest predictors of neonatal death. However, the extent to which they act independently is poorly understood. Our objective was to estimate the neonatal mortality risk associated with preterm birth when stratified by weight for gestational age in the high mortality setting of East Africa. METHODS AND FINDINGS Members and collaborators of the Malaria and the MARCH Centers, at the London School of Hygiene & Tropical Medicine, were contacted and protocols reviewed for East African studies that measured (1) birth weight, (2) gestational age at birth using antenatal ultrasound or neonatal assessment, and (3) neonatal mortality. Ten datasets were identified and four met the inclusion criteria. The four datasets (from Uganda, Kenya, and two from Tanzania) contained 5,727 births recorded between 1999-2010. 4,843 births had complete outcome data and were included in an individual participant level meta-analysis. 99% of 445 low birth weight (< 2,500 g) babies were either preterm (< 37 weeks gestation) or small for gestational age (below tenth percentile of weight for gestational age). 52% of 87 neonatal deaths occurred in preterm or small for gestational age babies. Babies born < 34 weeks gestation had the highest odds of death compared to term babies (odds ratio [OR] 58.7 [95% CI 28.4-121.4]), with little difference when stratified by weight for gestational age. Babies born 34-36 weeks gestation with appropriate weight for gestational age had just three times the likelihood of neonatal death compared to babies born term, (OR 3.2 [95% CI 1.0-10.7]), but the likelihood for babies born 34-36 weeks who were also small for gestational age was 20 times higher (OR 19.8 [95% CI 8.3-47.4]). Only 1% of babies were born moderately premature and small for gestational age, but this group suffered 8% of deaths. Individual level data on newborns are scarce in East Africa; potential biases arising due to the non-systematic selection of the individual studies, or due to the methods applied for estimating gestational age, are discussed. CONCLUSIONS Moderately preterm babies who are also small for gestational age experience a considerably increased likelihood of neonatal death in East Africa.
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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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