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Corboz J, Dartnall E, Brown C, Fulu E, Gordon S, Tomlinson M. Co-creating a global shared research agenda on violence against women in low- and middle-income countries. Health Res Policy Syst 2024; 22:71. [PMID: 38914999 PMCID: PMC11194916 DOI: 10.1186/s12961-024-01153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Despite a large growth in evidence on violence against women (VAW) over the last 25 years, VAW persists, as do gaps in the field's knowledge of how to prevent and respond to it. To ensure that research on VAW in low- and middle-income countries (LIMCs) is addressing the most significant gaps in knowledge, and to prioritise evidence needs to reduce VAW and better support victims/survivors, the Sexual Violence Research Initiative (SVRI) and Equality Institute (EQI) led a process of developing a global shared research agenda (GSRA) on VAW in LMICs. METHODS The GSRA was developed through a six-stage adaptation of the Child Health and Nutrition Research Initiative (CHNRI) method, which draws on the principle of the 'wisdom of the crowd'. These steps included: a review of the literature on VAW in LMICs and development of domains; the generation of research questions within four domains by an Advisory Group; the consolidation of research questions; scoring of research questions by a Global Expert Group and the Advisory Group according to three criteria (applicability, effectiveness and equity); consultation and validation of the findings with the Advisory Group; and wide dissemination of the findings. RESULTS The highest ranked research questions in the GSRA pertain to the domain of Intervention research, with some highly ranked questions also pertaining to the domain of Understanding VAW in its multiple forms. Questions under the other two domains, Improving existing interventions, and Methodological and measurement gaps, were not prioritised as highly by experts. There was strong consistency in top ranked research questions according to experts' characteristics, albeit with some important differences according to experts' gender, occupation and geographical location. CONCLUSIONS The GSRA findings suggest that currently the VAW field is shifting towards intervention research after several decades of building evidence on understanding VAW, including prevalence, drivers and impacts of violence. The findings also suggest a strong emphasis on under-served populations, and under-researched forms of VAW. Future priority setting exercises in LMICs that seek to decolonise knowledge should ensure that methodologies, and modalities of engagement, put diverse voices at the centre of engagement. Trial registration Not applicable.
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Affiliation(s)
| | | | - Chay Brown
- The Equality Institute, Melbourne, Australia
| | - Emma Fulu
- The Equality Institute, Melbourne, Australia
| | - Sarah Gordon
- Stellenbosch University, Stellenbosch, South Africa
| | - Mark Tomlinson
- Stellenbosch University, Stellenbosch, South Africa
- Queens University, Belfast, United Kingdom
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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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Clarence C, Shiras T, Zhu J, Boggs MK, Faltas N, Wadsworth A, Bradley SE, Sadruddin S, Wazny K, Goodman C, Awor P, Bhutta ZA, Källander K, Hamer DH. Setting global research priorities for private sector child health service delivery: Results from a CHNRI exercise. J Glob Health 2021; 10:021201. [PMID: 33403107 PMCID: PMC7750021 DOI: 10.7189/jogh.10.021201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The private health sector is an important source of sick child care, yet evidence gaps persist in best practices for integrated management of private sector child health services. Further, there is no prioritized research agenda to address these gaps. We used a Child Health and Nutrition Research Initiative (CHNRI) process to identify priority research questions in response to these evidence gaps. CHNRI is a consultative approach that entails prioritizing research questions by evaluating them against standardized criteria. Methods We engaged geographically and occupationally diverse experts in the private health sector and child health. Eighty-nine experts agreed to participate and provided 150 priority research questions. We consolidated submitted questions to reduce duplication into a final list of 50. We asked participants to complete an online survey to rank each question against 11 pre-determined criteria in four categories: (i) answerability, (ii) research feasibility, (iii) sustainability/equity, and (iv) importance/potential impact. Statistical data analysis was conducted in SAS 9.4 (SAS Institute Inc, Cary NC, USA). We weighted all 11 evaluation criteria equally to calculate the research priority score and average expert agreement for each question. We disaggregated results by location in high-income vs low- and middle-income countries. Results Forty-nine participants (55.1%) completed the online survey, including 33 high-income and 16 low- and middle-income country respondents. The top, prioritized research question asks whether accreditation or regulation of private clinical and non-clinical sources of care would improve integrated management of childhood illness services. Four of the top ten research priorities were related to adherence to case management protocols. Other top research priorities were related to training and supportive supervision, digital health, and infant and newborn care. Research priorities among high-income and low- and middle-income country respondents were highly correlated. Conclusion To our knowledge, this is the first systematic exercise conducted to define research priorities for the management of childhood illness in the private sector. The research priorities put forth in this CHNRI exercise aim to stimulate interest from policy makers, program managers, researchers, and donors to respond to and help close evidence gaps hindering the acceleration of reductions in child mortality through private sector approaches.
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Affiliation(s)
- Catherine Clarence
- Abt Associates, International Development Division, Rockville, Maryland, USA
| | - Tess Shiras
- Abt Associates, International Development Division, Rockville, Maryland, USA
| | - Jack Zhu
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Malia K Boggs
- United States Agency for International Development, Bureau for Global Health, Office of Maternal, Child Health and Nutrition, Washington, D.C., USA
| | - Nefra Faltas
- United States Agency for International Development, Bureau for Global Health, Office of Maternal, Child Health and Nutrition, Washington, D.C., USA
| | - Anna Wadsworth
- Abt Associates, International Development Division, Rockville, Maryland, USA
| | - Sarah Ek Bradley
- Abt Associates, International Development Division, Rockville, Maryland, USA
| | | | - Kerri Wazny
- Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Catherine Goodman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Phyllis Awor
- Makerere University College of Health Sciences School of Public Health, Makerere, Uganda
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,Institute for Global Health & Development, The Aga Khan University, Karachi, Pakistan
| | - Karin Källander
- Implementation Research & Delivery Science Unit, UNICEF, New York, New York, USA.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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4
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Biemba G, Chiluba B, Yeboah-Antwi K, Silavwe V, Lunze K, Mwale RK, Hamer DH, MacLeod WB. Impact of mobile health-enhanced supportive supervision and supply chain management on appropriate integrated community case management of malaria, diarrhoea, and pneumonia in children 2-59 months: A cluster randomised trial in Eastern Province, Zambia. J Glob Health 2021; 10:010425. [PMID: 32509293 PMCID: PMC7243069 DOI: 10.7189/jogh.10.010425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Despite progress made over the past twenty years, child mortality remains high, with 5.3 million children under five years having died in 2018 globally. Pneumonia, diarrhoea, and malaria remain among the commonest causes of under-five mortality; contributing 15%, 8%, and 5% of global mortality respectively. Recent evidence shows that integrated community case management (iCCM) of pneumonia, diarrhoea, and malaria can reduce under-five mortality. However, despite growing evidence of the effectiveness of iCCM, there are implementation challenges, especially stock out of iCCM commodities and inadequate supportive supervision of community health workers (CHWs). This study aimed to address these two key challenges to successful iCCM implementation by using mobile health (mHealth) technology. Methods This cluster randomised controlled trial compared health centre catchment areas (clusters) where CHWs and their supervisors implemented mHealth-enhanced iCCM supportive supervision and supply chain management vs clusters implementing iCCM as per current Zambian guidelines. CHWs in intervention clusters used community DHIS2 platform on mobile phones to report on a weekly basis children with iCCM conditions and make requisitions for iCCM commodities. Their supervisors received electronic reports on disease caseloads and monthly automated supervision reminders. The supervisors on receipt of requisitions, organized the medical supplies and notified CHWs for collection. Intention-to-treat analysis on the primary outcome, the percentage of children aged 2-59 months receiving appropriate treatment for malaria, pneumonia, or diarrhoea from an iCCM trained CHW, was performed using a generalized linear model. Prevalence ratios and 95% confidence intervals comparing the prevalence of appropriate treatment in the intervention and control groups were calculated using log binomial regression with an exchangeable correlation matrix, adjusted for clustering by health facility. Results In the intervention clusters, 61.3% (98/160) of expected monthly supervision visits took place vs 52.0% (78/150) in the controls. A total of 3690 children 2-59 months old presented with malaria, diarrhoea, or pneumonia. In the intervention group, 65.9% (1,252/1,899) of children received appropriate care for iCCM conditions, compared to 63.3% (1,134/1,791) in the control group. The mHealth intervention was associated with 18.0% improvement in supportive supervision and 21.0% increase in appropriate treatment for pneumonia; these changes were not statistically significant. There was a 2-3-fold increase in the proportion of CHWs receiving supplies ordered: prevalence ratios ranged from 2.82 (confidence interval (CI) = 1.50, 5.30) to 3.01 (95% CI = 1.29, 7.00) depending on the particular commodity. Conclusion This study was unable to determine whether using mHealth technology would strengthen supervision and supply chain management of iCCM commodities for community-level workers. There was no statistically significant effect of mHealth enhanced iCCM on appropriate diagnosis and treatment for children with malaria, pneumonia, and diarrhoea in rural Zambia. Longer term longitudinal studies are required to determine the impact of mHealth enhanced iCCM on health outputs and outcomes. Trial registration ClinicalTrials.gov, NCT02866097
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Affiliation(s)
- Godfrey Biemba
- National Health Research Authority, Lusaka, Zambia.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,Zambian Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia
| | - Boniface Chiluba
- Zambian Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia
| | - Kojo Yeboah-Antwi
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Karsten Lunze
- Division of Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Centre, Massachusetts, USA
| | | | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,Zambian Center for Applied Health Research and Development (ZCAHRD), Lusaka, Zambia.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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5
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Alobo M, Mgone C, Lawn J, Adhiambo C, Wazny K, Ezeaka C, Molyneux E, Temmerman M, Okong P, Malata A, Kariuki T. Research priorities in maternal and neonatal health in Africa: results using the Child Health and Nutrition Research Initiative method involving over 900 experts across the continent. AAS Open Res 2021; 4:8. [PMID: 34151141 PMCID: PMC8204196 DOI: 10.12688/aasopenres.13189.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Africa will miss the maternal and neonatal health (MNH) Sustainable Development Goals (SDGs) targets if the current trajectory is followed. The African Academy of Sciences has formed an expert maternal and newborn health group to discuss actions to improve MNH SDG targets. The team, among other recommendations, chose to implement an MNH research prioritization exercise for Africa covering four grand challenge areas. Methods: The team used the Child Health and Nutrition Research Initiative (CHNRI) research prioritization method to identify research priorities in maternal and newborn health in Africa. From 609 research options, a ranking of the top 46 research questions was achieved. Research priority scores and agreement statistics were calculated, with sub-analysis possible for the regions of East Africa, West Africa and those living out of the continent. Results: The top research priorities generally fell into (i) improving identification of high-risk mothers and newborns, or diagnosis of high-risk conditions in mothers and newborns to improve health outcomes; (ii) improving access to treatment through improving incentives to attract and retain skilled health workers in remote, rural areas, improving emergency transport, and assessing health systems' readiness; and (iii) improving uptake of proven existing interventions such as Kangaroo Mother Care. Conclusions: The research priorities emphasized building interventions that improved access to quality healthcare in the lowest possible units of the provision of MNH interventions. The lists prioritized participation of communities in delivering MNH interventions. The current burden of disease from MNCH in Africa aligns well with the list of priorities listed from this exercise but provides extra insights into current needs by African practitioners. The MNCH Africa expert group believes that the recommendations from this work should be implemented by multisectoral teams as soon as possible to provide adequate lead time for results of the succeeding programmes to be seen before 2030.
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Affiliation(s)
| | | | - Joy Lawn
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kerri Wazny
- Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA
| | - Chinyere Ezeaka
- College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Pius Okong
- Health Service Commission, Kampala, Uganda
| | - Address Malata
- Malawi University of Science and Technology,, Thyolo, Malawi
| | | | - African Academy of Sciences Maternal and Neonatal Health Working Group for Africa
- African Academy of Sciences, Nairobi, Kenya
- Hubert Kairuki University, Dar es Salaam, Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
- Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA
- College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
- College of Medicine, University of Malawi, Malawi, Blantyre, Malawi
- Aga Khan University, Nairobi, Kenya
- Health Service Commission, Kampala, Uganda
- Malawi University of Science and Technology,, Thyolo, Malawi
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6
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Miller JS, Patel P, Mian-McCarthy S, Wesuta AC, Matte M, Ntaro M, Bwambale S, Kenney J, Stone GS, Mulogo EM. Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey. Malar J 2021; 20:65. [PMID: 33516205 PMCID: PMC7847039 DOI: 10.1186/s12936-021-03601-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background In some areas of Uganda, village health workers (VHW) deliver Integrated Community Case Management (iCCM) care, providing initial assessment of children under 5 years of age as well as protocol-based treatment of malaria, pneumonia, and diarrhoea for eligible patients. Little is known about community perspectives on or satisfaction with iCCM care. This study examines usage of and satisfaction with iCCM care as well as potential associations between these outcomes and time required to travel to the household’s preferred health facility. Methods A cross-sectional household survey was administered in a rural subcounty in western Uganda during December 2016, using a stratified random sampling approach in villages where iCCM care was available. Households were eligible if the household contained one or more children under 5 years of age. Results A total of 271 households across 8 villages were included in the final sample. Of these, 39% reported that it took over an hour to reach their preferred health facility, and 73% reported walking to the health facility; 92% stated they had seen a VHW for iCCM care in the past, and 55% had seen a VHW in the month prior to the survey. Of respondents whose households had sought iCCM care, 60% rated their overall experience as “very good” or “excellent,” 97% stated they would seek iCCM care in the future, and 92% stated they were “confident” or “very confident” in the VHW’s overall abilities. Longer travel time to the household’s preferred health facility did not appear to be associated with higher propensity to seek iCCM care or higher overall satisfaction with iCCM care. Conclusions In this setting, community usage of and satisfaction with iCCM care for malaria, pneumonia, and diarrhoea appears high overall. Ease of access to facility-based care did not appear to impact the choice to access iCCM care or satisfaction with iCCM care.
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Affiliation(s)
- James S Miller
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Global Health Collaborative MUST Uganda, Mbarara, Uganda. .,Bugoye Community Health Collaboration, Bugoye, Uganda.
| | - Palka Patel
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Andrew Christopher Wesuta
- Global Health Collaborative MUST Uganda, Mbarara, Uganda.,Bugoye Community Health Collaboration, Bugoye, Uganda
| | - Michael Matte
- Global Health Collaborative MUST Uganda, Mbarara, Uganda.,Bugoye Community Health Collaboration, Bugoye, Uganda
| | - Moses Ntaro
- Global Health Collaborative MUST Uganda, Mbarara, Uganda.,Bugoye Community Health Collaboration, Bugoye, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Shem Bwambale
- Global Health Collaborative MUST Uganda, Mbarara, Uganda.,Bugoye Community Health Collaboration, Bugoye, Uganda.,Bugoye Health Centre, Bugoye, Uganda
| | - Jessica Kenney
- Massachusetts General Hospital, Boston, MA, USA.,Global Health Collaborative MUST Uganda, Mbarara, Uganda.,Bugoye Community Health Collaboration, Bugoye, Uganda
| | - Geren S Stone
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Global Health Collaborative MUST Uganda, Mbarara, Uganda.,Bugoye Community Health Collaboration, Bugoye, Uganda
| | - Edgar Mugema Mulogo
- Global Health Collaborative MUST Uganda, Mbarara, Uganda.,Bugoye Community Health Collaboration, Bugoye, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
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Gomes F, Bourassa MW, Adu-Afarwuah S, Ajello C, Bhutta ZA, Black R, Catarino E, Chowdhury R, Dalmiya N, Dwarkanath P, Engle-Stone R, Gernand AD, Goudet S, Hoddinott J, Kaestel P, Manger MS, McDonald CM, Mehta S, Moore SE, Neufeld LM, Osendarp S, Ramachandran P, Rasmussen KM, Stewart C, Sudfeld C, West K, Bergeron G. Setting research priorities on multiple micronutrient supplementation in pregnancy. Ann N Y Acad Sci 2019; 1465:76-88. [PMID: 31696532 PMCID: PMC7186835 DOI: 10.1111/nyas.14267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
Abstract
Prenatal micronutrient deficiencies are associated with negative maternal and birth
outcomes. Multiple micronutrient supplementation (MMS) during pregnancy is a
cost-effective intervention to reduce these adverse outcomes. However, important knowledge
gaps remain in the implementation of MMS interventions. The Child Health and Nutrition
Research Initiative (CHNRI) methodology was applied to inform the direction of research
and investments needed to support the implementation of MMS interventions for pregnant
women in low- and middle-income countries (LMIC). Following CHNRI methodology guidelines,
a group of international experts in nutrition and maternal health provided and ranked the
research questions that most urgently need to be resolved for prenatal MMS interventions
to be successfully implemented. Seventy-three research questions were received, analyzed,
and reorganized, resulting in 35 consolidated research questions. These were scored
against four criteria, yielding a priority ranking where the top 10 research options
focused on strategies to increase antenatal care attendance and MMS adherence, methods
needed to identify populations more likely to benefit from MMS interventions and some
discovery issues (e.g., potential benefit of extending MMS through lactation). This
exercise prioritized 35 discrete research questions that merit serious consideration for
the potential of MMS during pregnancy to be optimized in LMIC.
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Affiliation(s)
| | | | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, the Hospital for Sick Children, Toronto, Ontario, Canada.,Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | | | | | | | | | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Pernille Kaestel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mari S Manger
- IZiNCG, Children's Hospital Oakland Research Institute, Oakland, California
| | | | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Sophie E Moore
- Department of Women & Children's Health, King's College London, London, United Kingdom
| | | | | | | | | | | | | | - Keith West
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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8
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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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9
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Kavle JA, Pacqué M, Dalglish S, Mbombeshayi E, Anzolo J, Mirindi J, Tosha M, Safari O, Gibson L, Straubinger S, Bachunguye R. Strengthening nutrition services within integrated community case management (iCCM) of childhood illnesses in the Democratic Republic of Congo: Evidence to guide implementation. MATERNAL AND CHILD NUTRITION 2019; 15 Suppl 1:e12725. [PMID: 30748116 PMCID: PMC6594103 DOI: 10.1111/mcn.12725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
Abstract
In the Democratic Republic of Congo, 43% of children under 5 years of age suffer from stunting, and the majority (60%) of children, 6–59 months of age, are anaemic. Malaria, acute respiratory infections, and diarrheal diseases are common among children less than 5 years of age, with 31% of children 6–59 months affected by malaria. This qualitative implementation science study aimed to identify gaps and opportunities available to strengthen service delivery of nutrition within integrated community case management (iCCM) at the health facility and community level in Tshopo Province, Democratic Republic of Congo, through the following objectives: (a) examine cultural beliefs and perceptions of infant and young child feeding (IYCF) and child illness, (b) explore the perspectives and knowledge of facility‐based and community‐based health providers on nutrition and iCCM, and (c) gain an understanding of the influence of key family and community members on IYCF and care‐seeking practices. This study involved in‐depth interviews with mothers of children under 5 years of age (n = 48), grandmothers (n = 20), fathers (n = 21), facility‐based providers (n = 18), and traditional healers (n = 20) and eight focus group discussions with community health workers. Study findings reveal most mothers reported diminished quantity and quality of breastmilk linked to child/maternal illness, inadequate maternal diet, and feedings spaced too far apart. Mothers' return to work in the field led to early introduction of foods prior to 6 months of age, impeding exclusive breastfeeding. Moreover, children's diets are largely limited in frequency and diversity with small quantities of foods fed. Most families seek modern and traditional medicine to remedy child illness, dependent on type of disease, its severity, and cost. Traditional healers are the preferred source of information for families on certain child illnesses and breastmilk insufficiency. Community health workers often refer and accompany families to the health centre, yet are underutilized for nutrition counselling, which is infrequently given. Programme recommendations are to strengthen health provider capacity to counsel on IYCF and iCCM while equipping health workers with updated social and behavior change communication (SBCC) materials and continued supportive supervision. In addition, targeting key influencers to encourage optimal IYCF practices is needed through community and mother support groups. Finally, exploring innovative ways to work with traditional healers, to facilitate referrals for sick/malnourished children and provide simple nutrition advice for certain practices (i.e., breastfeeding), would aid in strengthening nutrition within iCCM.
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Affiliation(s)
- Justine A Kavle
- USAID's Maternal and Child Survival Program/PATH, Washington, District of Columbia, USA
| | - Michel Pacqué
- USAID's Maternal and Child Survival Program/JSI, Washington, District of Columbia, USA
| | - Sarah Dalglish
- Independent Qualitative Research Consultants, Paris, France
| | | | - Jimmy Anzolo
- USAID's Maternal and Child Survival Program/JSI DRC, Kisangani, DRC
| | | | | | | | - Lacey Gibson
- Independent Qualitative Research Consultants, Boston, Massachusetts, USA
| | - Sarah Straubinger
- USAID's Maternal and Child Survival Program/PATH, Washington, District of Columbia, USA
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Baker K, Alfvén T, Mucunguzi A, Wharton-Smith A, Dantzer E, Habte T, Matata L, Nanyumba D, Okwir M, Posada M, Sebsibe A, Nicholson J, Marasciulo M, Izadnegahdar R, Petzold M, Källander K. Performance of Four Respiratory Rate Counters to Support Community Health Workers to Detect the Symptoms of Pneumonia in Children in Low Resource Settings: A Prospective, Multicentre, Hospital-Based, Single-Blinded, Comparative Trial. EClinicalMedicine 2019; 12:20-30. [PMID: 31388660 PMCID: PMC6677646 DOI: 10.1016/j.eclinm.2019.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/09/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pneumonia is one of the leading causes of death in children under-five globally. The current diagnostic criteria for pneumonia are based on increased respiratory rate (RR) or chest in-drawing in children with cough and/or difficulty breathing. Accurately counting RR is difficult for community health workers (CHWs). Current RR counting devices are frequently inadequate or unavailable. This study analysed the performance of improved RR timers for detection of pneumonia symptoms in low-resource settings. METHODS Four RR timers were evaluated on 454 children, aged from 0 to 59 months with cough and/or difficulty breathing, over three months, by CHWs in hospital settings in Cambodia, Ethiopia, South Sudan and Uganda. The devices were the Mark Two ARI timer (MK2 ARI), counting beads with ARI timer, Rrate Android phone and the Respirometer feature phone applications. Performance was evaluated for agreement with an automated RR reference standard (Masimo Root patient monitoring and connectivity platform with ISA CO2 capnography). This study is registered with ANZCTR [ACTRN12615000348550]. FINDINGS While most CHWs managed to achieve a RR count with the four devices, the agreement was low for all; the mean difference of RR measurements from the reference standard for the four devices ranged from 0.5 (95% C.I. - 2.2 to 1.2) for the respirometer to 5.5 (95% C.I. 3.2 to 7.8) for Rrate. Performance was consistently lower for young infants (0 to < 2 months) than for older children (2 to ≤ 59 months). Agreement of RR classification into fast and normal breathing was moderate across all four devices, with Cohen's Kappa statistics ranging from 0.41 (SE 0.04) to 0.49 (SE 0.05). INTERPRETATION None of the four devices evaluated performed well based on agreement with the reference standard. The ARI timer currently recommended for use by CHWs should only be replaced by more expensive, equally performing, automated RR devices when aspects such as usability and duration of the device significantly improve the patient-provider experience. FUNDING Bill & Melinda Gates Foundation [OPP1054367].
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Affiliation(s)
- Kevin Baker
- Malaria Consortium, London, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Corresponding author at: Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London E2 9DA, United Kingdom.
| | - Tobias Alfvén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | - Max Petzold
- Gothenburg University, Gothenburg, Sweden
- University of the Witwatersrand, Johannesburg, South Africa
| | - Karin Källander
- Malaria Consortium, London, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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11
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Wazny K, Anderson N, Bassani DG, Ravenscroft J, Chan KY, Rudan I. Exploring individual and demographic characteristics and their relation to CHNRI Criteria from an international public stakeholder group: an analysis using random intercept and logistic regression modelling. J Glob Health 2019; 9:010701. [PMID: 30820318 PMCID: PMC6377795 DOI: 10.7189/jogh.09.010701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Child Health and Nutrition Research Initiative (CHNRI) method for health research prioritisation relies on stakeholders weighting criteria used to assess research options. These weights in turn impact on the final scores and ranks assigned to research options. Three quarters of CHNRI studies published to date have not involved stakeholders in criteria weighting. Of those that have, few incorporated members of the public into stakeholder groups. Those that have compared different stakeholder groups, such as donors, researchers, or policy makers, showed that different groups place different values upon CHNRI criteria. When choosing the composition of a stakeholder group, it may be important to understand factors that may influence weighting. Drawing upon a group of international public stakeholders, this study explores some of the effects of individual and demographic characteristics has on the weights assigned to the most commonly used CHNRI criteria, with the aim of informing future researchers on avoiding future biases. METHODS Individual and demographic information and 5-point Likert scale responses to questions about the importance of 15 CHNRI criteria were collected from 1031 "Turkers" (Amazon Mechanical Turk workers) via Amazon Mechanical Turk (AMT), which is an online crowdsourcing platform. Thirteen of the fifteen criteria were analysed using random-intercept models and the remaining two were analysed through logistic regression. RESULTS Self-reported health status explained most of the variability in participants' responses across criteria (11/15 criteria), followed by being female (10/15), ethnicity (9/15), employment (8/15), and religion (7/15). Differences across criteria indicate that when choosing stakeholder groups, researchers need to consider these factors to minimise bias. CONCLUSION Researchers should collect and report more detailed information from stakeholders, including individual and demographic characteristics, and ensure participation from both genders, multiple ethnicities, religious beliefs, and people with differing health statuses to be transparent regarding possible biases in health research prioritisation. Our analyses indicate that these factors do influence the relative importance of these values, even when the data appears fairly homogeneous.
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Affiliation(s)
- Kerri Wazny
- Centre for Global Health Research, Usher Institute of Informatics and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Niall Anderson
- Centre of Population Health Sciences, Usher Institute of Informatics and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Diego G Bassani
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - John Ravenscroft
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research, Usher Institute of Informatics and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Informatics and Population Health Sciences, University of Edinburgh, Edinburgh, UK
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12
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Fun WH, Sararaks S, Tan EH, Tang KF, Chong DWQ, Low LL, Sapian RA, Ismail SA, Govind SK, Mahmud SH, Murad S. Research funding impact and priority setting - advancing universal access and quality healthcare research in Malaysia. BMC Health Serv Res 2019; 19:248. [PMID: 31018843 PMCID: PMC6480746 DOI: 10.1186/s12913-019-4072-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 04/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health Research Priority Setting (HRPS) in the Ministry of Health (MOH) Malaysia was initiated more than a decade ago to drive effort toward research for informed decision and policy-making. This study assessed the impact of funded prioritised research and identified research gaps to inform future priority setting initiatives for universal access and quality healthcare in Malaysia. METHODS Research impact of universal access and quality healthcare projects funded by the National Institutes of Health Malaysia were assessed based on the modified Payback Framework, addressing categories of informing policy, knowledge production, and benefits to health and health sector. For the HRPS process, the Child Health and Nutrition Research Initiative methodology was adapted and adopted, with the incorporation of stakeholder values using weights and monetary allocation survey. Workshop discussions and interviews with stakeholders and research groups were conducted to identify research gaps, with the use of conceptual frameworks to guide the search. RESULTS Seventeen ongoing and 50 completed projects were identified for research funding impact analysis. Overall, research fund allocation differed from stakeholders' expectation. For research impact, 48 out of 50 completed projects (96.0%) contributed to some form of policy-making efforts. Almost all completed projects resulted in outputs that contributed to knowledge production and were expected to lead to health and health sector benefits. The HRPS process led to the identification of research priority areas that stemmed from ongoing and new issues identified for universal access and quality healthcare. CONCLUSION The concerted efforts of evaluation of research funding impact, prioritisation, dissemination and policy-maker involvement were valuable for optimal health research resource utilisation in a resource constrained developing country. Embedding impact evaluation into a priority setting process and funding research based on national needs could facilitate health research investment to reach its potential.
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Affiliation(s)
- Weng Hong Fun
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia.
| | - Sondi Sararaks
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Ee Hong Tan
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Kar Foong Tang
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Diane Woei Quan Chong
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Lee Lan Low
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Roslinda Abu Sapian
- National Institutes of Health Secretariat, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - S Asmaliza Ismail
- National Institutes of Health Secretariat, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Suresh Kumar Govind
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Haniza Mahmud
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Shahnaz Murad
- Office of Deputy Director General of Health, Research and Technical Support, Ministry of Health Malaysia, Putrajaya, Malaysia
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13
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Wazny K, Ravenscroft J, Chan KY, Bassani DG, Anderson N, Rudan I. Setting weights for fifteen CHNRI criteria at the global and regional level using public stakeholders: an Amazon Mechanical Turk study. J Glob Health 2019; 9:010702. [PMID: 30992986 PMCID: PMC6445564 DOI: 10.7189/jogh.09.010702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Stakeholder involvement has been described as an indispensable part of health research priority setting. Yet, more than 75% of the exercises using the Child Health and Nutrition Research Initiative (CHNRI) methodology have omitted the step involving stakeholders in priority setting. Those that have used stakeholders have rarely used the public, possibly due to the difficulty of assembling and/or accessing a public stakeholder group. In order to strengthen future exercises using the CHNRI methodology, we have used a public stakeholder group to weight 15 CHNRI criteria, and have explored regional differences or being a health stakeholder is influential, and whether the criteria are collapsible. Methods Using Amazon Mechanical Turk (AMT), an online crowdsourcing platform, we collected demographic information and conducted a Likert-scale format survey about the importance of the CHNRI criteria from 1051 stakeholders. The Kruskal-Wallis test, with Dunn's test for posthoc comparisons, was used to examine regional differences and Wilcoxon rank-sum test was used to analyse differences between stakeholders with health training/background and stakeholders without a health background and by region. A Factor Analysis (FA) was conducted on the criteria to identify the main domains connecting them. Criteria means were converted to weights. Results There were regional differences in thirteen of fifteen criteria according to the Kruskal-Wallis test and differences in responses from health stakeholders vs those who were not in eleven of fifteen criteria using the Wilcoxon rank-sum test. Three components were identified: improve and impact results; implementation and affordability; and, study design and dissemination. A formula is provided to convert means to weights for future studies. Conclusion In future CHNRI studies, researchers will need to ensure adequate representation from stakeholders to undue bias of CHNRI results. These results should be used in combination with other stakeholder groups, including government, donors, policy makers, and bilateral agencies. Global and regional stakeholder groups scored CHNRI criteria differently; due to this, researchers should consider which group to use in their CHNRI exercises.
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Affiliation(s)
- Kerri Wazny
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Ravenscroft
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Diego G Bassani
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Niall Anderson
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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14
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Chirambo GB, Muula AS, Thompson M. Factors affecting sustainability of mHealth decision support tools and mHealth technologies in Malawi. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Jarolimova J, Baguma S, Patel P, Mian-McCarthy S, Ntaro M, Matte M, Kenney J, Bwambale S, Mulogo E, Stone G. Completion of community health worker initiated patient referrals in integrated community case management in rural Uganda. Malar J 2018; 17:379. [PMID: 30348156 PMCID: PMC6198464 DOI: 10.1186/s12936-018-2525-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Uganda has sought to address leading causes of childhood mortality: malaria, pneumonia and diarrhoea, through integrated community case management (iCCM). The success of this approach relies on community health worker (CHW) assessment and referral of sick children to a nearby health centre. This study aimed to determine rates of referral completion in an iCCM programme in rural Uganda. Methods This was a prospective observational study of referrals made by CHWs in 8 villages in rural western Uganda. All patient referrals by CHWs were tracked and health centre registers were reviewed for documentation of completed referrals. Caregivers of referred patients were invited to complete a survey 2–3 weeks after the referral with questions on the CHW visit, referral completion, and the patient’s clinical condition. Results Among 143 total referrals, 136 (94%) caregivers completed the follow-up survey. Reasons for visiting the CHW were fever/malaria in 111 (82%) cases, cough in 61 (45%) cases, and fast/difficult breathing in 25 (18%) cases. Overall, 121 (89%) caregivers reported taking the referred child for further medical evaluation, of whom 102 (75% overall) were taken to the local public health centre. Ninety per cent of reported referral visits were confirmed in health centre documentation. For the 34 caregivers who did not complete referral at the local health centre, the most common reasons were improvement in child’s health, lack of time, ease of going elsewhere, and needing to care for other children. Referrals were slightly more likely to be completed on weekdays versus weekends (p = 0.0377); referral completion was otherwise not associated with child’s age or gender, caregiver age, or caregiver relationship to child. One village had a lower rate of referral completion than the others. Improvement in the child’s health was not associated with completed referral or timing of the referral visit. Conclusions A high percentage of children referred to the health centre through iCCM in rural Uganda completed the referral. Barriers to referral completion included improvement in the child’s health, time and distance. Interestingly, referral completion at the health centre was not associated with improvement in the child’s health. Barriers to referral completion and clinical management at all stages of referral linkages warrant further study.
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Affiliation(s)
- Jana Jarolimova
- Global Health Collaborative, Mbarara, Uganda. .,Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Stephen Baguma
- Global Health Collaborative, Mbarara, Uganda.,Bugoye Health Center, Bugoye, Uganda
| | - Palka Patel
- Global Health Collaborative, Mbarara, Uganda.,Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.,Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA
| | - Sara Mian-McCarthy
- Global Health Collaborative, Mbarara, Uganda.,Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA
| | - Moses Ntaro
- Global Health Collaborative, Mbarara, Uganda.,Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Michael Matte
- Global Health Collaborative, Mbarara, Uganda.,Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Jessica Kenney
- Global Health Collaborative, Mbarara, Uganda.,Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA
| | - Shem Bwambale
- Global Health Collaborative, Mbarara, Uganda.,Bugoye Health Center, Bugoye, Uganda
| | - Edgar Mulogo
- Global Health Collaborative, Mbarara, Uganda.,Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Geren Stone
- Global Health Collaborative, Mbarara, Uganda.,Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Massachusetts General Hospital Center for Global Health, 125 Nashua Street, Suite 722, Boston, MA, 02114, USA
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16
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Dagenais C, Degroote S, Otmani Del Barrio M, Bermudez-Tamayo C, Ridde V. Establishing research priorities in prevention and control of vector-borne diseases in urban areas: a collaborative process. Infect Dis Poverty 2018; 7:85. [PMID: 30173663 PMCID: PMC6120077 DOI: 10.1186/s40249-018-0463-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/18/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In 2015, following a call for proposals from the Special Programme for Research and Training in Tropical Diseases (TDR), six scoping reviews on the prevention and control of vector-borne diseases in urban areas were conducted. Those reviews provided a clear picture of the available knowledge and highlighted knowledge gaps, as well as needs and opportunities for future research. Based on the research findings of the scoping reviews, a concept mapping exercise was undertaken to produce a list of priority research needs to be addressed. METHODS Members of the six research teams responsible for the "VEctor boRne DiseAses Scoping reviews" (VERDAS) consortium's scoping reviews met for 2 days with decision-makers from Colombia, Brazil, Peru, Pan-American Health Organization, and World Health Organization. A total of 11 researchers and seven decision-makers (from ministries of health, city and regional vector control departments, and vector control programs) completed the concept mapping, answering the question: "In view of the knowledge synthesis and your own expertise, what do we still need to know about vector-borne diseases and other infectious diseases of poverty in urban areas?" Participants rated each statement on two scales from 1 to 5, one relative to 'priority' and the other to 'policy relevance', and grouped statements into clusters based on their own individual criteria and expertise. RESULTS The final map consisted of 12 clusters. Participants considered those entitled "Equity", "Technology", and "Surveillance" to have the highest priority. The cluster considered the most important concerns equity issues, confirming that these issues are rarely addressed in research on vector-borne diseases. On the other hand, the "Population mobility" and "Collaboration" clusters were considered to be the lowest priority but remained identified by participants as research priorities. The average policy relevance scores for each of the 12 clusters were roughly the same as the priority scores for all clusters. Some issues were not addressed during the brain-storming. This is the case for governance and for access and quality of care. CONCLUSIONS Based on this work, and adopting a participatory approach, the concept mapping exercise conducted collaboratively with researchers from these teams and high-level decision-makers identified research themes for which studies should be carried out as a priority.
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Affiliation(s)
- Christian Dagenais
- Department of Psychology, University of Montreal, Pavillon Marie-Victorin, Bureau C-355, C. P. 6128, succursale Centre-ville., Montreal, QC H3C 3J7 Canada
| | - Stéphanie Degroote
- University of Montreal Public Health Research Institute, Montreal, QC Canada
| | - Mariam Otmani Del Barrio
- Vector, Environment and Society Unit, Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Clara Bermudez-Tamayo
- Andalusian School of Public Health, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Valéry Ridde
- University of Montreal Public Health Research Institute, Montreal, QC Canada
- IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
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17
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Bermudez LG, Williamson K, Stark L. Setting global research priorities for child protection in humanitarian action: Results from an adapted CHNRI exercise. PLoS One 2018; 13:e0202570. [PMID: 30133538 PMCID: PMC6104993 DOI: 10.1371/journal.pone.0202570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Armed conflict, natural disaster, and forced displacement affect millions of children each year. Such humanitarian crises increase the risk of family separation, erode existing support networks, and often result in economic loss, increasing children's vulnerability to violence, exploitation, neglect, and abuse. Research is needed to understand these risks and vulnerabilities and guide donor investment towards the most effective interventions for improving the well-being of children in humanitarian contexts. METHODS The Assessment, Measurement & Evidence (AME) Working Group of the Alliance for Child Protection in Humanitarian Action (ACPHA) identified experts to participate in a research priority setting exercise adapted from the Child Health and Nutrition Research Initiative (CHNRI). Experts individually identified key areas for research investment which were subsequently ranked by participants using a Likert scale. Research Priority Scores (RPS) and Average Expert Agreement (AEA) were calculated for each identified research topic, the top fifteen of which are presented within this paper. RESULTS Intervention research, which aims to rigorously evaluate the effectiveness of standard child protection activities in humanitarian settings, ranked highly. Child labor was a key area of sector research with two of the top ten priorities examining the practice. Respondents also prioritized research efforts to understand how best to bridge humanitarian and development efforts for child protection as well as identifying most effective way to build the capacity of local systems in order to sustain child protection gains after a crisis. CONCLUSIONS Rigorous, scientific research that assesses the scope of child protection risks, examines the effectiveness of interventions to improve child well-being, and translates evidence to practice is critical. Findings from this research priority setting exercise offer guidance for a global research agenda on child protection in humanitarian settings, encouraging cooperation among donors, implementers, and academics to pursue a coordinated approach to evidence generation.
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Affiliation(s)
- Laura Gauer Bermudez
- Columbia University School of Social Work, New York, New York, United States of America
| | | | - Lindsay Stark
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
- George Warren Brown School of Social Work, Washington University in Saint Louis, St. Louis, Missouri, United States of America
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18
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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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Arora NK, Swaminathan S, Mohapatra A, Gopalan HS, Katoch VM, Bhan MK, Rasaily R, Shekhar C, Thavaraj V, Roy M, Das MK, Wazny K, Kumar R, Khera A, Bhatla N, Jain V, Laxmaiah A, Nair MKC, Paul VK, Ramachandran P, Ramji S, Vaidya U, Verma IC, Shah D, Bahl R, Qazi S, Rudan I, Black RE. Research priorities in Maternal, Newborn, & Child Health & Nutrition for India: An Indian Council of Medical Research-INCLEN Initiative. Indian J Med Res 2018; 145:611-622. [PMID: 28948951 PMCID: PMC5644295 DOI: 10.4103/ijmr.ijmr_139_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In India, research prioritization in Maternal, Newborn, and Child Health and Nutrition (MNCHN) themes has traditionally involved only a handful of experts mostly from major cities. The Indian Council of Medical Research (ICMR)-INCLEN collaboration undertook a nationwide exercise engaging faculty from 256 institutions to identify top research priorities in the MNCHN themes for 2016-2025. The Child Health and Nutrition Research Initiative method of priority setting was adapted. The context of the exercise was defined by a National Steering Group (NSG) and guided by four Thematic Research Subcommittees. Research ideas were pooled from 498 experts located in different parts of India, iteratively consolidated into research options, scored by 893 experts against five pre-defined criteria (answerability, relevance, equity, investment and innovation) and weighed by a larger reference group. Ranked lists of priorities were generated for each of the four themes at national and three subnational (regional) levels [Empowered Action Group & North-Eastern States, Southern and Western States, & Northern States (including West Bengal)]. Research priorities differed between regions and from overall national priorities. Delivery domain of research which included implementation research constituted about 70 per cent of the top ten research options under all four themes. The results were endorsed in the NSG meeting. There was unanimity that the research priorities should be considered by different governmental and non-governmental agencies for investment with prioritization on implementation research and issues cutting across themes.
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Affiliation(s)
- Narendra K Arora
- Executive Office, The INCLEN Trust International, New Delhi, India
| | | | | | - Hema S Gopalan
- Executive Office, The INCLEN Trust International, New Delhi, India
| | - Vishwa M Katoch
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Maharaj K Bhan
- Centre for Health Research and Development (CHRD), Society for Applied Studies, New Delhi, India
| | - Reeta Rasaily
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Chander Shekhar
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | | | - Malabika Roy
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Manoja K Das
- Executive Office, The INCLEN Trust International, New Delhi, India
| | - Kerri Wazny
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rakesh Kumar
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Ajay Khera
- Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of , New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanita Jain
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avula Laxmaiah
- Division of Community Studies, National Institute of Nutrition, Hyderabad, India
| | - M K C Nair
- Office of the Vice Chancellor, Kerala University of Health Sciences, Thrissur, India
| | - Vinod K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Siddharth Ramji
- Department of Neonatology, Maulana Azad Medical College, New Delhi, India
| | - Umesh Vaidya
- Department of Pediatrics, KEM Hospital, Pune, India
| | - I C Verma
- Editorial Office, Indian Journal of Pediatrics, New Delhi, India
| | - Dheeraj Shah
- Editorial Office, Indian Pediatrics, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Shamim Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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20
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Lal S, Ndyomugenyi R, Paintain L, Alexander ND, Hansen KS, Magnussen P, Chandramohan D, Clarke SE. Caregivers' compliance with referral advice: evidence from two studies introducing mRDTs into community case management of malaria in Uganda. BMC Health Serv Res 2018; 18:317. [PMID: 29720163 PMCID: PMC5932808 DOI: 10.1186/s12913-018-3124-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Several malaria endemic countries have implemented community health worker (CHW) programmes to increase access to populations underserved by health care. There is considerable evidence on CHW adherence to case management guidelines, however, there is limited evidence on the compliance to referral advice and the outcomes of children under-5 referred by CHWs. This analysis examined whether caregivers complied with CHWs referral advice. Methods Data from two cluster (village) randomised trials, one in a moderate-to-high malaria transmission setting, another in a low-transmission setting conducted between January 2010–July 2011 were analysed. CHW were trained to recognise signs and symptoms that required referral to a health centre. CHW in the intervention arm also had training on; malaria rapid diagnostic tests (mRDT) and administering artemisinin based combination therapy (ACT); CHW in the control arm were trained to treat malaria with ACTs based on fever symptoms. Caregivers’ referral forms were linked with CHW treatment forms to determine whether caregivers complied with the referral advice. Factors associated with compliance were examined with logistic regression. Results CHW saw 18,497 child visits in the moderate-to-high transmission setting and referred 15.2% (2815/18,497) of all visits; in the low-transmission setting, 35.0% (1135/3223) of all visits were referred. Compliance to referral was low, in both settings < 10% of caregivers complied with referral advice. In the moderate-to-high transmission setting compliance was higher if children were tested with mRDT compared to children who were not tested with mRDT. In both settings, nearly all children treated with pre-referral rectal artesunate failed to comply with referral and compliance was independently associated with factors such as health centre distance and day of referral by a CHW. In the moderate-to-high transmission setting, time of presentation, severity of referral were also associated with compliance, whilst in the low-transmission setting, compliance was low if an ACT was prescribed. Conclusions This analysis suggests there are several barriers to comply with CHWs referral advice by caregivers. This is concerning for children who received rectal artesunate. As CHW programmes continue scale-up, barriers to referral compliance need to be addressed to ensure a continuum of care from the community to the health centre. Trial registration The study was registered with ClinicalTrials.gov. Identifier NCT01048801, 13th January 2010. Electronic supplementary material The online version of this article (10.1186/s12913-018-3124-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sham Lal
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | | | - Lucy Paintain
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Neal D Alexander
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kristian S Hansen
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark.,Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Siân E Clarke
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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21
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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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22
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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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23
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Gordon S, Rotheram-Borus MJ, Skeen S, Parry C, Bryant K, Tomlinson M. Research Priorities for the Intersection of Alcohol and HIV/AIDS in Low and Middle Income Countries: A Priority Setting Exercise. AIDS Behav 2017; 21:262-273. [PMID: 28975440 PMCID: PMC5660137 DOI: 10.1007/s10461-017-1921-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The harmful use of alcohol is a component cause for more than 200 diseases. The association between alcohol consumption, risk taking behavior and a range of infectious diseases such as HIV/AIDS is well established. The prevalence of HIV/AIDS as well as harmful alcohol use in low and middle income countries is high. Alcohol has been identified as a modifiable risk factor in the prevention and treatment of HIV/AIDS. The objective of this paper is to define research priorities for the interaction of alcohol and HIV/AIDS in low and middle income countries. The Child Health and Nutrition Research Initiative (CHNRI) priority setting methodology was applied in order to assess research priorities of the interaction of alcohol and HIV/AIDS. A group of 171 global and local experts in the field of alcohol and or HIV/AIDS related research were identified and invited to generate research questions. This resulted in 205 research questions which have been categorized and refined by senior researchers into 48 research questions to be evaluated using five criteria: answerability, effectiveness, feasibility, applicability and impact, as well as equity. A total of 59 experts participated independently in the voluntary scoring exercise (a 34% response rate). There was substantial consensus among experts on priorities for research on alcohol and HIV. These tended to break down into two categories, those focusing on better understanding the nexus between alcohol and HIV and those directed towards informing practical interventions to reduce the impact of alcohol use on HIV treatment outcomes, which replicates what Bryant (Subst Use Misuse 41:1465–1507, 2006) and Parry et al. (Addiction 108:1–2, 2012) found. Responses from experts were stratified by location in order to determine any differences between groups. On average experts in the LMIC gave higher scores than the HIC experts. Recent research has shown the causal link between alcohol consumption and the incidence of HIV/AIDS including a better understanding of the pathways through which alcohol use affects ARV adherence (and other medications to treat opportunistic infections) and CD4 counts. The results of this process clearly indicated that the important priorities for future research related to the development and assessment of interventions focusing on addressing alcohol and HIV/AIDS, addressing and exploring the impact of HIV risk and comorbid alcohol use, as well as exploring the risk and protective factors in the field of alcohol and HIV/AIDS. The findings from this priority setting exercise could guide international research agenda and make research funding more effective in addressing the research on intersection of alcohol and HIV/AIDS
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Affiliation(s)
- Sarah Gordon
- The Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
- Global Center for Children and Families, Semel Institute and the Department of Psychiatry, University of California at Los Angeles, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024-6521, USA.
| | - Sarah Skeen
- The Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Charles Parry
- South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, South Africa
| | - Kendall Bryant
- National Institute of Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Bethesda, MD, 20892-7003, USA
| | - Mark Tomlinson
- The Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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Abstract
The main forms of childhood malnutrition occur predominantly in children <5 years of age living in low-income and middle-income countries and include stunting, wasting and kwashiorkor, of which severe wasting and kwashiorkor are commonly referred to as severe acute malnutrition. Here, we use the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research &Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - James A Berkley
- Clinical Research Department, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness &Nutrition (CHAIN) Network, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Robert H J Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research &Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- The Childhood Acute Illness &Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marko Kerac
- Department of Population Health, London School of Hygiene &Tropical Medicine, London, UK
| | - Indi Trehan
- Lao Friends Hospital for Children, Luang Prabang, Laos
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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Dalglish SL, George A, Shearer JC, Bennett S. Epistemic communities in global health and the development of child survival policy: a case study of iCCM. Health Policy Plan 2017; 30 Suppl 2:ii12-ii25. [PMID: 26516146 DOI: 10.1093/heapol/czv043] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Nearly all African countries have recently implemented some form of integrated community case management of childhood illness (iCCM), a strategy aimed at reducing child mortality by providing curative care for common yet fatal childhood illnesses. This case study describes the evolution of iCCM at the global level using the theory of epistemic communities first outlined by Haas, which explains how international policy coordination on technical issues takes place via transnational expert networks. We draw from in-depth interviews with global policy-makers (n = 25), a document review (n = 72) and co-authorship network analysis of scientific articles on iCCM. We find that members of the iCCM epistemic community were mainly mid- to upper-level technical officers working in the headquarters of large norm-setting bodies, implementing partners, funders and academic/research groups in global health. Already linked by pre-existing relationships, the epistemic community was consolidated as conflicts were overcome through structural changes in the network (including or excluding some members), changes in the state of technology or scientific evidence, shifting funding considerations, and the development of consensus through argument, legitimation and other means. Next, the epistemic community positioned iCCM as a preferred solution via three causal dynamics outlined by Haas: (1) responding to decision-makers' uncertainty about how to reduce child mortality after previous policies proved insufficient, (2) using sophisticated analytic tools to link the problem of child mortality to iCCM as a solution and (3) gaining buy-in from major norm-setting bodies and financial and institutional support from large implementing agencies. Applying the epistemic communities framework to the iCCM case study reveals the strengths and weaknesses of a focused policy enterprise with highly specialized and homogenous disciplinary origins, allowing for efficient sharing of complex, high-level scientific information, but possibly excluding voices with relevant methodological, operational or country-level perspectives.
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Affiliation(s)
- Sarah L Dalglish
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health,
| | - Asha George
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA and
| | | | - Sara Bennett
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA and
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26
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Rodríguez DC, Shearer J, Mariano ARE, Juma PA, Dalglish SL, Bennett S. Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy. Health Policy Plan 2017; 30 Suppl 2:ii36-ii45. [PMID: 26516149 PMCID: PMC4625759 DOI: 10.1093/heapol/czv033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss’ models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not be enough to overcome resistance if the policy is viewed as incompatible with national goals.
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Affiliation(s)
- Daniela C Rodríguez
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA,
| | - Jessica Shearer
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Alda R E Mariano
- Universidade Eduardo Mondlane, Community Health Department, Maputo, Mozambique and
| | - Pamela A Juma
- African Population and Health Research Center, Nairobi, Kenya
| | - Sarah L Dalglish
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
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27
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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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Lal S, Ndyomugenyi R, Paintain L, Alexander ND, Hansen KS, Magnussen P, Chandramohan D, Clarke SE. Community health workers adherence to referral guidelines: evidence from studies introducing RDTs in two malaria transmission settings in Uganda. Malar J 2016; 15:568. [PMID: 27881136 PMCID: PMC5121932 DOI: 10.1186/s12936-016-1609-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs' ability to adhere to malaria rapid diagnostic tests (RDTs) and treatment guidelines, there is limited evidence whether CHWs adhere to the referral guidelines and refer severely ill children for further management. In southwest Uganda, this study examined whether CHWs referred children according to training guidelines and described factors associated with adherence to the referral guideline. METHODS A secondary analysis was undertaken of data collected during two cluster-randomized trials conducted between January 2010 and July 2011, one in a moderate-to-high malaria transmission setting and the other in a low malaria transmission setting. All CHWs were trained to prescribe artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs and symptoms. CHW treatment registers were reviewed to identify children eligible for referral according to training guidelines (temperature of ≥38.5 °C), to assess whether CHWs adhered to the guidelines and referred them. Factors associated with adherence were examined with logistic regression models. RESULTS CHWs failed to refer 58.8% of children eligible in the moderate-to-high transmission and 31.2% of children in the low transmission setting. CHWs using RDTs adhered to the referral guidelines more frequently than CHWs not using RDTs (moderate-to-high transmission: 50.1 vs 18.0%, p = 0.003; low transmission: 88.5 vs 44.1%, p < 0.001). In both settings, fewer than 20% of eligible children received pre-referral treatment with rectal artesunate. Children who were prescribed ACT were very unlikely to be referred in both settings (97.7 and 73.3% were not referred in the moderate-to-high and low transmission settings, respectively). In the moderate-to-high transmission setting, day and season of visit were also associated with the likelihood of adherence to the referral guidelines, but not in the low transmission setting. CONCLUSIONS CHW adherence to referral guidelines was poor in both transmission settings. However, training CHWs to use RDT improved correct referral of children with a high fever compared to a presumptive diagnosis using sign and symptoms. As many countries scale up CHW programmes, routine monitoring of reported data should be examined carefully to assess whether CHWs adhere to referral guidelines and take remedial actions where required.
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Affiliation(s)
- Sham Lal
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | | | - Lucy Paintain
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Neal D Alexander
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kristian S Hansen
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Institute of International Health, Immunology and Microbiology & Institute of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Siân E Clarke
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Lal S, Ndyomugenyi R, Magnussen P, Hansen KS, Alexander ND, Paintain L, Chandramohan D, Clarke SE. Referral Patterns of Community Health Workers Diagnosing and Treating Malaria: Cluster-Randomized Trials in Two Areas of High- and Low-Malaria Transmission in Southwestern Uganda. Am J Trop Med Hyg 2016; 95:1398-1408. [PMID: 27799650 PMCID: PMC5154457 DOI: 10.4269/ajtmh.16-0598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/06/2016] [Indexed: 11/07/2022] Open
Abstract
Malaria-endemic countries have implemented community health worker (CHW) programs to provide malaria diagnosis and treatment to populations living beyond the reach of health systems. However, there is limited evidence describing the referral practices of CHWs. We examined the impact of malaria rapid diagnostic tests (mRDTs) on CHW referral in two cluster-randomized trials, one conducted in a moderate-to-high malaria transmission setting and one in a low-transmission setting in Uganda, between January 2010 and July 2012. All CHWs were trained to prescribe artemisinin-based combination therapy (ACT) for malaria and recognize signs and symptoms for referral to health centers. CHWs in the control arm used a presumptive diagnosis for malaria based on clinical symptoms, whereas intervention arm CHWs used mRDTs. CHWs recorded ACT prescriptions, mRDT results, and referral in patient registers. An intention-to-treat analysis was undertaken using multivariable logistic regression. Referral was more frequent in the intervention arm versus the control arm (moderate-to-high transmission, P < 0.001; low transmission, P < 0.001). Despite this increase, referral advice was not always given when ACTs or prereferral rectal artesunate were prescribed: 14% prescribed rectal artesunate in the moderate-to-high setting were not referred. In addition, CHWs considered factors alongside mRDTs when referring. Child visits during the weekends or the rainy season were less likely to be referred, whereas visits to CHWs more distant from health centers were more likely to be referred (low transmission only). CHWs using mRDTs and ACTs increased referral compared with CHWs using a presumptive diagnosis. To address these concerns, referral training should be emphasized in CHW programs as they are scaled-up.
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Affiliation(s)
- Sham Lal
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Pascal Magnussen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristian S Hansen
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Neal D Alexander
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lucy Paintain
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Siân E Clarke
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lohfeld L, Kangombe-Ngwenya T, Winters AM, Chisha Z, Hamainza B, Kamuliwo M, Miller JM, Burns M, Bridges DJ. A qualitative review of implementer perceptions of the national community-level malaria surveillance system in Southern Province, Zambia. Malar J 2016; 15:400. [PMID: 27502213 PMCID: PMC4977701 DOI: 10.1186/s12936-016-1455-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 07/28/2016] [Indexed: 11/12/2022] Open
Abstract
Background Parts of Zambia with very low malaria parasite prevalence and high coverage of vector control interventions are targeted for malaria elimination through a series of interventions including reactive case detection (RCD) at community level. When a symptomatic individual presenting to a community health worker (CHW) or government clinic is diagnostically confirmed as an incident malaria case an RCD response is initiated. This consists of a CHW screening the community around the incident case with rapid diagnostic tests (RDT) and treating positive cases with artemether-lumefantrine (AL, Coartem™) in accordance with national policy. Since its inception in 2011, Zambia’s RCD programme has relied on anecdotal feedback from staff to identify issues and possible solutions. In 2014, a systematic qualitative programme review was conducted to determine perceptions around malaria rates, incentives, operational challenges and solutions according to CHWs, their supervisors and district-level managers. Methods A criterion-based sampling framework based on training regime and performance level was used to select nine rural health posts in four districts of Southern Province. Twenty-two staff interviews were completed to produce English or bilingual (CiTonga or Silozi + English) verbatim transcripts, which were then analysed using thematic framework analysis. Results CHWs, their supervisors and district-level managers strongly credited the system with improving access to malaria services and significantly reducing the number of cases in their area. The main implementation barriers included access (e.g., lack of rain gear, broken bicycles), insufficient number of CHWs for programme coverage, communication (e.g. difficulties maintaining cell phones and “talk time” to transmit data by phone), and inconsistent supply chain (e.g., inadequate numbers of RDT kits and anti-malarial drugs to test and treat uncomplicated cases). Conclusions This review highlights the importance of a community surveillance system like RCD in shaping Zambia’s malaria elimination campaign by identifying community-based infections that might otherwise remain undetected. At this stage the system must ensure it can meet growing public demand by providing CHWs the tools and materials they need to consistently carry out their work and expand programme reach to more isolated communities. Results from this review will be used to plan programme scale-up into other parts of Zambia.
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Affiliation(s)
- Lynne Lohfeld
- Bachelor of Health Sciences (Honours) Program, McMaster University, Hamilton, ON, Canada
| | | | - Anna M Winters
- Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia
| | - Zunda Chisha
- Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia
| | - Busiku Hamainza
- National Malaria Control Centre, Government of Zambia Ministry of Health, Lusaka, Zambia
| | - Mulakwa Kamuliwo
- National Malaria Control Centre, Government of Zambia Ministry of Health, Lusaka, Zambia
| | - John M Miller
- Malaria Control and Evaluation Partnership in Africa (MACEPA/PATH), Lusaka, Zambia
| | - Matthew Burns
- Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia
| | - Daniel J Bridges
- Akros, Cresta Golfview Grounds, Great East Road, Lusaka, Zambia.
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Yourkavitch J, Zalisk K, Prosnitz D, Luhanga M, Nsona H. How do we know? An assessment of integrated community case management data quality in four districts of Malawi. Health Policy Plan 2016; 31:1162-71. [PMID: 27162235 DOI: 10.1093/heapol/czw047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/14/2022] Open
Abstract
The World Health Organization contracted annual data quality assessments of Rapid Access Expansion (RAcE) projects to review integrated community case management (iCCM) data quality and the monitoring and evaluation (M&E) system for iCCM, and to suggest ways to improve data quality. The first RAcE data quality assessment was conducted in Malawi in January 2014 and we present findings pertaining to data from the health management information system at the community, facility and other sub-national levels because RAcE grantees rely on that for most of their monitoring data. We randomly selected 10 health facilities (10% of eligible facilities) from the four RAcE project districts, and collected quantitative data with an adapted and comprehensive tool that included an assessment of Malawi's M&E system for iCCM data and a data verification exercise that traced selected indicators through the reporting system. We rated the iCCM M&E system across five function areas based on interviews and observations, and calculated verification ratios for each data reporting level. We also conducted key informant interviews with Health Surveillance Assistants and facility, district and central Ministry of Health staff. Scores show a high-functioning M&E system for iCCM with some deficiencies in data management processes. The system lacks quality controls, including data entry verification, a protocol for addressing errors, and written procedures for data collection, entry, analysis and management. Data availability was generally high except for supervision data. The data verification process identified gaps in completeness and consistency, particularly in Health Surveillance Assistants' record keeping. Staff at all levels would like more training in data management. This data quality assessment illuminates where an otherwise strong M&E system for iCCM fails to ensure some aspects of data quality. Prioritizing data management with documented protocols, additional training and approaches to create efficient supervision practices may improve iCCM data quality.
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Affiliation(s)
- Jennifer Yourkavitch
- ICF International, International Health and Development Division; 530 Gaither Road, Suite 500, Rockville Maryland, 20850 USA
| | - Kirsten Zalisk
- ICF International, International Health and Development Division; 530 Gaither Road, Suite 500, Rockville Maryland, 20850 USA
| | - Debra Prosnitz
- ICF International, International Health and Development Division; 530 Gaither Road, Suite 500, Rockville Maryland, 20850 USA
| | - Misheck Luhanga
- Independent consultant contracted by ICF International, International Health and Development Division; 530 Gaither Road, Suite 500, Rockville Maryland, 20850 USA
| | - Humphreys Nsona
- IMCI Unit, Community Health Sciences Unit, Ministry of Health; Tsiranana Drive, Mtunthama Road, Lilongwe, Central Region, Malawi
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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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Lal S, Ndyomugenyi R, Alexander ND, Lagarde M, Paintain L, Magnussen P, Chandramohan D, Clarke SE. Health Facility Utilisation Changes during the Introduction of Community Case Management of Malaria in South Western Uganda: An Interrupted Time Series Approach. PLoS One 2015; 10:e0137448. [PMID: 26356099 PMCID: PMC4565684 DOI: 10.1371/journal.pone.0137448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022] Open
Abstract
Background Malaria endemic countries have scaled-up community health worker (CHW) interventions, to diagnose and treat malaria in communities with limited access to public health systems. The evaluations of these programmes have centred on CHW’s compliance to guidelines, but the broader changes at public health centres including utilisation and diagnoses made, has received limited attention. Methods This analysis was conducted during a CHW–intervention for malaria in Rukungiri District, Western Uganda. Outpatient department (OPD) visit data were collected for children under-5 attending three health centres one year before the CHW-intervention started (pre-intervention period) and for 20 months during the intervention (intervention-period). An interrupted time series analysis with segmented regression models was used to compare the trends in malaria, non-malaria and overall OPD visits during the pre-intervention and intervention-period. Results The introduction of a CHW-intervention suggested the frequency of diagnoses of diarrhoeal diseases, pneumonia and helminths increased, whilst the frequency of malaria diagnoses declined at health centres. In May 2010 when the intervention began, overall health centre utilisation decreased by 63% compared to the pre-intervention period and the health centres saw 32 fewer overall visits per month compared to the pre-intervention period (p<0.001). Malaria visits also declined shortly after the intervention began and there were 27 fewer visits per month during the intervention-period compared with the pre-intervention period (p<0.05). The declines in overall and malaria visits were sustained for the entire intervention-period. In contrast, there were no observable changes in trends of non-malarial visits between the pre-intervention and intervention-period. Conclusions This analysis suggests introducing a CHW-intervention can reduce the number of child malaria visits and change the profile of cases presenting at health centres. The reduction in workload of health workers may allow them to spend more time with patients or undertake additional curative or preventative roles.
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Affiliation(s)
- Sham Lal
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Neal D Alexander
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mylene Lagarde
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lucy Paintain
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pascal Magnussen
- Institute of International Health, Immunology and Microbiology & Institute of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Siân E Clarke
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Young M, Sharkey A, Aboubaker S, Kasungami D, Swedberg E, Ross K. The way forward for integrated community case management programmes: A summary of lessons learned to date and future priorities. J Glob Health 2014; 4:020303. [PMID: 25520789 PMCID: PMC4267099 DOI: 10.7189/jogh.04.020303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Dyness Kasungami
- Maternal and Child Survival Program (MCSP)/John Snow International, Washington, DC, USA
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