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Chen S, Guo L, Xie Y, Dong D, Saber R, Alluhidan M, Alamri A, Alfaisal A, Alazemi N, Al-Farsi YM, Al Ohaly YA, Zhang Y, Rakic S, Hamza M, Herbst CH, Tang S. Government responses to the COVID-19 pandemic of the Gulf Cooperation Council countries: good practices and lessons for future preparedness. Glob Health Res Policy 2024; 9:10. [PMID: 38486301 PMCID: PMC10941437 DOI: 10.1186/s41256-024-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
The COVID-19 pandemic has dramatically threatened the Gulf Cooperation Council (GCC) countries which have a large proportion of foreign workers. The governments of GCC countries have proactively implemented a comprehensive set of policy measures, and up to our knowledge, a systematic analysis of qualitative and quantitative evidence on the government response is still lacking. We summarized the GCC countries' government response and quantitatively measured that response using four indexes-the Government Response Index, the Stringency Index, the Vaccine Index, and the Initial Response Index, to analyse their response for future pandemic preparedness. Overall, the government response of all the GCC countries to the COVID-19 pandemic has been comprehensive, stringent, and timely. Notably, the GCC countries have implemented comprehensive vaccine policies. In addition, they have worked actively to protect foreign workers to improve their access to health services and secure their essential living conditions, regardless of their immigrant status. All the GCC countries dynamically adjusted their response to the evolving COVID-19 epidemiological burden and started to relax the stringency of the control policies after the Omicron wave, though the governments had different response magnitudes as measured by the four indexes. These findings have provided several important lessons for future pandemic response and preparedness for countries with similar economic, demographic, and health contexts in (1) prompt actions of containment and closure policies with dynamic adjusting, (2) strengthening health system policies, (3) comprehensive vaccination policies with universal access, (4) equitable and free access to testing, diagnosis, and treatment for all, and (5) strengthening the resilience of health systems.
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Affiliation(s)
- Shu Chen
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, NSW, Australia
- School of Risk and Actuarial Studies, University of New South Wales, Sydney, NSW, Australia
| | - Lei Guo
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yewei Xie
- SingHealth Duke-NUS Global Health Institute, Duke-NUS, Singapore, Singapore
| | - Di Dong
- World Bank, Washington, D.C., USA
| | - Rana Saber
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Mohammed Alluhidan
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Adwa Alamri
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Abdulrahman Alfaisal
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Nahar Alazemi
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | | | | | - Yi Zhang
- World Bank, Washington, D.C., USA
| | | | | | | | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
- SingHealth Duke-NUS Global Health Institute, Duke-NUS, Singapore, Singapore.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
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Herbst CH, Bouteau A, Menykő EJ, Qin Z, Gyenge E, Su Q, Cooper V, Mabbott NA, Igyártó BZ. Dendritic cells overcome Cre/Lox induced gene deficiency by siphoning cytosolic material from surrounding cells. iScience 2024; 27:109119. [PMID: 38384841 PMCID: PMC10879714 DOI: 10.1016/j.isci.2024.109119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/10/2024] [Accepted: 01/31/2024] [Indexed: 02/23/2024] Open
Abstract
In a previous report, keratinocytes were shown to share their gene expression profile with surrounding Langerhans cells (LCs), influencing LC biology. Here, we investigated whether transferred material could substitute for lost gene products in cells subjected to Cre/Lox conditional gene deletion. We found that in human Langerin-Cre mice, epidermal LCs and CD11b+CD103+ mesenteric DCs overcome gene deletion if the deleted gene was expressed by neighboring cells. The mechanism of material transfer differed from traditional antigen uptake routes, relying on calcium and PI3K, being susceptible to polyguanylic acid inhibition, and remaining unaffected by inflammation. Termed intracellular monitoring, this process was specific to DCs, occurring in all murine DC subsets tested and human monocyte-derived DCs. The transferred material was presented on MHC-I and MHC-II, suggesting a role in regulating immune responses.
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Affiliation(s)
- Christopher H. Herbst
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Aurélie Bouteau
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Evelin J. Menykő
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Zhen Qin
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ervin Gyenge
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Qingtai Su
- OncoNano Medicine, Inc, Southlake, TX 76092, USA
| | - Vincent Cooper
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Neil A. Mabbott
- The Roslin Institute & Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Botond Z. Igyártó
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Alghannam AF, Malkin JD, Al-Hazzaa HM, AlAhmed R, Evenson KR, Rakic S, Alsukait R, Herbst CH, Alqahtani SA, Finkelstein EA. Public policies to increase physical activity and reduce sedentary behavior: a narrative synthesis of "reviews of reviews". Glob Health Action 2023; 16:2194715. [PMID: 37021717 PMCID: PMC10081086 DOI: 10.1080/16549716.2023.2194715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Physical inactivity among the general population is of great concern in public health. OBJECTIVE This narrative review aims to identify promising physical activity (PA) public policies based on the best available evidence from the literature. METHODS The study is a narrative synthesis of 'reviews of reviews' of public policies designed to increase physical activity among either (a) youths or (b) the community at large. We searched the literature for reviews of reviews of public policies of any country relevant to physical activity, physical inactivity, or sedentary behaviour published since 1 January 2000, in four databases. RESULTS Based on 12 reviews of reviews published between 2011 and 2022, we identified seven potentially effective PA public policies. Six of the seven were youth-based public policies that would be implemented in schools. The seventh was a policy aimed at establishing and promoting walking groups. CONCLUSIONS Policymakers seeking to increase PA should consider focusing on school-based PA policies and community-based walking groups, as this is where the evidence base is greatest. To implement these policies, pilot studies to assess the efficacy of such programmes in local communities should first be conducted due to methodological limitations in the underlying literature and questions of generalisability and reproducibility.
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Affiliation(s)
- Abdullah F Alghannam
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint, Abdulrahman University, Riyadh, Saudi Arabia
| | - Jesse D Malkin
- Health, Nutrition and Population MENA, World Bank, Washington, DC, USA
| | - Hazzaa M Al-Hazzaa
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint, Abdulrahman University, Riyadh, Saudi Arabia
| | - Reem AlAhmed
- Lifestyle and Health Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, CA, USA
| | - Severin Rakic
- Health, Nutrition and Population Practice, Middle East and North Africa Region, The World Bank, Washington, DC, USA
| | - Reem Alsukait
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Christopher H Herbst
- Human Development Unit, Middle East and North Africa Region, The World Bank, Washington, DC, USA
| | - Saleh A Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, USA
| | - Eric A Finkelstein
- Health Services and System Research Program, Duke-NUS Medical School, Singapore, Singapore
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Boettiger DC, Lin TK, Almansour M, Hamza MM, Alsukait R, Herbst CH, Altheyab N, Afghani A, Kattan F. Projected impact of population aging on non-communicable disease burden and costs in the Kingdom of Saudi Arabia, 2020-2030. BMC Health Serv Res 2023; 23:1381. [PMID: 38066590 PMCID: PMC10709902 DOI: 10.1186/s12913-023-10309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The number of people aged greater than 65 years per 100 people aged 20-64 years is expected to almost double in The Kingdom of Saudi Arabia (KSA) between 2020 and 2030. We therefore aimed to quantify the growing non-communicable disease (NCD) burden in KSA between 2020 and 2030, and the impact this will have on the national health budget. METHODS Ten priority NCDs were selected: ischemic heart disease, stroke, type 2 diabetes, chronic obstructive pulmonary disease, chronic kidney disease, dementia, depression, osteoarthritis, colorectal cancer, and breast cancer. Age- and sex-specific prevalence was projected for each priority NCD between 2020 and 2030. Treatment coverage rates were applied to the projected prevalence estimates to calculate the number of patients incurring treatment costs for each condition. For each priority NCD, the average cost-of-illness was estimated based on published literature. The impact of changes to our base-case model in terms of assumed disease prevalence, treatment coverage, and costs of care, coming into effect from 2023 onwards, were explored. RESULTS The prevalence estimates for colorectal cancer and stroke were estimated to almost double between 2020 and 2030 (97% and 88% increase, respectively). The only priority NCD prevalence projected to increase by less than 60% between 2020 and 2030 was for depression (22% increase). It is estimated that the total cost of managing priority NCDs in KSA will increase from USD 19.8 billion in 2020 to USD 32.4 billion in 2030 (an increase of USD 12.6 billion or 63%). The largest USD value increases were projected for osteoarthritis (USD 4.3 billion), diabetes (USD 2.4 billion), and dementia (USD 1.9 billion). In scenario analyses, our 2030 projection for the total cost of managing priority NCDs varied between USD 29.2 billion - USD 35.7 billion. CONCLUSIONS Managing the growing NCD burden in KSA's aging population will require substantial healthcare spending increases over the coming years.
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Grants
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
- P172148 The Ministry of Economy and Planning, Saudi Arabia and the Health, Nutrition and Population Reimbursable Advisory Services Program between the World Bank and the Ministry of Finance in Saudi Arabia
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Affiliation(s)
- David C Boettiger
- Institution for Health and Aging, University of California, San Francisco, CA, 94158, USA.
| | - Tracy Kuo Lin
- Institution for Health and Aging, University of California, San Francisco, CA, 94158, USA
| | | | - Mariam M Hamza
- Nutrition and Population Global Practice, World Bank, Washington, D.C, USA
| | - Reem Alsukait
- Community Health Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Nada Altheyab
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
| | - Ayman Afghani
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
| | - Faisal Kattan
- The Ministry of Economy and Planning, Riyadh, Saudi Arabia
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Werner K, Alsuhaibani SA, Alsukait RF, Alshehri R, Herbst CH, Alhajji M, Lin TK. Behavioural economic interventions to reduce health care appointment non-attendance: a systematic review and meta-analysis. BMC Health Serv Res 2023; 23:1136. [PMID: 37872612 PMCID: PMC10594857 DOI: 10.1186/s12913-023-10059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/24/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Appointment non-attendance - often referred to as "missed appointments", "patient no-show", or "did not attend (DNA)" - causes volatility in health systems around the world. Of the different approaches that can be adopted to reduce patient non-attendance, behavioural economics-oriented mechanisms (i.e., psychological, cognitive, emotional, and social factors that may impact individual decisions) are reasoned to be better suited in such contexts - where the need is to persuade, nudge, and/ or incentivize patients to honour their scheduled appointment. The aim of this systematic literature review is to identify and summarize the published evidence on the use and effectiveness of behavioural economic interventions to reduce no-shows for health care appointments. METHODS We systematically searched four databases (PubMed/Medline, Embase, Scopus, and Web of Science) for published and grey literature on behavioural economic strategies to reduce no-shows for health care appointments. Eligible studies met four criteria for inclusion; they were (1) available in English, Spanish, or French, (2) assessed behavioural economics interventions, (3) objectively measured a behavioural outcome (as opposed to attitudes or preferences), and (4) used a randomized and controlled or quasi-experimental study design. RESULTS Our initial search of the five databases identified 1,225 articles. After screening studies for inclusion criteria and assessing risk of bias, 61 studies were included in our final analysis. Data was extracted using a predefined 19-item extraction matrix. All studies assessed ambulatory or outpatient care services, although a variety of hospital departments or appointment types. The most common behaviour change intervention assessed was the use of reminders (n = 56). Results were mixed regarding the most effective methods of delivering reminders. There is significant evidence supporting the effectiveness of reminders (either by SMS, telephone, or mail) across various settings. However, there is a lack of evidence regarding alternative interventions and efforts to address other heuristics, leaving a majority of behavioural economic approaches unused and unassessed. CONCLUSION The studies in our review reflect a lack of diversity in intervention approaches but point to the effectiveness of reminder systems in reducing no-show rates across a variety of medical departments. We recommend future studies to test alternative behavioural economic interventions that have not been used, tested, and/or published before.
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Affiliation(s)
- Kalin Werner
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Sara Abdulrahman Alsuhaibani
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, KSA, Saudi Arabia
| | - Reem F Alsukait
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, KSA, Saudi Arabia
- Health, Nutrition and Population Global Practice, The World Bank, Washington, D.C, USA
| | - Reem Alshehri
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, D.C, USA
| | - Mohammed Alhajji
- Nudge Unit, Ministry of Health, Riyadh, KSA, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, KSA, Saudi Arabia
| | - Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Herbst CH, Bouteau A, Menykő EJ, Qin Z, Su Q, Buelvas DM, Gyenge E, Mabbott NA, Igyártó BZ. Dendritic Cells Overcome Cre/Lox Induced Gene Deficiency by Siphoning Material From Neighboring Cells Using Intracellular Monitoring-a Novel Mechanism of Antigen Acquisition. bioRxiv 2023:2023.07.22.550169. [PMID: 37546718 PMCID: PMC10401943 DOI: 10.1101/2023.07.22.550169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Macrophages and dendritic cells (DCs) in peripheral tissue interact closely with their local microenvironment by scavenging protein and nucleic acids released by neighboring cells. Material transfer between cell types is necessary for pathogen detection and antigen presentation, but thought to be relatively limited in scale. Recent reports, however, demonstrate that the quantity of transferred material can be quite large when DCs are in direct contact with live cells. This observation may be problematic for conditional gene deletion models that assume gene products will remain in the cell they are produced in. Here, we investigate whether conditional gene deletions induced by the widely used Cre/Lox system can be overcome at the protein level in DCs. Of concern, using the human Langerin Cre mouse model, we find that epidermal Langerhans cells and CD11b+CD103+ mesenteric DCs can overcome gene deletion if the deleted gene is expressed by neighboring cells. Surprisingly, we also find that the mechanism of material transfer does not resemble known mechanisms of antigen uptake, is dependent on extra- and intracellular calcium, PI3K, and scavenger receptors, and mediates a majority of material transfer to DCs. We term this novel process intracellular monitoring, and find that it is specific to DCs, but occurs in all murine DC subsets tested, as well as in human DCs. Transferred material is successfully presented and cross presented on MHC-II and MHC-I, and occurs between allogeneic donor and acceptors cells-implicating this widespread and unique process in immunosurveillance and organ transplantation.
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Affiliation(s)
- Christopher H. Herbst
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, U.S
| | - Aurélie Bouteau
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, U.S
| | - Evelin J. Menykő
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, U.S
| | - Zhen Qin
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, U.S
| | - Qingtai Su
- OncoNano Medicine, Inc., Southlake, TX 76092, U.S
| | - Dunia M. Buelvas
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, U.S
| | - Ervin Gyenge
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, U.S
| | - Neil A. Mabbott
- The Roslin Institute & Royal (Dick) School of Veterinary Studies, University of Edinburgh, UK
| | - Botond Z. Igyártó
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, U.S
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AlMarzooqi MA, Alsukait RF, Aljuraiban GS, Alothman SA, AlAhmed R, Rakic S, Herbst CH, Al-Hazzaa HM, Alqahtani SA. Comprehensive assessment of physical activity policies and initiatives in Saudi Arabia 2016-2022. Front Public Health 2023; 11:1236287. [PMID: 37614443 PMCID: PMC10443594 DOI: 10.3389/fpubh.2023.1236287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 08/25/2023] Open
Abstract
Objective This study aimed to review health-enhancing physical activity (HEPA) policies and initiatives introduced in Saudi Arabia (SA) since 2016 and identify the gaps in their design and implementation. Methods A combination of methods was used, including semi-structured interviews with key informants from relevant entities (such as those from the ministries of health, education, sports, tourism, and other regulatory bodies) and a review of policy/initiative documents provided by them. Stakeholder mapping led by local experts and snowball sampling supported the identification of key informants. Three existing frameworks-the World Health Organization's HEPA Policy Audit Tool, the Global Observatory for Physical Activity (PA) Policy Inventory, and the European Monitoring Framework for PA Indicators-were used to develop data collection instruments. Results The review identified 44 policies/initiatives from different sectors. The Saudi Sports for All Federation is the leader in PA promotion and community sports development. However, there is a lack of multisectoral agenda and governance structures for PA promotion. The overlap between initiatives by different key informants results in duplication of efforts, including initiatives to promote PA among the general public led by competitive professional sports and community-based sports. Conclusion The study findings indicate that several policies/initiatives have been implemented in SA since 2016. However, there is a need to focus on the challenges or barriers that affect the sustainability of policies/initiatives. A system-based approach can help build on sectoral synergies, thereby accelerating progress in engaging the Saudi population with PA.
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Affiliation(s)
- Mezna A. AlMarzooqi
- Leaders Development Institute, Ministry of Sport, Riyadh, Saudi Arabia
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Reem F. Alsukait
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- World Bank Group, Washington, DC, United States
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- World Bank Group, Washington, DC, United States
| | - Shaima A. Alothman
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reem AlAhmed
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Hazzaa M. Al-Hazzaa
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, United States
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8
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Shin S, Alqunaibet AM, Alsukait RF, Alruwaily A, Alfawaz RA, Algwizani A, Herbst CH, Shekar M, Finkelstein EA. A Randomized Controlled Study to Test Front-of-Pack (FOP) Nutrition Labels in the Kingdom of Saudi Arabia. Nutrients 2023; 15:2904. [PMID: 37447230 DOI: 10.3390/nu15132904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
One common strategy for governments to tackle the non-communicable disease (NCD) epidemic is front-of-package (FOP) nutrition labeling. The Kingdom of Saudi Arabia (KSA) is considering implementing a new FOP label that is based on either France's Nutri-Score (NS), which labels all foods (A = healthiest to E = least healthy) based on overall nutritional quality, or the Chilean warning label (WL) approach, which identifies foods to avoid based on select nutritional characteristics. Using a fully functional online grocery store, this study aimed to test these two promising FOP strategies by randomizing 656 KSA adults into one of the three versions of the store to complete a hypothetical grocery shop: no-label (control), NS, and WL. The NS was modified with a sugar percentage tag given that reducing sugar consumption is one of KSA's public health goals. We found that both modified NS labels and Chilean warning labels positively influenced food and beverage choices among KSA participants, but there were differential effects across the two labels. Relative to the control, NS improved the overall diet quality of the shopping baskets, measured by the weighted (by the number of servings) average NS point (ranging from 0, least healthy, to 55, healthiest), by 2.5 points [95% CI: 1.7, 3.4; p < 0.001], whereas results for WL were not statistically significant (0.6 points [95% CI: -0.2,1.5]). With respect to each nutritional attribute, we found that NS reduced sugar intake per serving, whereas WL was effective at decreasing energy and saturated fat intake per serving from food and beverages purchased. Our results suggest that the NS approach that identifies the healthiness of all foods using a holistic approach appears preferable if the purpose of the label is to improve overall diet quality as opposed to addressing select nutrients to avoid.
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Affiliation(s)
- Soye Shin
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | | | - Reem F Alsukait
- Department of Community Health Sciences, King Saud University, Riyadh 11362, Saudi Arabia
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | | | | | | | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | - Meera Shekar
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC 20433, USA
| | - Eric A Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
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9
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Alessy SA, Malkin JD, Finkelstein EA, AlAhmed R, Baattaiah BA, Evenson KR, Rakic S, Cetinkaya V, Herbst CH, Al-Hazzaa HM, Alqahtani SA. Effectiveness of Interventions Promoting Physical Activity and Reducing Sedentary Behavior in Community-Dwelling Older Adults: An Umbrella Review With Application to Saudi Arabia. J Epidemiol Glob Health 2023; 13:361-373. [PMID: 37199911 PMCID: PMC10193325 DOI: 10.1007/s44197-023-00111-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND As Saudi Arabia is expected to face population aging in the future, the burden of diseases arising from inadequate physical activity (PA) and excess sedentary behavior (SB) may subsequently increase without successful interventions. The present study critically reviews the global literature on the effectiveness of PA interventions targeting community-dwelling older adults to draw on lessons and applications for future interventions in Saudi Arabia. METHODS This umbrella review of systematic reviews included interventions designed to increase PA and/or reduce SB in community-dwelling older adults. We conducted searches in July 2022 in two electronic databases-PubMed and Embase-and identified relevant peer-reviewed systematic reviews in English. RESULTS Fifteen systematic reviews focusing on community-dwelling older adults were included. Several reviews reported that PA- or SB-based interventions, including eHealth interventions (such as automated advice, tele-counseling, digital PA coaching, automated PA tracking and feedback, online resources, online social support, and video demonstrations), mHealth interventions, and non-eHealth interventions (such as goal setting, individualized feedback, motivational sessions, phone calls, face-to-face education, counseling, supervised exercise sessions, sending educational materials to participants' homes, music, and social marketing programs), were effective in the short term (e.g., ≤ 3 months) but with wide heterogeneity in findings and methodologies. There were limited studies on PA- and SB-based interventions that could be effective for one year or more after the intervention. Most reviews were heavily skewed toward studies carried out in Western communities, limiting their generalizability to Saudi Arabia and other parts of the world. CONCLUSION There is evidence that some PA and SB interventions may be effective in the short term, but high-quality evidence regarding long-term effects is lacking. The cultural, climate, and environmental barriers related to PA and SB in Saudi Arabia require an innovative approach and research to evaluate such interventions in older individuals in the long term.
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Affiliation(s)
- Saleh A. Alessy
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
- Centre for Cancer, Society and Public Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Eric A. Finkelstein
- Duke-NUS Medical School, Health Services and System Research Program, Singapore, Singapore
| | - Reem AlAhmed
- King Faisal Specialist Hospital & Research Center, Liver Transplant Center, Riyadh, Saudi Arabia
| | - Baian A. Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina USA
| | | | | | | | - Hazzaa M. Al-Hazzaa
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- King Faisal Specialist Hospital & Research Center, Liver Transplant Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD USA
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Evenson KR, Alhusseini N, Moore CC, Hamza MM, Al-Qunaibet A, Rakic S, Alsukait RF, Herbst CH, AlAhmed R, Al-Hazzaa HM, Alqahtani SA. Scoping Review of Population-Based Physical Activity and Sedentary Behavior in Saudi Arabia. J Phys Act Health 2023; 20:471-486. [PMID: 37185448 DOI: 10.1123/jpah.2022-0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/10/2023] [Accepted: 02/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Saudi Arabia is experiencing rapid development of the built environment and implementing policy changes to promote physical activity (PA) and reduce sedentary behavior (SB) among its population. In light of these developments, this scoping review systematically summarized population levels of PA/SB in Saudi Arabia. METHODS The authors searched 6 databases on December 13, 2021, for articles published in English or Arabic from 2018 to the search date. Studies using population-based sampling in Saudi Arabia and measuring PA/SB were included. RESULTS Of the 1272 records found, 797 were screened, and 19 studies (9 on children/adolescents age 6-19 y and 10 on adults age 15-75 y) were included. All studies were cross-sectional in design, and 18 studies collected data at only one point in time, ranging from 2009 to 2020. A total of 18 studies relied on self-reporting to assess PA/SB using a variety of questionnaires. Among children/adolescents, approximately 80% to 90% did not attain at least 60 minutes per day of moderate to vigorous PA and 50% to 80% engaged in ≥2 hours per day of screen time or SB. Among adults, approximately 50% to 95% had low or insufficient PA (eg, less than meeting PA guidelines) and about half had a sitting time of ≥5 hours per day. Population-based studies were not found among children <10 years and adults >75 years. CONCLUSIONS A high proportion of participants in the reviewed studies did not meet PA recommendations and spent excessive time in SB. Ongoing surveillance efforts for all ages may help identify target populations for interventions and prioritize the national strategy on PA/SB in Saudi Arabia.
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Affiliation(s)
- Kelly R Evenson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC,USA
| | - Noara Alhusseini
- Department of Biostatistics, Epidemiology and Public Health, College of Medicine, Alfaisal University, Riyadh,Saudi Arabia
| | - Christopher C Moore
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC,USA
| | | | | | | | - Reem F Alsukait
- Department of Community Health Sciences, King Saud University, Riyadh,Saudi Arabia
| | | | - Reem AlAhmed
- Biostatics, Epidemiology, and Science Computing Department, King Faisal Specialist Hospital and Research Center, Riyadh,Saudi Arabia
| | - Hazzaa M Al-Hazzaa
- Lifestyle and Health Research Center, Princess Nourah Bint Abdulrahman University, Riyadh,Saudi Arabia
| | - Saleh A Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital and Research Centre, Riyadh,Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD,USA
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11
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Werner K, Kak M, Herbst CH, Lin TK. Emergency care in post-conflict settings: a systematic literature review. BMC Emerg Med 2023; 23:37. [PMID: 37005602 PMCID: PMC10068156 DOI: 10.1186/s12873-023-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 01/09/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Emergency care systems (ECS) organize and provide access to life-saving care both during transport and at health facilities. Not enough is known about ECS in uncertain contexts such as post-conflict settings. This review aims to systematically identify and summarize the published evidence on the delivery of emergency care in post-conflict settings and to guide health sector planning. METHODS We searched five databases (PubMed MEDLINE, Web of Science, Embase, Scopus, and Cochrane) in September 2021 to identify relevant articles on ECS in post-conflict settings. Included studies (1) described a context that is post-conflict, conflict-affected, or was impacted by war or crisis; (2) examined the delivery of an emergency care system function; (3) were available in English, Spanish, or French; and (4) were published between 1 and 2000 and 9 September 2021. Data were extracted and mapped using the essential system functions identified in the World Health Organization (WHO) ECS Framework to capture findings on essential emergency care functions at the scene of injury or illness, during transport, and through to the emergency unit and early inpatient care. RESULTS We identified studies that describe the unique burden of disease and challenges in delivering to the populations in these states, pointing to particular gaps in prehospital care delivery (both during scene response and during transport). Common barriers include poor infrastructure, lingering social distrust, scarce formal emergency care training, and lack of resources and supplies. CONCLUSION To our knowledge, this is the first study to systematically identify the evidence on ECS in fragile and conflict-affected settings. Aligning ECS with existing global health priorities would ensure access to these critical life-saving interventions, yet there is concern over the lack of investments in frontline emergency care. An understanding of the state of ECS in post-conflict settings is emerging, although current evidence related to best practices and interventions is extremely limited. Careful attention should be paid to addressing the common barriers and context-relevant priorities in ECS, such as strengthening prehospital care delivery, triage, and referral systems and training the health workforce in emergency care principles.
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Affiliation(s)
- Kalin Werner
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, CA, San Francisco, USA.
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
| | - Mohini Kak
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Tracy Kuo Lin
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, CA, San Francisco, USA
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12
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Evenson KR, Alothman SA, Moore CC, Hamza MM, Rakic S, Alsukait RF, Herbst CH, Baattaiah BA, AlAhmed R, Al-Hazzaa HM, Alqahtani SA. A scoping review on the impact of the COVID-19 pandemic on physical activity and sedentary behavior in Saudi Arabia. BMC Public Health 2023; 23:572. [PMID: 36973687 PMCID: PMC10041481 DOI: 10.1186/s12889-023-15422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND In Saudi Arabia, stay-at-home orders to address the coronavirus disease 2019 (COVID-19) pandemic between March 15 and 23, 2020 and eased on May 28, 2020. We conducted a scoping review to systematically describe physical activity and sedentary behavior in Saudi Arabia associated with the timing of the lockdown. METHODS We searched six databases on December 13, 2021 for articles published in English or Arabic from 2018 to the search date. Studies must have reported data from Saudi Arabia for any age and measured physical activity or sedentary behavior. RESULTS Overall, 286 records were found; after excluding duplicates, 209 records were screened, and 19 studies were included in the review. Overall, 15 studies were cross-sectional, and 4 studies were prospective cohorts. Three studies included children and adolescents (age: 2-18 years), and 16 studies included adults (age: 15-99 years). Data collection periods were < = 5 months, with 17 studies collecting data in 2020 only, one study in 2020-2021, and one study in 2021. The median analytic sample size was 363 (interquartile range 262-640). Three studies of children/adolescents collected behaviors online at one time using parental reporting, with one also allowing self-reporting. All three studies found that physical activity was lower during and/or following the lockdown than before the lockdown. Two studies found screen time, television watching, and playing video games were higher during or following the lockdown than before the lockdown. Sixteen adult studies assessed physical activity, with 15 utilizing self-reporting and one using accelerometry. Physical activity, exercise, walking, and park visits were all lower during or following the lockdown than before the lockdown. Six adult studies assessed sedentary behavior using self-report. Sitting time (4 studies) and screen time (2 studies) were higher during or following the lockdown than before the lockdown. CONCLUSIONS Among children, adolescents, and adults, studies consistently indicated that in the short-term, physical activity decreased and sedentary behavior increased in conjunction with the movement restrictions. Given the widespread impact of the pandemic on other health behaviors, it would be important to continue tracking behaviors post-lockdown and identify subpopulations that may not have returned to their physical activity and sedentary behavior to pre-pandemic levels to focus on intervention efforts.
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Affiliation(s)
- Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, NC, Chapel Hill, USA.
| | - Shaima A Alothman
- Lifestyle and Health Research Center, Health Science Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Christopher C Moore
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, NC, Chapel Hill, USA
| | | | | | - Reem F Alsukait
- World Bank Group, Washington, D.C, USA
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Baian A Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem AlAhmed
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Hazzaa M Al-Hazzaa
- Lifestyle and Health Research Center, Health Science Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saleh A Alqahtani
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
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13
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Rao KD, Mehta A, Kautsar H, Kak M, Karem G, Misra M, Joshi H, Herbst CH, Perry HB. Improving quality of non-communicable disease services at primary care facilities in middle-income countries: A scoping review. Soc Sci Med 2023; 320:115679. [PMID: 36731302 DOI: 10.1016/j.socscimed.2023.115679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/02/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Health systems in middle-income countries face important challenges in managing the high burden of Non-Communicable Diseases (NCD). Primary health care is widely recognized as key to managing NCDs in communities. However, the effectiveness of this approach is limited by poor quality of care (QoC), among others. This scoping review identifies the types of interventions that have been used in middle-income countries to improve the quality of NCD services at primary care facilities. Further, it identifies the range of outcomes these quality interventions have influenced. This scoping review covered both the grey and peer-reviewed literature. The 149 articles reviewed were classified into four domains - governance, service-delivery systems, health workforce, and patients and communities. There was a remarkable unevenness in the geographic distribution of studies - lower middle-income countries and some regions (Middle East, North Africa, and South East Asia) had a scarcity of published studies. NCDs such as stroke and cardiovascular disease, mental health, cancer, and respiratory disorders received less attention. The thrust of quality interventions was directed at the practice of NCD care by clinicians, facilities, or patients. Few studies provided evidence from interventions at the organizations or policy levels. Overall, effectiveness of quality interventions was mixed across domains. In general, positive or mixed effects on provider clinical skills and behavior, as well as, improvements in patient outcomes were found across interventions. Access to care and coverage of screening services were positively influenced by the interventions reviewed. This review shows that quality improvement interventions tried in middle-income countries mostly focused at the provider and facility level, with few focusing on the organizational and policy level. There is a need to further study the effectiveness of organizational and policy level interventions on the practice and outcomes of NCD care.
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Affiliation(s)
- Krishna D Rao
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Akriti Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Hunied Kautsar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Madhavi Misra
- Johns Hopkins India Private Limited, New Delhi, India
| | - Harsha Joshi
- Johns Hopkins India Private Limited, New Delhi, India
| | | | - Henry B Perry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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14
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Nikoloski Z, Alghaith T, Herbst CH, Hamza M, AlSaffer Q, Alluhidan M, Dong D, Alsukait R, Alqasem L, Alazemi N. Responsiveness of the healthcare system in the Kingdom of Saudi Arabia: evidence from a nationally representative survey. BMC Health Serv Res 2022; 22:1524. [PMID: 36517822 PMCID: PMC9749241 DOI: 10.1186/s12913-022-08779-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Responsiveness is one of the widely used metrics in assessing the performance of healthcare systems. An analysis of the determinants of health care demand and supply and how the Saudi health system responds to the needs of patients (inpatient and outpatient) is needed; hence the need for this study. METHODS We analysed data from the Saudi Health Systems Responsiveness survey - a nationally representative survey of 10,000 households interviewed in 2017. Using this dataset, we descriptively analysed the level of responsiveness of inpatient and outpatient services (using the standard World Health Organization (WHO) responsiveness dimensions). Based on a logit modelling approach, the relationship between responsiveness and its key determinants was analysed in terms of healthcare demand and supply. RESULTS Over four fifths of respondents are satisfied with the level of inpatient and outpatient responsiveness. Furthermore, we find that those in bad health tend to show lower levels of satisfaction with inpatient and outpatient care. We also find some evidence that age, gender, and to some extent nationality act as correlates of health system responsiveness. Specifically, we find evidence that Saudi nationals are less satisfied with health services compared to foreign nationals. CONCLUSION Based on these findings improving the responsiveness of public healthcare facilities would need to be prioritized. Focusing on patients in worse health and lower socio-economic status should also be one of the main priorities.
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Affiliation(s)
- Zlatko Nikoloski
- grid.13063.370000 0001 0789 5319Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | | | - Mariam Hamza
- grid.431778.e0000 0004 0482 9086World Bank, Washington DC, USA
| | - Quds AlSaffer
- Saudi Health Council, Riyadh, Kingdom of Saudi Arabia
| | | | - Di Dong
- grid.431778.e0000 0004 0482 9086World Bank, Washington DC, USA
| | - Reem Alsukait
- grid.431778.e0000 0004 0482 9086World Bank, Washington DC, USA ,grid.56302.320000 0004 1773 5396Department of Community Health, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Latifah Alqasem
- grid.507413.40000 0001 2178 8237Saudi Arabian Monetary Authority, Riyadh, Kingdom of Saudi Arabia
| | - Nahar Alazemi
- Saudi Health Council, Riyadh, Kingdom of Saudi Arabia
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15
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Lin TK, Werner K, Kak M, Herbst CH. Health-care worker retention in post-conflict settings: a systematic literature review. Health Policy Plan 2022; 38:109-121. [PMID: 36315458 PMCID: PMC9849712 DOI: 10.1093/heapol/czac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/06/2022] [Accepted: 10/29/2022] [Indexed: 11/04/2022] Open
Abstract
Conflicts affect health-care systems not only during but also well beyond periods of violence and immediate crises by draining resources, destroying infrastructure and perpetrating human resource shortages. Improving health-care worker (HCW) retention is critical to limiting the strain placed on health systems already facing infrastructure and financial challenges. We reviewed the evidence on the retention of HCWs in fragile, conflict-affected and post-conflict settings and evaluated strategies and their likely success in improving retention and reducing attrition. We conducted a systematic review of studies, following PRISMA guidelines. Included studies (1) described a context that is post-conflict, conflict-affected or was transformed by war or a crisis; (2) examined the retention of HCWs; (3) were available in English, Spanish or French and (4) were published between 1 January 2000 and 25 April 2021. We identified 410 articles, of which 25 studies, representing 17 countries, met the inclusion criteria. Most of the studies (22 out of 25) used observational study designs and qualitative methods to conduct research. Three studies were literature reviews. This review observed four main themes: migration intention, return migration, work experiences and conditions of service and deployment policies. Using these themes, we identify a consolidated list of six push and pull factors contributing to HCW attrition in fragile, conflict-affected and post-conflict settings. The findings suggest that adopting policies that focus on improving financial incentives, providing professional development opportunities, establishing flexibility and identifying staff with strong community links may ameliorate workforce attrition.
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Affiliation(s)
- Tracy Kuo Lin
- *Corresponding author. Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois St, 124K, San Francisco, CA 94158, USA. E-mail:
| | | | - Mohini Kak
- Health, Nutrition and Population Global Practice, The World Bank, 1818 H Street, N.W., Washington, DC 20433, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, 1818 H Street, N.W., Washington, DC 20433, USA
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16
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Allen LN, Aghilla M, Kak M, Loffreda G, Wild CEK, Hatefi A, Herbst CH, El Saeh H. Conflict as a macrodeterminant of non-communicable diseases: the experience of Libya. BMJ Glob Health 2022; 7:bmjgh-2021-007549. [PMID: 36210068 PMCID: PMC9540835 DOI: 10.1136/bmjgh-2021-007549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/20/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Luke N Allen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Giulia Loffreda
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
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17
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Alluhidan M, Alsukait RF, Alghaith T, Saber R, Alamri A, Al-Muhsen S, Alhowaitan F, Alqarni A, Herbst CH, Alazemi N, Hersi AS. Effectiveness of using e-government platform "Absher" as a tool for noncommunicable diseases survey in Saudi Arabia 2019-2020: A cross-sectional study. Front Public Health 2022; 10:875941. [PMID: 36211643 PMCID: PMC9534281 DOI: 10.3389/fpubh.2022.875941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/31/2022] [Indexed: 01/21/2023] Open
Abstract
Background E-government platforms provide an opportunity to use a novel data source for population health surveillance (also known as e-health). Absher is a Saudi e-government platform with 23 million authenticated users, including residents and citizens in Saudi Arabia. All Absher users were invited to participate in a web-based survey to estimate the prevalence of noncommunicable diseases and their risk factors in Saudi Arabia. Objective To assess the potential of using an e-government platform (Absher) to administer web-based health surveys. Methods A cross-sectional, web-based health survey was administered to Absher users between April 2019 and March 2020. The survey instrument included eight items and took <5 min to complete. The respondents' data were compared to Saudi Arabia's 2016 census. Descriptive summary statistics of the prevalence of major noncommuncable diseases are presented and compared to population-based prevalence data from Saudi Arabia's World Health Survey (WHS) 2019. All analysis was conducted using Stata 13.0. Results Overall, the Absher health survey had a 24.6% response rate, with most respondents being male (84%), Saudi (67%), and between 30 and 44 years of age (49%). Overall, the prevalence of noncommunicable diseases and risk factors among respondents was high for overweight (35%) and obesity (30%) and low for asthma (6%). The prevalence of diabetes, dyslipidemia, and hypertension was between 15 and 17% on average, and 26.5% were smokers. In comparison to population-based World Health Survey estimates, the Absher survey overestimated obesity, diabetes, dyslipidemia, hypertension, and smoking rates, and underestimated overweight, whereas asthma prevalence was similar for Absher and the WHS. Conclusions With improvements in the study design, the use of e-government platforms can provide a useful and potentially low-cost data source for public health research.
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Affiliation(s)
- Mohammed Alluhidan
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia,Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Reem F. Alsukait
- Community Health Department, King Saud University, Riyadh, Saudi Arabia
| | - Taghred Alghaith
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Rana Saber
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Adwa Alamri
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Saleh Al-Muhsen
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Christopher H. Herbst
- Health, Nutrition, and Population Global Practice Group, World Bank, Washington, DC, United States
| | - Nahar Alazemi
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh, Saudi Arabia
| | - Ahmad S. Hersi
- Cardiac Science Department, King Saud University, Riyadh, Saudi Arabia,*Correspondence: Ahmad S. Hersi
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Werner K, Kak M, Herbst CH, Lin TK. The role of community health worker-based care in post-conflict settings: a systematic review. Health Policy Plan 2022; 38:261-274. [PMID: 36124928 PMCID: PMC9923383 DOI: 10.1093/heapol/czac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/28/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022] Open
Abstract
Countries affected by conflict often experience the deterioration of health system infrastructure and weaken service delivery. Evidence suggests that healthcare services that leverage local community dynamics may ameliorate health system-related challenges; however, little is known about implementing these interventions in contexts where formal delivery of care is hampered subsequent to conflict. We reviewed the evidence on community health worker (CHW)-delivered healthcare in conflict-affected settings and synthesized reported information on the effectiveness of interventions and characteristics of care delivery. We conducted a systematic review of studies in OVID MedLine, Web of Science, Embase, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINHAL) and Google Scholar databases. Included studies (1) described a context that is post-conflict, conflict-affected or impacted by war or crisis; (2) examined the delivery of healthcare by CHWs in the community; (3) reported a specific outcome connected to CHWs or community-based healthcare; (4) were available in English, Spanish or French and (5) were published between 1 January 2000 and 6 May 2021. We identified 1976 articles, of which 55 met the inclusion criteria. Nineteen countries were represented, and five categories of disease were assessed. Evidence suggests that CHW interventions not only may be effective but also efficient in circumventing the barriers associated with access to care in conflict-affected areas. CHWs may leverage their physical proximity and social connection to the community they serve to improve care by facilitating access to care, strengthening disease detection and improving adherence to care. Specifically, case management (e.g. integrated community case management) was documented to be effective in improving a wide range of health outcomes and should be considered as a strategy to reduce barrier to access in hard-to-reach areas. Furthermore, task-sharing strategies have been emphasized as a common mechanism for incorporating CHWs into health systems.
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Affiliation(s)
- Kalin Werner
- *Corresponding author. Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois Street, 12th Floor, Box 0646, San Francisco, CA 94158, USA. E-mail:
| | - Mohini Kak
- Health, Nutrition and Population Global Practice, The World Bank, 1818 H Street, N.W., Washington, DC 20433, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, 1818 H Street, N.W., Washington, DC 20433, USA
| | - Tracy Kuo Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois Street, 12th Floor, Box 0646, San Francisco, CA 94158, USA
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Woollacott J, Alsufyani W, Beach RH, T. R. Morrison L, Bean de Hernández A, Rakic S, AlOmran M, Alsukait RF, Herbst CH, AlBalawi S. Effective options for addressing air quality– related environmental public health burdens in Saudi Arabia. Heliyon 2022; 8:e10335. [PMID: 36097490 PMCID: PMC9463589 DOI: 10.1016/j.heliyon.2022.e10335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/15/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Air pollution poses major disease burdens globally and accounts for approximately 10% of deaths annually through its contribution to a variety of respiratory, cardiovascular, and other diseases. The burden of disease is particularly acute in Saudi Arabia, where a mix of anthropogenic and natural sources of air pollution threatens public health. Addressing these burdens requires careful study of the costs and effectiveness of available technologies and policies for reducing emissions (mitigation) and avoiding exposure (adaptation). To help evaluate these options, we conduct a semi-systematic literature review of over 3,000 articles published since 2010 that were identified by searches of literature focused on pollution mitigation and pollution adaptation. We identify a wide variety of effective mitigation and adaptation technologies and find that cost-effectiveness information for policy design is highly variable in the case of mitigation, both within and across pollution source categories; or scarce, in the case of adaptation. While pollution control costs are well studied, policy costs differ; these may vary more by location because of factors such as technology operating conditions and behavioral responses to adaptation initiatives, limiting the generalizability of cost-effectiveness information. Moreover, potential cost advantages of multipollutant control policies are likely to depend on the existing mix of pollution sources and controls. While the policy literature generally favors more flexible compliance mechanisms that increase the cost of polluting to reflect its costs to society, important policy design factors include policy co-benefits, distributional concerns, and inter-regional harmonization. In addition to these key themes, we find that further study is needed both to improve the availability of cost information for adaptation interventions and to localize technology and policy cost estimates to the Saudi context. Literature review of environmental public health technology and policy options. Air pollution mitigation options have considerable cost variation. Air pollution adaptation options lack thorough cost effectiveness evaluation. Policy effectiveness will depend heavily on local conditions and design. Saudi Arabia requires a mix of mitigation and adaptation public health options.
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Malkin J, Finkelstein E, Baid D, Alqunaibet A, Almudarra S, Herbst CH, Dong D, Alsukait R, El-Saharty S, Algwizani A. Impact of noncommunicable diseases on direct medical costs and worker productivity, Saudi Arabia. East Mediterr Health J 2022; 28:296-301. [DOI: 10.26719/emhj/22.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022]
Abstract
Background: The prevalence of noncommunicable diseases (NCDs) has been increasing in Saudi Arabia. Aims: Our objective was to estimate the effect of NCDs on direct medical costs and workforce productivity in Saudi Arabia. Methods: To estimate direct medical costs, we estimated the unit cost of treating 10 NCDs, then multiplied the unit cost by disease prevalence and summed across diseases. To estimate workforce productivity losses, we multiplied gross domestic product per person in the labour force by the loss in productivity from each NCD and the prevalence in the labour force of each NCD. Results: We estimated annual direct medical costs of 11.8 billion international dollars (Int$) for the 10 NCDs assessed (13.6% of total annual health expenditure). We estimated workforce productivity losses of Int$ 75.7 billion (4.5% of gross domestic product). Conclusion: The economic burden of NCDs in Saudi Arabia – particularly the effect on worker productivity – is substantial.
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21
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Lin TK, Werner K, Witter S, Alluhidan M, Alghaith T, Hamza MM, Herbst CH, Alazemi N. Individual performance-based incentives for health care workers in Organisation for Economic Co-operation and Development member countries: a systematic literature review. Health Policy 2022; 126:512-521. [DOI: 10.1016/j.healthpol.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
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22
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Malkin JD, Baid D, Alsukait RF, Alghaith T, Alluhidan M, Alabdulkarim H, Altowaijri A, Almalki ZS, Herbst CH, Finkelstein EA, El-Saharty S, Alazemi N. The economic burden of overweight and obesity in Saudi Arabia. PLoS One 2022; 17:e0264993. [PMID: 35259190 PMCID: PMC8903282 DOI: 10.1371/journal.pone.0264993] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
CONTEXT The prevalence of overweight and obesity in Saudi Arabia has been rising. Although the health burden of excess weight is well established, little is known about the economic burden. AIMS To assess the economic burden-both direct medical costs and the value of absenteeism and presenteeism-resulting from overweight and obesity in Saudi Arabia. SETTINGS AND DESIGN The cost of overweight and obesity in Saudi Arabia was estimated from a societal perspective using an epidemiologic approach. METHODS AND MATERIALS Data were obtained from previously published studies and secondary databases. STATISTICAL ANALYSIS USED Overweight/obesity-attributable costs were calculated for six major noncommunicable diseases; sensitivity analyses were conducted for key model parameters. RESULTS The impact of overweight and obesity for these diseases is found to directly cost a total of $3.8 billion, equal to 4.3 percent of total health expenditures in Saudi Arabia in 2019. Estimated overweight and obesity-attributable absenteeism and presenteeism costs a total of $15.5 billion, equal to 0.9 percent of GDP in 2019. CONCLUSIONS Even when limited to six diseases and a subset of total indirect costs, results indicate that overweight and obesity are a significant economic burden in Saudi Arabia. Future studies should identify strategies to reduce the health and economic burden resulting from excess weight in Saudi Arabia.
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Affiliation(s)
- Jesse D. Malkin
- World Bank Group Consultant, Colorado Springs, Colo., United States of America
| | - Drishti Baid
- Sol Price School of Public Policy, University of Southern California, Los Angeles, Calif., United States of America
| | - Reem F. Alsukait
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Health, Nutrition and Population Global Practice, World Bank, Riyadh, Saudi Arabia
| | | | - Mohammed Alluhidan
- Saudi Health Council, Riyadh, Saudi Arabia
- Lancaster University, Lancaster, United Kingdom
| | - Hana Alabdulkarim
- Drug Policy and Economic Centre, Ministry of National Guards Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz Altowaijri
- Program for Health Assurance and Purchasing, Ministry of Health, Riyadh, Saudi Arabia
| | - Ziyad S. Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | | | - Sameh El-Saharty
- Health, Nutrition and Population Global Practice, World Bank, Kuwait City, Kuwait
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23
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Bisanzio D, Reithinger R, Alqunaibet A, Almudarra S, Alsukait RF, Dong D, Zhang Y, El-Saharty S, Herbst CH. Estimating the effect of non-pharmaceutical interventions to mitigate COVID-19 spread in Saudi Arabia. BMC Med 2022; 20:51. [PMID: 35125108 PMCID: PMC8818364 DOI: 10.1186/s12916-022-02232-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/03/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The Kingdom of Saudi Arabia (KSA) quickly controlled the spread of SARS-CoV-2 by implementing several non-pharmaceutical interventions (NPIs), including suspension of international and national travel, local curfews, closing public spaces (i.e., schools and universities, malls and shops), and limiting religious gatherings. The KSA also mandated all citizens to respect physical distancing and to wear face masks. However, after relaxing some restrictions during June 2020, the KSA is now planning a strategy that could allow resuming in-person education and international travel. The aim of our study was to evaluate the effect of NPIs on the spread of the COVID-19 and test strategies to open schools and resume international travel. METHODS We built a spatial-explicit individual-based model to represent the whole KSA population (IBM-KSA). The IBM-KSA was parameterized using country demographic, remote sensing, and epidemiological data. A social network was created to represent contact heterogeneity and interaction among age groups of the population. The IBM-KSA also simulated the movement of people across the country based on a gravity model. We used the IBM-KSA to evaluate the effect of different NPIs adopted by the KSA (physical distancing, mask-wearing, and contact tracing) and to forecast the impact of strategies to open schools and resume international travels. RESULTS The IBM-KSA results scenarios showed the high effectiveness of mask-wearing, physical distancing, and contact tracing in controlling the spread of the disease. Without NPIs, the KSA could have reported 4,824,065 (95% CI: 3,673,775-6,335,423) cases by June 2021. The IBM-KSA showed that mandatory mask-wearing and physical distancing saved 39,452 lives (95% CI: 26,641-44,494). In-person education without personal protection during teaching would have resulted in a high surge of COVID-19 cases. Compared to scenarios with no personal protection, enforcing mask-wearing and physical distancing in schools reduced cases, hospitalizations, and deaths by 25% and 50%, when adherence to these NPIs was set to 50% and 70%, respectively. The IBM-KSA also showed that a quarantine imposed on international travelers reduced the probability of outbreaks in the country. CONCLUSIONS This study showed that the interventions adopted by the KSA were able to control the spread of SARS-CoV-2 in the absence of a vaccine. In-person education should be resumed only if NPIs could be applied in schools and universities. International travel can be resumed but with strict quarantine rules. The KSA needs to keep strict NPIs in place until a high fraction of the population is vaccinated in order to reduce hospitalizations and deaths.
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Affiliation(s)
- Donal Bisanzio
- RTI International, Washington, D.C., USA. .,Epidemiology and Public Health Division, School of Medicine, University of Nottingham, Nottingham, UK.
| | | | | | | | - Reem F Alsukait
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,World Bank, Washington, D.C., USA
| | - Di Dong
- World Bank, Washington, D.C., USA
| | - Yi Zhang
- World Bank, Washington, D.C., USA
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24
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Malkin JD, Finkelstein EA, Baid D, Alqunaibet A, Almudarra S, Herbst CH, Dong D, Alsukait R, El-Saharty S, Algwizani A. Impact of noncommunicable diseases on direct medical costs and worker productivity, Saudi Arabia. East Mediterr Health J 2022. [DOI: 10.26719/emhj.22.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: The prevalence of noncommunicable diseases (NCDs) has been increasing in Saudi Arabia. Aim: Our objective was to estimate the effect of NCDs on direct medical costs and workforce productivity in Saudi Arabia. Methods: To estimate direct medical costs, we estimated the unit cost of treating 10 NCDs, then multiplied the unit cost by disease prevalence and summed across diseases. To estimate workforce productivity losses, we multiplied gross domestic product per person in the labour force by the loss in productivity from each NCD and the prevalence in the labour force of each NCD. Results: We estimated annual direct medical costs of 11.8 billion international dollars (Int$) for the 10 NCDs assessed (13.6% of total annual health expenditure). We estimated workforce productivity losses of Int$ 75.7 billion (4.5% of gross domestic product). Conclusion: The economic burden of NCDs in Saudi Arabia – particularly the effect on worker productivity – is substantial.
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25
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Perez-Saez J, Lee EC, Wada NI, Alqunaibet AM, Almudarra SS, Alsukait RF, Dong D, Zhang Y, El Saharty S, Herbst CH, Lessler J. Effect of non-pharmaceutical interventions in the early phase of the COVID-19 epidemic in Saudi Arabia. PLOS Glob Public Health 2022; 2:e0000237. [PMID: 36962205 PMCID: PMC10021433 DOI: 10.1371/journal.pgph.0000237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/13/2022] [Indexed: 11/19/2022]
Abstract
Non-pharmaceutical interventions have been widely employed to control the COVID-19 pandemic. Their associated effect on SARS-CoV-2 transmission have however been unequally studied across regions. Few studies have focused on the Gulf states despite their potential role for global pandemic spread, in particular in the Kingdom of Saudi Arabia through religious pilgrimages. We study the association between NPIs and SARS-CoV-2 transmission in the Kingdom of Saudi Arabia during the first pandemic wave between March and October 2020. We infer associations between NPIs introduction and lifting through a spatial SEIR-type model that allows for inferences of region-specific changes in transmission intensity. We find that reductions in transmission were associated with NPIs implemented shortly after the first reported case including Isolate and Test with School Closure (region-level mean estimates of the reduction in R0 ranged from 25-41%), Curfew (20-70% reduction), and Lockdown (50-60% reduction), although uncertainty in the estimates was high, particularly for the Isolate and Test with School Closure NPI (95% Credible Intervals from 1% to 73% across regions). Transmission was found to increase progressively in most regions during the last part of NPI relaxation phases. These results can help informing the policy makers in the planning of NPI scenarios as the pandemic evolves with the emergence of SARS-CoV-2 variants and the availability of vaccination.
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Affiliation(s)
- Javier Perez-Saez
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nikolas I Wada
- Johns Hopkins Novel Coronavirus Research Compendium, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Reem F Alsukait
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Health, Nutrition and Population Global Practice, World Bank Group, Washington DC, United States of America
| | - Di Dong
- Health, Nutrition and Population Global Practice, World Bank Group, Washington DC, United States of America
| | - Yi Zhang
- Health, Nutrition and Population Global Practice, World Bank Group, Washington DC, United States of America
| | - Sameh El Saharty
- Health, Nutrition and Population Global Practice, World Bank Group, Washington DC, United States of America
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, World Bank Group, Washington DC, United States of America
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
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26
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Witter S, Herbst CH, Smitz M, Balde MD, Magazi I, Zaman RU. How to attract and retain health workers in rural areas of a fragile state: Findings from a labour market survey in Guinea. PLoS One 2021; 16:e0245569. [PMID: 34914691 PMCID: PMC8675729 DOI: 10.1371/journal.pone.0245569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Most countries face challenges attracting and retaining health staff in remote areas but this is especially acute in fragile and shock-prone contexts, like Guinea, where imbalances in staffing are high and financial and governance arrangements to address rural shortfalls are weak. The objective of this study was to understand how health staff could be better motivated to work and remain in rural, under-served areas in Guinea. In order to inform the policy dialogue on strengthening human resources for health, we conducted three nationally representative cross-sectional surveys, adapted from tools used in other fragile contexts. This article focuses on the health worker survey. We found that the locational job preferences of health workers in Guinea are particularly influenced by opportunities for training, working conditions, and housing. Most staff are satisfied with their work and with supervision, however, financial aspects and working conditions are considered least satisfactory, and worrying findings include the high proportion of staff favouring emigration, their high tolerance of informal user payments, as well as their limited exposure to rural areas during training. Based on our findings, we highlight measures which could improve rural recruitment and retention in Guinea and similar settings. These include offering upgrading and specialization in return for rural service; providing greater exposure to rural areas during training; increasing recruitment from rural areas; experimenting with fixed term contracts in rural areas; and improving working conditions in rural posts. The development of incentive packages should be accompanied by action to tackle wider issues, such as reforms to training and staff management.
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Affiliation(s)
- Sophie Witter
- Institute of Global Health and Development & ReBUILD for Resilience, Queen Margaret University, Edinburgh, United Kingdom
- Oxford Policy Management, Oxford, United Kingdom
- * E-mail:
| | | | - Marc Smitz
- Oxford Policy Management, Oxford, United Kingdom
| | - Mamadou Dioulde Balde
- Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), Conakry, Guinea
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27
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Lin TK, Bruckner TA, Alghaith T, Hamza MM, Alluhidan M, Herbst CH, Alghodaier H, Alamri A, Saber R, Alazemi N, Liu JX. Correction to: Projecting health labor market dynamics for a health system in transition: planning for a resilient health workforce in Saudi Arabia. Global Health 2021; 17:127. [PMID: 34724960 PMCID: PMC8559342 DOI: 10.1186/s12992-021-00773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois St, San Francisco, CA, 94158, USA.
| | - Tim A Bruckner
- Center for Population, Inequality, and Policy, University of California, Irvine, USA
| | | | | | | | | | | | | | - Rana Saber
- Saudi Health Council, Riyadh, Saudi Arabia
| | | | - Jenny X Liu
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois St, San Francisco, CA, 94158, USA
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Lin TK, Bruckner TA, Alghaith T, Hamza MM, Alluhidan M, Herbst CH, Alghodaier H, Alamri A, Saber R, Alazemi N, Liu JX. Projecting health labor market dynamics for a health system in transition: planning for a resilient health workforce in Saudi Arabia. Global Health 2021; 17:105. [PMID: 34521436 PMCID: PMC8439018 DOI: 10.1186/s12992-021-00747-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background Health workforce planning is critical for health systems to safeguard the ability to afford, train, recruit, and retain the appropriate number and mix of health workers. This balance is especially important when macroeconomic structures are also reforming. The Kingdom of Saudi Arabia is moving toward greater diversification, privatization, and resiliency; health sectorreform is a key pillar of this transition. Methods We used the Ministry of Health Yearbook data on the number of workers and health expenditures from 2007 to 2018 and projected health labor market supply and demand of workers through 2030, evaluated the potential shortages and surpluses, and simulated different policy scenarios to identify relevant interventions. We further focused on projections for health workers who are Saudi nationals and health worker demand within the public sector (versus the private sector) to inform national objectives of reducing dependency on foreign workers and better deploying public sector resources. Results We projected the overall health labor market to demand 9.07 physicians and nurses per 1,000 population (356,514) in 2030; the public sector will account for approximately 67% of this overall demand. Compared to a projected supply of 10.16 physicians and nurses per 1,000 population (399,354), we estimated an overall modest surplus of about 42,840 physicians and nurses in 2030. However, only about 17% of these workers are estimated to be Saudi nationals, for whom there will be a demand shortage of 287,895 workers. Among policy scenarios considered, increasing work hours had the largest effect on reducing shortages of Saudi workers, followed by bridge programs for training more nurses. Government resources can also be redirected to supporting more Saudi nurses while still ensuring adequate numbers of physicians to meet service delivery goals in 2030. Conclusion Despite projected overall balance in the labor market for health workers in 2030, without policy interventions, severe gaps in the Saudi workforce will persist and limit progress toward health system resiliency in Saudi Arabia. Both supply- and demand-side policy interventions should be considered, prioritizing those that increase productivity among Saudi health workers, enhance training for nurses, and strategically redeploy financial resources toward employing these workers. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00747-8.
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Affiliation(s)
- Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois St, CA, 94158, San Francisco, USA.
| | - Tim A Bruckner
- Center for Population, Inequality, and Policy, University of California, Irvine, USA
| | | | | | | | | | | | | | - Rana Saber
- Saudi Health Council, Riyadh, Saudi Arabia
| | | | - Jenny X Liu
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois St, CA, 94158, San Francisco, USA
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29
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Chen S, Guo L, Alghaith T, Dong D, Alluhidan M, Hamza MM, Herbst CH, Zhang X, Tagtag GCA, Zhang Y, Alazemi N, Saber R, Alsukait R, Tang S. Effective COVID-19 Control: A Comparative Analysis of the Stringency and Timeliness of Government Responses in Asia. Int J Environ Res Public Health 2021; 18:ijerph18168686. [PMID: 34444434 PMCID: PMC8393310 DOI: 10.3390/ijerph18168686] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022]
Abstract
Aim: Many governments in East and Southeast Asia responded promptly and effectively at the onset of the COVID-19 pandemic. Synthesizing and analyzing these responses is vital for disease control evidence-based policymaking. Methods: An extensive review of COVID-19 control measures was conducted in selected Asian countries and subregions, including Mainland China, Hong Kong, Taiwan, South Korea, Singapore, Japan, and Vietnam from 1 January to 30 May 2020. Control measures were categorized into administrative, public health, and health system measures. To evaluate the stringency and timeliness of responses, we developed two indices: the Initial Response Index (IRI) and the Modified Stringency Index (MSI), which builds on the Oxford COVID-19 Government Response Tracker (OxCGRT). Results: Comprehensive administrative, public health, and health system control measures were implemented at the onset of the outbreak. Despite variations in package components, the stringency of control measures across the study sites increased with the acceleration of the outbreak, with public health control measures implemented the most stringently. Variations in daily average MSI scores are observed, with Mainland China scoring the highest (74.2), followed by Singapore (67.4), Vietnam (66.8), Hong Kong (66.2), South Korea (62.3), Taiwan (52.1), and Japan (50.3). Variations in IRI scores depicting timeliness were higher: Hong Kong, Taiwan, Vietnam, and Singapore acted faster (IRI > 50.0), while Japan (42.4) and Mainland China (4.2) followed. Conclusions: Timely setting of stringency of the control measures, especially public health measures, at dynamically high levels is key to optimally controlling outbreaks.
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Affiliation(s)
- Shu Chen
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney 2052, Australia
- School of Risk and Actuarial Studies, University of New South Wales, Sydney 2052, Australia
- Correspondence:
| | - Lei Guo
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA; (L.G.); (X.Z.); (S.T.)
| | - Taghred Alghaith
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh 13315, Saudi Arabia; (T.A.); (M.A.); (N.A.); (R.S.)
| | - Di Dong
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC 20433, USA; (D.D.); (M.M.H.); (C.H.H.); (Y.Z.); (R.A.)
| | - Mohammed Alluhidan
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh 13315, Saudi Arabia; (T.A.); (M.A.); (N.A.); (R.S.)
- Division of Health Research, Lancaster University, Bailrigg LA1 4YX, UK
| | - Mariam M. Hamza
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC 20433, USA; (D.D.); (M.M.H.); (C.H.H.); (Y.Z.); (R.A.)
| | - Christopher H. Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC 20433, USA; (D.D.); (M.M.H.); (C.H.H.); (Y.Z.); (R.A.)
| | - Xinqi Zhang
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA; (L.G.); (X.Z.); (S.T.)
| | | | - Yi Zhang
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC 20433, USA; (D.D.); (M.M.H.); (C.H.H.); (Y.Z.); (R.A.)
| | - Nahar Alazemi
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh 13315, Saudi Arabia; (T.A.); (M.A.); (N.A.); (R.S.)
| | - Rana Saber
- General Directorate for National Health Economics and Policy, Saudi Health Council, Riyadh 13315, Saudi Arabia; (T.A.); (M.A.); (N.A.); (R.S.)
| | - Reem Alsukait
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC 20433, USA; (D.D.); (M.M.H.); (C.H.H.); (Y.Z.); (R.A.)
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA; (L.G.); (X.Z.); (S.T.)
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30
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Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH, Alsukait RF, Alluhidan M, Alazemi N, Shekar M. Reply to the John Speakman critique of "Impact of obesity on COVID-19 related mortality: A comment on estimates in Popkin et al (2020)" published in Obesity Reviews. Obes Rev 2021; 22:e13259. [PMID: 33855774 DOI: 10.1111/obr.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Barry M Popkin
- Health, Nutrition and Population Department, The World Bank, Washington DC, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shufa Du
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William D Green
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melinda A Beck
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Reem F Alsukait
- Health, Nutrition and Population Department, The World Bank, Washington DC, USA.,Community Health Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | | | - Nahar Alazemi
- Saudi Health Council, Riyadh, Kingdom of Saudi Arabia
| | - Meera Shekar
- Health, Nutrition and Population Department, The World Bank, Washington DC, USA
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Nikoloski Z, Alqunaibet AM, Alfawaz RA, Almudarra SS, Herbst CH, El-Saharty S, Alsukait R, Algwizani A. Covid-19 and non-communicable diseases: evidence from a systematic literature review. BMC Public Health 2021; 21:1068. [PMID: 34090396 PMCID: PMC8178653 DOI: 10.1186/s12889-021-11116-w] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022] Open
Abstract
Background Since early 2020, the Covid-19 pandemic has engulfed the world. Amidst the growing number of infections and deaths, there has been an emphasis of patients with non-communicable diseases as they are particularly susceptible to the virus. The objective of this literature review is to systematize the available evidence on the link between non-communicable diseases and Covid-19. Methods We have conducted a systematic review of the literature on Covid-19 and non-communicable diseases from December, 2019 until 15th of November, 2020. The search was done in PubMed and in doing so we used a variety of searching terms in order to isolate the final set of papers. At the end of the selection process, 45 papers were selected for inclusion in the literature review. Results The results from the review indicate that patients with certain chronic illnesses such as diabetes, hypertension (and other cardiovascular diseases), chronic respiratory illnesses, chronic kidney and liver conditions are more likely to be affected by Covid-19. More importantly, once they do get infected by the virus, patients with chronic illnesses have a much higher likelihood of having worse clinical outcomes (developing a more severe form of the disease or dying) than an average patient. There are two hypothesized channels that explain this strong link between the chronic illnesses enumerated above and Covid 19: (i) increased ACE2 (angiotensin-converting enzyme 2) receptor expressions, which facilitates the entry of the virus into the host body; and (ii) hyperinflammatory response, referred to as “cytokine storm”. Finally, the literature review does not find any evidence that diabetes or hypertension related medications exacerbate the overall Covid-19 condition in chronic illness patients. Conclusions Thus, the evidence points out to ‘business as usual’ disease management model, although with greater supervision. However, given the ongoing Covid-19 vulnerabilities among people with NCDs, prioritizing them for the vaccination process should also figure high on the agenda on health authorities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11116-w.
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Affiliation(s)
| | | | | | | | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, World Bank Group, Riyadh, Saudi Arabia
| | - Sameh El-Saharty
- Health, Nutrition and Population Global Practice, World Bank Group, Kuwait City, Kuwait
| | - Reem Alsukait
- Health, Nutrition and Population Global Practice, World Bank Group, Riyadh, Saudi Arabia
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Herbst CH, Bouteau A, Igyártó BZ. Langerhans cells rely on good neighbors to overcome gene deficiencies. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.96.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
We recently identified that epidermal resident Langerhans Cells (LCs) acquire gene expression fingerprints from surrounding Keratinocytes (KCs) in the form of mRNA and protein. In the present study, we aimed to determine whether this transfer can also overcome gene deficiencies. For this purpose, using the Cre/Lox system, we specifically deleted genes for Connexin 43 (Cx43), MyD88, and MHC-II in LCs. While all three genes underwent recombination, reduced protein levels were only observed for MHC-II, whereas Cx43 and MyD88 protein levels remained unaltered. Considering that KCs lack MHC-II, but express Cx43 and MyD88 at high levels, we posit that LCs can acquire gene products from surrounding KCs to overcome their own deficiencies if those products are available.
In summary, we present evidence that cells can compensate for gene deficiencies if the surrounding cells can provide. These findings highlight the limitations of cell-specific gene deletion, and could provide an explanation as to why certain gene deletions do not lead to measurable deficiencies.
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Gailey S, Bruckner TA, Lin TK, Liu JX, Alluhidan M, Alghaith T, Alghodaier H, Tashkandi N, Herbst CH, Hamza MM, Alazemi N. A needs-based methodology to project physicians and nurses to 2030: the case of the Kingdom of Saudi Arabia. Hum Resour Health 2021; 19:55. [PMID: 33902617 PMCID: PMC8072319 DOI: 10.1186/s12960-021-00597-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Kingdom of Saudi Arabia (KSA), as part of its 2030 National Transformation Program, set a goal of transforming the healthcare sector to increase access to, and improve the quality and efficiency of, health services. To assist with the workforce planning component, we projected the needed number of physicians and nurses into 2030. We developed a new needs-based methodology since previous global benchmarks of health worker concentration may not apply to the KSA. METHODS We constructed an epidemiologic "needs-based" model that takes into account the health needs of the KSA population, cost-effective treatment service delivery models, and worker productivity. This model relied heavily on up-to-date epidemiologic and workforce surveys in the KSA. We used demographic population projections to estimate the number of nurses and physicians needed to provide this core set of services into 2030. We also assessed several alternative scenarios and policy decisions related to scaling, task-shifting, and enhanced public health campaigns. RESULTS When projected to 2030, the baseline needs-based estimate is approximately 75,000 workers (5788 physicians and 69,399 nurses). This workforce equates to 2.05 physicians and nurses per 1000 population. Alternative models based on different scenarios and policy decisions indicate that the actual needs for physicians and nurses may range from 1.64 to 3.05 per 1000 population in 2030. CONCLUSIONS Based on our projections, the KSA will not face a needs-based health worker shortage in 2030. However, alternative model projections raise important policy and planning issues regarding various strategies the KSA may pursue in improving quality and efficiency of the existing workforce. More broadly, where country-level data are available, our needs-based strategy can serve as a useful step-by-step workforce planning tool to complement more economic demand-based workforce projections.
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Affiliation(s)
- Samantha Gailey
- School of Social Ecology, University of California Irvine, Irvine, CA, USA.
| | - Tim A Bruckner
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - Tracy Kuo Lin
- Department of Clinical Pharmacy, Medication Outcomes Center, University of California San Francisco, San Francisco, CA, USA
| | - Jenny X Liu
- Department of Social and Behavioral Sciences, Institute for Health and Aging, University of California San Francisco, San Francisco, CA, USA
| | - Mohammed Alluhidan
- Saudi Health Council, Riyadh, Saudi Arabia
- Lancaster University, Lancashire, UK
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Al Saffer Q, Al-Ghaith T, Alshehri A, Al-Mohammed R, Al Homidi S, Hamza MM, Herbst CH, Alazemi N. The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources. BMC Health Serv Res 2021; 21:365. [PMID: 33879136 PMCID: PMC8056511 DOI: 10.1186/s12913-021-06355-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Primary healthcare (PHC) is an essential component of an effective healthcare system. The Kingdom of Saudi Arabia’s (KSA) health reforms prioritize tackling the increasing noncommunicable disease burden by prioritizing PHC, centering it as the core of the newly proposed Model of Care. To identify challenges and opportunities to scale up PHC capacity, understanding the current capacity of primary health care centers (PHCC) is critical. A limited number of publications review PHC capacity in KSA, focusing on specific regions/sectors; this paper is a first to examine PHC capacity on a national level. Methods The study uses a countrywide Facility Survey that collected data in 2018 from 2319 PHCCs, generating information on their characteristics, number of health workers, services provided, and capacity elements captured through the Service Availability and Drug Availability constructed indices. Descriptive analysis was performed by rural-urban classification. Ordinary Least Squares (OLS) regressions were used to understand correlates to health workers and equipment availability. Finally, a logistic regression was fitted for selected services. Regressions controlled for various measures to determine correlates with facilities’ capacity. Results On a national level, there are 0.74 PHCCs per 10,000 population in KSA. There are variations in the distribution of PHCCs across regions and within regions across rural and urban areas. PHCCs in urban areas have more examination rooms but lower examination room densities. Offering 24 × 7 services in PHCCs is infrequent and dependency on paper-based medical recording remains common. More urban regions are more likely to offer general services but less likely to offer burn management and emergency services. PHCCs are mostly staffed with general medicine, family medicine, and obstetrics & gynecology physicians, whose numbers are more concentrated in urban areas; however, their densities are higher in rural areas. Finally, psychiatrists and nutritionists are rare to find in PHCCs. Conclusions Decision-makers need to consider several factors when designing PHC policies. For instance, PHC accreditation needs to be prioritized given its positive correlation with service provision and health workers availability. PHC 24 × 7 operation also needs considerations in rural areas due to the high dependency on PHCCs. Finally, there is a substantial need for improvements in e-health.
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Rojas-Rueda D, Morales-Zamora E, Alsufyani WA, Herbst CH, AlBalawi SM, Alsukait R, Alomran M. Environmental Risk Factors and Health: An Umbrella Review of Meta-Analyses. Int J Environ Res Public Health 2021; 18:ijerph18020704. [PMID: 33467516 PMCID: PMC7830944 DOI: 10.3390/ijerph18020704] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/31/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
Background: Environmental health is a growing area of knowledge, continually increasing and updating the body of evidence linking the environment to human health. Aim: This study summarizes the epidemiological evidence on environmental risk factors from meta-analyses through an umbrella review. Methods: An umbrella review was conducted on meta-analyses of cohort, case-control, case-crossover, and time-series studies that evaluated the associations between environmental risk factors and health outcomes defined as incidence, prevalence, and mortality. The specific search strategy was designed in PubMed using free text and Medical Subject Headings (MeSH) terms related to risk factors, environment, health outcomes, observational studies, and meta-analysis. The search was limited to English, Spanish, and French published articles and studies on humans. The search was conducted on September 20, 2020. Risk factors were defined as any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or death. The environment was defined as the external elements and conditions that surround, influence, and affect a human organism or population’s life and development. The environment definition included the physical environment such as nature, built environment, or pollution, but not the social environment. We excluded occupational exposures, microorganisms, water, sanitation and hygiene (WASH), behavioral risk factors, and no-natural disasters. Results: This umbrella review found 197 associations among 69 environmental exposures and 83 diseases and death causes reported in 103 publications. The environmental factors found in this review were air pollution, environmental tobacco smoke, heavy metals, chemicals, ambient temperature, noise, radiation, and urban residential surroundings. Among these, we identified 65 environmental exposures defined as risk factors and 4 environmental protective factors. In terms of study design, 57 included cohort and/or case-control studies, and 46 included time-series and/or case-crossover studies. In terms of the study population, 21 included children, and the rest included adult population and both sexes. In this review, the largest body of evidence was found in air pollution (91 associations among 14 air pollution definitions and 34 diseases and mortality diagnoses), followed by environmental tobacco smoke with 24 associations. Chemicals (including pesticides) were the third larger group of environmental exposures found among the meta-analyses included, with 19 associations. Conclusion: Environmental exposures are an important health determinant. This review provides an overview of an evolving research area and should be used as a complementary tool to understand the connections between the environment and human health. The evidence presented by this review should help to design public health interventions and the implementation of health in all policies approach aiming to improve populational health.
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Affiliation(s)
- David Rojas-Rueda
- Department of Environmental and Radiological Health Sciences, Colorado State University, Environmental Health Building, 1601 Campus Delivery, Fort Collins, CO 80523, USA
- Correspondence: ; Tel.: +1-(970)-491-7038; Fax: +1-(970)-491-2940
| | | | - Wael Abdullah Alsufyani
- Saudi Center for Disease Prevention and Control, 70 SCDC Building, Al Aarid, King Abdulaziz Rd, Riyadh 13354, Saudi Arabia; (W.A.A.); (S.M.A.); (M.A.)
| | - Christopher H. Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Diplomatic Quarter, Riyadh Country Office, Riyadh 94623, Saudi Arabia; (C.H.H.); (R.A.)
| | - Salem M. AlBalawi
- Saudi Center for Disease Prevention and Control, 70 SCDC Building, Al Aarid, King Abdulaziz Rd, Riyadh 13354, Saudi Arabia; (W.A.A.); (S.M.A.); (M.A.)
| | - Reem Alsukait
- Health, Nutrition and Population Global Practice, The World Bank, Diplomatic Quarter, Riyadh Country Office, Riyadh 94623, Saudi Arabia; (C.H.H.); (R.A.)
- Community Health Department, King Saud University, Riyadh 11433, Saudi Arabia
| | - Mashael Alomran
- Saudi Center for Disease Prevention and Control, 70 SCDC Building, Al Aarid, King Abdulaziz Rd, Riyadh 13354, Saudi Arabia; (W.A.A.); (S.M.A.); (M.A.)
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Finkelstein EA, Malkin JD, Baid D, Alqunaibet A, Mahdi K, Al-Thani MBH, Abdulla Bin Belaila B, Al Nawakhtha E, Alqahtani S, El-Saharty S, Herbst CH. The impact of seven major noncommunicable diseases on direct medical costs, absenteeism, and presenteeism in Gulf Cooperation Council countries. J Med Econ 2021; 24:828-834. [PMID: 34138664 DOI: 10.1080/13696998.2021.1945242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS To estimate the current burden of seven major noncommunicable diseases on direct medical costs, absenteeism, and presenteeism in the six countries in the Gulf Cooperation Council: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. MATERIALS AND METHODS We used data from pre-existing datasets and the literature. We identified seven major noncommunicable diseases for which data were available: coronary heart disease, stroke, type-2 diabetes mellitus, breast cancer, colon cancer, chronic obstructive pulmonary disease, and asthma. We estimated the per unit cost (the annual cost of treating each illness for one person) of each disease, multiplied per unit cost by disease prevalence counts to generate disease-specific costs, and then summed across diseases. We calculated the cost of absenteeism and presenteeism by multiplying the gross domestic product per person in the labor force by the loss in productivity from each disease due to absenteeism and presenteeism, respectively, and the prevalence in the labor force of each disease. RESULTS We estimate that the direct medical costs of seven major noncommunicable diseases in Gulf Cooperation Council countries are $16.7 billion (2019 International $), equal to 0.6% of gross domestic product. We estimate that absenteeism and presenteeism due to these seven noncommunicable diseases cost 0.5 and 2.2% of gross domestic product, respectively. LIMITATIONS Our study does not capture all noncommunicable diseases and does not capture all types of indirect costs. Our cost estimates are particularly sensitive to our assumptions regarding type-2 diabetes mellitus. CONCLUSION The economic burden of noncommunicable diseases in Gulf Cooperation Council countries is substantial, suggesting that successful preventive interventions have the potential to improve both population health and reduce costs. Further research is needed to capture a broader array of noncommunicable diseases and to develop more precise estimates.
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Affiliation(s)
| | | | - Drishti Baid
- Duke-NUS Medical School, Health Services and System Research Program, Singapore, Singapore
| | | | - Khaled Mahdi
- Supreme Council for Planning and Development, Kuwait City, Kuwait
| | | | | | | | - Saleh Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
| | - Sameh El-Saharty
- Health, Nutrition and Population Global Practice, World Bank, Kuwait City, Kuwait
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, World Bank, Riyadh, Saudi Arabia
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Alluhidan M, Tashkandi N, Alblowi F, Omer T, Alghaith T, Alghodaier H, Alazemi N, Tulenko K, Herbst CH, Hamza MM, Alghamdi MG. Challenges and policy opportunities in nursing in Saudi Arabia. Hum Resour Health 2020; 18:98. [PMID: 33276794 PMCID: PMC7716289 DOI: 10.1186/s12960-020-00535-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/10/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND The Kingdom of Saudi Arabia's (KSA) health sector is undergoing rapid reform in line with the National Transformation Program, as part of Saudi's vision for the future, Vision 2030. From a nursing human resources for health (HRH) perspective, there are challenges of low nursing school capacity, high employment of expatriates, labor market fragmentation, shortage of nurses in rural areas, uneven quality, and gender challenges. CASE PRESENTATION This case study summarizes Saudi Ministry of Health (MOH) and Saudi Health Council's (SHCs) evaluation of the current challenges facing the nursing profession in the KSA. We propose policy interventions to support the transformation of nursing into a profession that contributes to efficient, high-quality healthcare for every Saudi citizen. Key to the success of modernizing the Saudi workforce will be an improved pipeline of nurses that leads from middle and high school to nursing school; followed by a diverse career path that includes postgraduate education. To retain nurses in the profession, there are opportunities to make nursing practice more attractive and family friendly. Interventions include reducing shift length, redesigning the nursing team to add more allied health workers, and introducing locum tenens staffing to balance work-load. There are opportunities to modernize existing nurse postgraduate education, open new postgraduate programs in nursing, and create new positions and career paths for nurses such as telenursing, informatics, and quality. Rural pipelines should be created, with incentives and increased compensation packages for underserved areas. CONCLUSIONS Critical to these proposed reforms is the collaboration of the MOH with partners across the healthcare system, particularly the private sector. Human resources planning should be sector-wide and nursing leadership should be strengthened at all levels.
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Affiliation(s)
- Mohammed Alluhidan
- Saudi Health Council, Riyadh, Saudi Arabia.
- Lancaster University, Lancashire, UK.
| | - Nabiha Tashkandi
- Saudi Commission for Health Specialities, Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | | | - Tagwa Omer
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH, Alsukait RF, Alluhidan M, Alazemi N, Shekar M. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev 2020; 21:e13128. [PMID: 32845580 PMCID: PMC7461480 DOI: 10.1111/obr.13128] [Citation(s) in RCA: 654] [Impact Index Per Article: 163.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
The linkage of individuals with obesity and COVID-19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID-19, 75 studies were used to conduct a series of meta-analyses on the relationship of individuals with obesity-COVID-19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID-19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID-19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30-1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74-2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46-2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22-1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID-19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID-19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.
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Affiliation(s)
- Barry M. Popkin
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Shufa Du
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - William D. Green
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Melinda A. Beck
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | | | - Reem F. Alsukait
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
- Community Health SciencesKing Saud UniversityRiyadhKingdom of Saudi Arabia
| | | | | | - Meera Shekar
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
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Witter S, Hamza MM, Alazemi N, Alluhidan M, Alghaith T, Herbst CH. Human resources for health interventions in high- and middle-income countries: findings of an evidence review. Hum Resour Health 2020; 18:43. [PMID: 32513184 PMCID: PMC7281920 DOI: 10.1186/s12960-020-00484-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/28/2020] [Indexed: 05/28/2023]
Abstract
Many high- and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low- and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high- and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low- and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.
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Affiliation(s)
- Sophie Witter
- Queen Margaret University, Edinburgh, United Kingdom
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McPake B, Dayal P, Herbst CH. Never again? Challenges in transforming the health workforce landscape in post-Ebola West Africa. Hum Resour Health 2019; 17:19. [PMID: 30845978 PMCID: PMC6407225 DOI: 10.1186/s12960-019-0351-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/13/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND The 2013-2014 West African Ebola outbreak highlighted how the world's weakest health systems threaten global health security and heralded huge support for their recovery. All three Ebola-affected countries had large shortfalls and maldistribution in their health workforce before the crisis, which were made worse by the epidemic. This paper analyzes the investment plans in Liberia, Sierra Leone, and Guinea to strengthen their health workforces and assesses their potential contribution to the re-establishment and strengthening of their health systems. The analysis calculates the plans' costs and compares those to likely fiscal space, to assess feasibility. METHODS Public sector payroll data from 2015 from each country was used for the workforce analysis and does not include the private sector. Data were coded into the major cadres defined by the International Standard Classification of Occupations (ISCO-88). We estimated health worker training numbers and costs to meet international health worker density targets in the future and used sensitivity analysis to model hypothetical alternate estimates of attrition, drop-outs, and employment rates. RESULTS Health worker-to-population density targets per 1000 population for doctors, nurses, and midwives are only specified in Liberia (1.12) and Guinea's (0.78) investment plans and fall far short of the regional average for Africa (1.33) or international benchmarks of 2.5 per 1000 population and 4.45 for universal health coverage. Even these modest targets translate into substantial scaling-up requirements with Liberia having to almost double, Guinea quadruple, and Sierra Leone having to increase its workforce by seven to tenfold to achieve Liberia and Guinea's targets. Costs per capita to meet the 2.5 per 1000 population density targets with 5% attrition, 10% drop-out, and 75% employment rate range from US$4.2 in Guinea to US$7.9 in Liberia in 2029, with projected fiscal space being adequate to accommodate the proposed scaling-up targets in both countries. CONCLUSIONS Achieving even a modest scale-up of health workforce will require a steady growth in health budgets, a long-term horizon and substantial scale-up of current training institution capacity. Increasing value-for-money in health workforce investments will require more efficient geographical distribution of the health workforce and more consideration to the mix of cadres to be scaled-up.
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Affiliation(s)
- Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Level 5, 333 Exhibition St, Parkville, 3010 Australia
| | - Prarthna Dayal
- Nossal Institute for Global Health, University of Melbourne, Level 5, 333 Exhibition St, Parkville, 3010 Australia
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Atnafu A, Otto K, Herbst CH. The role of mHealth intervention on maternal and child health service delivery: findings from a randomized controlled field trial in rural Ethiopia. Mhealth 2017; 3:39. [PMID: 29184891 PMCID: PMC5682387 DOI: 10.21037/mhealth.2017.08.04] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/18/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The provision of consistent and quality maternal and child health (MCH) services is a challenge for Ethiopia where most of the population lives in the rural setup. Health service delivery is constrained mainly by shortage of health professionals, meager resources, limited awareness among the society and bureaucratic procedures. Low health service utilization of antenatal care (ANC), delivery services, and postnatal care (PNC) are believed to contribute for high maternal and child mortality rates. Innovative approach like mHealth based technological intervention believed to alleviate such challenges in countries like ours. However, currently, there are few evidences that demonstrate the impact of mHealth technology applications on the level of service utilization. Therefore, the objective our study is to assess the role of mobile phone equipped with short message service (SMS) based data-exchange software linking community health workers to Health Centers in rural Ethiopia affect selected MCH outcomes. METHODS A community-based randomized control trial (RCT) was conducted in three woredas of Guraghe zone (Ezha, partial &Abeshge full intervention, Sodo Control). Mobile phones equipped with FrontlineSMS based, locally developed application was distributed to all health extension workers (HEWs) to both intervention woredas who filled maternal, child and stock related forms and submitted to the central server which in turn sends reminder about the scheduled date of ANC visit, expected date of delivery, PNC, immunization schedule and vaccine and contraceptive stock status. Moreover, in Abeshge, the voluntary health workers (vCHW) and HEW supervisors in both intervention woreda were given a phone to facilitate communication with the HEW. No mobile was offered to the control woreda.Pre [2012] and post [2013] intervention community based survey on mothers who have under 5 and under 1 year old child was done to assess the effect of the mobile intervention on selected MCH process indicators. Structured and pretested questionnaire was used to collect data and SPSS v16 statistical software was used for analysis. RESULTS Three thousand two hundred and forty mothers, 1,080 from each, were surveyed in the three woredas. The study revealed that the proportion of mothers receiving more than four ANC visits increased significantly in both intervention woredas. Besides, the rate of ANC delivered by HEWs improved in Ezha woreda (T1) (19.01% to 28.27%), proportions of deliveries attended by skilled health workers increased and home delivery decreased in all woredas; most pronounced increases in referrals from health post to health center by HEWs, reported in Ezha and Abeshge. The intervention also led to a significant reduction in stock-outs of preferred contraceptive products in Ezha (T1) from 16.96% to 8.24% but no change was observed in both contraceptive prevalence and immunization rates in the control and the other intervention woreda. CONCLUSIONS The study confirmed the positive contribution of SMS based mobile phone intervention in most of the selected MCH service indicators, like improvement in the percent of recommended number of ANC visit, percentage of delivery attended by health workers and facilitating the work processes of the health workers in rural Ethiopia.
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Affiliation(s)
- Asfaw Atnafu
- Center for e-Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kate Otto
- The World Bank, African Regional Technical Health Unit, Washington, DC, USA
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