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Udo S, Ogbu Sunday P, Tsaku PA, Oladejo IO, Meka A, Ugwu LC, Ajisola M, Akinyemi J, Oladejo A, Omigbodun A, Choudhury SM, Sartori J, Ilozumba O, Watson S, Lilford R. Raw, Unadulterated African Honey for Ulcer Healing in Leprosy: Protocol for the Honey Experiment on Leprosy Ulcer (HELP) Randomized Controlled Trial. JMIRx Med 2024; 5:e50970. [PMID: 38488451 PMCID: PMC11024902 DOI: 10.2196/50970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/27/2023] [Accepted: 01/13/2024] [Indexed: 04/20/2024]
Abstract
Background Leprosy leads to nerve damage and slow-healing ulcers, which are treatable with routine therapy. There has been a recent resurgence of interest in the use of honey for the treatment of different kinds of wounds. Objective The aim of this study, Honey Experiment on Leprosy Ulcer (HELP), is to evaluate the healing properties of raw, unadulterated African honey in comparison with normal saline dressing for the treatment leprosy ulcers. Methods This is a multicenter, comparative, prospective, single-blinded, parallel-group, and 1:1 individually randomized controlled trial to be conducted at The Leprosy Referral Hospital, Chanchaga in Minna, Niger State, North Central Nigeria, and St. Benedict Tuberculosis and Leprosy Rehabilitation Hospital in Ogoja, Cross River State, South-South Nigeria. Raw, unadulterated honey will be used in the ulcer dressing of eligible, consenting participants in the intervention group, whereas those in the control group will be treated by dressing with normal saline. The main outcomes will be the proportion of complete healing and the rate of healing up to 84 days after randomization. Follow-up will be conducted 6 months after randomization. We aim to enroll 90-130 participants into the study. Blinded observers will examine photographs of ulcers to determine the outcomes. Results The recruitment of trial participants began on March 14, 2022, and has been continuing for approximately 24 months. Conclusions Our study will provide an unbiased estimate of the effect of honey on the healing of neuropathic ulcers.
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Affiliation(s)
- Sunday Udo
- The Leprosy Mission Nigeria, Abuja, Nigeria
| | | | | | | | - Anthony Meka
- German Leprosy and TB Relief Association/RedAid Nigeria, Enugu, Nigeria
| | | | | | | | | | | | | | - Jo Sartori
- University of Birmingham, Birmingham, UK
| | | | - Sam Watson
- University of Birmingham, Birmingham, UK
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Udo S, Ogbu Sunday P, Tsaku PA, Oladejo IO, Meka A, Ugwu LC, Ajisola M, Akinyemi J, Oladejo A, Omigbodun A, Choudhury SM, Sartori J, Ilozumba O, Watson S, Lilford R. Authors' Response to Peer Reviews of "Raw, Unadulterated African Honey for Ulcer Healing in Leprosy: Protocol for the Honey Experiment on Leprosy Ulcer (HELP) Randomized Controlled Trial". JMIRx Med 2024; 5:e56442. [PMID: 38563447 PMCID: PMC10986330 DOI: 10.2196/56442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Sunday Udo
- The Leprosy Mission Nigeria, Abuja, Nigeria
| | | | | | | | - Anthony Meka
- German Leprosy and TB Relief Association/RedAid Nigeria, Enugu, Nigeria
| | | | | | | | | | | | | | - Jo Sartori
- University of Birmingham, Birmingham, UK
| | | | - Sam Watson
- University of Birmingham, Birmingham, UK
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Darlong J, Govindasamy K, Ilozumba O, Choudhury S, Shrivastva A, Griffiths F, Watson S, Sartori J, Lilford R. An evaluation protocol of 'Replicability Model' project for detection and treatment of leprosy and related disability in Chhattisgarh, India. PLoS One 2023; 18:e0275763. [PMID: 37851621 PMCID: PMC10584107 DOI: 10.1371/journal.pone.0275763] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/22/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION People affected by leprosy are at increased risk of impairments and deformities from peripheral nerve damage. This mostly occurs if diagnosis and treatment is delayed and contributes to continued transmission within the community. Champa district of Chhattisgarh state in India is an endemic area with the highest national annual case detection and disability rates for leprosy. The Replicability Model is a system strengthening intervention implemented by the Leprosy Mission Trust India in Champa that aims to promote early diagnosis and treatment of leprosy, improve on-going management of the effects of leprosy and improve welfare for the people affected by leprosy. This protocol presents a plan to describe the overall implementation of the Replicability Model and describe the barriers and facilitators encountered in the process. We will also quantify the effect of the program on one of its key aims- early leprosy diagnosis. METHODS The replicability model will be implemented over four years, and the work described in this protocol will be conducted in the same timeframe. We have two Work Packages (WPs). In WP1, we will conduct a process evaluation. This will include three methods i) observations of replicability model implementation teams' monthly meetings ii) key informant interviews (n = 10) and interviews with stakeholders (n = 30) iii) observations of key actors (n = 15). Our purpose is to describe the implementation process and identify barriers and facilitators to successful implementation. WP2 will be a quantitative study to track existing and new cases of leprosy using routinely collected data. If the intervention is successful, we expect to see an increase in cases (with a higher proportion detected at an early clinical stage) followed by a decrease in total cases. CONCLUSION This study will enable us to improve and disseminate the Replicability Model by identifying factors that promote success. It will also identify its effectiveness in fulfilling one of its aims: reducing the incidence of leprosy by finding and tracking cases at an earlier stage in the disease.
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Affiliation(s)
| | | | - Onaedo Ilozumba
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sopna Choudhury
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Frances Griffiths
- Warwick Medical School, A-155, University of Warwick, Coventry, United Kingdom
| | - Samuel Watson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jo Sartori
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Richard Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Choudhury S, Ilozumba O, Darlong J, Govindasamy K, Tsaku PA, Udo S, Shrestha D, Napit IB, Ugwu L, Meka A, Sartori J, Griffiths F, Lilford RJ. Investigating the sustainability of self-help programmes in the context of leprosy and the work of leprosy missions in Nigeria, Nepal and India: a qualitative study protocol. BMJ Open 2023; 13:e070604. [PMID: 37192811 DOI: 10.1136/bmjopen-2022-070604] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Leprosy occurs among very poor people who may be stigmatised and pushed further to the margins of society. Programmes to improve social integration and stimulate economic development have been implemented to help break the vicious cycle of poverty, reduced quality of life and ulcer recurrence. These involve forming groups of people, with a common concern, to provide mutual support and form saving syndicates-hence the term 'self-help groups' (SHGs). While there is literature on the existence and effectiveness of SHGs during the funded periods, little is known about their sustainability. We aim to explore the extent to which SHG programme activities have continued beyond the funding period and record evidence of sustained benefits. METHODS AND ANALYSIS In India, Nepal and Nigeria, we identified programmes funded by international non-governmental organisations, primarily aimed at people affected by leprosy. In each case, financial and technical support was allocated for a predetermined period (up to 5 years).We will review documents, including project reports and meeting minutes, and conduct semistructured interviews with people involved in delivery of the SHG programme, potential beneficiaries and people in the wider environment who may have been familiar with the programme. These interviews will gauge participant and community perceptions of the programmes and barriers and facilitators to sustainability. Data will be analysed thematically and compared across four study sites. ETHICS AND DISSEMINATION Approval was obtained from the University of Birmingham Biomedical and Scientific Research Ethics Committee. Local approval was obtained from: The Leprosy Mission Trust India Ethics Committee; Federal Capital Territory Health Research Ethics Committee in Nigeria and the Health Research Ethics Committee of Niger State Ministry of Health; University of Nigeria Teaching Hospital and the Nepal Health and Research Council. Results will be disseminated via peer-reviewed journals, conference presentations and community engagement events through the leprosy missions.
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Affiliation(s)
- Sopna Choudhury
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Onaedo Ilozumba
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Sunday Udo
- The Leprosy Mission Nigeria, Abuja, Nigeria
| | | | - Indra B Napit
- The Leprosy Mission Nepal, Lalitpur, Kathmandu, Nepal
| | - Linda Ugwu
- The German Leprosy and Tuberculosis Relief Association, Enugu, Nigeria
| | - Anthony Meka
- The German Leprosy and Tuberculosis Relief Association, Enugu, Nigeria
| | - Jo Sartori
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK
- University of the Witwatersrand, Johannesburg, South Africa
| | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Conlan C, Cunningham T, Watson S, Madan J, Sfyridis A, Sartori J, Ferhatosmanoglu H, Lilford R. Perceived quality of care and choice of healthcare provider in informal settlements. PLOS Glob Public Health 2023; 3:e0001281. [PMID: 36962860 PMCID: PMC10022014 DOI: 10.1371/journal.pgph.0001281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
When a person chooses a healthcare provider, they are trading off cost, convenience, and a latent third factor: "perceived quality". In urban areas of lower- and middle-income countries (LMICs), including slums, individuals have a wide range of choice in healthcare provider, and we hypothesised that people do not choose the nearest and cheapest provider. This would mean that people are willing to incur additional cost to visit a provider they would perceive to be offering better healthcare. In this article, we aim to develop a method towards quantifying this notion of "perceived quality" by using a generalised access cost calculation to combine monetary and time costs relating to a visit, and then using this calculated access cost to observe facilities that have been bypassed. The data to support this analysis comes from detailed survey data in four slums, where residents were questioned on their interactions with healthcare services, and providers were surveyed by our team. We find that people tend to bypass more informal local services to access more formal providers, especially public hospitals. This implies that public hospitals, which tend to incur higher access costs, have the highest perceived quality (i.e., people are more willing to trade cost and convenience to visit these services). Our findings therefore provide evidence that can support the 'crowding out' hypothesis first suggested in a 2016 Lancet Series on healthcare provision in LMICs.
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Affiliation(s)
- Chris Conlan
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Teddy Cunningham
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Sam Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Alexandros Sfyridis
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Quinn L, Ahmed T, Falk H, Miranda Altamirano A, Muganza A, Nakarmi K, Nawar A, Peck M, Man Rai S, Sartori J, Philipe Molina Vana L, Wabwire B, Moiemen N, Lilford R. Burn Admissions Across Low- and Middle-income Countries: A Repeated Cross-sectional Survey. J Burn Care Res 2022; 44:320-328. [PMID: 35802351 PMCID: PMC9981866 DOI: 10.1093/jbcr/irac096] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 11/12/2022]
Abstract
Burn injuries have decreased markedly in high-income countries while the incidence of burns remains high in Low- and Middle-Income Countries (LMICs) where more than 90% of burns are thought to occur. However, the cause of burns in LMIC is poorly documented. The aim was to document the causes of severe burns and the changes over time. A cross-sectional survey was completed for 2014 and 2019 in eight burn centers across Africa, Asia, and Latin America: Cairo, Nairobi, Ibadan, Johannesburg, Dhaka, Kathmandu, Sao Paulo, and Guadalajara. The information summarised included demographics of burn patients, location, cause, and outcomes of burns. In total, 15,344 patients were admitted across all centers, 37% of burns were women and 36% of burns were children. Burns occurred mostly in household settings (43-79%). In Dhaka and Kathmandu, occupational burns were also common (32 and 43%, respectively). Hot liquid and flame burns were most common while electric burns were also common in Dhaka and Sao Paulo. The type of flame burns varies by center and year, in Dhaka, 77% resulted from solid fuel in 2014 while 74% of burns resulted from Liquefied Petroleum Gas in 2019. In Nairobi, a large proportion (32%) of burns were intentional self-harm or assault. The average length of stay in hospitals decreased from 2014 to 2019. The percentage of deaths ranged from 5% to 24%. Our data provide important information on the causes of severe burns which can provide guidance in how to approach the development of burn injury prevention programs in LMIC.
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Affiliation(s)
- Laura Quinn
- Address correspondence to Laura Quinn, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B152TT, UK.
| | - Tanveer Ahmed
- Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Henry Falk
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Adelin Muganza
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Kiran Nakarmi
- Department of Burns, Plastic and Reconstructive Surgery, phect-NEPAL, Kirtipur Hospital, Kathmandu, Nepal
| | - Ahmed Nawar
- Plastic Surgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Michael Peck
- University of Arizona College of Medicine, Phoenix, USA
| | - Shankar Man Rai
- Department of Burns, Plastic and Reconstructive Surgery, phect-NEPAL, Kirtipur Hospital, Kathmandu, Nepal,National Academy of Medical Science, Kathmandu, Nepal
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Luiz Philipe Molina Vana
- Department of Plastic Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK,University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
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Uthman OA, Ayorinde A, Oyebode O, Sartori J, Gill P, Lilford RJ. Global prevalence and trends in hypertension and type 2 diabetes mellitus among slum residents: a systematic review and meta-analysis. BMJ Open 2022; 12:e052393. [PMID: 35210339 PMCID: PMC8883228 DOI: 10.1136/bmjopen-2021-052393] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE First, to obtain regional estimates of prevalence of hypertension and type 2 diabetes in urban slums; and second, to compare these with those in urban and rural areas. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA Studies that reported hypertension prevalence using the definition of blood pressure ≥140/90 mm Hg and/or prevalence of type 2 diabetes. INFORMATION SOURCES Ovid MEDLINE, Cochrane CENTRAL and EMBASE from inception to December 2020. RISK OF BIAS Two authors extracted relevant data and assessed risk of bias independently using the Strengthening the Reporting of Observational Studies in Epidemiology guideline. SYNTHESIS OF RESULTS We used random-effects meta-analyses to pool prevalence estimates. We examined time trends in the prevalence estimates using meta-regression regression models with the prevalence estimates as the outcome variable and the calendar year of the publication as the predictor. RESULTS A total of 62 studies involving 108 110 participants met the inclusion criteria. Prevalence of hypertension and type 2 diabetes in slum populations ranged from 4.2% to 52.5% and 0.9% to 25.0%, respectively. In six studies presenting comparator data, all from the Indian subcontinent, slum residents were 35% more likely to be hypertensive than those living in comparator rural areas and 30% less likely to be hypertensive than those from comparator non-slum urban areas. LIMITATIONS OF EVIDENCE Of the included studies, only few studies from India compared the slum prevalence estimates with those living in non-slum urban and rural areas; this limits the generalisability of the finding. INTERPRETATION The burden of hypertension and type 2 diabetes varied widely between countries and regions and, to some degree, also within countries. PROSPERO REGISTRATION NUMBER CRD42017077381.
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Affiliation(s)
| | - Abimbola Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Oyinlola Oyebode
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - R J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Napit IB, Shrestha D, Bishop J, Choudhury S, Dulal S, Gill P, Gkini E, Gwyther H, Hagge DA, Neupane K, Sartori J, Slinn G, Watson SI, Lilford R. An individual randomised efficacy trial of autologous blood products, leukocyte and platelet-rich fibrin (L-PRF), to promote ulcer healing in leprosy in Nepal: the TABLE trial protocol. Trials 2021; 22:453. [PMID: 34266456 PMCID: PMC8281567 DOI: 10.1186/s13063-021-05392-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Leprosy is curable with multidrug therapy and treatment in the early stages can prevent disability. However, local nerve damage can lead to injury and consequently recurring and disfiguring ulcers. The aim of this study is to evaluate the treatment of leprosy ulcers using an autologous blood product; leukocyte and platelet-rich fibrin (L-PRF) to promote healing. METHODS This is a single-centre study in the Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal. Consenting patients (n=130) will be individually randomised in a single-blinded, controlled trial. Participants will be 18 years of age or older, admitted to the hospital with a clean, dry and infection-free chronic foot ulcer between 2 and 20 cm2 in size. If the ulcer is infected, it will be treated before enrolment into the study. The intervention involves the application of leukocyte and platelet-rich fibrin (L-PRF) matrix on the ulcer beds during twice-weekly dressing changes. Controls receive usual care in the form of saline dressings only during their twice-weekly dressing changes. Primary outcomes are the rate of healing assessed using standardised photographs by observers blind to allocated treatment, and time to complete re-epithelialization. Follow-up is at 6 months from randomisation. DISCUSSION This research will provide valuable information on the clinical and cost-effectiveness of L-PRF in the treatment of leprosy ulcers. An additional benefit is the evaluation of the effects of treatment on quality of life for people living with leprosy ulcers. The results will improve our understanding of the scalability of this treatment across low-income countries for ulcer healing in leprosy and potentially other conditions such as diabetic ulcers. TRIAL REGISTRATION ClinicalTrials.gov ISRCTN14933421 . Registered on 16 June 2020.
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Affiliation(s)
- Indra B. Napit
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Dilip Shrestha
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Jon Bishop
- grid.6572.60000 0004 1936 7486Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Sopna Choudhury
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Santosh Dulal
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Paramjit Gill
- grid.7372.10000 0000 8809 1613Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Eleni Gkini
- grid.6572.60000 0004 1936 7486Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Holly Gwyther
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Deanna A. Hagge
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Karuna Neupane
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Jo Sartori
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Gemma Slinn
- grid.6572.60000 0004 1936 7486Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Samuel I. Watson
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Richard Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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Shrestha D, Napit IB, Ansari S, Choudhury SM, Dhungana B, Gill P, Griffiths F, Gwyther H, Hagge D, Kandel S, Puri S, Sartori J, Watson SI, Lilford R. Evaluation of a self-help intervention to promote the health and wellbeing of marginalised people including those living with leprosy in Nepal: a prospective, observational, cluster-based, cohort study with controls. BMC Public Health 2021; 21:873. [PMID: 33957899 PMCID: PMC8101219 DOI: 10.1186/s12889-021-10847-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People affected by leprosy are at increased risk of ulcers from peripheral nerve damage. This in turn can lead to visible impairments, stigmatisation and economic marginalisation. Health care providers suggest that patients should be empowered to self-manage their condition to improve outcomes and reduce reliance on services. Self-care involves carrying out personal care tasks with the aim of preventing disabilities or preventing further deterioration. Self-help, on the other hand, addresses the wider psychological, social and economic implications of leprosy and incorporates, for example, skills training and microfinance schemes. The aim of this study, known as SHERPA (Self-Help Evaluation for lepRosy and other conditions in NePAl) is to evaluate a service intervention called Integrated Mobilization of People for Active Community Transformation (IMPACT) designed to encourage both self-care and self-help in marginalised people including those affected by leprosy. METHODS A mixed-method evaluation study in Province 5, Nepal comprising two parts. First, a prospective, cluster-based, non-randomised controlled study to evaluate the effectiveness of self-help groups on ulcer metrics (people affected by leprosy only) and on four generic outcome measures (all participants) - generic health status, wellbeing, social integration and household economic performance. Second, a qualitative study to examine the implementation and fidelity of the intervention. IMPACT This research will provide information on the effectiveness of combined self-help and self-care groups, on quality of life, social integration and economic wellbeing for people living with leprosy, disability or who are socially and economically marginalised in low- and middle- income countries.
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Affiliation(s)
- Dilip Shrestha
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Indra B. Napit
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Subi Ansari
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Sopna Mannan Choudhury
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Bishnu Dhungana
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Paramjit Gill
- grid.7372.10000 0000 8809 1613Warwick Centre for Applied Health Research & Delivery (W-CAHRD), Warwick Medical School, University of Warwick, Warwick, UK
| | - Frances Griffiths
- grid.7372.10000 0000 8809 1613Warwick Centre for Applied Health Research & Delivery (W-CAHRD), Warwick Medical School, University of Warwick, Warwick, UK
| | - Holly Gwyther
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Deanna Hagge
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Shovakhar Kandel
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Suraj Puri
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Jo Sartori
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Samuel Ian Watson
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Richard Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
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Aujla N, Chen YF, Samarakoon Y, Wilson A, Grolmusová N, Ayorinde A, Hofer TP, Griffiths F, Brown C, Gill P, Mallen C, Sartori J, Lilford RJ. Comparing the use of direct observation, standardized patients and exit interviews in low- and middle-income countries: a systematic review of methods of assessing quality of primary care. Health Policy Plan 2021; 36:341-356. [PMID: 33313845 PMCID: PMC8058951 DOI: 10.1093/heapol/czaa152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/31/2022] Open
Abstract
Clinical records in primary healthcare settings in low- and middle-income countries (LMIC) are often lacking or of too poor quality to accurately assess what happens during the patient consultation. We examined the most common methods for assessing healthcare workers' clinical behaviour: direct observation, standardized patients and patient/healthcare worker exit interview. The comparative feasibility, acceptability, reliability, validity and practicalities of using these methods in this setting are unclear. We systematically review and synthesize the evidence to compare and contrast the advantages and disadvantages of each method. We include studies in LMICs where methods have been directly compared and systematic and narrative reviews of each method. We searched several electronic databases and focused on real-life (not educational) primary healthcare encounters. The most recent update to the search for direct comparison studies was November 2019. We updated the search for systematic and narrative reviews on the standardized patient method in March 2020 and expanded it to all methods. Search strategies combined indexed terms and keywords. We searched reference lists of eligible articles and sourced additional references from relevant review articles. Titles and abstracts were independently screened by two reviewers and discrepancies resolved through discussion. Data were iteratively coded according to pre-defined categories and synthesized. We included 12 direct comparison studies and eight systematic and narrative reviews. We found that no method was clearly superior to the others-each has pros and cons and may assess different aspects of quality of care provision by healthcare workers. All methods require careful preparation, though the exact domain of quality assessed and ethics and selection and training of personnel are nuanced and the methods were subject to different biases. The differential strengths suggest that individual methods should be used strategically based on the research question or in combination for comprehensive global assessments of quality.
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Affiliation(s)
- Navneet Aujla
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Yen-Fu Chen
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Yasara Samarakoon
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Anna Wilson
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Natalia Grolmusová
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Abimbola Ayorinde
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Timothy P Hofer
- Department of Medicine, UM Institute for Health Policy and Innovation, Building 16 3rd Floor, North Campus Research Centre, University of Michigan Medical School, Ann Arbor, MI 48109-2800 USA
| | - Frances Griffiths
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Celia Brown
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Paramjit Gill
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christian Mallen
- Keele School of Medicine, David Wetherall Building, Keele University, Keele, ST5 5BG, UK
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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11
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Ahmed SAKS, Ajisola M, Azeem K, Bakibinga P, Chen YF, Choudhury NN, Fayehun O, Griffiths F, Harris B, Kibe P, Lilford RJ, Omigbodun A, Rizvi N, Sartori J, Smith S, Watson SI, Wilson R, Yeboah G, Aujla N, Azam SI, Diggle PJ, Gill P, Iqbal R, Kabaria C, Kisia L, Kyobutungi C, Madan JJ, Mberu B, Mohamed SF, Nazish A, Odubanjo O, Osuh ME, Owoaje E, Oyebode O, Porto de Albuquerque J, Rahman O, Tabani K, Taiwo OJ, Tregonning G, Uthman OA, Yusuf R. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Health 2020; 5:e003042. [PMID: 32819917 PMCID: PMC7443197 DOI: 10.1136/bmjgh-2020-003042] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. METHODS In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. RESULTS Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. CONCLUSION Slum residents' ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.
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Affiliation(s)
- Syed A K Shifat Ahmed
- Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh
| | - Motunrayo Ajisola
- National Institute for Health Research Project, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Kehkashan Azeem
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Olufunke Fayehun
- Department of Sociology, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Bronwyn Harris
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Kibe
- African Population and Health Research Center, Nairobi, Kenya
| | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Jo Sartori
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Simon Smith
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samuel I Watson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ria Wilson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Godwin Yeboah
- Institute for Global Sustainable Development, University of Warwick, Coventry, UK
| | - Navneet Aujla
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Syed Iqbal Azam
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Peter J Diggle
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Lyagamula Kisia
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Jason J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Shukri F Mohamed
- African Population and Health Research Center, Nairobi, Kenya
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ahsana Nazish
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | | | - Mary E Osuh
- Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oyinlola Oyebode
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Omar Rahman
- University of Liberal Arts Bangladesh, Dhaka, Bangladesh
| | - Komal Tabani
- Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
| | - Olalekan John Taiwo
- Department of Geography, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Grant Tregonning
- Institute for Global Sustainable Development, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh
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12
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Griffiths F, Watkins JA, Huxley C, Harris B, Cave J, Pemba S, Chipwaza B, Lilford R, Ajisola M, Arvanitis TN, Bakibinga P, Billah M, Choudhury N, Davies D, Fayehun O, Kabaria C, Iqbal R, Omigbodun A, Owoaje E, Rahman O, Sartori J, Sayani S, Tabani K, Yusuf R, Sturt J. Mobile consulting (mConsulting) and its potential for providing access to quality healthcare for populations living in low-resource settings of low- and middle-income countries. Digit Health 2020; 6:2055207620919594. [PMID: 32341793 PMCID: PMC7175047 DOI: 10.1177/2055207620919594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/01/2019] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The poorest populations of the world lack access to quality healthcare. We defined the key components of consulting via mobile technology (mConsulting), explored whether mConsulting can fill gaps in access to quality healthcare for poor and spatially marginalised populations (specifically rural and slum populations) of low- and middle-income countries, and considered the implications of its take-up. Methods We utilised realist methodology. First, we undertook a scoping review of mobile health literature and searched for examples of mConsulting. Second, we formed our programme theories and identified potential benefits and hazards for deployment of mConsulting for poor and spatially marginalised populations. Finally, we tested our programme theories against existing frameworks and identified published evidence on how and why these benefits/hazards are likely to accrue. Results We identified the components of mConsulting, including their characteristics and range. We discuss the implications of mConsulting for poor and spatially marginalised populations in terms of competent care, user experience, cost, workforce, technology, and the wider health system. Conclusions For the many dimensions of mConsulting, how it is structured and deployed will make a difference to the benefits and hazards of its use. There is a lack of evidence of the impact of mConsulting in populations that are poor and spatially marginalised, as most research on mConsulting has been undertaken where quality healthcare exists. We suggest that mConsulting could improve access to quality healthcare for these populations and, with attention to how it is deployed, potential hazards for the populations and wider health system could be mitigated.
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Affiliation(s)
- Frances Griffiths
- Warwick Medical School, University of Warwick, UK.,Centre for Health Policy, University of the Witwatersrand, South Africa
| | | | | | - Bronwyn Harris
- Warwick Medical School, University of Warwick, UK.,Centre for Health Policy, University of the Witwatersrand, South Africa
| | | | - Senga Pemba
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences, Tanzania
| | | | | | | | | | | | | | - David Davies
- Warwick Medical School, University of Warwick, UK
| | | | | | | | | | | | - Omar Rahman
- Independent University Bangladesh, Bangladesh
| | - Jo Sartori
- Warwick Medical School, University of Warwick, UK
| | | | | | - Rita Yusuf
- Independent University Bangladesh, Bangladesh
| | - Jackie Sturt
- The Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK
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13
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Lilford R, Kyobutungi C, Ndugwa R, Sartori J, Watson SI, Sliuzas R, Kuffer M, Hofer T, Porto de Albuquerque J, Ezeh A. Because space matters: conceptual framework to help distinguish slum from non-slum urban areas. BMJ Glob Health 2019; 4:e001267. [PMID: 31139443 PMCID: PMC6509608 DOI: 10.1136/bmjgh-2018-001267] [Citation(s) in RCA: 35] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/10/2018] [Accepted: 12/24/2018] [Indexed: 11/04/2022] Open
Abstract
Despite an estimated one billion people around the world living in slums, most surveys of health and well-being do not distinguish between slum and non-slum urban residents. Identifying people who live in slums is important for research purposes and also to enable policymakers, programme managers, donors and non-governmental organisations to better target investments and services to areas of greatest deprivation. However, there is no consensus on what a slum is let alone how slums can be distinguished from non-slum urban precincts. Nor has attention been given to a more fine-grained classification of urban spaces that might go beyond a simple slum/non-slum dichotomy. The purpose of this paper is to provide a conceptual framework to help tackle the related issues of slum definition and classification of the urban landscape. We discuss:The concept of space as an epidemiological variable that results in 'neighbourhood effects'.The problems of slum area definition when there is no 'gold standard'.A long-list of variables from which a selection must be made in defining or classifying urban slum spaces.Methods to combine any set of identified variables in an operational slum area definition.Two basic approaches to spatial slum area definitions-top-down (starting with a predefined area which is then classified according to features present in that area) and bottom-up (defining the areal unit based on its features).Different requirements of a slum area definition according to its intended use.Implications for research and future development.
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Affiliation(s)
- Richard Lilford
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | | | - Robert Ndugwa
- Global Urban Observatory Unit, United Nations Human Settlements Programme, Nairobi, Kenya
| | - Jo Sartori
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Samuel I Watson
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Richard Sliuzas
- Faculty of Geo-Information Science and Earth Observation, Universiteit Twente, Enschede, The Netherlands
| | - Monika Kuffer
- Faculty of Geo-Information Science and Earth Observation, Universiteit Twente, Enschede, The Netherlands
| | - Timothy Hofer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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14
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Watson SI, Sartori J, Uthman O, Lilford RJ. Health effects of sanitation facilities: a Bayesian semiparametric analysis of compositional data. J R Stat Soc Ser C Appl Stat 2019. [DOI: 10.1111/rssc.12339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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15
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Plowright A, Taylor C, Davies D, Sartori J, Hundt GL, Lilford RJ. Formative evaluation of a training intervention for community health workers in South Africa: A before and after study. PLoS One 2018; 13:e0202817. [PMID: 30248100 PMCID: PMC6152868 DOI: 10.1371/journal.pone.0202817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/31/2017] [Accepted: 08/09/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Community Health Workers (CHWs) have a crucial role in improving health in their communities and their role is being expanded in many parts of the world. However, the effectiveness of CHWs is limited by poor training and the education of CHWs has received little scientific attention. METHODS Our study was carried out in two districts of KwaZulu-Natal, South Africa. We developed and piloted an inexpensive (two day) training intervention covering national government priorities: HIV/AIDS, sexually transmitted disease and Tuberculosis; and Women's Sexual and Reproductive Health and Rights. Sixty-four CHWs consented to participate in the main study which measured knowledge gains using a modified Solomon design of four different testing schedules to distinguish between the effects of the intervention, testing and any interaction between intervention and testing. We also measured confidence, satisfaction and costs. RESULTS Following the training intervention, improvements in knowledge scores were seen across topics and across districts. These changes in knowledge were statistically significant (p<0.001) and of large magnitude (over 45 percentage points or four standard deviations). However, the CHWs assigned to the test-test-train schedule in one district showed high gains in knowledge prior to receiving the training. All CHWs reported high levels of satisfaction with the training and marked improvements in their confidence in advising clients. The training cost around US$48 per CHW per day and has the potential to be cost-effective if the large gains in knowledge are translated into improved field-based performance and thus health outcomes. CONCLUSION Training CHWs can result in large improvements in knowledge with a short intervention. However, improvements seen in other studies could be due to test 'reactivity'. Further work is needed to measure the generalisability of our results, retention of knowledge and the extent to which improved knowledge is translated into improved practice.
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Affiliation(s)
| | - Celia Taylor
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- * E-mail:
| | - David Davies
- Educational Development & Research Team, University of Warwick, Coventry, United Kingdom
| | - Jo Sartori
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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16
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Lilford RJ, Oyebode O, Satterthwaite D, Melendez-Torres GJ, Chen YF, Mberu B, Watson SI, Sartori J, Ndugwa R, Caiaffa W, Haregu T, Capon A, Saith R, Ezeh A. Improving the health and welfare of people who live in slums. Lancet 2017; 389:559-570. [PMID: 27760702 DOI: 10.1016/s0140-6736(16)31848-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the first paper in this Series we assessed theoretical and empirical evidence and concluded that the health of people living in slums is a function not only of poverty but of intimately shared physical and social environments. In this paper we extend the theory of so-called neighbourhood effects. Slums offer high returns on investment because beneficial effects are shared across many people in densely populated neighbourhoods. Neighbourhood effects also help explain how and why the benefits of interventions vary between slum and non-slum spaces and between slums. We build on this spatial concept of slums to argue that, in all low-income and-middle-income countries, census tracts should henceforth be designated slum or non-slum both to inform local policy and as the basis for research surveys that build on censuses. We argue that slum health should be promoted as a topic of enquiry alongside poverty and health.
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Affiliation(s)
- Richard J Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK.
| | - Oyinlola Oyebode
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | | | - G J Melendez-Torres
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - Samuel I Watson
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Jo Sartori
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Robert Ndugwa
- Global Urban Observatory, Research and Capacity Development Branch, United Nations Human Settlements Programme, Nairobi, Kenya
| | - Waleska Caiaffa
- School of Medicine, Federal University of Minas Gerais, Brazil
| | - Tilahun Haregu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | | | - Ruhi Saith
- Oxford Policy Management, New Delhi, India
| | - Alex Ezeh
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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17
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Ezeh A, Oyebode O, Satterthwaite D, Chen YF, Ndugwa R, Sartori J, Mberu B, Melendez-Torres GJ, Haregu T, Watson SI, Caiaffa W, Capon A, Lilford RJ. The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet 2017; 389:547-558. [PMID: 27760703 DOI: 10.1016/s0140-6736(16)31650-6] [Citation(s) in RCA: 271] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022]
Abstract
Massive slums have become major features of cities in many low-income and middle-income countries. Here, in the first in a Series of two papers, we discuss why slums are unhealthy places with especially high risks of infection and injury. We show that children are especially vulnerable, and that the combination of malnutrition and recurrent diarrhoea leads to stunted growth and longer-term effects on cognitive development. We find that the scientific literature on slum health is underdeveloped in comparison to urban health, and poverty and health. This shortcoming is important because health is affected by factors arising from the shared physical and social environment, which have effects beyond those of poverty alone. In the second paper we will consider what can be done to improve health and make recommendations for the development of slum health as a field of study.
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Affiliation(s)
- Alex Ezeh
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Oyinlola Oyebode
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | | | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Robert Ndugwa
- Global Urban Observatory Research and Capacity Development Branch, United Nations Human Settlements Programme, UN Avenue Gigiri, UN Complex, GPO Nairobi, Kenya
| | - Jo Sartori
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - G J Melendez-Torres
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Tilahun Haregu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - Samuel I Watson
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Waleska Caiaffa
- School of Medicine, Federal University of Minas Gerais, Brazil
| | | | - Richard J Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK.
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Ribeiro CTM, Zanatta AR, Sartori J, Nunes LAO, Messaddeq Y. Espectroscopia óptica de vidros fluoroindatos dopados com íons Er3+ e Yb3+. QUIM NOVA 1998. [DOI: 10.1590/s0100-40421998000400028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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