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Boo YY, Bora AK, Chhabra S, Choudhury SS, Deka G, Kakoty S, Kumar P, Mahanta P, Minz B, Rani A, Rao S, Roy I, Solomi V C, Verma A, Zahir F, Deka R, Kurinczuk JJ, Nair M. Maternal and fetal factors associated with stillbirth in singleton pregnancies in 13 hospitals across six states in India: A prospective cohort study. Int J Gynaecol Obstet 2024; 165:462-473. [PMID: 38234106 DOI: 10.1002/ijgo.15367] [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: 10/06/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE This study aimed to investigate the incidence of and risk factors for stillbirth in an Indian population. METHODS We conducted a secondary data analysis of a hospital-based cohort from the Maternal and Perinatal Health Research collaboration, India (MaatHRI), including pregnant women who gave birth between October 2018-September 2023. Data from 9823 singleton pregnancies recruited from 13 hospitals across six Indian states were included. Univariable and multivariable Poisson regression analysis were performed to examine the relationship between stillbirth and potential risk factors. Model prediction was assessed using the area under the receiver-operating characteristic (AUROC) curve. RESULTS There were 216 stillbirths (48 antepartum and 168 intrapartum) in the study population, representing an overall stillbirth rate of 22.0 per 1000 total births (95% confidence interval [CI]: 19.2-25.1). Modifiable risk factors for stillbirth were: receiving less than four antenatal check-ups (adjusted relative risk [aRR]: 1.75, 95% CI: 1.25-2.47), not taking any iron and folic acid supplementation during pregnancy (aRR: 7.23, 95% CI: 2.12-45.33) and having severe anemia in the third trimester (aRR: 3.37, 95% CI: 1.97-6.11). Having pregnancy/fetal complications such as hypertensive disorders of pregnancy (aRR: 1.59, 95% CI: 1.03-2.36), preterm birth (aRR: 4.41, 95% CI: 3.21-6.08) and birth weight below the 10th percentile for gestational age (aRR: 1.35, 95% CI: 1.02-1.79) were also associated with an increased risk of stillbirth. Identified risk factors explained 78.2% (95% CI: 75.0%-81.4%) of the risk of stillbirth in the population. CONCLUSION Addressing potentially modifiable antenatal factors could reduce the risk of stillbirths in India.
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Affiliation(s)
- Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amrit K Bora
- Sonapur District Hospital, Guwahati, Assam, India
| | - Shakuntala Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | | | - Gitanjali Deka
- Tezpur Medical College and Hospital, Tezpur, Assam, India
| | - Swapna Kakoty
- Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Pramod Kumar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | | | - Bina Minz
- Sewa Bhawan Hospital Society, Basna, Chhattisgarh, India
| | - Anjali Rani
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sereesha Rao
- Silchar Medical College and Hospital, Silchar, Assam, India
| | - Indrani Roy
- Nazareth Hospital, Shillong, Meghalaya, India
| | - Carolin Solomi V
- Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
| | - Ashok Verma
- Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Farzana Zahir
- Assam Medical College (AMC), Dibrugarh, Assam, India
| | - Rupanjali Deka
- Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Gwacham-Anisiobi U, Boo YY, Oladimeji A, Kurinczuk JJ, Roberts N, Opondo C, Nair M. Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 67:102386. [PMID: 38152414 PMCID: PMC10751841 DOI: 10.1016/j.eclinm.2023.102386] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine the effect of community-based interventions on stillbirth in SSA. Methods In this systematic review and meta-analysis, we searched eight databases (MEDLINE [OvidSP], Embase [OvidSP], Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index [Web of Science Core Collection], CINAHL [EBSCOhost] and Global Index Medicus) and four grey literature sources from January 1, 2000 to July 7, 2023 for relevant studies from SSA. Community-based interventions targeting stillbirths solely or as part of complex interventions, with or without hospital interventions were included, while hospital-only interventions, microcredit schemes and maternity waiting home interventions were excluded. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. The study outcome was odds of stillbirth in intervention versus control communities. Pooled odds ratios (ORs) were estimated using random-effects models, and subgroup analyses were performed by intervention type and strategies. Publication bias was evaluated by funnel plot and Egger's test. This study is registered with PROSPERO, CRD42021296623. Findings Of the 4223 records identified, seventeen studies from fifteen SSA countries were eligible for inclusion. One study had four arms (community only, hospital only, community and hospital, and control arms), so information was extracted from each arm. Analysis of 13 of the 17 studies which had community-only intervention showed that the odds of stillbirth did not vary significantly between community-based intervention and control groups (OR 0.96; 95% CI 0.78-1.17, I2 = 57%, p ≤ 0.01, n = 63,884). However, analysis of four (out of five) studies that included both community and health facility components found that in comparison with community only interventions, this combination strategy significantly reduced the odds of stillbirth by 17% (OR 0.83; 95% CI 0.79-0.87, I2 = 11%, p = 0.37, n = 244,868), after excluding a study with high risk of bias. The quality of the 17 studies were graded as poor (n = 2), fair (n = 9) and good (n = 6). Interpretation Community-based interventions alone, without strengthening the quality and capacity of health facilities, are unlikely to have a substantial effect on reducing stillbirths in SSA. Funding Nuffield Department of Population Health, Balliol College, the Clarendon Fund, Medical Research Council.
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Affiliation(s)
- Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Gwacham-Anisiobi U, Boo YY, Oladimeji A, Kurinczuk JJ, Roberts N, Opondo C, Nair M. Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review. EClinicalMedicine 2023; 62:102133. [PMID: 37593225 PMCID: PMC10430180 DOI: 10.1016/j.eclinm.2023.102133] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background Community-based interventions are increasingly being implemented in Sub-Saharan Africa (SSA) for stillbirth prevention, but the nature of these interventions, their reporting and acceptability are poorly assessed. In addition to understanding their effectiveness, complete reporting of the methods, results and intervention acceptability is essential as it could potentially reduce research waste from replication of inadequately implemented and unacceptable interventions. We conducted a systematic review to investigate these aspects of community-based interventions for preventing stillbirths in SSA. Methods In this systematic review, eight databases (MEDLINE(OvidSP), Embase (OvidSP), Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index (Web of Science Core Collection), CINAHL (EBSCOhost) and Global Index Medicus) and four grey literature sources were searched from January 1, 2000 to July 7, 2023 for relevant quantitative and qualitative studies from SSA (PROSPERO-CRD42021296623). Following deduplication, abstract screening and full-text review, studies were included if the interventions were community-based with or without a health facility component. The main outcomes were types of community-based interventions, completeness of intervention reporting using the TIDier (Template for Intervention Description and replication) checklist, and themes related to intervention acceptability identified using a theoretical framework. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. Findings Thirty-nine reports from thirty-four studies conducted in 18 SSA countries were eligible for inclusion. Four types of interventions were identified: nutritional, infection prevention, access to skilled childbirth attendants and health knowledge/behaviour of women. These interventions were implemented using nine strategies: mHealth (defined as the use of mobile and wireless technologies to support the achievement of health objectives), women's groups, community midwifery, home visits, mass media sensitisation, traditional birth attendant and community volunteer training, community mobilisation and transport vouchers. The completeness of reporting using the TIDier checklist varied across studies with a very low proportion of the included studies reporting the intervention intensity, dosing, tailoring and modification. The quality of the included studies were graded as poor (n = 6), fair (n = 14) and good (n = 18). Though interventions were acceptable, only 4 (out of 7) studies explored women's perceptions, mostly focusing on perceived intervention effects and how they felt, omitting key constructs like ethicality, opportunity cost and burden of participation. Interpretation Different community-based interventions have been tried and evaluated for stillbirth prevention in SSA. The reproducibility and implementation scale-up of these interventions may be limited by incomplete intervention descriptions in the published literature. To strengthen impact, it is crucial to holistically explore the acceptability of these interventions among women and their families. Funding Clarendon/Balliol/NDPH DPhil scholarship for UGA. MN is funded by a Medical Research Council Transition Support Award (MR/W029294/1).
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Affiliation(s)
- Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- London Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Boo YY, Gwacham-Anisiobi U, Thakrar DB, Roberts N, Kurinczuk JJ, Lakhanpaul M, Nair M. Facility-based stillbirth review processes used in different countries across the world: a systematic review. EClinicalMedicine 2023; 59:101976. [PMID: 37180470 PMCID: PMC10173150 DOI: 10.1016/j.eclinm.2023.101976] [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] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Facility-based stillbirth review provides opportunities to estimate incidence, evaluate causes and risk factors for stillbirths, and identify any issues related to the quality of pregnancy and childbirth care which require improvement. Our aim was to systematically review all types and methods of facility-based stillbirth review processes used in different countries across the world, to examine how stillbirth reviews in facility settings are being conducted worldwide and to identify the outcomes of implementing the reviews. Moreover, to identify facilitators and barriers influencing the implementation of the identified facility-based stillbirth reviews processes by conducting subgroup analyses. Methods A systematic review of published literature was conducted by searching MEDLINE (OvidSP) [1946-present], EMBASE (OvidSP) [1974-present], WHO Global Index Medicus (globalindexmedicus.net), Global Health (OvidSP) [1973-2022 Week 8] and CINAHL (EBSCOHost) [1982-present] from their inception until 11 January, 2023. For unpublished or grey literature, the WHO databases, Google Scholar and ProQuest Dissertations & Theses Global were searched, as well as hand searching the reference lists of included studies. MESH terms encompassing "∗Clinical Audit", "∗Perinatal Mortality", "Pregnancy Complications", and "Stillbirth" were used with Boolean operators. Studies that used a facility-based review process or any approach to evaluate care prior to stillbirth, and explained the methods used were included. Reviews and editorials were excluded. Three authors (YYB, UGA, and DBT) independently screened and extracted data, and assessed the risk of bias using an adapted JBI's Checklist for Case Series. A logic model was used to inform the narrative synthesis. The review protocol was registered with PROSPERO, CRD42022304239. Findings A total of 68 studies from 17 high-income (HICs) and 22 low-and-middle-income countries (LMICs) met the inclusion criteria from a total of 7258 identified records. These were stillbirth reviews conducted at different levels: district, state, national, and international. Three types were identified: audit, review, and confidential enquiry, but not all desired components were included in most processes, which led to a mismatch between the description of the type and the actual method used. Routine data from hospital records was the most common data source for identifying stillbirths, and case assessment was based on stillbirth definition in 48 out of 68 studies. Hospital notes were the most common source of information about care received and causes/risk factors for stillbirth. Short-term and medium-term outcomes were reported in 14 studies, but impact of the review process on reducing stillbirth, which is more difficult to establish, was not reported in any study. Facilitators and barriers in implementing a successful stillbirth review process identified from 14 studies focused on three main themes: resources, expertise, and commitment. Interpretation This systematic review's findings identified that there is a need for clear guidelines on how to measure the impact of implementation of changes based on outputs of stillbirth reviews and methods to enable effective dissemination of learning points in the future and promoting them through training platforms. In addition, there is a need to develop and adopt a universal definition of stillbirth to facilitate meaningful comparison of stillbirth rates between regions. The key limitation of this review is that while using a logic model for narrative synthesis was deemed most appropriate for this study, sequence of implementing a stillbirth review in the real world is not linear, and assumptions are often not met. Therefore, the logic model proposed in this study should be interpreted with flexibility when designing a stillbirth review process. The generated learnings from the stillbirth review processes inform the action plans and allow facilities to consider where the changes should happen to improve the quality of care in the facilities, enabling positive short-term and medium-term outcomes. Funding Kellogg College, University of Oxford, Clarendon Fund, University of Oxford, Nuffield Department of Population Health, University of Oxford and Medical Research Council (MRC).
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Affiliation(s)
- Yebeen Ysabelle Boo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Uchenna Gwacham-Anisiobi
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Dixa B. Thakrar
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Monica Lakhanpaul
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Nixon LS, Hudson N, Culley L, Lakhanpaul M, Robertson N, Johnson MRD, McFeeters M, Johal N, Hamlyn-Williams C, Boo YY, Lakhanpaul M. Key considerations when involving children in health intervention design: reflections on working in partnership with South Asian children in the UK on a tailored Management and Intervention for Asthma (MIA) study. Res Involv Engagem 2022; 8:9. [PMID: 35227322 PMCID: PMC8883750 DOI: 10.1186/s40900-022-00342-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
Participatory research is an empowering process through which individuals can increase control over their lives, and allows researchers/clinicians to gain a clearer understanding of a child's needs. However, involving children in participatory research is still relatively novel, despite national and international mandates to engage children in decision making. This paper draws on the learnings from designing the Management and Intervention for Asthma (MIA) study, which used a collaborative participatory method to develop an intervention-planning framework for South Asian children with asthma. There are currently 1 million children in the UK receiving treatment for asthma, making it one of the most prevalent chronic childhood illnesses. Symptoms of asthma are often underrecognized in children from South Asian communities in the UK, contributing to increased disease severity and increased attendance at the emergency department compared to White British children. Despite this, ethnic minorities are often excluded from research and thus absent from the 'evidence base', making it essential to hear their perspectives if health inequalities are to be successfully addressed. We worked alongside healthcare professionals, community facilitators, parents, and children to identify the key concerns and priorities they had and then designed the framework around their needs. Reflecting on the process, we identified several key considerations that need to be addressed when co-developing interventions with children. These include the power dynamics between the parent/researcher and child; navigating the consent/assent process; how parental involvement might affect the research; establishing a convenient time and location; how to keep children engaged throughout the process; tailoring activities to different levels of ability; and accounting for cultural differences. These factors were considered by the researchers when designing the study, however, implementing them was not without its challenges and highlighted the need for researchers to develop expertise in this field. Tailoring existing research methods allowed us to explore children's perceptions, priorities, and experiences of illness more effectively. However, involving children in participatory research is a complex undertaking, and researchers need to ensure that they have the expertise, time, and resources necessary to be able to fully support the needs of child participants before deciding to commit to this approach.
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Affiliation(s)
- Laura S. Nixon
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Nicky Hudson
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Lorraine Culley
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Maya Lakhanpaul
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Noelle Robertson
- Department of Neuroscience Psychology and Behaviour, University of Leicester, Leicester, UK
| | | | - Melanie McFeeters
- NHS England, Direct Commissioning, Midlands Region, Leicestershire, UK
| | | | | | - Yebeen Ysabelle Boo
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
- Aceso Global Health Consultants Ltd., London, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
- Community Paediatrics, Whittington NHS Trust, London, UK
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Boo YY, Rai K, Cupp MA, Lakhanpaul M, Factor-Litvak P, Parikh P, Panda R, Manikam L. What are the determinants of childhood infections in India's peri-urban slums? A case study of eight cities. PLoS One 2021; 16:e0257797. [PMID: 34653203 PMCID: PMC8519422 DOI: 10.1371/journal.pone.0257797] [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: 05/13/2020] [Accepted: 09/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Respiratory Tract Infections (RTIs) and Gastro-Intestinal (GI) infections are the leading causes of child mortality and morbidity. This study investigates the associations between the individual, household and slum-level determinants of children's health and vulnerability to RTIs and GI infections in peri-urban slums in India; an area of research interest at the Childhood Infections and Pollution Consortium. METHODS The 2015-16 Indian National Family Health Survey was used for data analysis on children aged 0-5 years. NFHS-4 includes data on slums in eight Indian cities, including Delhi, Meerut, Kolkata, Indore, Mumbai, Nagpur, Hyderabad, Chennai. The outcome variables, having fever and cough (FeCo) and diarrhoea in the last two weeks, were used to define the phenotype of infections; for this analysis fever and cough were measures of RTIs and diarrhoea was used to measure GI infections. Exposures considered in this study include variables at the individual, household and slum level and were all informed by existing literature. Multilevel models were used to estimate the association between exposures and outcomes variables; a prior of Cauchy distribution with a scale of 2.5 was selected when building the multilevel logistic models. RESULTS The total sample size of the number of children included in the analysis was n = 1,424. Data was imputed to account for missingness, and the original and imputed sample showing similar distributions. Results showed that diarrhoea and FeCo were both found to be more present in younger children than older children by a few months. In fixed effects, the odds of developing FeCo were higher if the mother perceives the child was born smaller than average (AOR 4.41, 1.13-17.17, P<0.05) at individual level. On the other hand, the odds of the diarrhoea outcome were lower if the child was older (AOR 0.97, 0.96-0.98, P<0.05) at individual level, and household's water source was public tap or standpipe (AOR 0.54, 0.31-0.96, P<0.05) at household level. CONCLUSION The determinants of health, both social and related to health care, at all levels demonstrated linkages to child morbidity in RTIs and GI infections. The empirical evidence highlights the need for contextualised ideas at each level, including one health approach when designing interventions to improve child health.
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Affiliation(s)
- Yebeen Ysabelle Boo
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kritika Rai
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
| | - Meghan A. Cupp
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Whittington Health NHS Trust, London, United Kingdom
| | - Pam Factor-Litvak
- Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Priti Parikh
- Engineering for International Development Centre, Bartlett School of Construction and Project Management, Faculty of Built Environment, University College London, London, United Kingdom
| | | | - Logan Manikam
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, United Kingdom
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Boo YY, Jutila OE, Cupp MA, Manikam L, Cho SI. The identification of established modifiable mid-life risk factors for cardiovascular disease which contribute to cognitive decline: Korean Longitudinal Study of Aging (KLoSA). Aging Clin Exp Res 2021; 33:2573-2586. [PMID: 33538990 PMCID: PMC8429388 DOI: 10.1007/s40520-020-01783-x] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/25/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We explored how different chronic diseases, risk factors, and protective factors highly associated with cardiovascular diseases (CVD) are associated with dementia or Mild Cognitive Impairment (MCI) in Korean elders, with a focus on those that manifest in mid-life. METHODS A CVD-free cohort (n = 4289) from the Korean Longitudinal Study of Aging was selected to perform Cox mixed-effects proportional hazard regressions. Eighteen control variables with strong associations to CVD were chosen as explanatory variables, and Mini-Mental State Examination (MMSE) score cut-off for dementia and MCI were used as outcome variables. RESULTS The statistically significant (P < 0.05) adverse factors that contribute in developing dementia were age (aHR 1.07, 1.05-1.09), Centre for Epidemiological Studies Depression Scale (CESD-10) (aHR 1.17, 1.12-1.23), diagnosis with cerebrovascular disease (aHR 3.73, 1.81-7.66), living with diabetes (aHR 2.30, 1.22-4.35), and living with high blood pressure (HBP) (aHR 2.05, 1.09-3.87). In contrast, the statistically significant protective factors against developing dementia were current alcohol consumption (aHR 0.67, 0.46-0.99), higher educational attainment (aHR 0.36, 0.26-0.56), and regular exercise (aHR 0.37, 0.26-0.51). The factors with a statistically significant adverse association with progression to MCI were age (aHR 1.02, 1.01-1.03) and CESD-10 (aHR 1.17, 1.14-1.19). In contrast, the statistically significant protective factors against developing MCI were BMI (aHR 0.96, 0.94-0.98), higher educational attainment (aHR 0.33, 0.26-0.43), and regular exercise (aHR 0.83, 0.74-0.92). CONCLUSION In lieu of the protective factor of MCI and dementia, implementing regular exercise routine well before mid-life and cognitive decline is significant, with adjustments made for those suffering from health conditions, so they can continue exercising despite their morbidity. Further attention in diabetes care and management is needed for patients who already show decline in cognitive ability as it is likely that their MCI impacts their ability to manage their existing chronic conditions, which may adversely affect their cognitive ability furthermore.
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Affiliation(s)
- Yebeen Ysabelle Boo
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK.
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK.
| | - Otto-Emil Jutila
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Meghan A Cupp
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK
- Aceso Global Health Consultants Ltd, London, UK
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Logan Manikam
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, London, UK
- Aceso Global Health Consultants Ltd, London, UK
| | - Sung-Il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Lakhanpaul M, Culley L, Robertson N, Alexander EC, Bird D, Hudson N, Johal N, McFeeters M, Hamlyn-Williams C, Manikam L, Boo YY, Lakhanpaul M, Johnson MRD. A structured collaborative approach to intervention design using a modified intervention mapping approach: a case study using the Management and Interventions for Asthma (MIA) project for South Asian children. BMC Med Res Methodol 2020; 20:271. [PMID: 33138784 PMCID: PMC7607819 DOI: 10.1186/s12874-020-01148-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/15/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To describe how using a combined approach of community-based participatory research and intervention mapping principles could inform the development of a tailored complex intervention to improve management of asthma for South Asian (SA) children; Management and Interventions for Asthma (MIA) study. METHODS A qualitative study using interviews, focus groups, workshops, and modified intervention mapping procedures to develop an intervention planning framework in an urban community setting in Leicester, UK. The modified form of intervention mapping (IM) included: systematic evidence synthesis; community study; families and healthcare professionals study; and development of potential collaborative intervention strategies. Participants in the community study were 63 SA community members and 12 key informants; in-depth semi-structured interviews involved 30 SA families, 14 White British (WB) families and 37 Healthcare Professionals (HCPs) treating SA children living with asthma; prioritisation workshops involved 145 SA, 6 WB and 37 HCP participants; 30 participants in finalisation workshops. RESULTS Two key principles were utilised throughout the development of the intervention; community-based participatory research (CBPR) principles and intervention mapping (IM) procedures. The CBPR approach allowed close engagement with stakeholders and generated valuable knowledge to inform intervention development. It accounted for diverse perceptions and experiences with regard to asthma and recognised the priorities of patients and their families/caregivers for service improvement. The 'ACT on Asthma' programme was devised, comprising four arms of an intervention strategy: education and training, clinical support, advice centre and raising awareness, to be co-ordinated by a central team. CONCLUSIONS The modified IM principles utilised in this study were systematic and informed by theory. The combined IM and participatory approach could be considered when tailoring interventions for other clinical problems within diverse communities. The IM approach to intervention development was however resource intensive. Working in meaningful collaboration with minority communities requires specific resources and a culturally competent methodology.
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Affiliation(s)
- Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK. .,Whittington Health NHS Trust, London, UK.
| | - Lorraine Culley
- School of Applied Social Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
| | - Noelle Robertson
- Clinical Psychology, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Lancaster Road, Leicester, LE1 7HA, UK
| | - Emma C Alexander
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, King's College Hospital, London, SE5 9RS, UK.,Aceso Global Health Consultants Ltd., 3 Abbey Terrace, London, SE2 9EY, UK
| | - Deborah Bird
- Child Development Team, Ealing Services for Children with Additional Needs, West London NHS Trust, Carmelita House, 21-22 The Mall, Ealing, W5 2PJ, UK
| | - Nicky Hudson
- School of Applied Social Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
| | | | - Melanie McFeeters
- Specialised Commissioning, NHS England and NHS Improvement, Midlands Region, Fosse House, 6 Smith Way, Grove Park, Enderby, Leicester, LE19 1SX, UK
| | - Charlotte Hamlyn-Williams
- Center for Health Services and Clinical Research, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | - Logan Manikam
- Aceso Global Health Consultants Ltd., 3 Abbey Terrace, London, SE2 9EY, UK.,UCL Institute of Epidemiology & Healthcare, 1 - 19 Torrington Place, London, WC1E 7HB, UK
| | - Yebeen Ysabelle Boo
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.,Aceso Global Health Consultants Ltd., 3 Abbey Terrace, London, SE2 9EY, UK.,Nuffield Department of Population Health, University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Maya Lakhanpaul
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Mark R D Johnson
- Faculty of Health and Life Sciences, Mary Seacole Research Centre, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
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Manikam L, Bou Karim Y, Boo YY, Allaham S, Marwaha R, Parikh P, Lakhanpaul M. Operationalising a One Health approach to reduce the infection and antimicrobial resistance (AMR) burden in under-5 year old urban slum dwellers: The Childhood Infections and Pollution (CHIP) Consortium. One Health 2020; 10:100144. [PMID: 32518814 PMCID: PMC7272496 DOI: 10.1016/j.onehlt.2020.100144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/06/2020] [Revised: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022] Open
Abstract
The WHO advocates the use of a One Health approach to address antimicrobial resistance (AMR), focusing on integrating human, animal and environmental health factors. Nevertheless, there is a dearth of AMR research investigating the complexity of down and upstream factors across the One Health spectrum, especially in resource-deprived settings. The Childhood Infections and Pollution Consortium (CHIP) was designed to reduce the burden of childhood infections and AMR in urban slums, particularly in low-and middle-income countries, using One Health and technology-enabled Citizen Science approaches. Currently operationalized in three countries; India, Indonesia and Chile; CHIP is composed of interdisciplinary academics, healthcare professionals, veterinarians, international and local non-governmental organisations, current and former policymakers, local artists and community champions, amongst others. The CHIP Consortium invites collaborations for evidence-driven research, targeted investment and co-development of interventions in slums. We will host our third annual consortium workshop in Hong Kong in 2021 to build on our current work and explore new avenues to tackle childhood infections and AMR.
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Affiliation(s)
- Logan Manikam
- Aceso Global Health Consultants Limited, London, UK.,Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, UK
| | - Yasmin Bou Karim
- Aceso Global Health Consultants Limited, London, UK.,Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Yebeen Ysabelle Boo
- Aceso Global Health Consultants Limited, London, UK.,Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, UK
| | - Shereen Allaham
- Aceso Global Health Consultants Limited, London, UK.,Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, UK
| | - Ria Marwaha
- School of Medicine, The University of Manchester, Manchester, UK
| | - Priti Parikh
- Engineering for International Development Centre, Civil Environmental and Geomatic Engineering, University College of London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Whittington Health NHS Trust, London, UK
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Tariq H, Emes DT, Boo YY, Light A, Sadique Z, Khan M, Knight A, Dar O, Manikam L. Economic impact of Ebola virus disease outbreak on an extractive firm: a case study. UCL Open Environ 2020; 2:e007. [PMID: 37229294 PMCID: PMC10208325 DOI: 10.14324/111.444/ucloe.000007] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/17/2020] [Indexed: 05/27/2023]
Abstract
Purpose The recent Ebola virus disease (EVD) epidemic was one of the most severe public health emergencies in modern times. The economic impact of epidemics has mostly been analysed at the macroeconomic level. Conversely, we aimed to estimate the economic costs of preventive measures of the epidemic to an extractive firm, ArcelorMittal (AM), using data in the epidemic region from March 2014 to December 2015. AM is the world's largest steel producer and is particularly important in West Africa, where the extractive industry is economically crucial. Methods Qualitative methods, in-depth interviews (IDIs) and focus group discussions (FGDs), were used to investigate the events and channels of impact of the epidemic on the firm, as perceived by employees and contractors. Quantitative data regarding these costs were also collected. Retrospective cost analysis estimated the actual cost of preventive methods adopted. Results Most respondents indicated the largest cost impact was suspension of the Phase II expansion, a series of projects designed to increase iron ore production in Liberia. The next largest cost was the preventive measures adopted to counter disease spread. Total costs incurred for adopting preventive measures were USD 10.58-11.11 million. The overall direct costs of preventive measures adopted within the fence, meaning within the physical boundary of the firm's sites, shared 30-31% of the total costs incurred. The share of external donations supporting humanitarian response was 11-12% of the total costs, followed by 7-12% of relational costs. Conclusions The firm's response during the EVD epidemic focussed on its employees and operations, which was later expanded to the wider community and then in supporting the international humanitarian response.
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Affiliation(s)
- Hisham Tariq
- THINKLab, The University of Salford, Maxwell Building, The Crescent, 7 Floor, Salford M5 4WT, UK
- Centre of Disaster Resilience, The University of Salford, The Crescent, Salford M5 4WT, UK
| | - David Tresco Emes
- Oxford Department of International Development and Department of Economics, University of Oxford, Oxford OX1 3TB, UK
| | - Yebeen Ysabelle Boo
- UCL Institute of Epidemiology and Healthcare, University College London, Gower Street, London WC1E 6BT, UK
- Aceso Global Health Consultants Ltd, 3 Abbey Terrace, London SE2 9EY, UK
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK
| | | | - Zia Sadique
- Department for Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK
| | - Mishal Khan
- Department for Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK
| | - Alan Knight
- ArcelorMittal, 7 Floor, Berkeley Square House, Berkeley Square, London W1J 6DA, UK
| | - Osman Dar
- Chatham House, 10 St. James’ Square, St. James’s, London SW1Y 4LE, UK
| | - Logan Manikam
- UCL Institute of Epidemiology and Healthcare, University College London, Gower Street, London WC1E 6BT, UK
- Aceso Global Health Consultants Ltd, 3 Abbey Terrace, London SE2 9EY, UK
- Chatham House, 10 St. James’ Square, St. James’s, London SW1Y 4LE, UK
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