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El Arifeen S, Grove J, Hansen PM, Hargreaves JR, Johnson HL, Johri M, Saville E. Evaluating global health initiatives to improve health equity. Bull World Health Organ 2024; 102:137-139. [PMID: 38313152 PMCID: PMC10835640 DOI: 10.2471/blt.23.290531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - John Grove
- Office of the Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Peter M Hansen
- Global Financing Facility for Women, Children and Adolescents, Washington, DC, United States of America
| | | | | | - Mira Johri
- Département de gestion, d’évaluation et de politique de santé, École de santé publique de l’Université de Montréal, 7101, avenue du Parc, Montréal, QuébecH3N 1X9, Canada
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van der Wal R, Cockcroft A, Kobo M, Kgakole L, Marokaone N, Johri M, Vedel I, Andersson N. HIV-sensitive social protection for unemployed and out-of-school young women in Botswana: An exploratory study of barriers and solutions. PLoS One 2024; 19:e0293824. [PMID: 38198458 PMCID: PMC10781194 DOI: 10.1371/journal.pone.0293824] [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: 05/13/2023] [Accepted: 10/20/2023] [Indexed: 01/12/2024] Open
Abstract
Promotive social protection programs aim to increase income and capabilities and could help address structural drivers of HIV-vulnerability like poverty, lack of education and gender inequality. Unemployed and out-of-school young women bear the brunt of HIV infection in Botswana, but rarely benefit from such economic empowerment programs. Using a qualitative exploratory study design and a participatory research approach, we explored factors affecting perceived program benefit and potential solutions to barriers. Direct stakeholders (n = 146) included 87 unemployed and out-of-school young women and 59 program and technical officers in five intervention districts. Perceived barriers were identified in 20 semi-structured interviews (one intervention district) and 11 fuzzy cognitive maps. Co-constructed improvement recommendations were generated in deliberative dialogues. Analysis relied on Framework and the socioecological model. Overall, participants viewed existing programs in Botswana as ineffective and inadequate to empower vulnerable young women socially or economically. Factors affecting perceived program benefit related to programs, program officers, the young women, and their social and structural environment. Participants perceived barriers at every socioecological level. Young women's lack of life and job skills, unhelpful attitudes, and irresponsible behaviors were personal-level barriers. At an interpersonal level, competing care responsibilities, lack of support from boyfriends and family, and negative peer influence impeded program benefit. Traditional venues for information dissemination, poverty, inequitable gender norms, and lack of coordination were community- and structural-level barriers. Improvement recommendations focused on improved outreach and peer approaches to implement potential solutions. Unemployed and out-of-school young women face multidimensional, interacting barriers that prevent benefit from available promotive social protection programs in Botswana. To become HIV-sensitive, these socioeconomic empowerment programs would need to accommodate or preferentially attract this key population. This requires more generous and comprehensive programs, a more client-centered program delivery, and improved coordination. Such structural changes require a holistic, intersectoral approach to HIV-sensitive social protection.
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Affiliation(s)
- Ran van der Wal
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
- CIET Trust, Gaborone, South-East, Botswana
| | | | | | | | - Mira Johri
- Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département de Gestion, d’évaluation, et de Politique de Santé, École de Santé Publique de l’Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
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Chaillet N, Mâsse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser WD, Gagnon R, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Blouin S, Ducruet T, Girard M, Bujold E. Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial. Lancet 2024; 403:44-54. [PMID: 38096892 DOI: 10.1016/s0140-6736(23)01855-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. METHODS We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. FINDINGS 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52-0·99]; p=0·042; adjusted risk difference -1·2% [95% CI -2·0 to -0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33-0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. INTERPRETATION A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. FUNDING Canadian Institutes of Health Research (CIHR, MOP-142448).
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Affiliation(s)
- Nils Chaillet
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada.
| | - Benoît Mâsse
- School of Public Health, University of Montreal, Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Patrick Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Marylène Dugas
- Department of Health Sciences, Interdisciplinary Research Chair in Rural Health and Social Services, University of Quebec at Rimouski, Rimouski, QC, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Suzanne Demers
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Laval University, Quebec, QC, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Guy-Paul Gagné
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Diane Francoeur
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Louise Duperron
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Mira Johri
- School of Public Health, University of Montreal, Montreal, QC, Canada; University of Montreal Hospital Research Center, University of Montreal, QC, Canada
| | - Eric Dubé
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Simon Blouin
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | | | - Mario Girard
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Emmanuel Bujold
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
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Ducharme J, Correa GC, Reynolds HW, Sharkey AB, Fonner VA, Johri M. Mapping of Pro-Equity Interventions Proposed by Immunisation Programs in Gavi Health Systems Strengthening Grants. Vaccines (Basel) 2023; 11:vaccines11020341. [PMID: 36851218 PMCID: PMC9961887 DOI: 10.3390/vaccines11020341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Reaching zero-dose (ZD) children, operationally defined as children who have not received a first dose of the diphtheria, tetanus, and pertussis (DTP1) vaccine, is crucial to increase equitable immunisation coverage and access to primary health care. However, little is known about the approaches already taken by countries to improve immunisation equity. We reviewed all Health System Strengthening (HSS) proposals submitted by Gavi-supported countries from 2014 to 2021 inclusively and extracted information on interventions favouring equity. Pro-equity interventions were mapped to an analytical framework representing Gavi 5.0 programmatic guidance on reaching ZD children and missed communities. Data from keyword searches and manual screening were extracted into an Excel database. Open format responses were analysed using inductive and deductive thematic coding. Data analysis was conducted using Excel and R. Of the 56 proposals included, 51 (91%) included at least one pro-equity intervention. The most common interventions were conducting outreach sessions, tailoring the location of service delivery, and partnerships. Many proposals had "bundles" of interventions, most often involving outreach, microplanning and community-level education activities. Nearly half prioritised remote-rural areas and only 30% addressed gender-related barriers to immunisation. The findings can help identify specific interventions on which to focus future evidence syntheses, case studies and implementation research and inform discussions on what may or may not need to change to better reach ZD children and missed communities moving forward.
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Affiliation(s)
- Joelle Ducharme
- Measurement, Evaluation and Learning Department, Gavi, The Vaccine Alliance, 1218 Le Grand-Saconnex, Switzerland
- Correspondence:
| | - Gustavo Caetano Correa
- Measurement, Evaluation and Learning Department, Gavi, The Vaccine Alliance, 1218 Le Grand-Saconnex, Switzerland
| | - Heidi W. Reynolds
- Measurement, Evaluation and Learning Department, Gavi, The Vaccine Alliance, 1218 Le Grand-Saconnex, Switzerland
| | - Alyssa B. Sharkey
- School of Public and International Affairs, Princeton University, Princeton, NJ 08544, USA
| | | | - Mira Johri
- Carrefour de l’Innovation, Centre de Recherche de l’Université de Montréal (CRCHUM), Montréal, QC H2X 0A9, Canada
- Département de Gestion, D’évaluation, et de Politique de Santé, École de Santé Publique de l’Université de Montréal (ESPUM), Montréal, QC H3N 1X9, Canada
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Taneja G, Datta E, Sapru M, Johri M, Singh K, Jandu HS, Das S, Ray A, Laserson K, Dhawan V. An Equity Analysis of Zero-Dose Children in India Using the National Family Health Survey Data: Status, Challenges, and Next Steps. Cureus 2023; 15:e35404. [PMID: 36851944 PMCID: PMC9963392 DOI: 10.7759/cureus.35404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
Background While immunization programs across the world have made considerable progress, children and communities continue to be beyond the reach of healthcare services. Globally, they are now referred to as zero-dose (ZD) children (those who have not received a single dose of diphtheria, pertussis, and tetanus-containing vaccine). Pre-COVID-19 pandemic analyses suggest that nearly 50% of vaccine-preventable deaths occur among ZD children. Two-thirds of these children live in extremely poor households suffering from multiple deprivations including lack of access to reproductive health services, water, and sanitation. Hence, ZD children have now been prioritized as a key cohort for identification and integration with the health systems as we build back from the pandemic. Methodology Extracting data from the last two National Family Health Survey (NFHS) rounds (NFHS 4, 2015-2016 and NFHS 5, 2019-2021), this study aims to ascertain the status of ZD children aged 12-23 months in India, the challenges, and the necessary action agenda going forward. Data were analyzed for equity determinants such as gender, place of residence, religion, birth order, caste, and mother's schooling. Key determinants included the change in ZD prevalence at the national, state, and district levels; variations across equity parameters and states with maximum improvements; and disparity across these indicators. A correlation analysis was also conducted to understand the nature of the association between ZD prevalence and critical maternal and child health indicators. Results The overall ZD prevalence between the two rounds was reduced by 4.1% (10.5-6.4%). A total of 26 states in the country reported a ZD prevalence of <10% in NFHS 5 compared to 18 in NFHS 4. In total, 324 districts reported a ZD prevalence of <5%, and 145 districts reported a prevalence of >10%. The equity parameters reflected a slow-footed reduction among ZD for girl children, across urban geographies, firstborn children, mothers with 12 or more years of schooling, and children in families with the highest wealth quintiles. A negative correlation accentuated between the two NFHS rounds was established between first-trimester registration, four or more antenatal visits, institutional deliveries, and ZD prevalence. Conclusions The findings point toward sustained improvement across key equity parameters, however, challenges do exist. Moreover, the impact of the pandemic on immunization programs across the globe and in India is bound to halt and reverse the progress and potentiate further inequities. It is thus imperative that continued and augmented efforts are continued to identify, integrate, and immunize ZD children, families, and communities.
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Affiliation(s)
- Gunjan Taneja
- Infectious Disease Cluster, India Country Office, Bill & Melinda Gates Foundation, New Delhi, IND
| | - Eshita Datta
- Social Impact Practice, Evalueserve, New Delhi, IND
| | - Mahima Sapru
- Social Impact Practice, Evalueserve, New Delhi, IND
| | - Mira Johri
- School of Public Health, University of Montreal, Montreal, CAN
| | - Kapil Singh
- Immunization Division, Ministry of Health and Family Welfare, Government of India, New Delhi, IND
| | | | - Shyamashree Das
- Infectious Disease Cluster, India Country Office, Bill & Melinda Gates Foundation, New Delhi, IND
| | - Arindam Ray
- Infectious Disease Cluster, India Country Office, Bill & Melinda Gates Foundation, New Delhi, IND
| | - Kayla Laserson
- Infectious Disease Cluster, India Country Office, Bill & Melinda Gates Foundation, New Delhi, IND
| | - Veena Dhawan
- Immunization Division, Ministry of Health and Family Welfare, Government of India, New Delhi, IND
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Rajpal S, Kumar A, Johri M, Kim R, Subramanian SV. Patterns in the Prevalence of Unvaccinated Children Across 36 States and Union Territories in India, 1993-2021. JAMA Netw Open 2023; 6:e2254919. [PMID: 36763362 PMCID: PMC9918883 DOI: 10.1001/jamanetworkopen.2022.54919] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
IMPORTANCE Children who do not receive any routine vaccinations (ie, who have 0-dose status) are at elevated risk of death, morbidity, and socioeconomic vulnerabilities that limit their development over the life course. India has the world's highest number of children with 0-dose status; analysis of national and subnational patterns is the first important step to addressing this problem. OBJECTIVES To examine the patterns among children with 0-dose immunization status across all 36 states and union territories (UTs) in India over 29 years, from 1993 to 2021, and to elucidate the relative share of multiple geographic regions in the total geographic variation in 0-dose immunization. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study analyzed all 5 rounds of India's National Family Health Survey (1992-1993, 1998-1999, 2005-2006, 2015-2016, and 2019-2021) to compare the prevalence of children with 0-dose status across time-space and geographic regions. The Integrated Public Use of Microdata Series was used to construct comparable geographic boundaries for states and UTs across surveys. The study included a total of 125 619 live children aged 12 to 23 months who were born to participating women. MAIN OUTCOMES AND MEASURES The outcome was a binary indicator of children's 0-dose vaccination status, coded as children aged 12 to 23 months at the time of the survey who had not received the first dose of the diphtheria-tetanus-pertussis-containing vaccine. The significance of each geographic unit was computed using the variance partition coefficient (VPC). RESULTS Among 125 619 children, the national prevalence of those with 0-dose status in India decreased from 33.4% (95% CI, 32.5%-34.2%) in 1993 to 6.6% (95% CI, 6.4%-6.8%) in 2021. A substantial reduction in the IQR of 0-dose prevalence across states from 30.1% in 1993 to 3.1% in 2021 suggested a convergence in state disparities. The prevalence in the northeastern states of Meghalaya (17.0%), Nagaland (16.1%), Mizoram (14.3%), and Arunachal Pradesh (12.6%) remained relatively high in 2021. Prevalence increased between 2016 and 2021 in 10 states, including several traditionally high-performing states and UTs, such as Telangana (1.16 percentage points) and Sikkim (0.92 percentage points). In 2021, 53.0% of children with 0-dose status resided in the populous states of Uttar Pradesh, Bihar, and Maharashtra. A multilevel analysis comparing the share of variation at the state, district, and cluster (primary sampling unit) levels revealed that clusters accounted for the highest share of the total variation in 2016 (44.7%; VPC [SE], 1.04 [0.32]) and 2021 (64.3%; VPC [SE], 0.38 [0.12]). CONCLUSIONS AND RELEVANCE In this cross-sectional study, findings from approximately 3 decades of analysis suggest the need for sustained efforts to target populous states like Uttar Pradesh and Bihar and northeastern parts of India. The resurgence of 0-dose prevalence in 10 states highlights the importance of programs like Intensified Mission Indradhanush 4.0, a major national initiative to improve immunization coverage. Prioritizing small administrative units will be important to strengthening India's efforts to bring every child into the immunization regime.
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Affiliation(s)
- Sunil Rajpal
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Department of Economics, FLAME University, Pune, India
| | - Akhil Kumar
- Turner Fenton Secondary School, Brampton, Ontario, Canada
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier, University of Montréal, Montréal, Québec, Canada
- Department of Management, Evaluation, and Health Policy, School of Public Health, University of Montréal, Montréal, Québec, Canada
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Gutierrez JP, Johri M. Socioeconomic and geographic inequities in vaccination among children 12 to 59 months in Mexico, 2012 to 2021. Rev Panam Salud Publica 2023; 47:e35. [PMID: 36751676 PMCID: PMC9899057 DOI: 10.26633/rpsp.2023.35] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/29/2022] [Indexed: 02/07/2023] Open
Abstract
Objective To document the evolution of socioeconomic and geographical inequalities in childhood vaccination in Mexico from 2012 to 2021. Methods Repeated cross-sectional analysis using three rounds of National Health and Nutrition Surveys (2012, 2018, and 2021). Dichotomous variables were created to identify the proportion of children who received no dose of each vaccine included in the national immunization schedule (BCG; diphtheria, pertussis, and tetanus-containing; rotavirus; pneumococcal conjugate; and measles, mumps, and rubella [MMR]), and the proportion completely unvaccinated. The distribution of unvaccinated children was analyzed by state, and by socioeconomic status using the concentration index. Results The prevalence of completely unvaccinated children in Mexico was low, with 0.3% children in 2012 and 0.8% children in 2021 receiving no vaccines (p = 0.070). Notwithstanding, for each vaccine, an important proportion of children missed receiving any dose. Notably, the prevalence of MMR unvaccinated children was 10.2% (95% CI 9.2-11.1) in 2012, 22.3% (95% CI 20.9-23.8) in 2018, and 29.1% (95% CI 26.3-31.8) in 2021 (p < 0.001 for the difference between 2012 and 2021). The concentration index indicated pro-rich inequalities in non-vaccination for 2 of 5 vaccines in 2012, 3 of 5 vaccines in 2018, and 4 of 5 vaccines in 2021. There were marked subnational variations. The percentage of MMR unvaccinated children ranged from 3.3% to 17.9% in 2012, 5.5% to 36.5% in 2018, and 13.1% to 72.5% in 2021 across the 32 states of Mexico. Conclusions Equitable access to basic childhood vaccines in Mexico has deteriorated over the past decade. Vigilant equity monitoring coupled with tailored strategies to reach those left out is urgently required.
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Affiliation(s)
- Juan Pablo Gutierrez
- National Autonomous University of MexicoMexico CityMexicoNational Autonomous University of Mexico, Mexico City, Mexico,
| | - Mira Johri
- Université de MontréalMontreal, QuebecCanadaUniversité de Montréal, Montreal, Quebec, Canada
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Chaillet N, Masse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser W, Gagnon R, Monnier P, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Ducruet T, Girard M, Bujold E. A cluster-randomized trial to reduce perinatal morbidity among women with a prior cesarean delivery (PRISMA). Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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van der Wal R, Kobo M, Cockcroft A, Vedel I, Johri M, Andersson N. Vulnerable young women and frontline service providers identify options to improve the HIV-sensitivity of social protection programmes in Botswana: A modified Policy Delphi approach. Glob Public Health 2023; 18:2255030. [PMID: 38081774 DOI: 10.1080/17441692.2023.2255030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/30/2023] [Indexed: 12/18/2023]
Abstract
Poverty, lack of education and gender inequality make unemployed and out-of-school young women extremely vulnerable to HIV infection. Promotive social protection programmes aim to increase livelihood and capabilities and could empower this priority population to act on HIV prevention choices. In Botswana, they rarely benefit from such programmes.A modified Policy Delphi engaged a panel of 22 unemployed and out-of-school young women and eight frontline service providers to consider alternative policy and practice options, and tailor available programmes to their own needs and social situation. The panel assessed the desirability and feasibility of improvement proposals and, in a second round, ranked them for relative importance.Nearly all 40 improvement proposals were considered very desirable and definitely, or possibly, feasible, and panellists prioritised a wide range of proposals. Frontline service providers stressed foundational skills, like life skills and second chance education. Young women preferred options with more immediate benefits. Overall, panellists perceived positive role models for programme delivery, access to land and water, job skills training, and stipends as most important to empower HIV-vulnerable young women. Results suggest ample policy space to make existing social protection programmes in Botswana more inclusive of unemployed and out-of-school young women, hence more HIV-sensitive.
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Affiliation(s)
- Ran van der Wal
- Department of Family Medicine, McGill University, Montreal, Canada
| | | | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, Canada
- CIET Trust, Gaborone, Botswana
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Mira Johri
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
- Département de gestion, d'évaluation, et de politique de santé, École de santé publique de l'Université de Montréal, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Nassiri-Ansari T, Atuhebwe P, Ayisi AS, Goulding S, Johri M, Allotey P, Schwalbe N. Shifting gender barriers in immunisation in the COVID-19 pandemic response and beyond. Lancet 2022; 400:24. [PMID: 35780789 PMCID: PMC9246460 DOI: 10.1016/s0140-6736(22)01189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/12/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Tiffany Nassiri-Ansari
- International Institute for Global Health, United Nations University, Hospital Canselor Tuanku Muhriz UKM, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Phionah Atuhebwe
- WHO Regional Office for Africa, Cité du Djoué, Brazzaville, Democratic Republic of the Congo
| | - Akosua Sika Ayisi
- Greater Accra Regional Health Directorate, Ghana Health Service, Accra, Ghana
| | - Sarah Goulding
- Department of Foreign Affairs and Trade, Australian Federal Government, Barton, ACT, Australia
| | - Mira Johri
- Département de gestion, d'évaluation, et de politique de santé, École de santé publique de l'Université de Montréal, Montreal, Canada
| | - Pascale Allotey
- International Institute for Global Health, United Nations University, Hospital Canselor Tuanku Muhriz UKM, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Nina Schwalbe
- International Institute for Global Health, United Nations University, Hospital Canselor Tuanku Muhriz UKM, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, New York, NY 10032, USA; Spark Street Advisors, New York, NY, USA.
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Abstract
In India, strict public health measures to suppress COVID-19 transmission and reduce burden have been rapidly adopted. Pandemic containment and confinement measures impact societies and economies; their costs and benefits must be assessed holistically. This study provides an evolving portrait of the health, economic and social consequences of the COVID-19 pandemic on vulnerable populations in India. Our analysis focuses on 100 days early in the pandemic from 13 March to 20 June 2020. We developed a conceptual framework based on the human right to health and the UN Sustainable Development Goals (SDGs). We analysed people's experiences recorded and shared via mobile phone on the voice platforms operated by the Gram Vaani COVID-19 response network, a service for rural and low-income populations now being deployed to support India's COVID-19 response. Quantitative and visual methods were used to summarize key features of the data and explore relationships between factors. In its first 100 days, the platform logged over 1.15 million phone calls, of which 793 350 (69%) were outbound calls related largely to health promotion in the context of COVID-19. Analysis of 6636 audio recordings by network users revealed struggles to secure the basic necessities of survival, including food (48%), cash (17%), transportation (10%) and employment or livelihoods (8%). Themes were mapped to shortfalls in 10 SDGs and their associated targets. Pre-existing development deficits and weak social safety nets are driving vulnerability during the COVID-19 crisis. For an effective pandemic response and recovery, these must be addressed through inclusive policy design and institutional reforms.
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Affiliation(s)
- Mira Johri
- Centre de recherche du CHUM (CRCHUM), Montréal, Québec H2X 0A9, Canada
- Département de gestion, d’évaluation, et de politique de santé, École de santé publique de l’Université de Montréal (ÉSPUM), 3-7101 Av du Parc, Montréal QC H3N 1X9, Canada
| | - Sumeet Agarwal
- Department of Electrical Engineering, Indian Institute of Technology Delhi, Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi 110016, India
- School of Information Technology, Indian Institute of Technology, Delhi Hauz Khas, New Delhi 110 016, India
| | - Aman Khullar
- Gram Vaani Community Media (Onion Dev Technologies Pvt. Ltd.), Plot No. 2, First Floor, 100 Feet Road Ghitorni, MG Road, New Delhi 110030 India
| | - Dinesh Chandra
- Raah Health and Social Development Foundation, Kh.No 54/1, Street No-6, Block- A, Parasram Enclave, Burari, New Delhi 110084, India
| | - Vijay Sai Pratap
- Gram Vaani Community Media (Onion Dev Technologies Pvt. Ltd.), Plot No. 2, First Floor, 100 Feet Road Ghitorni, MG Road, New Delhi 110030 India
| | - Aaditeshwar Seth
- School of Information Technology, Indian Institute of Technology, Delhi Hauz Khas, New Delhi 110 016, India
- Gram Vaani Community Media (Onion Dev Technologies Pvt. Ltd.), Plot No. 2, First Floor, 100 Feet Road Ghitorni, MG Road, New Delhi 110030 India
- Department of Computer Science and Engineering Block IIA, Bharti Building Indian Institute of Technology Delhi Hauz Khas, New Delhi 110 016, India
| | - the Gram Vaani Team
- Gram Vaani Community Media (Onion Dev Technologies Pvt. Ltd.), Plot No. 2, First Floor, 100 Feet Road Ghitorni, MG Road, New Delhi 110030 India
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12
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van der Wal R, Loutfi D, Hong QN, Vedel I, Cockcroft A, Johri M, Andersson N. HIV-sensitive social protection for vulnerable young women in East and Southern Africa: a systematic review. J Int AIDS Soc 2021; 24:e25787. [PMID: 34473406 PMCID: PMC8412122 DOI: 10.1002/jia2.25787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Social protection programmes are considered HIV-sensitive when addressing risk, vulnerability or impact of HIV infection. Socio-economic interventions, like livelihood and employability programmes, address HIV vulnerabilities like poverty and gender inequality. We explored the HIV-sensitivity of socio-economic interventions for unemployed and out-of-school young women aged 15 to 30 years, in East and Southern Africa, a key population for HIV infection. METHODS We conducted a systematic review using a narrative synthesis method and the Mixed Methods Appraisal Tool for quality appraisal. Interventions of interest were work skills training, microfinance, and employment support. Outcomes of interest were socio-economic outcomes (income, assets, savings, skills, (self-) employment) and HIV-related outcomes (behavioural and biological). We searched published and grey literature (January 2005 to November 2019; English/French) in MEDLINE, Scopus, Web of Science and websites of relevant international organizations. RESULTS We screened 3870 titles and abstracts and 188 full-text papers to retain 18 papers, representing 12 projects. Projects offered different combinations of HIV-sensitive social protection programmes, complemented with mentors, safe space and training (HIV, reproductive health and gender training). All 12 projects offered work skills training to improve life and business skills. Six offered formal (n = 2) or informal (n = 5) livelihood training. Eleven projects offered microfinance, including microgrants (n = 7), microcredit (n = 6) and savings (n = 4). One project offered employment support in the form of apprenticeships. In general, microgrants, savings, business and life skills contributed improved socio-economic and HIV-related outcomes. Most livelihood training contributed positive socio-economic outcomes, but only two projects showed improved HIV-related outcomes. Microcredit contributed little to either outcome. Programmes were effective when (i) sensitive to beneficiaries' age, needs, interests and economic vulnerability; (ii) adapted to local implementation contexts; and (iii) included life skills. Programme delivery through mentorship and safe space increased social capital and may be critical to improve the HIV-sensitivity of socio-economic programmes. CONCLUSIONS A wide variety of livelihood and employability programmes were leveraged to achieve improved socio-economic and HIV-related outcomes among unemployed and out-of-school young women. To be HIV-sensitive, programmes should be designed around their interests, needs and vulnerability, adapted to local implementation contexts, and include life skills. Employment support received little attention in this literature.
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Affiliation(s)
- Ran van der Wal
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - David Loutfi
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - Quan Nha Hong
- EPPI‐CentreUCL Social Research InstituteUniversity College LondonLondonUK
| | - Isabelle Vedel
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - Anne Cockcroft
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
- CIET TrustGaboroneBotswana
| | - Mira Johri
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM)MontrealQuebecCanada
- Département de gestiond’évaluationet de politique de santéÉcole de santé publique de l'Université de MontréalMontrealQuebecCanada
| | - Neil Andersson
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
- Centro de Investigación de Enfermedades TropicalesUniversidad Autónoma de GuerreroAcapulcoMexico
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Labonté R, Johri M, Plamondon K, Murthy S. Canada, global vaccine supply, and the TRIPS waiver : Le Canada, l'offre mondiale de vaccins et l'exemption ADPIC. Can J Public Health 2021. [PMID: 34019281 DOI: 10.17269/s41997‐021‐00541‐4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Mira Johri
- École de santé publique, Université de Montréal, Montréal, QC, Canada
| | - Katrina Plamondon
- School of Nursing, Faculty of Health & Social Development, University of British Columbia, Vancouver, BC, Canada
| | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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14
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Labonté R, Johri M, Plamondon K, Murthy S. Canada, global vaccine supply, and the TRIPS waiver : Le Canada, l'offre mondiale de vaccins et l'exemption ADPIC. Can J Public Health 2021; 112:543-547. [PMID: 34019281 PMCID: PMC8139222 DOI: 10.17269/s41997-021-00541-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Mira Johri
- École de santé publique, Université de Montréal, Montréal, QC, Canada
| | - Katrina Plamondon
- School of Nursing, Faculty of Health & Social Development, University of British Columbia, Vancouver, BC, Canada
| | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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Pérez MC, Chandra D, Koné G, Singh R, Ridde V, Sylvestre MP, Seth A, Johri M. Implementation fidelity and acceptability of an intervention to improve vaccination uptake and child health in rural India: a mixed methods evaluation of a pilot cluster randomized controlled trial. Implement Sci Commun 2020; 1:88. [PMID: 33043302 PMCID: PMC7542710 DOI: 10.1186/s43058-020-00077-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background The Tika Vaani intervention, an initiative to improve basic health knowledge and empower beneficiaries to improve vaccination uptake and child health for underserved rural populations in India, was assessed in a pilot cluster randomized trial. The intervention was delivered through two strategies: mHealth (using mobile phones to send vaccination reminders and audio-based messages) and community mobilization (face-to-face meetings) in rural Indian villages from January to September 2018. We assessed acceptability and implementation fidelity to determine whether the intervention delivered in the pilot trial can be implemented at a larger scale. Methods We adapted the Conceptual Framework for implementation fidelity to assess acceptability and fidelity of the pilot interventions using a mixed methods design. Quantitative data sources include a structured checklist, household surveys, and mobile phone call patterns. Qualitative data came from field observations, intervention records, semi-structured interviews and focus groups with project recipients and implementers. Quantitative analyses assessed whether activities were implemented as planned, using descriptive statistics to describe participant characteristics and the percentage distribution of activities. Qualitative data were analyzed using content analysis and in the light of the implementation fidelity model to explore moderating factors and to determine how well the intervention was received. Results Findings demonstrated high (86.7%) implementation fidelity. A total of 94% of the target population benefited from the intervention by participating in a face-to-face group meeting or via mobile phone. The participants felt that the strategies were useful means for obtaining information. The clarity of the intervention theory, the motivation, and commitment of the implementers as well as the periodic meetings of the supervisors largely explain the high level of fidelity obtained. Geographic distance, access to a mobile phone, level of education, and gender norms are contextual factors that contributed to heterogeneity in participation. Conclusions Although the intervention was evaluated in the context of a randomized trial that could explain the high level of fidelity obtained, this evaluation provides confirmatory evidence that the results of the study reflect the underlying theory. The mobile platform coupled with community mobilization was well-received by the participants and could be a useful way to improve health knowledge and change behavior. Trial registration ISRCTN 44840759 (22 April 2018)
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Affiliation(s)
- Myriam Cielo Pérez
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-102, 850, rue St-Denis, Montréal, Québec H2X 0A9 Canada.,Département de Médicine Sociale et Préventive, École de Santé Publique (ESPUM), Université de Montréal, Montréal, Québec Canada
| | | | - Georges Koné
- Management Sciences for Health (MSH)/USAID, Port-au-Prince, Haiti
| | - Rohit Singh
- Gram Vaani Community Media Pvt. Ltd., New Delhi, India
| | - Valery Ridde
- Centre de recherche en santé publique, Université de Montréal, 7101 avenue du Parc, Montréal, Québec Canada.,IRD (French Institute for Research on Sustainable Development), CEPED (IRD-Université Paris), Université de Paris, ERL INSERM SAGESUD, 45 rue des Saints-Pères, 75006 Paris, France
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-102, 850, rue St-Denis, Montréal, Québec H2X 0A9 Canada.,Département de Médicine Sociale et Préventive, École de Santé Publique (ESPUM), Université de Montréal, Montréal, Québec Canada
| | - Aaditeshwar Seth
- Gram Vaani Community Media Pvt. Ltd., New Delhi, India.,Department of Computer Science, Indian Institute of Technology Delhi, New Delhi, India
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-102, 850, rue St-Denis, Montréal, Québec H2X 0A9 Canada.,Département de gestion, d'évaluation, et de politique de santé, École de Santé Publique (ESPUM), Université de Montréal, Montréal, Québec Canada
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16
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Johri M, Chandra D, Kone KG, Sylvestre MP, Mathur AK, Harper S, Nandi A. Social and Behavior Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study. JMIR Mhealth Uhealth 2020; 8:e20356. [PMID: 32955455 PMCID: PMC7546625 DOI: 10.2196/20356] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/01/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background In resource-poor settings, lack of awareness and low demand for services constitute important barriers to expanding the coverage of effective interventions. In India, childhood immunization is a priority health strategy with suboptimal uptake. Objective To assess study feasibility and key implementation outcomes for the Tika Vaani model, a new approach to educate and empower beneficiaries to improve immunization and child health. Methods A cluster-randomized pilot trial with a 1:1 allocation ratio was conducted in rural Uttar Pradesh, India, from January to September 2018. Villages were randomly assigned to either the intervention or control group. In each participating village, surveyors conducted a complete enumeration to identify eligible households and requested participation before randomization. Interventions were designed through formative research using a social marketing approach and delivered over 3 months using strategies adapted to disadvantaged populations: (1) mobile health (mHealth): entertaining educational audio capsules (edutainment) and voice immunization reminders via mobile phone and (2) face-to-face: community mobilization activities, including 3 small group meetings offered to each participant. The control group received usual services. The main outcomes were prespecified criteria for feasibility of the main study (recruitment, randomization, retention, contamination, and adoption). Secondary endpoints tested equity of coverage and changes in intermediate outcomes. Statistical methods included descriptive statistics to assess feasibility, penalized logistic regression and ordered logistic regression to assess coverage, and generalized estimating equation models to assess changes in intermediate outcomes. Results All villages consented to participate. Gaps in administrative data hampered recruitment; 14.0% (79/565) of recorded households were nonresident. Only 1.4% (8/565) of households did not consent. A total of 387 households (184 intervention and 203 control) with children aged 0 to 12 months in 26 villages (13 intervention and 13 control) were included and randomized. The end line survey occurred during the flood season; 17.6% (68/387) of the households were absent. Contamination was less than 1%. Participation in one or more interventions was 94.0% (173/184), 78.3% (144/184) for the face-to-face strategy, and 67.4% (124/184) for the mHealth strategy. Determinants including place of residence, mobile phone access, education, and female empowerment shaped intervention use; factors operated differently for face-to-face and mHealth strategies. For 11 of 13 intermediate outcomes, regression results showed significantly higher basic health knowledge among the intervention group, supporting hypothesized causal mechanisms. Conclusions A future trial of a new intervention model is feasible. The interventions could strengthen the delivery of immunization and universal primary health care. Social and behavior change communication via mobile phones proved viable and contributed to standardization and scalability. Face-to-face interactions remain necessary to achieve equity and reach, suggesting the need for ongoing health system strengthening to accompany the introduction of communication technologies. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 44840759; https://doi.org/10.1186/ISRCTN44840759
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Département de gestion, d'évaluation, et de politique de santé, École de santé publique de l'Université de Montréal, Montréal, QC, Canada
| | | | - Karna Georges Kone
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Principal Technical Advisor for Health Financing at Management Sciences for Health (MSH)/USAID, Port-au-Prince, Haiti
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, QC, Canada
| | - Alok K Mathur
- Indian Institute of Health Management Research University, Jaipur, India
| | - Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada.,Department of Public Health, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada.,The Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
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Chan G, Storey JD, Das MK, Sacks E, Johri M, Kabakian-Khasholian T, Paudel D, Yoshida S, Portela A. Global research priorities for social, behavioural and community engagement interventions for maternal, newborn and child health. Health Res Policy Syst 2020; 18:97. [PMID: 32854722 PMCID: PMC7450986 DOI: 10.1186/s12961-020-00597-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background Social, behavioural and community engagement (SBCE) interventions are essential for global maternal, newborn and child health (MNCH) strategies. Past efforts to synthesise research on SBCE interventions identified a need for clear priorities to guide future research. WHO led an exercise to identify global research priorities for SBCE interventions to improve MNCH. Methods We adapted the Child Health and Nutrition Research Initiative method and combined quantitative and qualitative methods to determine MNCH SBCE intervention research priorities applicable across different contexts. Using online surveys and meetings, researchers and programme experts proposed up to three research priorities and scored the compiled priorities against four criteria – health and social impact, equity, feasibility, and overall importance. Priorities were then ranked by score. A group of 29 experts finalised the top 10 research priorities for each of maternal, newborn or child health and a cross-cutting area. Results A total of 310 experts proposed 867 research priorities, which were consolidated into 444 priorities and scored by 280 experts. Top maternal and newborn health priorities focused on research to improve the delivery of SBCE interventions that strengthen self-care/family care practices and care-seeking behaviour. Child health priorities focused on the delivery of SBCE interventions, emphasising determinants of service utilisation and breastfeeding and nutrition practices. Cross-cutting MNCH priorities highlighted the need for better integration of SBCE into facility-based and community-based health services. Conclusions Achieving global targets for MNCH requires increased investment in SBCE interventions that build capacities of individuals, families and communities as agents of their own health. Findings from this exercise provide guidance to prioritise investments and ensure that they are best directed to achieve global objectives. Stakeholders are encouraged to use these priorities to guide future research investments and to adapt them for country programmes by engaging with national level stakeholders.
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Affiliation(s)
| | - J Douglas Storey
- Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Baltimore, United States of America
| | | | - Emma Sacks
- Department of Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland.
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18
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Johri M, Rodgers L, Chandra D, Abou-Rizk C, Nash E, Mathur AK. Implementation fidelity of village health and nutrition days in Hardoi District, Uttar Pradesh, India: a cross-sectional survey. BMC Health Serv Res 2019; 19:756. [PMID: 31655588 PMCID: PMC6815402 DOI: 10.1186/s12913-019-4625-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Village Health and Nutrition Days (VHNDs) are a cornerstone of the Government of India's strategy to provide first-contact primary health care to rural areas. Recent government programmes such as the Janani Suraksha Yojana (JSY) and Mission Indradhanush (MI) have catalysed important changes impacting VHNDs. To learn how VHNDs are currently being delivered, we assessed the fidelity of services provided as compared to government norms in a priority district of Uttar Pradesh. METHODS We fielded a cross-sectional study of VHNDs to provide a snapshot of health services functioning. Process evaluation data were collected via administrative sources, non-participant observation using a standardised form, and structured questionnaires. Questionnaires were designed using a framework to assess implementation fidelity. Key respondents were VHND participants, front-line workers involved in VHND delivery, and VHND non-participants (pregnant women due for antenatal care or children due for vaccination as per administrative records). Results were summarised as counts, frequencies, and proportions. RESULTS In the 30 villages randomly selected for inclusion, 36 VHNDs were scheduled but four (11.1%) were cancelled and one VHND was not surveyed. Vaccination and antenatal care were offered at 96.8% (30/31) and child weighing at 83.9% (26/31) of VHNDs. Other normed services were infrequently provided or completely absent. Health education and promotion were particularly weak; institutional delivery was the only topic discussed in a majority of VHNDs. The true proportion of any serious problem impeding vaccine delivery was 47.2% (17/36), comprising 4 VHND cancellations and 13 VHNDs experiencing vaccine shortages. Of the 13 incidents of vaccine shortage, 11 related to an unexpected global shortage of injectable polio vaccine (IPV). Over the 31 VHNDs, 37.8% (171 of the 452 scheduled beneficiaries) did not participate. Analysis of missed opportunities for vaccination highlighted inaccuracies in beneficiary identification and tracking and demand side-factors. CONCLUSIONS The transformative potential of VHNDs to improve population health is only partially being met. A core subset of high-priority services for antenatal care, institutional delivery, and vaccination associated with high-priority government programmes (JSY, MI) is now being provided quite successfully. Other basic health promotion and prevention services are largely not provided, constituting a critical missed opportunity.
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Affiliation(s)
- Mira Johri
- University of Montreal Hospital Research Centre (CRCHUM), Tour Saint-Antoine, Porte S03-910, 850, rue St-Denis, Montréal, (Québec), H2X 0A9, Canada. .,Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montréal, Québec, Canada.
| | - Louis Rodgers
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, Québec, Canada
| | | | - Cybil Abou-Rizk
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Eleanor Nash
- Faculty of Arts and Sciences, University of Montreal, Montréal, Québec, Canada
| | - Alok K Mathur
- Indian Institute of Health Management Research University, Jaipur, India
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Johri M, Sylvestre MP, Koné GK, Chandra D, Subramanian SV. Effects of improved drinking water quality on early childhood growth in rural Uttar Pradesh, India: A propensity-score analysis. PLoS One 2019; 14:e0209054. [PMID: 30620737 PMCID: PMC6324831 DOI: 10.1371/journal.pone.0209054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/27/2018] [Accepted: 11/27/2018] [Indexed: 12/17/2022] Open
Abstract
Context Recent randomised controlled trials in Bangladesh and Kenya concluded that household water treatment, alone or in combination with upgraded sanitation and handwashing, did not reduce linear growth faltering or improve other child growth outcomes. Whether these results are applicable in areas with distinct constellations of water, sanitation and hygiene (WaSH) risks is unknown. Analysis of observational data offers an efficient means to assess the external validity of trial findings. We studied whether a water quality intervention could improve child growth in a rural Indian setting with higher levels of circulating pathogens than the original trial sites. Methods We analysed a cross-sectional dataset including a microbiological measure of household water quality. All households accessed water from an improved source. We applied propensity score methods to emulate a randomised trial investigating the hypothesis that receipt of drinking water meeting Sustainable Development Goal (SDG) 6.1 quality standards for absence of faecal contamination leads to improved growth. Growth outcomes (stunting, underweight, wasting, and their corresponding Z-scores) were assessed in children 12–23 months of age. For each outcome, we estimated the mean and 95% confidence interval of the absolute risk difference between treatment groups. Findings Of 1088 households, 442 (40.62%) received drinking water meeting SDG 6.1 standards. The adjusted risk of child underweight was 7.4% (1.3% to 13.4%) lower among those drinking water satisfying SDG 6.1 norms than among controls. Evidence concerning the relationship of drinking water meeting SDG 6.1 norms to length-for-age and weight-for-age was inconclusive, and there was no apparent relationship with stunting or wasting. Conclusions In contexts characterised by high pathogen transmission, water quality improvements have the potential to reduce the proportion of underweight children, but are unlikely to impact stunting or wasting. Further research is required to assess how these modelled benefits can best be achieved in real world settings.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
- Département d’administration de la santé, École de santé publique, Université de Montréal, Montreal, Canada
- * E-mail:
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
- Département de médicine sociale et préventive, École de santé publique, Université de Montréal, Montreal, Canada
| | - Georges Karna Koné
- Abt associates, Health finance and governance (FHG) Project, Port-au-Prince, Haiti
| | - Dinesh Chandra
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
- Independent consultant, New Delhi, India
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge MA, United States of America
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Pérez MC, Minoyan N, Ridde V, Sylvestre MP, Johri M. Comparison of registered and published intervention fidelity assessment in cluster randomised trials of public health interventions in low- and middle-income countries: systematic review. Trials 2018; 19:410. [PMID: 30064484 PMCID: PMC6069979 DOI: 10.1186/s13063-018-2796-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/09/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cluster randomised trials (CRTs) are a key instrument to evaluate public health interventions. Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned. Evaluation of implementation fidelity (IF) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions conducted in low- and middle-income countries (LMICs). However, current CRT reporting guidelines offer no guidance on IF assessment. The objective of this review was to study current practices concerning the assessment of IF in CRTs of public health interventions in LMICs. METHODS CRTs of public health interventions in LMICs that planned or reported IF assessment in either the trial protocol or the main trial report were included. The MEDLINE/PubMed, CINAHL and EMBASE databases were queried from January 2012 to May 2016. To ensure availability of a study protocol, CRTs reporting a registration number in the abstract were included. Relevant data were extracted from each study protocol and trial report by two researchers using a predefined screening sheet. Risk of bias for individual studies was assessed. RESULTS We identified 90 CRTs of public health interventions in LMICs with a study protocol in a publicly available trial registry published from January 2012 to May 2016. Among these 90 studies, 25 (28%) did not plan or report assessing IF; the remaining 65 studies (72%) addressed at least one IF dimension. IF assessment was planned in 40% (36/90) of trial protocols and reported in 71.1% (64/90) of trial reports. The proportion of overall agreement between the trial protocol and trial report concerning occurrence of IF assessment was 66.7% (60/90). Most studies had low to moderate risk of bias. CONCLUSIONS IF assessment is not currently a systematic practice in CRTs of public health interventions carried out in LMICs. In the absence of IF assessment, it may be difficult to determine if CRT results are due to the intervention design, to its implementation, or to unknown or external factors that may influence results. CRT reporting guidelines should promote IF assessment. TRIAL REGISTRATION Protocol published and available at: https://doi.org/10.1186/s13643-016-0351-0.
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Affiliation(s)
- Myriam Cielo Pérez
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Tour Saint-Antoine Porte S03.414, Montréal, Québec, H2X 0A9, Canada.,Département de médicine sociale et préventive, École de santé publique (ESPUM), Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Tour Saint-Antoine Porte S03.414, Montréal, Québec, H2X 0A9, Canada.,Département de médicine sociale et préventive, École de santé publique (ESPUM), Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Valéry Ridde
- Institut de Recherche en Santé Publique Université de Montréal (IRSPUM), Pavillon 7101 Avenue du Parc, P.O. Box 6128, Centre-ville Station, Montréal, Québec, H3C 3J7, Canada.,Institut de Recherche Pour le Développement (IRD), Le Sextant 44, bd de Dunkerque, CS 90009 13572, Cedex 02, Marseille, France
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Tour Saint-Antoine Porte S03.414, Montréal, Québec, H2X 0A9, Canada.,Département de médicine sociale et préventive, École de santé publique (ESPUM), Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Tour Saint-Antoine Porte S03.414, Montréal, Québec, H2X 0A9, Canada. .,Département de gestion, d'évaluation, et de politique de santé, École de santé publique, Université de Montréal, 7101, avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada.
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21
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Bermúdez-Tamayo C, Johri M, Chaillet N. Budget impact of a program for safely reducing caesarean sections in Canada. Midwifery 2018; 60:20-26. [PMID: 29477053 DOI: 10.1016/j.midw.2018.01.022] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/26/2018] [Accepted: 01/27/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION audits of indications for cesarean section (CS), feedback for health professionals, and implementation of best practices, as compared with usual care (QUARISMA study), resulted in a small reduction in the rate of CS in Quebec and important cost savings from a health care payer perspective. Determining the budget impact would enable estimation of the financial consequences if the program is extended nationwide. MATERIAL AND METHODS a retrospective pre-post study design was used to estimate cost prior to and after the implementation of QUARISMA in Quebec (105,351 subjects). A prospective analysis was performed to measure the budget impact in Canada's provinces. The primary analytic perspective was that of the Minister of Health, for a 4-year time horizon. Data were taken from the trial for Quebec and extrapolated to Canada's provinces. A sensitivity analysis was conducted by varying more than one probability at a time. FINDINGS over 4 years, there was a decrease of more than $7.8 million in CS burden in Quebec, $11.9 million in vaginal birth and $9.8 million for neonatal complications. The impact on high-risk women was lower than that on low-risk. In years 1 and 2, the provinces would have to cover the cost of program implementation. CONCLUSIONS QUARISMA led to savings of $27 million in Quebec over 4 years. In the short to medium term, extending the QUARISMA program nationwide could lead to savings of $150.5 million.
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Affiliation(s)
- Clara Bermúdez-Tamayo
- Centre de recherche du CHUS, 12e Avenue Nord, Sherbrooke, QC, Canada J1H 5 N4; Andalusian School of Public Health, Cuesta del Observatorio 4, 18010 Granada, Spain; CIBERESP, Ciber de Epidemiologia y Salud Publica, Madrid, Spain.
| | - Mira Johri
- Division of Global Health, University of Montreal, Hospital Research Centre (CRCHUM), 900, rue Saint-Denis, Montreal, QC, Canada H2X 0A9; Department of Health Administration, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Nils Chaillet
- Centre Hospitalier de l'Université Laval (CHUL), Québec, Canada
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22
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Chaillet N, Bujold E, Masse B, Grobman WA, Rozenberg P, Pasquier JC, Shorten A, Johri M, Beaudoin F, Abenhaim H, Demers S, Fraser W, Dugas M, Blouin S, Dubé E, Gauthier R. A cluster-randomized trial to reduce major perinatal morbidity among women with one prior cesarean delivery in Québec (PRISMA trial): study protocol for a randomized controlled trial. Trials 2017; 18:434. [PMID: 28931404 PMCID: PMC5608183 DOI: 10.1186/s13063-017-2150-x] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Rates of cesarean delivery are continuously increasing in industrialized countries, with repeated cesarean accounting for about a third of all cesareans. Women who have undergone a first cesarean are facing a difficult choice for their next pregnancy, i.e.: (1) to plan for a second cesarean delivery, associated with higher risk of maternal complications than vaginal delivery; or (b) to have a trial of labor (TOL) with the aim to achieve a vaginal birth after cesarean (VBAC) and to accept a significant, but rare, risk of uterine rupture and its related maternal and neonatal complications. The objective of this trial is to assess whether a multifaceted intervention would reduce the rate of major perinatal morbidity among women with one prior cesarean. Methods/design The study is a stratified, non-blinded, cluster-randomized, parallel-group trial of a multifaceted intervention. Hospitals in Quebec are the units of randomization and women are the units of analysis. As depicted in Figure 1, the study includes a 1-year pre-intervention period (baseline), a 5-month implementation period, and a 2-year intervention period. At the end of the baseline period, 20 hospitals will be allocated to the intervention group and 20 to the control group, using a randomization stratified by level of care. Medical records will be used to collect data before and during the intervention period. Primary outcome is the rate of a composite of major perinatal morbidities measured during the intervention period. Secondary outcomes include major and minor maternal morbidity; minor perinatal morbidity; and TOL and VBAC rate. The effect of the intervention will be assessed using the multivariable generalized-estimating-equations extension of logistic regression. The evaluation will include subgroup analyses for preterm and term birth, and a cost-effectiveness analysis. Discussion The intervention is designed to facilitate: (1) women’s decision-making process, using a decision analysis tool (DAT), (2) an estimate of uterine rupture risk during TOL using ultrasound evaluation of low-uterine segment thickness, (3) an estimate of chance of TOL success, using a validated prediction tool, and (4) the implementation of best practices for intrapartum management. Trial registration Current Controlled Trials, ID: ISRCTN15346559. Registered on 20 August 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2150-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Chaillet
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada. .,Faculté de Médecine, Département d'Obstétrique & Gynécologie, Université Laval, Centre de recherche du CHUQ, 2705, Boul. Laurier, local T-R-92, Quebec, QC, G1V 4G2, Canada.
| | - E Bujold
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - B Masse
- Department of Epidemiology and Biostatistics, University of Montréal, Montréal, QC, Canada
| | - W A Grobman
- Department of Obstetrics and Gynaecology, Northwestern University, Chicago, IL, USA
| | - P Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303, Poissy, France
| | - J C Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Quebec, QC, Canada
| | - A Shorten
- UAB School of Nursing, University of Alabama, Birmingham, AL, USA
| | - M Johri
- University of Montreal, Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - F Beaudoin
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
| | - H Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Jewish Hospital, Montreal, QC, Canada
| | - S Demers
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - W Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Quebec, QC, Canada
| | - M Dugas
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Quebec, QC, Canada
| | - S Blouin
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - E Dubé
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - R Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada
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Verguet S, Jones EO, Johri M, Morris SK, Suraweera W, Gauvreau CL, Jha P, Jit M. Characterizing measles transmission in India: a dynamic modeling study using verbal autopsy data. BMC Med 2017; 15:151. [PMID: 28793891 PMCID: PMC5550950 DOI: 10.1186/s12916-017-0908-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decreasing trends in measles mortality have been reported in recent years. However, such estimates of measles mortality have depended heavily on assumed regional measles case fatality risks (CFRs) and made little use of mortality data from low- and middle-income countries in general and India, the country with the highest measles burden globally, in particular. METHODS We constructed a dynamic model of measles transmission in India with parameters that were empirically inferred using spectral analysis from a time series of measles mortality extracted from the Million Death Study, an ongoing longitudinal study recording deaths across 2.4 million Indian households and attributing causes of death using verbal autopsy. The model was then used to estimate the measles CFR, the number of measles deaths, and the impact of vaccination in 2000-2015 among under-five children in India and in the states of Bihar and Uttar Pradesh (UP), two states with large populations and the highest numbers of measles deaths in India. RESULTS We obtained the following estimated CFRs among under-five children for the year 2005: 0.63% (95% confidence interval (CI): 0.40-1.00%) for India as a whole, 0.62% (0.38-1.00%) for Bihar, and 1.19% (0.80-1.75%) for UP. During 2000-2015, we estimated that 607,000 (95% CI: 383,000-958,000) under-five deaths attributed to measles occurred in India as a whole. If no routine vaccination or supplemental immunization activities had occurred from 2000 to 2015, an additional 1.6 (1.0-2.6) million deaths for under-five children would have occurred across India. CONCLUSIONS We developed a data- and model-driven estimation of the historical measles dynamics, CFR, and vaccination impact in India, extracting the periodicity of epidemics using spectral and coherence analysis, which allowed us to infer key parameters driving measles transmission dynamics and mortality.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA.
| | - Edward O Jones
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mira Johri
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, Québec, Canada
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Wilson Suraweera
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Prabhat Jha
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
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24
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Johri M, Ng ESW, Bermudez-Tamayo C, Hoch JS, Ducruet T, Chaillet N. A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis. BMC Med 2017; 15:96. [PMID: 28528578 PMCID: PMC5439122 DOI: 10.1186/s12916-017-0859-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 04/20/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Widespread increases in caesarean section (CS) rates have sparked concerns about risks to mothers and infants and rising healthcare costs. A multicentre, two-arm, cluster-randomized trial in Quebec, Canada assessed whether an audit and feedback intervention targeting health professionals would reduce CS rates for pregnant women compared to usual care, and concluded that it reduced CS rates without adverse effects on maternal or neonatal health. The effect was statistically significant but clinically small. We assessed cost-effectiveness to inform scale-up decisions. METHODS A prospective economic evaluation was undertaken using individual patient data from the Quality of Care, Obstetrics Risk Management, and Mode of Delivery (QUARISMA) trial (April 2008 to October 2011). Analyses took a healthcare payer perspective. The time horizon captured hospital-based costs and clinical events for mothers and neonates from labour onset to 3 months postpartum. Resource use was identified and measured from patient charts and valued using standardized government sources. We estimated the changes in CS rates and costs for the intervention group (versus controls) between the baseline and post-intervention periods. We examined heterogeneity between clinical subgroups of high-risk versus low-risk pregnancies and estimated the joint uncertainty in cost-effectiveness over 20,000 trial simulations. We decomposed costs to identify drivers of change. RESULTS The intervention group experienced per-patient reductions of 0.005 CS (95% confidence interval (CI): -0.015 to 0.004, P = 0.09) and $180 (95% CI: -$277 to - $83, P < 0.001). Women with low-risk pregnancies experienced statistically significant reductions in CS rates and costs; changes for the high-risk subgroup were not significant. The intervention was "dominant" (effective in reducing CS and less costly than usual care) in 86.08% of simulations. It reduced costs in 99.99% of simulations. Cost reductions were driven by lower rates of neonatal complications in the intervention group (-$190, 95% CI: -$255 to - $125, P < 0.001). Given 88,000 annual provincial births, a similar intervention could save $15.8 million (range: $7.3 to $24.4 million) in Quebec annually. CONCLUSIONS From a healthcare payer perspective, a multifaceted intervention involving audits and feedback resulted in a small reduction in caesarean deliveries and important cost savings. Cost reductions are consistent with improved quality of care in intervention group hospitals. TRIAL REGISTRATION International Clinical Trials Registry Platform, ISRCTN95086407 . Registered on 23 October 2007.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-910, 850, rue St-Denis, Montréal, Québec, H2X 0A9, Canada. .,Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montréal, Québec, Canada. .,Department of Maternal, Neonatal, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
| | - Edmond S W Ng
- Director's Office, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Clara Bermudez-Tamayo
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire (CHU) de Sherbrooke, Sherbrooke, Québec, Canada.,Andalusian School of Public Health, Granada, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Jeffrey S Hoch
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Centre for Excellence in Economic Analysis and Research (CLEAR), Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Public Health Sciences, University of California, Davis, California, USA
| | - Thierry Ducruet
- Department of Biostatistics, Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Nils Chaillet
- Département Obstétrique et Gynécologie, Centre Hospitalier de l'Université Laval (CHUL), Québec, Québec, Canada
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Bermudez-Tamayo C, Besançon S, Johri M, Assa S, Brown JB, Ramaiya K. Direct and indirect costs of diabetes mellitus in Mali: A case-control study. PLoS One 2017; 12:e0176128. [PMID: 28545129 PMCID: PMC5436679 DOI: 10.1371/journal.pone.0176128] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 07/26/2016] [Accepted: 04/05/2017] [Indexed: 12/02/2022] Open
Abstract
Background Diabetes mellitus (DM) is one of the most burdensome chronic diseases and is associated with shorter lifetime, diminished quality of life and economic burdens on the patient and society as a result of healthcare, medication, and reduced labor market participation. We aimed to estimate the direct (medical and non-medical) and indirect costs of DM and compare them with those of people without DM (ND), as well as the cost predictors. Methods and findings Observational retrospective case–control study performed in Mali. Participants were identified and randomly selected from diabetes registries. We recruited 500 subjects with DM and 500 subjects without DM, matched by sex and age. We conducted structured, personal interviews. Costs were expressed for a 90-day period. Direct medical costs comprised: inpatient stays, ICU, laboratory tests and other hospital visits, specialist and primary care doctor visits, others, traditional practitioners, and medication. Direct non-medical costs comprised travel for treatment and paid caregivers. The indirect costs include the productivity losses by patients and caregivers, and absenteeism. We estimate a two-part model by type of service and a linear multiple regression model for the total cost. We found that total costs of persons with DM were almost 4 times higher than total cost of people without DM. Total costs were $77.08 and $281.92 for ND and DM, respectively, with a difference of $204.84. Conclusions Healthcare use and costs were dramatically higher for people with DM than for people with normal glucose tolerance and, in relative terms, much higher than in developed countries.
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Affiliation(s)
- Clara Bermudez-Tamayo
- Andalusian School of Public Health, Granada, Spain
- CIBER Epidemiologia y Salud Publica (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | | | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
- Département d'administration de la santé, École de santé publique, Université de Montréal, Montréal, Canada
| | - Sidibe Assa
- Endocrinology Department, Mali National Hospital, Bamako, Mali
| | - Jonathan Betz Brown
- Kaiser Permanente Center for Health Research, Portland, Oregon, United States of America
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Arsenault C, Johri M, Nandi A, Mendoza Rodríguez JM, Hansen PM, Harper S. Country-level predictors of vaccination coverage and inequalities in Gavi-supported countries. Vaccine 2017; 35:2479-2488. [PMID: 28365251 DOI: 10.1016/j.vaccine.2017.03.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Important inequalities in childhood vaccination coverage persist between countries and population groups. Understanding why some countries achieve higher and more equitable levels of coverage is crucial to redress these inequalities. In this study, we explored the country-level determinants of (1) coverage of the third dose of diphtheria-tetanus-pertussis- (DTP3) containing vaccine and (2) within-country inequalities in DTP3 coverage in 45 countries supported by Gavi, the Vaccine Alliance. METHODS We used data from the most recent Demographic and Health Surveys (DHS) conducted between 2005 and 2014. We measured national DTP3 coverage and the slope index of inequality in DTP3 coverage with respect to household wealth, maternal education, and multidimensional poverty. We collated data on country health systems, health financing, governance and geographic and sociocultural contexts from published sources. We used meta-regressions to assess the relationship between these country-level factors and variations in DTP3 coverage and inequalities. To validate our findings, we repeated these analyses for coverage with measles-containing vaccine (MCV). RESULTS We found considerable heterogeneity in DTP3 coverage and in the magnitude of inequalities across countries. Results for MCV were consistent with those from DTP3. Political stability, gender equality and smaller land surface were important predictors of higher and more equitable levels of DTP3 coverage. Inequalities in DTP3 coverage were also lower in countries receiving more external resources for health, with lower rates of out-of-pocket spending and with higher national coverage. Greater government spending on heath and lower linguistic fractionalization were also consistent with better vaccination outcomes. CONCLUSION Improving vaccination coverage and reducing inequalities requires that policies and programs address critical social determinants of health including geographic and social exclusion, gender inequality and the availability of financial protection for health. Further research should investigate the mechanisms contributing to these associations.
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Affiliation(s)
- Catherine Arsenault
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
| | - Mira Johri
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada; Département de gestion, d'évaluation et de politique de santé, École de santé publique de l'Université de Montréal (ESPUM), Montreal, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
| | | | | | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Institute for Health and Social Policy, McGill University, Montreal, Canada
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Arsenault C, Harper S, Nandi A, Rodríguez JMM, Hansen PM, Johri M. An equity dashboard to monitor vaccination coverage. Bull World Health Organ 2016; 95:128-134. [PMID: 28250513 PMCID: PMC5327933 DOI: 10.2471/blt.16.178079] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 11/27/2022] Open
Abstract
Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti.
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Affiliation(s)
- Catherine Arsenault
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | | | | | - Mira Johri
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
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Pérez MC, Minoyan N, Ridde V, Sylvestre MP, Johri M. Comparison of registered and published intervention fidelity assessment in cluster randomised trials of public health interventions in low- and middle-income countries: systematic review protocol. Syst Rev 2016; 5:177. [PMID: 27756435 PMCID: PMC5069975 DOI: 10.1186/s13643-016-0351-0] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cluster randomised trials (CRTs) are a key instrument to evaluate public health interventions, particularly in low- and middle-income countries (LMICs). Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned. Evaluation of implementation fidelity (IF) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions. Current CRT reporting guidelines offer no guidance on IF assessment. We will systematically review the scientific literature to study current practices concerning the assessment of IF in CRTs of public health interventions in LMICs. METHODS We will include CRTs of public health interventions in LMICs that planned or assessed IF in either the trial protocol or the main trial report (or an associated document). Search strategies use Medical Subject Headings (MESH) and text words related to CRTs, developing countries, and public health interventions. The electronic database search was developed first for MEDLINE and adapted for the following databases: EMBASE, CINAHL, PubMed, and EMB Reviews, to identify CRT reports in English, Spanish, or French published on or after January 1, 2012. To ensure availability of a study protocol, we will include CRTs reporting a registration number in the abstract. For each included study, we will compare planned versus reported assessment of IF, and consider the dimensions of IF studied, and data collection methods used to evaluate each dimension. Data will be synthesised using quantitative and narrative techniques. Risk of bias for individual studies will be assessed using the Cochrane Collaboration Risk of Bias Tool criteria and additional criteria related to CRT methods. We will investigate possible sources of heterogeneity by performing subgroup analysis. This review was not eligible for inclusion in the PROSPERO registry. DISCUSSION Fidelity assessment may be a key tool for making studies more reliable, internally valid, and externally generalizable. This review will provide a portrait of current practices related to the assessment of intervention fidelity in CRTs and offer suggestions for improvement. Results will be relevant to researchers, those who finance health interventions, and for decision-makers who seek the best evidence on public health interventions.
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Affiliation(s)
- Myriam Cielo Pérez
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.,Département de Médicine Sociale et Préventive, École de Santé Publique (ESPUM), Université de Montréal, Montréal, Québec, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.,Département de Médicine Sociale et Préventive, École de Santé Publique (ESPUM), Université de Montréal, Montréal, Québec, Canada
| | - Valéry Ridde
- Département de Médicine Sociale et Préventive, École de Santé Publique (ESPUM), Université de Montréal, Montréal, Québec, Canada.,Institut de Recherche en Santé Publique Université de Montrèal (IRSPUM), Pavillon 7101 Avenue du Parc, Centre-ville Station, P.O. Box 6128, Montreal, Quebec, H3C 3J7, Canada
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.,Département de Médicine Sociale et Préventive, École de Santé Publique (ESPUM), Université de Montréal, Montréal, Québec, Canada
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada. .,Département de Gestion, d'évaluation, et de Politique de Santé, École de Santé Publique, Université de Montréal, Montréal, Québec, Canada.
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Mukamana O, Johri M. What is known about school-based interventions for health promotion and their impact in developing countries? A scoping review of the literature. Health Educ Res 2016; 31:587-602. [PMID: 27516095 DOI: 10.1093/her/cyw040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
Schools can play an important role in health promotion mainly by improving students' health literacy, behaviors and academic achievements. School-based health promotion can be particularly valuable in developing countries facing the challenges of low health literacy and high burden of disease. We conducted a scoping review of the published literature focusing on school-based interventions for health promotion and their impact in developing countries. We included 30 studies meeting specific criteria: (i) studies mainly targeted school going children or adolescents; (ii) admissible designs were randomized controlled trials, controlled before-after studies or interrupted time series; (iii) studies included at least one measure of impact and (iv) were primary studies or systematic reviews. We found that school-based interventions can be classified in two main categories: those targeting individual determinants of health such as knowledge, skills and health behaviors and those targeting environmental determinants such as the social and physical environment at the school, family and community level. Findings suggest that a comprehensive approach addressing both individual and environmental determinants can induce long-term behavior change and significantly improve health and educational outcomes. We highlight the need for further study of the long-term impact of school-based interventions on health outcomes in developing countries.
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Affiliation(s)
- O Mukamana
- Research Center of the Sainte-Justine University Hospital, Montréal, H3T 1C5, Canada
| | - M Johri
- Unité de Santé Internationale, et Axe Risques, prévention et promotion de la santé, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, H2X 0A9, Canada Département d'administration de la santé, École de santé publique, Université de Montréal, Montréal, H3N 1X9, Canada
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Johri M, Verguet S, Morris SK, Sharma JK, Ram U, Gauvreau C, Jones E, Jha P, Jit M. Adding interventions to mass measles vaccinations in India. Bull World Health Organ 2016; 94:718-727. [PMID: 27843161 PMCID: PMC5043198 DOI: 10.2471/blt.15.160044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 02/01/2016] [Accepted: 04/07/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To quantify the impact on mortality of offering a hypothetical set of technically feasible, high-impact interventions for maternal and child survival during India's 2010-2013 measles supplementary immunization activity. METHODS We developed Lives Saved Tool models for 12 Indian states participating in the supplementary immunization, based on state- and sex-specific data on mortality from India's Million Deaths Study and on health services coverage from Indian household surveys. Potential add-on interventions were identified through a literature review and expert consultations. We quantified the number of lives saved for a campaign offering measles vaccine alone versus a campaign offering measles vaccine with six add-on interventions (nutritional screening and complementary feeding for children, vitamin A and zinc supplementation for children, multiple micronutrient and calcium supplementation in pregnancy, and free distribution of insecticide-treated bednets). FINDINGS The measles vaccination campaign saved an estimated 19 016 lives of children younger than 5 years. A hypothetical campaign including measles vaccine with add-on interventions was projected to save around 73 900 lives (range: 70 200-79 300), preventing 73 700 child deaths (range: 70 000-79 000) and 300 maternal deaths (range: 200-400). The most effective interventions in the whole package were insecticide-treated bednets, measles vaccine and preventive zinc supplementation. Girls accounted for 66% of expected lives saved (12 712/19 346) for the measles vaccine campaign, and 62% of lives saved (45 721/74 367) for the hypothetical campaign including add-on interventions. CONCLUSION In India, a measles vaccination campaign including feasible, high-impact interventions could substantially increase the number of lives saved and mitigate gender-related inequities in child mortality.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Tour Saint-Antoine, Porte S03-458, 850 Rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, United States of America
| | - Shaun K Morris
- Division of Infectious Diseases, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jitendar K Sharma
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Usha Ram
- Centre for Global Health Research, Dalla Lana School of Public Health, Toronto, Canada
| | - Cindy Gauvreau
- Centre for Global Health Research, Dalla Lana School of Public Health, Toronto, Canada
| | - Edward Jones
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
| | - Prabhat Jha
- Centre for Global Health Research, Dalla Lana School of Public Health, Toronto, Canada
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
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Arsenault C, Harper S, Nandi A, Rodríguez JMM, Hansen P, Johri M. Equity measurement in the post-2015: a systematic analysis of
inequalities in vaccination coverage in GAVI-supported countries. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Olry de Labry Lima A, Bermúdez Tamayo C, Pastor Moreno G, Bolívar Muñoz J, Ruiz Pérez I, Johri M, Quesada Jiménez F, Cruz Vela P, de Los Ríos Álvarez AM, Prados Quel MÁ, Moratalla López E, Domínguez Martín S, Lopez de Hierro JA, Ricci Cabello I. Effectiveness of an intervention to improve diabetes self-management on clinical outcomes in patients with low educational level. Gac Sanit 2016; 31:40-47. [PMID: 27477476 DOI: 10.1016/j.gaceta.2016.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. METHODS 12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. RESULTS The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference. CONCLUSIONS In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Clara Bermúdez Tamayo
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
| | | | - Julia Bolívar Muñoz
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Isabel Ruiz Pérez
- Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mira Johri
- Division of Global Health, University of Montreal; Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | | | | | | | | | | | | | | | - Ignacio Ricci Cabello
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
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Johri M, Subramanian SV, Koné GK, Dudeja S, Chandra D, Minoyan N, Sylvestre MP, Pahwa S. Maternal Health Literacy Is Associated with Early Childhood Nutritional Status in India. J Nutr 2016; 146:1402-10. [PMID: 27306895 DOI: 10.3945/jn.115.226290] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 05/09/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The global burden of child undernutrition is concentrated in South Asia, where gender inequality and female educational disadvantage are important factors. Maternal health literacy is linked to women's education and empowerment, can influence multiple malnutrition determinants, and is rapidly modifiable. OBJECTIVE This study investigated whether maternal health literacy is associated with child undernutrition in 2 resource-poor Indian populations. METHODS We conducted cross-sectional surveys in an urban and a rural site, interviewing 1 woman with a child aged 12-23 mo/household. Multivariate logistic regression analyses were conducted independently for each site. The main exposure was maternal health literacy. We assessed respondents' ability to understand, appraise, and apply health-related information with the use of Indian health promotion materials. The main outcomes were severe stunting, severe underweight, and severe wasting. We classified children as having a severe nutritional deficiency if their z score was <-3 SDs from the WHO reference population for children of the same age and sex. Analyses controlled for potential confounding factors including parental education and household wealth. RESULTS Rural and urban analyses included 1116 and 657 mother-child pairs, respectively. In each site, fully adjusted models showed that children of mothers with high health literacy had approximately half the likelihood of being severely stunted (rural adjusted OR: 0.50; 95% CI: 0.33, 0.74; P = 0.001; urban adjusted OR: 0.58; 95% CI: 0.35, 0.94; P = 0.028) or severely underweight (rural adjusted OR: 0.57; 95% CI: 0.38, 0.87; P = 0.009; urban adjusted OR: 0.48; 95% CI: 0.25, 0.91; P = 0.025) than children of mothers with low health literacy. Health literacy was not associated with severe wasting. CONCLUSIONS In resource-poor rural and urban settings in India, maternal health literacy is associated with child nutritional status. Programs targeting health literacy may offer effective entry points for intervention.
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Affiliation(s)
- Mira Johri
- University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Departments of Health Administration and
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA
| | - Georges K Koné
- University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Department of Economics, University of Daloa, Daloa, Ivory Coast; and
| | - Sakshi Dudeja
- Pratham Education Foundation (ASER Center), New Delhi, India
| | - Dinesh Chandra
- Pratham Education Foundation (ASER Center), New Delhi, India
| | - Nanor Minoyan
- Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Marie-Pierre Sylvestre
- University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Smriti Pahwa
- Pratham Education Foundation (ASER Center), New Delhi, India
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Johri M, Cielo Pérez M, Arsenault C, Sharma JK, Pant Pai N, Pahwa S, Marie-Pierre S. Estrategias para incrementar la demanda de vacunación infantil en países de ingresos bajos y medios: una revisión sistemática y un metanálisis. Rev Fac Nac Salud Pública 2016. [DOI: 10.17533/udea.rfnsp.v34n2a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bermúdez-Tamayo C, Johri M, Perez-Ramos FJ, Maroto-Navarro G, Caño-Aguilar A, Garcia-Mochon L, Aceituno L, Audibert F, Chaillet N. Erratum to: 'Evaluation of quality improvement for cesarean sections programmes through mixed methods'. Implement Sci 2016; 11:37. [PMID: 26984271 PMCID: PMC4793735 DOI: 10.1186/s13012-016-0402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Clara Bermúdez-Tamayo
- Centre de recherche du CHUS, 12e Avenue Nord, Sherbrooke, QC, J1H 5 N4, Canada. .,Andalusian School of Public Health, Cuesta del Observatorio 4 s/n, 18010, Granada, Spain. .,CIBERESP, Ciber de Epidemiologia y Salud Publica, València, Spain.
| | - Mira Johri
- Division of Global Health, University of Montreal, Hospital Research Centre (CRCHUM), 900, rue Saint-Denis, H2X 0A9, Montreal, QC, Canada.,Department of Health Administration, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francisco Jose Perez-Ramos
- General Secretary of Quality iInnovation and Public Health, Consejería de Igualdad, Salud y Políticas Sociales, Junta de Andalucía, Avd. De Hytasa n° 14, 41006, Sevilla, Spain
| | - Gracia Maroto-Navarro
- Andalusian School of Public Health, Cuesta del Observatorio 4 s/n, 18010, Granada, Spain.,CIBERESP, Ciber de Epidemiologia y Salud Publica, València, Spain
| | - Africa Caño-Aguilar
- UGC Obstetrics and Gynaecology, Hospital Universitario San Cecilio, Av Doctor Oloriz, 16, 18012, Granada, Spain
| | - Leticia Garcia-Mochon
- Andalusian School of Public Health, Cuesta del Observatorio 4 s/n, 18010, Granada, Spain
| | - Longinos Aceituno
- UGC Gynaecology, Hospital La Inmaculada, Av. Dra. Parra, S/N., 04600, Huercal-Overa, Almeria, Spain
| | - François Audibert
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada.,Sainte Justine Hospital, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Nils Chaillet
- Department of Obstetrics and Gynaecology, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, QC, J1H 5 N4, Canada
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Alouki K, Delisle H, Bermúdez-Tamayo C, Johri M. Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies. J Diabetes Res 2016; 2016:2159890. [PMID: 26885527 PMCID: PMC4738686 DOI: 10.1155/2016/2159890] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 01/29/2023] Open
Abstract
Objective. To summarize key findings of economic evaluations of lifestyle interventions for the primary prevention of type 2 diabetes (T2D) in high-risk subjects. Methods. We conducted a systematic review of peer-reviewed original studies published since January 2009 in English, French, and Spanish. Eligible studies were identified through relevant databases including PubMed, Medline, National Health Services Economic Evaluation, CINHAL, EconLit, Web of sciences, EMBASE, and the Latin American and Caribbean Health Sciences Literature. Studies targeting obesity were also included. Data were extracted using a standardized method. The BMJ checklist was used to assess study quality. The heterogeneity of lifestyle interventions precluded a meta-analysis. Results. Overall, 20 studies were retained, including six focusing on obesity control. Seven were conducted within trials and 13 using modeling techniques. T2D prevention by physical activity or diet or both proved cost-effective according to accepted thresholds, except for five inconclusive studies, three on diabetes prevention and two on obesity control. Most studies exhibited limitations in reporting results, primarily with regard to generalizability and justification of selected sensitivity parameters. Conclusion. This confirms that lifestyle interventions for the primary prevention of diabetes are cost-effective. Such interventions should be further promoted as sound investment in the fight against diabetes.
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Affiliation(s)
- Koffi Alouki
- TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1A8
| | - Hélène Delisle
- TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1A8
- *Hélène Delisle:
| | - Clara Bermúdez-Tamayo
- Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Avenue du Parc, 3e Étage, Montréal, QC, Canada H3N 1X9
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, 850 Rue Saint-Denis, Montréal, QC, Canada H2X 0A9
- Department of Health Administration, School of Public Health (ESPUM), Faculty of Medicine, University of Montreal, 7101 Avenue du Parc, 3e Étage, Montréal, QC, Canada H3N 1X9
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Johri M, Chandra D, Koné GK, Dudeja S, Sylvestre MP, Sharma JK, Pahwa S. Interventions to increase immunisation coverage among children 12-23 months of age in India through participatory learning and community engagement: pilot study for a cluster randomised trial. BMJ Open 2015; 5:e007972. [PMID: 26384721 PMCID: PMC4577868 DOI: 10.1136/bmjopen-2015-007972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 11/13/2022] Open
Abstract
OBJECTIVE With the aim of conducting a future cluster randomised trial to assess intervention impact on child vaccination coverage, we designed a pilot study to assess feasibility and aid in refining methods for the larger study. TRIAL DESIGN Cluster-randomised design with a 1:1 allocation ratio. METHODS Clusters were 12 villages in rural Uttar Pradesh. All women residing in a selected village who were mothers of a child 0-23 months of age were eligible; participants were chosen at random. Over 4 months, intervention group (IG) villages received: (1) home visits by volunteers; (2) community mobilisation events to promote immunisation. Control group (CG) villages received community mobilisation to promote nutrition. A toll-free number for immunisation was offered to all IG and CG village residents. Primary outcomes were ex-ante criteria for feasibility of the main study related to processes for recruitment and randomisation (50% of villages would agree to participate and accept randomisation; 30 women could be recruited in 70% of villages), and retention of participants (50% of women retained from baseline to endline). Clusters were assigned to IG or CG using a computer-generated randomisation schedule. Neither participants nor those delivering interventions were blinded, but those assessing outcomes were blinded to group assignment. RESULTS All villages contacted agreed to participate and accepted randomisation. 36 women were recruited per village; 432 participants were randomised (IG n=216; CG n=216). No clusters were lost to follow-up. The main analysis included 86% (373/432) of participants, 90% (195/216) from the IG and 82% (178/216) from the CG. CONCLUSIONS Criteria related to feasibility were satisfied, giving us confidence that we can successfully conduct a larger cluster randomised trial. Methodological lessons will inform design of the main study. TRIAL REGISTRATION NUMBER ISRCTN16703097.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'administration de la santé, École de santé publique, Université de Montréal, Montréal, Québec, Canada
| | - Dinesh Chandra
- Pratham Education Foundation (ASER Centre), New Delhi, India
| | - Georges K Koné
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Sakshi Dudeja
- Pratham Education Foundation (ASER Centre), New Delhi, India
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département de medicine sociale et preventive, École de santé publique, Université de Montréal, Montréal, Québec, Canada
| | - Jitendar K Sharma
- National Health Systems Resource Centre (NHSRC), Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Smriti Pahwa
- Pratham Education Foundation (ASER Centre), New Delhi, India
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Johri M, Subramanian SV, Sylvestre MP, Dudeja S, Chandra D, Koné GK, Sharma JK, Pahwa S. Association between maternal health literacy and child vaccination in India: a cross-sectional study. J Epidemiol Community Health 2015; 69:849-57. [PMID: 25827469 PMCID: PMC4552929 DOI: 10.1136/jech-2014-205436] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 12/29/2014] [Accepted: 03/10/2015] [Indexed: 11/15/2022]
Abstract
Background Education of mothers may improve child health. We investigated whether maternal health literacy, a rapidly modifiable factor related to mother's education, was associated with children's receipt of vaccines in two underserved Indian communities. Methods Cross-sectional surveys in an urban and a rural site. We assessed health literacy using Indian child health promotion materials. The outcome was receipt of three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. We used multivariate logistic regression to investigate the relationship between maternal health literacy and vaccination status independently in each site. For both sites, adjusted models considered maternal age, maternal and paternal education, child sex, birth order, household religion and wealth quintile. Rural analyses used multilevel models adjusted for service delivery characteristics. Urban analyses represented cluster characteristics through fixed effects. Results The rural analysis included 1170 women from 60 villages. The urban analysis included 670 women from nine slum clusters. In each site, crude and adjusted models revealed a positive association between maternal health literacy and DTP3. In the rural site, the adjusted OR was 1.57 (95% CI 1.11 to 2.21, p=0.010) for those with medium health literacy, and OR=1.30 (95% CI 0.89 to 1.91, p=0.172) for those with high health literacy. In the urban site, the adjusted OR was 1.10 (95% CI 0.65 to 1.88, p=0.705) for those with medium health literacy, and OR=2.06 (95% CI 1.06 to 3.99, p=0.032) for those with high health literacy. Conclusions In these study settings, maternal health literacy is independently associated with child vaccination. Initiatives targeting health literacy could improve vaccination coverage.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada Département d'administration de la santé, École de santé publique, Université de Montréal, Montreal, Canada
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada Département de médicine sociale et préventive, École de santé publique, Université de Montréal, Montreal, Canada
| | - Sakshi Dudeja
- Pratham Education Foundation (ASER Centre), New Delhi, India
| | - Dinesh Chandra
- Pratham Education Foundation (ASER Centre), New Delhi, India
| | - Georges K Koné
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Québec, Canada l'Université de Daloa, Daloa, Cote d'Ivoire
| | - Jitendar K Sharma
- National Health Systems Resource Centre (NHSRC), Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Smriti Pahwa
- Pratham Education Foundation (ASER Centre), New Delhi, India
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Johri M, Pérez MC, Arsenault C, Sharma JK, Pai NP, Pahwa S, Sylvestre MP. Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ 2015; 93:339-346C. [PMID: 26229205 PMCID: PMC4431517 DOI: 10.2471/blt.14.146951] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/05/2014] [Accepted: 01/23/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and middle-income countries. METHODS We searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis. FINDINGS We identified 11 studies comprising four randomized controlled trials, six cluster randomized controlled trials and one controlled before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an eligible intervention. Six studies demonstrated low risk of bias and five studies had moderate to high risk of bias. We conducted a pooled analysis considering all 11 studies, with data from 11,512 participants. Demand-side interventions were associated with significantly higher receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17-1.44). Subgroup analyses also demonstrated significant effects of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20-1.63) and of four studies which used incentives, RR: 1.28 (95% CI: 1.12-1.45). CONCLUSION Demand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries. Educational approaches and use of incentives were both effective strategies.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Myriam Cielo Pérez
- Département d'administration de la santé, Université de Montréal, Montréal, Canada
| | - Catherine Arsenault
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Jitendar K Sharma
- National Health Systems Resource Centre (NHSRC), Ministry of Health and Family Welfare, New Delhi, India
| | | | - Smriti Pahwa
- Pratham Education Foundation (ASER Centre), New Delhi, India
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
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Abstract
INTRODUCTION Accurate measurement of health inequities is indispensable to track progress or to identify needs for health equity policy interventions. A key empirical task is to measure the extent to which observed inequality in health - a difference in health - is inequitable. Empirically operationalizing definitions of health inequity has generated an important question not considered in the conceptual literature on health inequity. Empirical analysis can explain only a portion of observed health inequality. This paper demonstrates that the treatment of unexplained inequality is not only a methodological but ethical question and that the answer to the ethical question - whether unexplained health inequality is unfair - determines the appropriate standardization method for health inequity analysis and can lead to potentially divergent estimates of health inequity. METHODS We use the American sample of the 2002-03 Joint Canada/United States Survey of Health and measure health by the Health Utilities Index (HUI). We model variation in the observed HUI by demographic, socioeconomic, health behaviour, and health care variables using Ordinary Least Squares. We estimate unfair HUI by standardizing fairness, removing the fair component from the observed HUI. We consider health inequality due to factors amenable to policy intervention as unfair. We contrast estimates of inequity using two fairness-standardization methods: direct (considering unexplained inequality as ethically acceptable) and indirect (considering unexplained inequality as unfair). We use the Gini coefficient to quantify inequity. RESULTS Our analysis shows that about 75% of the variation in the observed HUI is unexplained by the model. The direct standardization results in a smaller inequity estimate (about 60% of health inequality is inequitable) than the indirect standardization (almost all inequality is inequitable). CONCLUSIONS The choice of the fairness-standardization method is ethical and influences the empirical health inequity results considerably. More debate and analysis is necessary regarding which treatment of the unexplained inequality has the stronger foundation in equity considerations.
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Affiliation(s)
- Yukiko Asada
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia, B3H1V7, Canada.
| | - Jeremiah Hurley
- Department of Economics and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, L8S4M4, Canada.
| | - Ole Frithjof Norheim
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850, rue St-Denis, Montreal, Quebec, H2X0A9, Canada.
- Département d'administration de la santé, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, Quebec, H3C3J7, Canada.
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Verguet S, Johri M, Morris SK, Gauvreau CL, Jha P, Jit M. Controlling measles using supplemental immunization activities: a mathematical model to inform optimal policy. Vaccine 2014; 33:1291-6. [PMID: 25541214 PMCID: PMC4336184 DOI: 10.1016/j.vaccine.2014.11.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/17/2014] [Accepted: 11/27/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Measles & Rubella Initiative, a broad consortium of global health agencies, has provided support to measles-burdened countries, focusing on sustaining high coverage of routine immunization of children and supplementing it with a second dose opportunity for measles vaccine through supplemental immunization activities (SIAs). We estimate optimal scheduling of SIAs in countries with the highest measles burden. METHODS We develop an age-stratified dynamic compartmental model of measles transmission. We explore the frequency of SIAs in order to achieve measles control in selected countries and two Indian states with high measles burden. Specifically, we compute the maximum allowable time period between two consecutive SIAs to achieve measles control. RESULTS Our analysis indicates that a single SIA will not control measles transmission in any of the countries with high measles burden. However, regular SIAs at high coverage levels are a viable strategy to prevent measles outbreaks. The periodicity of SIAs differs between countries and even within a single country, and is determined by population demographics and existing routine immunization coverage. CONCLUSIONS Our analysis can guide country policymakers deciding on the optimal scheduling of SIA campaigns and the best combination of routine and SIA vaccination to control measles.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mira Johri
- International Health Unit (USI), University of Montreal Hospital Research Centre (CR-CHUM), Montreal, Québec, Canada; Department of Health Administration, School of Public Health, University of Montreal, Montreal, Québec, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Center for Global Health Research, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Cindy L Gauvreau
- Center for Global Health Research, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Prabhat Jha
- Center for Global Health Research, Saint Michael's Hospital, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bermúdez-Tamayo C, Johri M, Perez-Ramos FJ, Maroto-Navarro G, Caño-Aguilar A, Garcia-Mochon L, Aceituno L, Audibert F, Chaillet N. Evaluation of quality improvement for cesarean sections caesarean section programmes through mixed methods. Implement Sci 2014; 9:182. [PMID: 25496430 PMCID: PMC4268855 DOI: 10.1186/s13012-014-0182-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/24/2014] [Indexed: 12/03/2022] Open
Abstract
Background The rate of avoidable caesarean sections (CS) could be reduced through multifaceted strategies focusing on the involvement of health professionals and compliance with clinical practice guidelines (CPGs). Quality improvements for CS (QICS) programmes (QICS) based on this approach, have been implemented in Canada and Spain. Objectives Their objectives are as follows: 1) Toto identify clusters in each setting with similar results in terms of cost-consequences, 2) Toto investigate whether demographic, clinical or context characteristics can distinguish these clusters, and 3) Toto explore the implementation of QICS in the 2 regions, in order to identify factors that have been facilitators in changing practices and reducing the use of obstetric intervention, as well as the challenges faced by hospitals in implementing the recommendations. Methods Descriptive study with a quantitative and qualitative approach. 1) Cluster analysis at patient level with data from 16 hospitals in Quebec (Canada) (n = 105,348) and 15 hospitals in Andalusia (Spain) (n = 64,760). The outcome measures are CS and costs. For the cost, we will consider the intervention, delivery and complications in mother and baby, from the hospital perspective. Cluster analysis will be used to identify participants with similar patterns of CS and costs based, and t tests will be used to evaluate if the clusters differed in terms of characteristics: Hospital level (academic status of hospital, level of care, supply and demand factors), patient level (mother age, parity, gestational age, previous CS, previous pathology, presentation of the baby, baby birth weight). 2) Analysis of in-depth interviews with obstetricians and midwives in hospitals where the QICS were implemented, to explore the differences in delivery-related practices, and the importance of the different constructs for positive or negative adherence to CPGs. Dimensions: political/management level, hospital level, health professionals, mothers and their birth partner. Discussion This work sets out a new approach for programme evaluation, using different techniques to make it possible to take into account the specific context where the programmes were implemented.
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Abstract
INTRODUCTION Measurement of health inequities is fundamental to all health equity initiatives. It is complex because it requires considerations of ethics, methods, and policy. Drawing upon the recent developments in related specialized fields, in this paper we incorporate alternative definitions of health inequity explicitly and transparently in its measurement. We propose a three-stage approach to measuring health inequities that assembles univariate health inequality, univariate health inequity, and bivariate health inequities in a systematic and comparative manner. METHODS We illustrate the application of the three-stage approach using the Joint Canada/United States Survey of Health, measuring health by the Health Utilities Index (HUI). Univariate health inequality is the distribution of the observed HUI across individuals. Univariate health inequity is the distribution of unfair HUI--components of HUI associated with ethically unacceptable factors--across individuals. To estimate the unfair HUI, we apply two popular definitions of inequity: "equal opportunity for health" (health outcomes due to factors beyond individual control are unfair), and "policy amenability" (health outcomes due to factors amenable to policy interventions are unfair). We quantify univariate health inequality and inequity using the Gini coefficient. We assess bivariate inequities using a regression-based decomposition method. RESULTS Our analysis reveals that, empirically, different definitions of health inequity do not yield statistically significant differences in the estimated amount of univariate inequity. This derives from the relatively small explanatory power common in regression models describing variations in health. As is typical, our model explains about 20% of the variation in the observed HUI. With regard to bivariate inequities, income and health care show strong associations with the unfair HUI. CONCLUSIONS The measurement of health inequities is an excitingly multidisciplinary endeavour. Its development requires interdisciplinary integration of advances from relevant disciplines. The proposed three-stage approach is one such effort and stimulates cross-disciplinary dialogues, specifically, about conceptual and empirical significance of definitions of health inequities.
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Affiliation(s)
- Yukiko Asada
- />Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia B3H1V7 Canada
| | - Jeremiah Hurley
- />Department of Economics and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario L8S4M4 Canada
| | - Ole Frithjof Norheim
- />Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, 5021 Bergen, Norway
| | - Mira Johri
- />Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850, rue St-Denis, Montreal, Quebec H2X0A9 Canada
- />Département d’administration de la santé, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, Quebec H3C3J7 Canada
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Johri M, Ridde V, Heinmüller R, Haddad S. Estimation of maternal and child mortality one year after user-fee elimination: an impact evaluation and modelling study in Burkina Faso. Bull World Health Organ 2014; 92:706-15. [PMID: 25378724 PMCID: PMC4208477 DOI: 10.2471/blt.13.130609] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 03/04/2014] [Accepted: 03/17/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso. METHODS Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change, we used interrupted time series, propensity scores and three independent data sources. Coverage changes were assessed for four variables: women giving birth at a health facility, and children aged 1 to 59 months receiving oral rehydration salts for diarrhoea, antibiotics for pneumonia and artemesinin for malaria. We modelled the mortality impact of coverage changes in the Lives Saved Tool using several scenarios. FINDINGS Coverage increased for all variables, however, the increase was not statistically significant for antibiotics for pneumonia. For estimated mortality impact, the intervention saved approximately 593 (estimate range 168-1060) children's lives in both districts during the first year. This lowered the estimated under-five mortality rate from 235 deaths per 1000 live births in 2008 to 210 (estimate range 189-228) in 2009. If a similar intervention were to be introduced nationwide, 14,000 to 19,000 (estimate range 4000-28,000) children's lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios. CONCLUSION In this setting, eliminating user fees increased use of health services and may have contributed to reduced child mortality.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Tour Saint-Antoine (Porte S03-458), 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Valéry Ridde
- Institut de Recherche en Sciences de la Santé, Centre national de la recherche scientifique et technologique du Burkina Faso, Ouagadougou, Burkina Faso
| | - Rolf Heinmüller
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Tour Saint-Antoine (Porte S03-458), 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Slim Haddad
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Tour Saint-Antoine (Porte S03-458), 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
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Sissoko D, Trottier H, Malvy D, Johri M. The influence of compositional and contextual factors on non-receipt of basic vaccines among children of 12-23-month old in India: a multilevel analysis. PLoS One 2014; 9:e106528. [PMID: 25211356 PMCID: PMC4161331 DOI: 10.1371/journal.pone.0106528] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 01/16/2014] [Accepted: 08/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children unreached by vaccination are at higher risk of poor health outcomes and India accounts for nearly a quarter of unvaccinated children worldwide. The objective of this study was to investigate compositional and contextual determinants of non-receipt of childhood vaccines in India using multilevel modelling. METHODS AND FINDINGS We studied characteristics of unvaccinated children using the District Level Health and Facility Survey 3, a nationally representative probability sample containing 65 617 children aged 12-23 months from 34 Indian states and territories. We developed four-level Bayesian binomial regression models to examine the determinants of non-vaccination. The analysis considered two outcomes: completely unvaccinated (CUV) children who had not received any of the eight vaccine doses recommended by India's Universal Immunization Programme, and children who had not received any dose from routine immunisation services (no RI). The no RI category includes CUV children and those who received only polio doses administered via mass campaigns. Overall, 4.83% (95% CI: 4.62-5.06) of children were CUV while 12.01% (11.68-12.35) had received no RI. Individual compositional factors strongly associated with CUV were: non-receipt of tetanus immunisation for mothers during pregnancy (OR = 3.65 [95% CrI: 3.30-4.02]), poorest household wealth index (OR = 2.44 [1.81-3.22] no maternal schooling (OR = 2.43 [1.41-4.05]) and no paternal schooling (OR = 1.83 [1.30-2.48]). In rural settings, the influence of maternal illiteracy disappeared whereas the role of household wealth index was reinforced. Factors associated with no RI were similar to those for CUV, but effect sizes for individual compositional factors were generally larger. Low maternal education was the strongest risk factor associated with no RI in all models. All multilevel models found significant variability at community, district, and state levels net of compositional factors. CONCLUSION Non-vaccination in India is strongly related to compositional characteristics and is geographically distinct. Tailored strategies are required to overcome current barriers to immunisation.
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Affiliation(s)
- Daouda Sissoko
- Department of Social and Preventive Medicine, Faculty of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
- International Health Unit (USI), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- * E-mail:
| | - Helen Trottier
- Department of Social and Preventive Medicine, Faculty of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Denis Malvy
- Département des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM 897 & Centre René-Labusquière, Université de Bordeaux, Bordeaux, France
| | - Mira Johri
- International Health Unit (USI), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Health Administration, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
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Norheim OF, Baltussen R, Johri M, Chisholm D, Nord E, Brock D, Carlsson P, Cookson R, Daniels N, Danis M, Fleurbaey M, Johansson KA, Kapiriri L, Littlejohns P, Mbeeli T, Rao KD, Edejer TTT, Wikler D. Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc 2014; 12:18. [PMID: 25246855 PMCID: PMC4171087 DOI: 10.1186/1478-7547-12-18] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022] Open
Abstract
This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form of a checklist, is especially targeted at decision makers who set priorities at national and sub-national levels, and those who interpret findings from cost-effectiveness analysis. It is also targeted at researchers conducting cost-effectiveness analysis to improve reporting of their results in the light of these other criteria. THE GUIDANCE WAS DEVELOP THROUGH A SERIES OF EXPERT CONSULTATION MEETINGS AND INVOLVED THREE STEPS: i) methods and normative concepts were identified through a systematic review; ii) the review findings were critically assessed in the expert consultation meetings which resulted in a draft checklist of normative criteria; iii) the checklist was validated though an extensive hearing process with input from a range of relevant stakeholders. The GPS-Health incorporates criteria related to the disease an intervention targets (severity of disease, capacity to benefit, and past health loss); characteristics of social groups an intervention targets (socioeconomic status, area of living, gender; race, ethnicity, religion and sexual orientation); and non-health consequences of an intervention (financial protection, economic productivity, and care for others).
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Affiliation(s)
- Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, PB 7800, 5020 Bergen, Norway
| | - Rob Baltussen
- Nijmegen International Centre for Health Systems Research and Education (NICHE), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Québec, Canada
| | - Dan Chisholm
- Department of Health Systems Financing, World Health Organization, Geneva, Switzerland
| | - Erik Nord
- Norwegian Institute of Public Health, Oslo, Norway
| | - DanW Brock
- Harvard Medical School, Harvard University, Cambridge, USA
| | - Per Carlsson
- National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
| | | | - Norman Daniels
- Harvard School of Public Health, Harvard University, Cambridge, USA
| | - Marion Danis
- Section on Ethics and Health Policy, NIH Clinical Centre, Bethesda, USA
| | - Marc Fleurbaey
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, USA
| | - Kjell A Johansson
- Department of Global Public Health and Primary Care, University of Bergen, PB 7800, 5020 Bergen, Norway
| | - Lydia Kapiriri
- Department of Health, Aging, and Society, McMaster University, Hamilton, Canada
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, Previous affiliation the National Institute for Health and Care Excellence (NICE), London, England, UK
| | - Thomas Mbeeli
- Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Tessa Tan-Torres Edejer
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Québec, Canada
| | - Dan Wikler
- Harvard School of Public Health, Harvard University, Cambridge, USA
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2V4P3, Canada.
| | | | - S V Subramanian
- Harvard Center for Population and Development Studies, Boston, MA, USA
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2V4P3, Canada
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Soubeiga D, Gauvin L, Hatem MA, Johri M. Birth Preparedness and Complication Readiness (BPCR) interventions to reduce maternal and neonatal mortality in developing countries: systematic review and meta-analysis. BMC Pregnancy Childbirth 2014; 14:129. [PMID: 24708719 PMCID: PMC4234142 DOI: 10.1186/1471-2393-14-129] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Birth Preparedness and Complication Readiness (BPCR) interventions are widely promoted by governments and international agencies to reduce maternal and neonatal health risks in developing countries; however, their overall impact is uncertain, and little is known about how best to implement BPCR at a community level. Our primary aim was to evaluate the impact of BPCR interventions involving women, families and communities during the prenatal, postnatal and neonatal periods to reduce maternal and neonatal mortality in developing countries. We also examined intervention impact on a variety of intermediate outcomes important for maternal and child survival. METHODS We conducted a systematic review and meta-analysis of randomized trials of BPCR interventions in populations of pregnant women living in developing countries. To identify relevant studies, we searched the scientific literature in the Pubmed, Embase, Cochrane library, Reproductive health library, CINAHL and Popline databases. We also undertook manual searches of article bibliographies and web sites. Study inclusion was based on pre-specified criteria. We synthesised data by computing pooled relative risks (RR) using the Cochrane RevMan software. RESULTS Fourteen randomized studies (292 256 live births) met the inclusion criteria. Meta-analyses showed that exposure to BPCR interventions was associated with a statistically significant reduction of 18% in neonatal mortality risk (twelve studies, RR = 0.82; 95% CI: 0.74, 0.91) and a non-significant reduction of 28% in maternal mortality risk (seven studies, RR = 0.72; 95% CI: 0.46, 1.13). Results were highly heterogeneous (I2 = 76%, p < 0.001 and I2 = 72%, p = 0.002 for neonatal and maternal results, respectively). Subgroup analyses of studies in which at least 30% of targeted women participated in interventions showed a 24% significant reduction of neonatal mortality risk (nine studies, RR = 0.76; 95% CI: 0.69, 0.85) and a 53% significant reduction in maternal mortality risk (four studies, RR = 0.47; 95% CI: 0.26, 0.87).Pooled results revealed that BPCR interventions were also associated with increased likelihood of use of care in the event of newborn illness, clean cutting of the umbilical cord and initiation of breastfeeding in the first hour of life. CONCLUSIONS With adequate population coverage, BPCR interventions are effective in reducing maternal and neonatal mortality in low-resources settings.
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Affiliation(s)
- Dieudonné Soubeiga
- Department of Health Administration, Faculty of Medicine, University of Montreal, Montreal, Canada.
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Kahn SR, Shapiro S, Wells PS, Rodger MA, Kovacs MJ, Anderson DR, Tagalakis V, Houweling AH, Ducruet T, Holcroft C, Johri M, Solymoss S, Miron MJ, Yeo E, Smith R, Schulman S, Kassis J, Kearon C, Chagnon I, Wong T, Demers C, Hanmiah R, Kaatz S, Selby R, Rathbun S, Desmarais S, Opatrny L, Ortel TL, Ginsberg JS. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 2014; 383:880-8. [PMID: 24315521 DOI: 10.1016/s0140-6736(13)61902-9] [Citation(s) in RCA: 295] [Impact Index Per Article: 29.5] [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: 01/17/2023]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a common and burdensome complication of deep venous thrombosis (DVT). Previous trials suggesting benefit of elastic compression stockings (ECS) to prevent PTS were small, single-centre studies without placebo control. We aimed to assess the efficacy of ECS, compared with placebo stockings, for the prevention of PTS. METHODS We did a multicentre randomised placebo-controlled trial of active versus placebo ECS used for 2 years to prevent PTS after a first proximal DVT in centres in Canada and the USA. Patients were randomly assigned to study groups with a web-based randomisation system. Patients presenting with a first symptomatic, proximal DVT were potentially eligible to participate. They were excluded if the use of compression stockings was contraindicated, they had an expected lifespan of less than 6 months, geographical inaccessibility precluded return for follow-up visits, they were unable to apply stockings, or they received thrombolytic therapy for the initial treatment of acute DVT. The primary outcome was PTS diagnosed at 6 months or later using Ginsberg's criteria (leg pain and swelling of ≥1 month duration). We used a modified intention to treat Cox regression analysis, supplemented by a prespecified per-protocol analysis of patients who reported frequent use of their allocated treatment. This study is registered with ClinicalTrials.gov, number NCT00143598, and Current Controlled Trials, number ISRCTN71334751. FINDINGS From 2004 to 2010, 410 patients were randomly assigned to receive active ECS and 396 placebo ECS. The cumulative incidence of PTS was 14·2% in active ECS versus 12·7% in placebo ECS (hazard ratio adjusted for centre 1·13, 95% CI 0·73-1·76; p=0·58). Results were similar in a prespecified per-protocol analysis of patients who reported frequent use of stockings. INTERPRETATION ECS did not prevent PTS after a first proximal DVT, hence our findings do not support routine wearing of ECS after DVT. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Susan R Kahn
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada.
| | - Stan Shapiro
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada; Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - Philip S Wells
- Department of Medicine, University of Ottawa/Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marc A Rodger
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael J Kovacs
- Division of Hematology, London Health Sciences Centre, London, ON, Canada
| | - David R Anderson
- Department of Medicine, Dalhousie University, Halifax, NS, Canada; Capital Health, Halifax, NS, Canada
| | - Vicky Tagalakis
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada
| | | | - Thierry Ducruet
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada
| | - Christina Holcroft
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Mira Johri
- International Health Unit, University of Montreal Hospital Research Centre, Montreal, QC, Canada; Department of Health Administration, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Susan Solymoss
- Division of Hematology, Montreal General Hospital, Montreal, QC, Canada; St Mary's Hospital, Montreal, QC, Canada
| | - Marie-José Miron
- Department of Medicine, Hôpital Notre-Dame, Montreal, QC, Canada
| | - Erik Yeo
- Division of Hematology, University Health Network, Toronto, ON, Canada
| | - Reginald Smith
- Divisions of Cardiology and Thrombosis, Victoria Heart Institute Foundation, Victoria, BC, Canada
| | - Sam Schulman
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada; Karolinska Institute, Stockholm, Sweden
| | - Jeannine Kassis
- Division of Hematology, Hôpital Maisonneuve-Rosemont, QC, Canada
| | - Clive Kearon
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Isabelle Chagnon
- Department of Medicine, Hôpital du Sacré-Coeur, University of Montreal, Montreal, QC, Canada
| | - Turnly Wong
- Department of Medicine, St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Rajendar Hanmiah
- Division of General Internal Medicine, St Joseph's Hospital, Hamilton, ON, Canada
| | - Scott Kaatz
- Academic Hospital Medicine, Hurley Medical Center, Flint, MI, USA
| | - Rita Selby
- Department of Medicine and Department of Clinical Pathology, Sunnybrook Health Sciences Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Suman Rathbun
- Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Sylvie Desmarais
- Department of Medicine, Hôpital Pierre-Boucher, Longueuil, QC, Canada
| | - Lucie Opatrny
- Professional Services, St Mary's Hospital Center, Montreal, QC, Canada
| | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, NC, USA
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Johri M, Sharma JK, Jit M, Verguet S. Use of measles supplemental immunization activities (SIAs) as a delivery platform for other maternal and child health interventions: opportunities and challenges. Vaccine 2012; 31:1259-63. [PMID: 23041086 DOI: 10.1016/j.vaccine.2012.09.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 09/15/2012] [Accepted: 09/18/2012] [Indexed: 11/30/2022]
Abstract
Measles supplementary immunization activities (SIAs) offer children in countries with weaker immunization delivery systems like India a second opportunity for measles vaccination. They could also provide a platform to deliver additional interventions, but the feasibility and acceptability of including add-ons is uncertain. We surveyed Indian programme officers involved in the current (2010-2012) measles SIAs concerning opportunities and challenges of using SIAs as a delivery platform for other maternal and child health interventions. Respondents felt that an expanded SIA strategy including add-ons could be of great value in improving access and efficiency. They viewed management challenges, logistics, and safety as the most important potential barriers. They proposed that additional interventions be selected using several criteria, of which importance of the health problem, safety, and contribution to health equity figured most prominently. For children, they recommended inclusion of basic interventions to address nutritional deficiencies, diarrhoea and parasites over vaccines. For mothers, micronutrient interventions were highest ranked.
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Affiliation(s)
- Mira Johri
- International Health Unit (USI), University of Montreal Hospital Research Centre (CR-CHUM), Édifice St-Urbain 3875, rue St-Urbain, 5e étage, Montreal, Québec, Canada H2W 1V1.
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