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Damba FU, Mtshali NG, Chimbari MJ. Factors influencing the utilization of doctoral research findings at a university in KwaZulu-Natal, South Africa: Views of academic leaders. PLoS One 2023; 18:e0290651. [PMID: 37651413 PMCID: PMC10470883 DOI: 10.1371/journal.pone.0290651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Translation of health research findings into policy remains a challenge in sub-Saharan Africa. Factors influencing health research utilization are poorly described in literature. Therefore, identifying factors that influence the utilization of research findings for policy formulation is essential to facilitate implementation of evidence-based interventions. The purpose of this study was to explore the views of academic leaders as to why doctoral research is not adequately used in policymaking. METHODS In-depth interviews were held with purposively selected key informants from the College of Health Sciences. An open-ended interview guide aimed at exploring college leadership views on factors influencing utilization of PhD generated knowledge into policy was used. Data was analysed thematically using NVivo 12 software. Thematic analysis was used to generate themes around the factors influencing utilization of doctoral research into policy. RESULTS Factors such as inaccessibility of research results, lack of funding, poor quality of research, lack of continuity in translating research into policy, lack of timeliness of research results and lack of collaboration between researchers and policymakers hindered the utilization of PhD generated knowledge. Participants recommended engagement with the Department of Health/policymakers, collaboration with Department of Health/policymakers, increasing enrolment of South African citizens into PhD program, making final research products available to Department of Health/policymakers, and provision of funding for dissemination of research results. CONCLUSION The study demonstrated that final doctoral research results are mainly disseminated through journal articles and theses. Participants cited inaccessibility of research findings, lack of funding and poor-quality research as the most common factors hindering utilization of doctoral research findings. The study also recommended availing adequate funding for dissemination of research results, collaboration between researchers and policymakers, facilitation of policymaker-researcher engagement to find best ways of using research findings to influence policy and making final research products accessible to policymakers. Further research to gain the perspective of policymakers as to why doctoral research is not adequately used in policy formulation is recommended.
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Affiliation(s)
- Florence Upenyu Damba
- School of Nursing and Public Health, College of Health Sciences, Howard College, University of KwaZulu-Natal, Berea, Durban, South Africa
| | - Ntombifikile Gloria Mtshali
- School of Nursing and Public Health, College of Health Sciences, Howard College, University of KwaZulu-Natal, Berea, Durban, South Africa
| | - Moses John Chimbari
- School of Nursing and Public Health, College of Health Sciences, Howard College, University of KwaZulu-Natal, Berea, Durban, South Africa
- Great Zimbabwe University, Masvingo, Zimbabwe
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Dartey AF, Dzansi G, Lotse CW, Obuobisa R, Afua Bosu CE, Afaya A. Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study. SAGE Open Nurs 2022; 8:23779608221094542. [PMID: 35600007 PMCID: PMC9118454 DOI: 10.1177/23779608221094542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Eclampsia remains a public health issue, especially in low-resource countries worldwide. Midwives are the backbone of the pregnancy and delivery process. Midwives trained in the necessary knowledge and skills are more likely to notice early warning signals of preeclampsia and immediately help clients in such emergencies. This study explored midwives’ experiences in managing patients with eclampsia in Ghana. Methods This study was conducted among eight registered midwives at maternity units of two district hospitals in the Eastern Region of Ghana, using an exploratory, descriptive qualitative research design. A purposive sampling technique was adopted to select and interview participants. Interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. The right of participation and withdrawal from the study was respected. Findings The three emerged overriding themes are: 1. Midwives have knowledge (warning signs, regimens, and prevention of complications) about the management of eclampsia. 2. Challenges in managing clients included inadequate equipment, staffing, and access to drugs. 3. Strategies for mitigating barriers to care for women with eclampsia (adherence to protocols, teamwork, peer mentoring and supervision, midwives’ attitude, and client education. Conclusion Midwives working in underserved facilities have the knowledge and skill to monitor and manage pregnant women experiencing eclampsia. However, they need to be supported with appropriate resources and advanced equipment to ensure adherence to protocols on managing eclampsia promptly referred. Continuous training and workshops for midwives in the management of hypertension in pregnancy are recommended and the public educated on the dangers of eclampsia.
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Affiliation(s)
- Anita Fafa Dartey
- School of Nursing and Midwifery, The University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Gladys Dzansi
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Comfort Worna Lotse
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Racheal Obuobisa
- Department of Women and Children, University of Ghana Medical Centre, Ghana
| | | | - Agani Afaya
- College of Nursing, Yonsei University, Yonsei-ro, Seodaemun-gu, Seoul, South Korea
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Eddy KE, Vogel JP, Zahroh RI, Bohren MA. Factors affecting use of magnesium sulphate for pre-eclampsia or eclampsia: a qualitative evidence synthesis. BJOG 2021; 129:379-391. [PMID: 34520111 PMCID: PMC9291451 DOI: 10.1111/1471-0528.16913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
Background Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO4) is recommended for prevention and treatment of pre‐eclampsia/eclampsia. However, MgSO4 remains underused, particularly in low‐ and middle‐income countries (LMICs). Objective This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy‐makers regarding factors affecting use of MgSO4 to prevent or treat pre‐eclampsia/eclampsia. Search strategy We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health and Global Index Medicus, and grey literature for studies published between January 1995 and June 2021. Selection criteria Primary qualitative and mixed‐methods studies on factors affecting use of MgSO4 in healthcare settings, from the perspectives of healthcare providers, administrators and policy‐makers, were eligible for inclusion. Data collection and analysis We applied a thematic synthesis approach to analysis, using COM‐B behaviour change theory to map factors affecting appropriate use of MgSO4. Main results We included 22 studies, predominantly from LMICs. Key themes included provider competence and confidence administering MgSO4 (attitudes and beliefs, complexities of administering, knowledge and experience), capability of health systems to ensure MgSO4 availability at point of use (availability, resourcing and pathways to care) and knowledge translation (dissemination of research and recommendations). Within each COM‐B domain, we mapped facilitators and barriers to physical and psychological capability, physical and social opportunity, and how the interplay between these domains influences motivation. Conclusions These findings can inform policy and guideline development and improve implementation of MgSO4 in clinical care. Such action is needed to ensure this life‐saving treatment is widely available and appropriately used. Tweetable abstract Global qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia. Global qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia. This article includes Author Insights, a video abstract available at https://vimeo.com/manage/videos/623192027 Linked article This article is commented on by LA Magee, p. 392 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16971.
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Affiliation(s)
- K E Eddy
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - J P Vogel
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - R I Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - M A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Tiwari HC, Srivastav R, Khan SM. Training and mentorship of medical officers to improve MCH care in public health facilities: Lessons learned from eastern Uttar Pradesh. J Family Med Prim Care 2019; 8:3202-3206. [PMID: 31742142 PMCID: PMC6857420 DOI: 10.4103/jfmpc.jfmpc_543_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/22/2019] [Accepted: 08/30/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction To improve the quality of MCH services in high priority districts of eastern Uttar Pradesh, Regional Resource Training Center (RRTC) has been established in BRD Medical College Gorakhpur. Medical College faculties empanelled at RRTC Gorakhpur carried out the training and mentoring of medical officers of public health facilities. Aims and Objectives To study the role of training and mentoring of medical officers in terms of quality improvements of MCH services at public health facilities. Materials and Methods The present study was carried out in women hospitals of seven districts and one of their respective CHCs of eastern Uttar Pradesh from December 2017 to October 2018. Data was collected by direct observation and review of records of OPD/IPD, labor room, operation theaters, blood bank, and blood storage facilities by mentoring team. Findings of these observations were recorded in predesigned 50 point quality assurance, and facility score was calculated. Technical score was calculated from data collected during one-to-one interaction of mentor and mentees in a predesigned and tested proforma. Result Technical scores of medical officers showed marked improvement after mentoring visits in majority of facilities. Mentoring visits build the confidence of medical officers to deal with the complications like severe anemia, eclampsia, and postpartum hemorrhage as per latest guidelines and protocol. It also helped in the initiation and augmentation of LSCS at certain facilities. Technical scores at few facilities showed little improvement (DWH Sant Kabir Nagar, CHC Colonelganj). Mentoring visit also helped in overall facility improvement at these centers. Conclusions The whole training and mentorship program was found effective to improve the knowledge and skills of the medical officer with few exceptions of opposition/resistance. It was found useful in overall facility improvement up to some extent.
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Affiliation(s)
- Harish Chandra Tiwari
- Department of Community Medicine, BRD Medical College, Gorakhpur, Uttar Pradesh, India
| | - Reena Srivastav
- Department of Obstetrics and Gynaecology, BRD Medical College, Gorakhpur, Uttar Pradesh, India
| | - Saim Mohd Khan
- Specialist-FRU Strenghthening/RRTC BRDMC, IHAT, UPTSU, Uttar Pradesh, India
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Billah SM, Chowdhury MAK, Khan ANS, Karim F, Hassan A, Zaka N, Arifeen SE, Manu A. Quality of care during childbirth at public health facilities in Bangladesh: a cross-sectional study using WHO/UNICEF 'Every Mother Every Newborn (EMEN)' standards. BMJ Open Qual 2019; 8:e000596. [PMID: 31523736 PMCID: PMC6711449 DOI: 10.1136/bmjoq-2018-000596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/09/2022] Open
Abstract
Background This manuscript presents findings from a baseline assessment of health facilities in Bangladesh prior to the implementation of the ‘Every Mother Every Newborn Quality Improvement’ initiative. Methodology A cross-sectional survey was conducted between June and August 2016 in 15 government health facilities. Structural readiness was assessed by observing the physical environment, the availability of essential drugs and equipment, and the functionality of the referral system. Structured interviews were conducted with care providers and facility managers on human resource availability and training in the maternal and newborn care. Observation of births, reviews of patient records and exit interviews with women who were discharged from the selected health facilities were used to assess the provision and experience of care. Results Only six (40%) facilities assessed had designated maternity wards and 11 had newborn care corners. There were stock-outs of emergency drugs including magnesium sulfate and oxytocin in nearly all facilities. Two-thirds of the positions for medical officers was vacant in district hospitals and half of the positions for nurses was vacant in subdistrict facilities. Only 60 (45%) healthcare providers interviewed received training on newborn complication management. No health facility used partograph for labour monitoring. Blood pressure was not measured in half (48%) and urine protein in 99% of pregnant women. Only 27% of babies were placed skin to skin with their mothers. Most mothers (97%) said that they were satisfied with the care received, however, only 46% intended on returning to the same facility for future deliveries. Conclusions Systematic implementation of quality standards to mitigate these gaps in service readiness, provision and experience of care is the next step to accelerate the country’s progress in reducing the maternal and neonatal deaths.
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Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.,Epidemiology, University of South Carolina, Columbia, South Carolina, USA
| | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.,Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Farhana Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Aniqa Hassan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nabila Zaka
- Health Section, Maternal and Newborn Health team, UNICEF Headquarter, New York City, New York, USA
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Alexander Manu
- Department of Population Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Brantnell A, Baraldi E, van Achterberg T. An inductive exploration of the implementation knowledge of research funders. Health Res Policy Syst 2019; 17:67. [PMID: 31319867 PMCID: PMC6637601 DOI: 10.1186/s12961-019-0472-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 06/28/2019] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare research funders may undertake various roles to facilitate implementation of research findings. Their ability to enact such roles depends on several factors, knowledge of implementation being one essential requirement. However, previous studies do not assess the type or level of knowledge about implementation that research funders possess. This paper therefore presents findings from a qualitative, inductive study of the implementation knowledge of research funders. Three aspects of this knowledge are explored, namely how research funders define implementation, their level of self-assessed implementation knowledge and the factors influencing their self-assessment of implementation knowledge. Methods Research funders (n = 18) were purposefully selected from a sample of research funding organisations in Sweden (n = 10). In-depth semi-structured interviews were conducted, recorded and transcribed verbatim. An inductive method using a systematic coding procedure was employed to derive the findings. Results The research funders defined implementation as either an outcome or a process, with the majority believing that implementation of healthcare research results demands a process, although its complexity varied in the research funders’ view. They perceived their own level of implementation knowledge as either limited or substantial, with a majority regarding it as limited. Clinical research experience, clinical experience and task relevance were singled out as the clearest factors affecting the self-assessment of their own implementation knowledge. Conclusions This study, the first to focus on implementation knowledge of research funders, demonstrates that they are a category of policy-makers who may possess knowledge, based on their previous professional experience, that is comparable to some important findings from implementation research. Consequently, the findings not only pinpoint the relevance of professional experience, but also reveal a lack of awareness and knowledge of the results of implementation research among research funders in charge of healthcare research. Electronic supplementary material The online version of this article (10.1186/s12961-019-0472-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anders Brantnell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Enrico Baraldi
- Department of Industrial Engineering and Management, Uppsala University, Uppsala, Sweden
| | - Theo van Achterberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,KU Leuven Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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7
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Williamson A, Makkar SR, Redman S. How was research engaged with and used in the development of 131 policy documents? Findings and measurement implications from a mixed methods study. Implement Sci 2019; 14:44. [PMID: 31039811 PMCID: PMC6492336 DOI: 10.1186/s13012-019-0886-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/29/2019] [Indexed: 11/19/2022] Open
Abstract
Background Much has been written about the use of evidence in policy; however, there is still little known about whether and how research is engaged with and used in policy development or the impact of reported barriers and facilitators. This paper aims to (1) describe the characteristics of 131 policy documents, (2) describe the ways in which research was engaged with (e.g. was searched for, appraised or generated) and used (e.g. to clarify understanding, persuade others or inform a policy) in the development of these policy documents, and (3) identify the most commonly reported barriers and facilitators and describe their association with research engagement and use. Methods Six health policy and program development agencies based in Sydney, Australia, contributed four recently finalised policy documents for consideration over six measurement periods. Structured, qualitative interviews were conducted with the policymakers most heavily involved in developing each of the 131 policy documents. Interviews covered whether and how research was engaged with and used in the development of the policy product and any barriers or facilitators related to this. Interviews were scored using the empirically validated SAGE tool and thematically analysed. Descriptive statistics were calculated for all key variables and comparisons made between agencies. Multiple regression analyses were used to estimate the impact of specific barriers and facilitators on research engagement and use. Results Our data shows large variations between policy agencies in the types of policy documents produced and the characteristics of these documents. Nevertheless, research engagement and use was generally moderate across agencies. A number of barriers and facilitators to research use were identified. No barriers were significantly associated with any aspects of research engagement or use. Access to consultants and relationships with researchers were both associated with increased research engagement but not use. Thus, access to consultants and relationships with researchers may increase the extent and quality of the evidence considered in policy development. Conclusions Our findings suggest that those wishing to develop interventions and programs designed to improve the use of evidence in policy agencies might usefully target increasing access to consultants and relationships with researchers in order to increase the extent and quality of the research considered, but that a greater consideration of context might be required to develop strategies to increase evidence use. Electronic supplementary material The online version of this article (10.1186/s13012-019-0886-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Williamson
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia. .,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. .,School of Public Health, University of Sydney, Sydney, Australia.
| | - Steve R Makkar
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sally Redman
- The Sax Institute, Level 13, Building 10, 235 Jones Street, Ultimo, NSW, 2007, Australia
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Raney JH, Morgan MC, Christmas A, Sterling M, Spindler H, Ghosh R, Gore A, Mahapatra T, Walker DM. Simulation-enhanced nurse mentoring to improve preeclampsia and eclampsia care: an education intervention study in Bihar, India. BMC Pregnancy Childbirth 2019; 19:41. [PMID: 30674286 PMCID: PMC6344989 DOI: 10.1186/s12884-019-2186-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inadequately treated, preeclampsia and eclampsia (PE/E) may rapidly lead to severe complications in both mothers and neonates, and are estimated to cause 60,000 global maternal deaths annually. Simulation-based training on obstetric and neonatal emergency management has demonstrated promising results in low- and middle-income countries. However, the impact of simulation training on use of evidence-based practices for PE/E diagnosis and management in low-resource settings remains unknown. METHODS This study was based on a statewide, high fidelity in-situ simulation training program developed by PRONTO International and implemented in collaboration with CARE India on PE/E management in Bihar, India. Using a mixed methods approach, we evaluated changes over time in nurse mentees' use of evidence-based practices during simulated births at primary health clinics. We compared the proportion and efficiency of evidence-based practices completed during nurse mentees' first and last participation in simulated PE/E cases. Twelve semi-structured interviews with nurse mentors explored barriers and enablers to high quality PE/E care in Bihar. RESULTS A total of 39 matched first and last simulation videos, paired by facility, were analyzed. Videos occurred a median of 62 days apart and included 94 nurses from 33 primary health centers. Results showed significant increases in the median number of 'key history questions asked,' (1.0 to 2.0, p = 0.03) and 'key management steps completed,' (2.0 to 3.0, p = 0.03). The time from BP measured to magnesium sulfate given trended downwards by 3.2 min, though not significantly (p = 0.06). Key barriers to high quality PE/E care included knowledge gaps, resource shortages, staff hierarchy between physicians and nurses, and poor relationships with patients. Enablers included case-based and simulation learning, promotion of teamwork and communication, and effective leadership. CONCLUSION Simulation training improved the use of evidence-based practices in PE/E simulated cases and has the potential to increase nurse competency in diagnosing and managing complex maternal complications such as PE/E. However, knowledge gaps, resource limitations, and interpersonal barriers must be addressed in order to improve care. Teamwork, communication, and leadership are key mechanisms to facilitate high quality PE/E care in Bihar.
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Affiliation(s)
- Julia H. Raney
- Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510 USA
| | - Melissa C. Morgan
- Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Amelia Christmas
- PRONTO International, State RMNCH+A Unit, C-16 Krishi Nagar, A.G. Colony, Patna, Bihar 80002 India
| | - Mona Sterling
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
| | - Aboli Gore
- CARE India, Bihar technical Support Program, 14, Patliputra Colony, Patna, Bihar 800013 India
| | - Tanmay Mahapatra
- CARE India, Bihar technical Support Program, 14, Patliputra Colony, Patna, Bihar 800013 India
| | - Dilys M. Walker
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158 USA
- Department of Obstetrics and Gynecology and Reproductive Services, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110 USA
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Rawlins B, Plotkin M, Rakotovao JP, Getachew A, Vaz M, Ricca J, Lynam P, Kagema F, Gomez P. Screening and management of pre-eclampsia and eclampsia in antenatal and labor and delivery services: findings from cross-sectional observation studies in six sub-Saharan African countries. BMC Pregnancy Childbirth 2018; 18:346. [PMID: 30139342 PMCID: PMC6108136 DOI: 10.1186/s12884-018-1972-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/08/2018] [Indexed: 11/25/2022] Open
Abstract
Background Preeclampsia and eclampsia (PE/E) are major contributors to maternal and neonatal deaths in developing countries, associated with 10–15% of direct maternal deaths and nearly a quarter of stillbirths and newborn deaths, many of which are preventable with improved care. We present results related to WHO-recommended interventions for screening and management of PE/E during antenatal care (ANC) and labor and delivery (L & D) from a study conducted in six sub-Saharan African countries. Methods From 2010 to 2012, cross-sectional studies which directly observed provision of ANC and L & D services in six sub-Saharan African countries were conducted. Results from 643 health facilities of different levels in Ethiopia (n = 19), Kenya (n = 509), Madagascar (n = 36), Mozambique (n = 46), Rwanda (n = 72), and Tanzania (n = 52), were combined for this analysis. While studies were sampled separately in each country, all used standardized observation checklists and inventory assessment tools. Results 2920 women receiving ANC and 2689 women in L & D were observed. Thirty-nine percent of ANC clients were asked about PE/E danger signs, and 68% had their blood pressure (BP) taken correctly (range 48–96%). Roughly half (46%) underwent testing for proteinuria. Twenty-three percent of women in L & D were asked about PE/E danger signs (range 11–34%); 77% had their BP checked upon admission (range 59–85%); and 6% had testing for proteinuria. Twenty-five cases of severe PE/E were observed: magnesium sulfate (MgSO4) was used in 15, not used in 5, and for 5 use was unknown. The availability of MgSO4 in L & D varied from 16% in Ethiopia to 100% in Mozambique. Conclusions Observed ANC consultations and L & D cases showed low use of WHO-recommended practices for PE/E screening and management. Availability of MgSO4 was low in multiple countries, though it was on the essential drug list of all surveyed countries. Country programs are encouraged to address gaps in screening and management of PE/E in ANC and L & D to contribute to lower maternal and perinatal mortality. Electronic supplementary material The online version of this article (10.1186/s12884-018-1972-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Marya Plotkin
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA.
| | | | | | - Maria Vaz
- Jhpiego Mozambique, Maputo, Mozambique
| | - Jim Ricca
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA
| | - Pam Lynam
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA
| | - Frank Kagema
- Kenyatta Referral and Teaching Hospital, Nairobi, Kenya
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10
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Abekah-Nkrumah G, Issiaka S, Virgil L, Ermel J. A review of the process of knowledge transfer and use of evidence in reproductive and child health in Ghana. Health Res Policy Syst 2018; 16:75. [PMID: 30075725 PMCID: PMC6090619 DOI: 10.1186/s12961-018-0350-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 07/13/2018] [Indexed: 04/07/2023] Open
Abstract
Background The paper carries out a situational analysis to examine the production, dissemination and utilisation of reproductive and child health-related evidence to inform policy formulation in Ghana’s health sector. Methods The study used Wald’s model of knowledge production, transfer and utilisation as a conceptual model to collect relevant data via interviews and administration of questionnaire to a network of persons who either previously or currently hold policy-relevant positions in Ghana’s health sector. Additional data was also gathered through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and child health policies, protocols and guidelines and information available on the websites of relevant institutions in Ghana’s health sector. Results The findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities (access to major donors who have the resources to fund good quality research and access to both local and international networks for collaborative research). What remains a challenge, however, is the absence of a robust institutional-wide mechanism for collating research needs and communicating these to researchers, communicating research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research into the budget of the health sector. Conclusion The study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing strengths and opportunities to address the identified challenges.
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Affiliation(s)
- Gordon Abekah-Nkrumah
- Department of Public Administration and Health Services Management, University of Ghana Business School, P. O. Box 72, Legon, Accra, Ghana.
| | - Sombié Issiaka
- West African Health Organisation, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Lokossou Virgil
- West African Health Organisation, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Johnson Ermel
- West African Health Organisation, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
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11
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Wu S, Legido-Quigley H, Spencer J, Coker RJ, Khan MS. Designing evaluation studies to optimally inform policy: what factors do policy-makers in China consider when making resource allocation decisions on healthcare worker training programmes? Health Res Policy Syst 2018; 16:16. [PMID: 29471840 PMCID: PMC5824449 DOI: 10.1186/s12961-018-0292-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 01/30/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In light of the gap in evidence to inform future resource allocation decisions about healthcare provider (HCP) training in low- and middle-income countries (LMICs), and the considerable donor investments being made towards training interventions, evaluation studies that are optimally designed to inform local policy-makers are needed. The aim of our study is to understand what features of HCP training evaluation studies are important for decision-making by policy-makers in LMICs. We investigate the extent to which evaluations based on the widely used Kirkpatrick model - focusing on direct outcomes of training, namely reaction of trainees, learning, behaviour change and improvements in programmatic health indicators - align with policy-makers' evidence needs for resource allocation decisions. We use China as a case study where resource allocation decisions about potential scale-up (using domestic funding) are being made about an externally funded pilot HCP training programme. METHODS Qualitative data were collected from high-level officials involved in resource allocation at the national and provincial level in China through ten face-to-face, in-depth interviews and two focus group discussions consisting of ten participants each. Data were analysed manually using an interpretive thematic analysis approach. RESULTS Our study indicates that Chinese officials not only consider information about the direct outcomes of a training programme, as captured in the Kirkpatrick model, but also need information on the resources required to implement the training, the wider or indirect impacts of training, and the sustainability and scalability to other settings within the country. In addition to considering findings presented in evaluation studies, we found that Chinese policy-makers pay close attention to whether the evaluations were robust and to the composition of the evaluation team. CONCLUSIONS Our qualitative study indicates that training programme evaluations that focus narrowly on direct training outcomes may not provide sufficient information for policy-makers to make decisions on future training programmes. Based on our findings, we have developed an evidence-based framework, which incorporates but expands beyond the Kirkpatrick model, to provide conceptual and practical guidance that aids in the design of training programme evaluations better suited to meet the information needs of policy-makers and to inform policy decisions.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
| | - Julia Spencer
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
| | - Richard James Coker
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mishal Sameer Khan
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
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Kim C, Wilcher R, Petruney T, Krueger K, Wynne L, Zan T. A research utilisation framework for informing global health and development policies and programmes. Health Res Policy Syst 2018; 16:9. [PMID: 29426325 PMCID: PMC5807737 DOI: 10.1186/s12961-018-0284-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 01/11/2018] [Indexed: 12/02/2022] Open
Abstract
A shift in the culture and practice of health and development research is required to maximise the real-world use of evidence by non-academic or non-research-oriented audiences. Many frameworks have been developed to guide and measure the research utilisation process, yet none have been widely applied. Some frameworks are simplified to an unrealistic linear representation while others are rendered overly complex and unusable in an attempt to capture all aspects of the research utilisation process. Additionally, many research utilisation frameworks have focused on the policy development process or within a clinical setting, with less application of the translation process at the programme level. In response to this gap – and drawing from over a decade of experience implementing research utilisation strategies – we developed a simple, four-phase framework to guide global health and development efforts that seek to apply evidence to policies and programmes. We present a detailed description of each phase in our framework, with examples of its relevance and application illustrated through our own case study experiences in global health. We believe the utility of this framework extends beyond the health sector and is relevant for maximising use of evidence to achieve the Sustainable Development Goals.
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Affiliation(s)
- Christine Kim
- Gillings School of Global Public Health, Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States of America
| | | | | | | | - Leigh Wynne
- FHI 360, Durham, NC, United States of America
| | - Trinity Zan
- FHI 360, Durham, NC, United States of America.
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13
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A Knowledge Translation framework on ageing and health. Health Policy 2017; 121:282-291. [DOI: 10.1016/j.healthpol.2016.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 12/05/2016] [Accepted: 12/31/2016] [Indexed: 12/14/2022]
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Dalglish SL, Rodríguez DC, Harouna A, Surkan PJ. Knowledge and power in policy-making for child survival in Niger. Soc Sci Med 2017; 177:150-157. [PMID: 28167340 DOI: 10.1016/j.socscimed.2017.01.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
Calls to enhance the use of scientific evidence in international health and development policy have increased in recent years; however, analytic frameworks for understanding evidence use focus narrowly on scientific research and were created using data and observations nearly exclusively from Western countries. We examine processes of health policy development in a case study of Niger, a low-income West African country that adopted integrated community case management of childhood illness (iCCM) beginning in 2007, resulting in measurable declines in child mortality. Data collection included in-depth interviews with policy actors in Niger (N = 32), document review (N = 103) and direct observation of policy forums (N = 3). Data analysis used process tracing methodology and applied an Aristotelian definition of "knowledge" as 1) episteme (facts), 2) techne (skills) and 3) phronesis (practical wisdom), while also using a critical perspective to understand issues of power. We found sharp differentials in policy-makers' possession and use of codified forms of knowledge (episteme), with Nigerien policy officers' access highly mediated by actors at international agencies. Government policy-makers possessed skills and capacities (techne) to negotiate with donors and deliberate and weigh conflicting considerations; however they lacked capacity and resources to formally evaluate and document programs and thus reliably draw lessons from them. Practical wisdom (phronesis) emerged as key to the iCCM policy enterprise, particularly among Nigerien government actors, who used logical and ethical arguments to make decisions later found to be critical to iCCM's success. While codified knowledge confers power on members of policy discussions who can access it, this represents only one form of knowledge used in the policy process and perhaps not the most important. Future research on evidence-based policy should use broader definitions of evidence or knowledge, examine on how power conditions the use of knowledge, and examine challenges specific to low-resource policy environments.
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Affiliation(s)
- Sarah L Dalglish
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States.
| | - Daniela C Rodríguez
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Abdoutan Harouna
- Laboratoire d'Études et de recherche sur les Dynamiques sociales et le développement local, Niamey, Niger
| | - Pamela J Surkan
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
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15
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Boene H, Vidler M, Augusto O, Sidat M, Macete E, Menéndez C, Sawchuck D, Qureshi R, von Dadelszen P, Munguambe K, Sevene E. Community health worker knowledge and management of pre-eclampsia in southern Mozambique. Reprod Health 2016; 13:105. [PMID: 27719683 PMCID: PMC5056526 DOI: 10.1186/s12978-016-0220-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Mozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990–2013 but the rates still high. Pre-eclampsia and eclampsia constitute the third major cause of maternal death in the country. Women in rural areas, with limited access to health facilities are at greatest risk. This study aimed to assess the current state of knowledge and the regular practices regarding pre-eclampsia and eclampsia by community health workers in southern Mozambique. Methods This mixed methods study was conducted from 2013 to 2014, in Maputo and Gaza Provinces, southern Mozambique. Self-administered questionnaires, in-depth interviews and focus group discussions were conducted with CHWs, district medical officers, community health workers’ supervisors, Gynaecologists-Obstetricians and matrons. Quantitative data were entered into a database written in REDCap and subsequently analyzed using Stata 13. Qualitative data was imported into NVivo10 for thematic analysis. Results Ninety-three percent of CHW had some awareness of pregnancy complications. Forty-one percent were able to describe the signs and symptoms of hypertension. In cases of eclampsia, CHWs reported to immediately refer the women. The vast majority of the CHWs surveyed reported that they could neither measure blood pressure nor proteinuria (90 %). Fewer reported confidence in providing oral antihypertensives (14 %) or injections in pregnancy (5 %). The other community health care providers are matrons. They do not formally offer health services, but assists pregnant women in case of an emergency. Regarding pre-eclampsia and eclampsia, matrons were unable to recognise these biomedical terms. Conclusions Although CHWs are aware of pregnancy complications, they hold limited knowledge specific to pre-eclampsia and eclampsia. There is a need to promote studies to evaluate the impact of enhancing their training to include additional content related to the identification and management of pre-eclampsia and eclampsia. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0220-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, V5Z4H4, Canada
| | - Orvalho Augusto
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.,Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique
| | - Mohsin Sidat
- Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.,Ministério da Saúde, Av. Eduardo Mondlane, Maputo, 1008, Moçambique
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.,Barcelona Institute for Global Health (ISGlobal) /Hospital Clinic - Universitat de Barcelona, Calle Rosselló, 132, Barcelona, 08036, Spain
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, V8R 1J8, Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George's University London, London, SW17 0RE, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.,Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique. .,Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique.
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Sheikh S, Qureshi RN, Khowaja AR, Salam R, Vidler M, Sawchuck D, von Dadelszen P, Zaidi S, Bhutta Z. Health care provider knowledge and routine management of pre-eclampsia in Pakistan. Reprod Health 2016; 13:104. [PMID: 27719673 PMCID: PMC5056497 DOI: 10.1186/s12978-016-0215-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices. METHODS We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn. RESULTS All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities. CONCLUSION This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre-eclampsia is due to lack of refresher trainings and written guidelines for management of pre-eclampsia and presentation of fewer pre-eclamptic patients at first and secondary level health care facilities. We suggest to include management of pre-eclampsia in regular trainings of health care providers and to provide management protocols at all health facilities. TRIAL REGISTRATION NCT01911494.
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Affiliation(s)
- Sana Sheikh
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Asif Raza Khowaja
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, V5Z 4H4 Canada
| | - Rehana Salam
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, V5Z 4H4 Canada
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, V8R 1J8 Canada
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George’s, University of London, London, SW17 0RE UK
| | - Shujat Zaidi
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- Program for Global Pediatric Research, Hospital for Sick Children, Toronto, M5G 2L3 Canada
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17
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Ellen ME, Lavis JN, Shemer J. Examining the use of health systems and policy research in the health policymaking process in Israel: views of researchers. Health Res Policy Syst 2016; 14:66. [PMID: 27585630 PMCID: PMC5009503 DOI: 10.1186/s12961-016-0139-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All too often, health policy and management decisions are made without making use of or consulting with the best available research evidence, which can lead to ineffective and inefficient health systems. One of the main actors that can ensure the use of evidence to inform policymaking is researchers. The objective of this study is to explore Israeli health systems and policy researchers' views and perceptions regarding the role of health systems and policy research (HSPR) in health policymaking and the barriers and facilitators to the use of evidence in the policymaking process. METHODS A survey of researchers who have conducted HSPR in Israel was developed. The survey consisted of a demographics section and closed questions, which focused on support both within the researchers' organisations and the broader environment for KTE activities, perceptions on the policymaking process, and the potential influencing factors on the process. The survey was sent to all health systems and policy researchers in Israel from academic institutions, hospital settings, government agencies, the four health insurance funds, and research institutes (n = 107). All responses were analyzed using descriptive statistics. For close-ended questions about level of agreement we combined together the two highest categories (agree or strongly agree) for analysis. RESULTS Thirty-seven respondents participated in the survey. While many respondents felt that the use of HSPR may help raise awareness on policy issues, the majority of respondents felt that the actual use of HSPR was hindered for many reasons. While facilitators do exist to support the use of research evidence in policymaking, numerous barriers hinder the process such as challenges in government/provider relations, policymakers lacking the expertise for acquiring, assessing, and applying HSPR and priorities in the health system drawing attention away from HSPR. Furthermore, it is perceived by a majority of respondents that the health insurance funds and the physician organisations exert a strong influence in the policymaking process. CONCLUSIONS Health system and policy researchers in Israel need to be introduced to the benefits and potential advantages of evidence-informed policy in an organised and systematic way. Future research should examine the perceptions of policymakers in Israel and thus we can gain a broader perspective on where the actual issues lie.
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Affiliation(s)
- Moriah E Ellen
- Jerusalem College of Technology, Ha-Va'ad ha-Le'umi Street 21, Jerusalem, 93721, Israel. .,Israeli Center for Technology Assessment in Health Care, Gertner Institute, Sheba Medical Center, Tel Hashomer, 52621, Israel. .,McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada.,Department of Political Science, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L6, Canada.,Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States of America
| | - Joshua Shemer
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Sheba Medical Center, Tel Hashomer, 52621, Israel.,Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv, 6997801, Israel
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18
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Corluka A, Hyder AA, Winch PJ, Segura E. Exploring health researchers' perceptions of policymaking in Argentina: a qualitative study. Health Policy Plan 2016; 29 Suppl 2:ii40-9. [PMID: 25274639 PMCID: PMC4202917 DOI: 10.1093/heapol/czu071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Much of the published research on evidence-informed health policymaking in low- and middle-income countries has focused on policymakers, overlooking the role of health researchers in the research-to-policy process. Through 20 semi-structured, in-depth qualitative interviews conducted with researchers in Argentina's rural northwest and the capital of Buenos Aires, we explore the perspectives, experiences and attitudes of Argentine health researchers regarding the use and impact of health research in policymaking in Argentina. We find that the researcher, and the researcher's function of generating evidence, is nested within a broader complex system that influences the researcher's interaction with policymaking. This system comprises communities of practice, government departments/civil society organizations, bureaucratic processes and political governance and executive leadership. At the individual level, researcher capacity and determinants of research availability also play a role in contributing to evidence-informed policymaking. In addition, we find a recurrent theme around 'lack of trust' and explore the role of trust within a research system, finding that researchers' distrust towards policymakers and even other researchers are linked inextricably to the sociopolitical history of Argentina, which contributes to shaping researchers' identities in opposition to policymakers. For policymakers, national research councils and funders of national health research systems, this article provides a deeper understanding of researchers' perceptions which can help inform and improve programme design when developing interventions to enhance research utilization and develop equitable and rational health policies. For donors and development agencies interested in health research capacity building and achieving development goals, this research demonstrates a need for investment in building research capacity and training health researchers to interact with the public policy 'world' and enhancing research communications and transferability to decision makers. It also highlights an opportunity to invest in implementation research platforms, such as health policy research and analysis institutions.
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Affiliation(s)
- Adrijana Corluka
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA and National Institute of Parasitology, "Dr. M. Fatala Chabén", Administración Nacional de Laboratorios e Institutos de Salud (ANLIS), Ministerio de Salud, Buenos Aires, Argentina
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA and National Institute of Parasitology, "Dr. M. Fatala Chabén", Administración Nacional de Laboratorios e Institutos de Salud (ANLIS), Ministerio de Salud, Buenos Aires, Argentina
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA and National Institute of Parasitology, "Dr. M. Fatala Chabén", Administración Nacional de Laboratorios e Institutos de Salud (ANLIS), Ministerio de Salud, Buenos Aires, Argentina
| | - Elsa Segura
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA and National Institute of Parasitology, "Dr. M. Fatala Chabén", Administración Nacional de Laboratorios e Institutos de Salud (ANLIS), Ministerio de Salud, Buenos Aires, Argentina
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Kirigia JM, Pannenborg CO, Amore LGC, Ghannem H, IJsselmuiden C, Nabyonga-Orem J. Global Forum 2015 dialogue on "From evidence to policy - thinking outside the box": perspectives to improve evidence uptake and good practices in the African Region. BMC Health Serv Res 2016; 16 Suppl 4:215. [PMID: 27453984 PMCID: PMC4959371 DOI: 10.1186/s12913-016-1453-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Global Forum 2015 panel session dialogue entitled "From evidence to policy - thinking outside the box" was held on 26 August 2015 in the Philippines to debate why evidence was not fully translated into policy and practice and what could be done to increase its uptake. This paper reports the reasons and possible actions for increasing the uptake of evidence, and highlights the actions partners could take to increase the use of evidence in the African Region. DISCUSSION The Global Forum 2015 debate attributed African Region's low uptake of evidence to the big gap in incentives and interests between research for health researchers and public health policy-makers; limited appreciation on the side of researchers that public health decisions are based on multiple and complex considerations; perception among users that research evidence is not relevant to local contexts; absence of knowledge translation platforms; sub-optimal collaboration and engagement between industry and research institutions; lack of involvement of civil society organizations; lack of engagement of communities in the research process; failure to engage the media; limited awareness and debate in national and local parliaments on the importance of investing in research and innovation; and dearth of research and innovation parks in the African Region. CONCLUSION The actions needed in the Region to increase the uptake of evidence in policy and practice include strengthening NHRS governance; bridging the motivation gap between researchers and health policy-makers; restoring trust between researchers and decision-makers; ensuring close and continuous intellectual intercourse among researchers, ministry of health policy-makers and technocrats during the life course of research projects or programmes; proactive collaboration between academia and industry; regular briefings of civil society, media, relevant parliamentary committees and development partners; development of vibrant knowledge translation platforms; development of action plans for implementing research recommendations, preferably in the context of the Sustainable Development Goals; and encouragement of competition on NHRS strengthening and research output and uptake among the countries using a barometer or scorecard to review their performance at various regional ministerial forums and taking into account the lessons learned from the MDG period.
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Affiliation(s)
- Joses Muthuri Kirigia
- Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, B. P. 06, Brazzaville, Congo
| | | | - Luis Gabriel Cuervo Amore
- Research Promotion and Development, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington, D.C, USA
| | - Hassen Ghannem
- Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunis Tunisia
| | - Carel IJsselmuiden
- Council on Health Research for Development (COHRED), Geneva, Switzerland
| | - Juliet Nabyonga-Orem
- Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, B. P. 06, Brazzaville, Congo
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20
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Ellen ME, Horowitz E, Vaknin S, Lavis JN. Views of health system policymakers on the role of research in health policymaking in Israel. Isr J Health Policy Res 2016; 5:24. [PMID: 27330738 PMCID: PMC4915086 DOI: 10.1186/s13584-016-0088-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background The use of research evidence in health policymaking is an international challenge. Health systems, including that of Israel, are usually characterized by scarce resources and the necessity to make rapid policy decisions. Knowledge transfer and exchange (KTE) has emerged as a paradigm to start bridging the “know-do” gap. The purpose of this study was to explore the views of health system policymakers and senior executives involved in the policy development process in Israel regarding the role of health systems and policy research (HSPR) in health policymaking, the barriers and facilitators to the use of evidence in the policymaking process, and suggestions for improving the use of HSPR in the policymaking process. Methods A survey and an interview were verbally administered in a single face-to-face meeting with health system policymakers and senior executives involved in the policy development process in Israel. The data collection period was from July to October 2014. The potential participants included members of Knesset, officials from Israel’s Ministry of Health, Ministry of Finance, health services organizations, and other stakeholder organizations (i.e., National Insurance Institute). The close-ended questions were based on previous surveys that had been conducted in this field. Interviews were tape recorded and transcribed. Descriptive statistics were conducted for close ended survey-questions and thematic analysis was conducted for open-ended interview questions. Results There were 32 participants in this study. Participants felt that the use of HSPR helps raise awareness on policy issues, yet the actual use of HSPR was hindered for many reasons. Facilitators do exist to support the use of HSPR in the policymaking process, such as a strong foundation of relationships between researchers and policymakers. However, many barriers exist such as the lack of relevance and timeliness of much of the currently available research to support decision-making and the paucity of funding to support research use. Suggestions to improve the use of HSPR focused on improving dissemination of research findings and ensuring that the research was more relevant and timely. Conclusions This research demonstrated that health systems policymakers in Israel perceive having strong relationships and collaborations with researchers however there is room for improvement, e.g. partnering in research projects to ensure relevance and use. Furthermore, health system policymakers seem to be interested in receiving relevant research in a more useable format and are open to using research in decision making.
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Affiliation(s)
- Moriah E Ellen
- Jerusalem College of Technology, Ha-Va'ad ha-Le'umi St 21, Jerusalem, 93721 Israel ; Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel ; McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L6 Canada ; Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6 Canada
| | - Einav Horowitz
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - Sharona Vaknin
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L6 Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Department of Political Science, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Department of Global Health and Population, Harvard School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115-6018 USA
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Salam RA, Das JK, Ali A, Bhaumik S, Lassi ZS. Diagnosis and management of preeclampsia in community settings in low and middle-income countries. J Family Med Prim Care 2016; 4:501-6. [PMID: 26985406 PMCID: PMC4776599 DOI: 10.4103/2249-4863.174265] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Hypertensive disorders of pregnancy contribute significantly to maternal mortality and morbidity. Preeclampsia belongs to the spectrum of hypertensive disorders of pregnancy and if undiagnosed and/or untreated leads to fatal consequences for both the mother and the baby. Early detection and prevention of preeclampsia is limited by uncertainty in the knowledge about its etiopathogenesis. While much work has been done in establishing clinical guidelines for management of preeclampsia in the hospital or tertiary care settings, there is considerable lack of work in the domain of evidence-based guidelines for screening, identification and management of preeclampsia at the community-level. The article reviews these issues with special considerations and to challenges faced in low and middle-income countries. There is a need to focus on low-cost screening and interventions in the community to achieve a significant impact on preventable maternal and fetal mortality in order to control the burden of preeclampsia significantly as well as investing on more research at primary care level to improve the evidence base for community-level interventions.
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Affiliation(s)
- Rehana A Salam
- Department of Paediatrics, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Department of Paediatrics, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anum Ali
- Department of Paediatrics, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Zohra S Lassi
- Department of Paediatrics, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan; Department of Obstetrics and Gynecology, Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
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Dasgupta S. Single Loading Dose of Magnesium Sulphate in Severe Preeclampsia and Eclampsia-Is it Effective? A Randomized Prospective Study. ACTA ACUST UNITED AC 2015. [DOI: 10.15406/ogij.2015.02.00059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Corluka A, Hyder AA, Segura E, Winch P, McLean RKD. Survey of Argentine health researchers on the use of evidence in policymaking. PLoS One 2015; 10:e0125711. [PMID: 25928292 PMCID: PMC4415923 DOI: 10.1371/journal.pone.0125711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 03/18/2015] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE In this study, Argentine health researchers were surveyed regarding their perceptions of facilitators and barriers to evidence-based policymaking in Argentina, as well as their publication activities, and research environment satisfaction. METHODS A self-administered online survey was sent to health researchers in Argentina. The survey questions were based on a preceding qualitative study of Argentine health researchers, as well as the scientific literature. RESULTS Of the 647 researchers that were reached, 226 accessed the survey, for a response rate of 34.9%. Over 80% of researchers surveyed had never been involved in or contributed to decision-making, while over 90% of researchers indicated they would like to be involved in the decision-making process. Decision-maker self-interest was perceived to be the driving factor in the development of health and healthcare policies. Research conducted by a research leader was seen to be the most influential factor in influencing health policy, followed by policy relevance of the research. With respect to their occupational environment, researchers rated highest and most favourably the opportunities available to present, discuss and publish research results and their ability to further their education and training. Argentine researchers surveyed demonstrated a strong interest and willingness to contribute their work and expertise to inform Argentine health policy development. CONCLUSION Despite Argentina's long scientific tradition, there are relatively few institutionalized linkages between health research results and health policymaking. Based on the results of this study, the disconnect between political decision-making and the health research system, coupled with fewer opportunities for formalized or informal researcher/decision-maker interaction, contribute to the challenges in evidence informing health policymaking in Argentina. Improving personal contact and the building of relationships between researchers and policymakers in Argentina will require taking into account researcher perceptions of policymakers, as highlighted in this study.
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Affiliation(s)
- Adrijana Corluka
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Adnan A. Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elsa Segura
- National Institute of Parasitology “Dr. M. Fatala Chaben”, Ministry of Health, Buenos Aires, Argentina
| | - Peter Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Robert K. D. McLean
- Policy, Strategy, and Evaluation Division, International Development Research Centre, Ottawa, Canada
- Evaluation Unit, Canadian Institutes of Health Research, Ottawa, Canada
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Nabyonga-Orem J, Mijumbi R. Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda. Int J Health Policy Manag 2015; 4:285-93. [PMID: 25905479 DOI: 10.15171/ijhpm.2015.52] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 03/03/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. METHODS Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. RESULTS Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. CONCLUSION What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making.
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Affiliation(s)
| | - Rhona Mijumbi
- Regional East African Community Health (REACH) Policy Initiative, Uganda.,College of Health Sciences, Makerere University Medical School, Kampala, Uganda
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Nabyonga-Orem J, Ssengooba F, Mijumbi R, Tashobya CK, Marchal B, Criel B. Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda. BMC Health Serv Res 2014; 14:639. [PMID: 25560092 PMCID: PMC4310169 DOI: 10.1186/s12913-014-0639-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Several countries in Sub Saharan Africa have abolished user fees for health care but the extent to which such a policy decision is guided by evidence needs further exploration. We explored the barriers and facilitating factors to uptake of evidence in the process of user fee abolition in Uganda and how the context and stakeholders involved shaped the uptake of evidence. This study builds on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitating factors for knowledge translation (KT). Application of the MRT to the case of abolition of user fees contributes to its refining. Methods Employing a theory-driven inquiry and case study approach given the need for in-depth investigation, we reviewed documents and conducted interviews with 32 purposefully selected key informants. We assessed whether evidence was available, had or had not been considered in policy development and the reasons why and; assessed how the actors and the context shaped the uptake of evidence. Results Symbolic, conceptual and instrumental uses of evidence were manifest. Different actors were influenced by different types of evidence. While technocrats in the ministry of health (MoH) relied on formal research, politicians relied on community complaints. The capacity of the MoH to lead the KT process was weak and the partnerships for KT were informal. The political window and alignment of the evidence with overall government discourse enhanced uptake of evidence. Stakeholders were divided, seemed to be polarized for various reasons and had varying levels of support and influence impacting the uptake of evidence. Conclusion Evidence will be taken up in policy development in instances where the MoH leads the KT process, there are partnerships for KT in place, and the overall government policy and the political situation can be expected to play a role. Different actors will be influenced by different types of evidence and their level of support and influence will impact the uptake of evidence. In addition, the extent to which a policy issue is contested and, whether stakeholders share similar opinions and preferences will impact the uptake of evidence. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0639-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juliet Nabyonga-Orem
- WHO Regional Office for Africa, Health systems and services cluster, P.O Box 6, Brazaville, Congo.
| | - Freddie Ssengooba
- Makerere University, School of Public Health, P.O. Box 7072, Kampala, Uganda.
| | - Rhona Mijumbi
- Regional East African Community Health (REACH) policy initiative, Uganda, College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | | | - Bruno Marchal
- Institute of Tropical Medicine Antwerp-Belgium, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Bart Criel
- Institute of Tropical Medicine Antwerp-Belgium, Nationalestraat 155, 2000, Antwerp, Belgium.
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Placenta-derived angiogenic proteins and their contribution to the pathogenesis of preeclampsia. Angiogenesis 2014; 18:115-23. [DOI: 10.1007/s10456-014-9452-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/16/2014] [Indexed: 10/24/2022]
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Nabyonga-Orem J, Nanyunja M, Marchal B, Criel B, Ssengooba F. The roles and influence of actors in the uptake of evidence: the case of malaria treatment policy change in Uganda. Implement Sci 2014; 9:150. [PMID: 25294279 PMCID: PMC4193992 DOI: 10.1186/s13012-014-0150-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uganda changed its malaria treatment policy in response to evidence of resistance to commonly used antimalarials. The use of evidence in policy development--also referred to as knowledge translation (KT)--is crucial, especially in resource-limited settings. However, KT processes occur amidst a complex web of stakeholder interactions. Stakeholder involvement in evidence generation and in KT activities is essential. In the present study, we explored how stakeholders impacted the uptake of evidence in the malaria treatment policy change in Uganda. METHODS We employed a qualitative case study methodology involving interviews with key informants and review of documents. A timeline of events was developed, which guided the purposive sampling of respondents and identification of relevant documents. Data were analysed using inductive content analysis techniques. RESULTS Stakeholders played multiple roles in evidence uptake in the malaria treatment policy change. Donors, the Ministry of Health (MoH), service providers, and researchers engaged in the role of evidence generation. The MoH, parliamentarians, and opinion leaders at the national and local levels engaged in dissemination of evidence. The donors, MoH, researchers, and service providers engaged in the uptake of evidence in policy development and implementation. Stakeholders exerted varying levels of support and influence for different reasons. It is noteworthy that all of the influential stakeholders were divided regarding the best antimalarial alternative to adopt. CONCLUSION Our results showed a diverse group of stakeholders who played multiple roles, with varying levels of support and influence on the uptake of evidence in the malaria treatment policy change. For a given KT processes, mapping the relevant stakeholders and devising mechanism for their engagement and for how to resolve conflicts of interest and disagreements a priori will enhance uptake of evidence in policy development.
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Nabyonga-Orem J, Ssengooba F, Macq J, Criel B. Malaria treatment policy change in Uganda: what role did evidence play? Malar J 2014; 13:345. [PMID: 25179532 PMCID: PMC4164770 DOI: 10.1186/1475-2875-13-345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/26/2014] [Indexed: 01/22/2023] Open
Abstract
Background Although increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. The present study explores the role of evidence, barriers, and factors facilitating the uptake of evidence in the change in malaria treatment policy in Uganda, building on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitatory factors for KT. Application of the MRT to a health policy case will contribute to refining it. Methods Using a case study approach and mixed methods, perceptions of respondents on whether evidence was available, had been considered and barriers and facilitatory factors to the uptake of evidence were explored. In addition, the respondents’ rating of the degree of consistency between the policy decision and available evidence was assessed. Data collection methods included key informant interviews and document review. Qualitative data were analysed using content thematic analysis, whereas quantitative data were analysed using Excel spreadsheets. The two data sets were eventually triangulated. Results Evidence was used to change the malaria treatment policy, though the consistency between evidence and policy decisions varied along the policy development cycle. The availability of high-quality and contextualized evidence, including effective dissemination, Ministry of Health institutional capacity to lead the KT process, intervention of the WHO and a regional professional network, the existence of partnerships for KT with mutual trust and availability of funding, tools, and inputs to implement evidence, were the most important facilitatory factors that enhanced the uptake of evidence. Among the barriers that had to be overcome were resistance from implementers, the health system capacity to implement evidence, and financial sustainability. Conclusion The results agree with facilitatory factors identified in the earlier developed MRT, though additional factors emerged. These results refine the earlier MRT stating that high-quality and contextualized evidence will be taken up in policies, leading to evidence-informed policies when the MoH leads the KT process, partnerships are in place for KT, the WHO and regional professional bodies play a role, and funding, tools, and required inputs for implementing evidence are available. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-345) contains supplementary material, which is available to authorized users.
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Oliver K, Lorenc T, Innvær S. New directions in evidence-based policy research: a critical analysis of the literature. Health Res Policy Syst 2014; 12:34. [PMID: 25023520 PMCID: PMC4107868 DOI: 10.1186/1478-4505-12-34] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/30/2014] [Indexed: 01/07/2023] Open
Abstract
Despite 40 years of research into evidence-based policy (EBP) and a continued drive from both policymakers and researchers to increase research uptake in policy, barriers to the use of evidence are persistently identified in the literature. However, it is not clear what explains this persistence - whether they represent real factors, or if they are artefacts of approaches used to study EBP. Based on an updated review, this paper analyses this literature to explain persistent barriers and facilitators. We critically describe the literature in terms of its theoretical underpinnings, definitions of 'evidence', methods, and underlying assumptions of research in the field, and aim to illuminate the EBP discourse by comparison with approaches from other fields. Much of the research in this area is theoretically naive, focusing primarily on the uptake of research evidence as opposed to evidence defined more broadly, and privileging academics' research priorities over those of policymakers. Little empirical data analysing the processes or impact of evidence use in policy is available to inform researchers or decision-makers. EBP research often assumes that policymakers do not use evidence and that more evidence - meaning research evidence - use would benefit policymakers and populations. We argue that these assumptions are unsupported, biasing much of EBP research. The agenda of 'getting evidence into policy' has side-lined the empirical description and analysis of how research and policy actually interact in vivo. Rather than asking how research evidence can be made more influential, academics should aim to understand what influences and constitutes policy, and produce more critically and theoretically informed studies of decision-making. We question the main assumptions made by EBP researchers, explore the implications of doing so, and propose new directions for EBP research, and health policy.
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Affiliation(s)
- Kathryn Oliver
- School of Social Sciences, University of Manchester, Bridgeford Street, Manchester M13 9PL, UK
- Department of Science, Technology, Engineering and Public Policy (STEaPP), University College London, 66-72 Gower Street, London WC1E 6BT, UK
| | - Theo Lorenc
- Department of Science, Technology, Engineering and Public Policy (STEaPP), University College London, 66-72 Gower Street, London WC1E 6BT, UK
| | - Simon Innvær
- Faculty of Social Sciences, Oslo University College, P.O Box 1084, Blindern, 0317 OSLO, Norway
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Ekeroma AJ, Kenealy T, Shulruf B, McCowan LME, Hill A. Building reproductive health research and audit capacity and activity in the Pacific Islands (BRRACAP) study: methods, rationale and baseline results. BMC MEDICAL EDUCATION 2014; 14:121. [PMID: 24947243 PMCID: PMC4069343 DOI: 10.1186/1472-6920-14-121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Clinical research and audit in reproductive health is essential to improve reproductive health outcomes and to address the Millennium Development Goals 4 and 5. Research training, mentoring and a supportive participatory research environment have been shown to increase research activity and capacity in low to middle income countries (LMIC). This paper details the methods, rationale and baseline findings of a research program aimed at increasing clinical research activity and audit in the six Pacific Islands of Fiji, Samoa, Tonga, Vanuatu, Cook Islands and the Solomon Islands. METHOD Twenty-eight clinician participants were selected by the five Ministries of Health and the Fiji National University to undergo a research capacity building program which includes a research workshop and mentoring support to perform research and audit as teams in their country. Data on the participants' characteristics, knowledge and experiences were collected from structured interviews, questionnaires, focus groups, and an online survey. The interviews and the two focus groups were audio-recorded and all replies were analysed in a thematic framework. RESULTS The 28 participants included 9 nurses/midwives, 17 medical doctors of whom 8 were specialists in reproductive health and 2 other health workers. Most (24, 86%) were required to perform research as part of their employment and yet 17 (61%) were not confident in writing a research proposal, 13 (46%) could not use an electronic spreadsheet and the same number had not analysed quantitative data. The limited environmental enablers contributed to poor capacity with only 11 (46%) having access to a library, 10 (42%) receiving management support and 6 (25%) having access to an experienced researcher. Barriers to research that affected more than 70% of the participants were time constraints, poor coordination, no funding and a lack of skills. CONCLUSION Building a research capacity program appropriate for the diversity of Pacific clinicians required research evidence and collaborative effort of key stakeholders in the Pacific Islands and the region. The participants had limited research knowledge, skills and experience and would require individualized training and continuous intensive mentorship to realize their potential as clinician researchers for their services in the Pacific.
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Affiliation(s)
- Alec J Ekeroma
- South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Tim Kenealy
- South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Boaz Shulruf
- Office of Medical Education, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lesley ME McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Andrew Hill
- South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, Auckland, New Zealand
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Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. LANCET GLOBAL HEALTH 2014; 2:e323-33. [PMID: 25103301 DOI: 10.1016/s2214-109x(14)70227-x] [Citation(s) in RCA: 3015] [Impact Index Per Article: 301.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data for the causes of maternal deaths are needed to inform policies to improve maternal health. We developed and analysed global, regional, and subregional estimates of the causes of maternal death during 2003-09, with a novel method, updating the previous WHO systematic review. METHODS We searched specialised and general bibliographic databases for articles published between between Jan 1, 2003, and Dec 31, 2012, for research data, with no language restrictions, and the WHO mortality database for vital registration data. On the basis of prespecified inclusion criteria, we analysed causes of maternal death from datasets. We aggregated country level estimates to report estimates of causes of death by Millennium Development Goal regions and worldwide, for main and subcauses of death categories with a Bayesian hierarchical model. FINDINGS We identified 23 eligible studies (published 2003-12). We included 417 datasets from 115 countries comprising 60 799 deaths in the analysis. About 73% (1 771 000 of 2 443 000) of all maternal deaths between 2003 and 2009 were due to direct obstetric causes and deaths due to indirect causes accounted for 27·5% (672 000, 95% UI 19·7-37·5) of all deaths. Haemorrhage accounted for 27·1% (661 000, 19·9-36·2), hypertensive disorders 14·0% (343 000, 11·1-17·4), and sepsis 10·7% (261 000, 5·9-18·6) of maternal deaths. The rest of deaths were due to abortion (7·9% [193 000], 4·7-13·2), embolism (3·2% [78 000], 1·8-5·5), and all other direct causes of death (9·6% [235 000], 6·5-14·3). Regional estimates varied substantially. INTERPRETATION Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible for more than half of maternal deaths worldwide. More than a quarter of deaths were attributable to indirect causes. These analyses should inform the prioritisation of health policies, programmes, and funding to reduce maternal deaths at regional and global levels. Further efforts are needed to improve the availability and quality of data related to maternal mortality.
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Affiliation(s)
- Lale Say
- UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Alison Gemmill
- UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Department of Demography, University of California, Berkeley, CA, USA
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jane Daniels
- Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Marleen Temmerman
- UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Leontine Alkema
- Department of Statistics and Applied Probability and Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Gordon R, Magee LA, Payne B, Firoz T, Sawchuck D, Tu D, Vidler M, de Silva D, von Dadelszen P. Magnesium sulphate for the management of preeclampsia and eclampsia in low and middle income countries: a systematic review of tested dosing regimens. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:154-163. [PMID: 24518915 DOI: 10.1016/s1701-2163(15)30662-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To review systematically the magnesium sulphate (MgSO4) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or eclampsia (treatment). DATA SOURCES We searched Medline, EMBASE, IPA, CINAHL, CDSR, and CENTRAL databases for relevant English language publications. STUDY SELECTION Our search yielded 753 publications, of which 26 (10 randomized controlled trials and 16 observational studies) evaluated MgSO4 for preeclampsia and/or eclampsia in World Bank-classified LMICs. DATA EXTRACTION Independent, by two authors. DATA SYNTHESIS Twenty-five studies were conducted in hospital settings and one in the community. Rates of eclampsia were usually < 5% (median 3.0%, range 0.0% to 26.5%) even when MgSO4 was administered for eclampsia. When dosage varied from the standard Pritchard or Zuspan regimens, almost all (n = 22) reduced the dose or duration of treatment, most commonly because of concerns about maternal safety, cost, or resource availability. Four trials of a loading dose only (4 g IV + 10 g IM) versus loading plus maintenance dosing of 5 g/4 hr IM found no difference in eclampsia recurrence (RR 1.64; 95% CI 0.48 to 5.65, n = 396). One study documented less eclampsia recurrence associated with community administration of a MgSO4 loading dose before referral to a care facility versus treatment in a care facility (RR 0.23; 95% CI 0.11 to 0.49, n = 265). CONCLUSION Use of MgSO4 for eclampsia treatment and prevention has been well-studied in LMICs, but concern remains about potential toxicity. Further studies are needed to identify the minimum effective dosage of MgSO4 for management of preeclampsia and eclampsia and whether MgSO4 loading can be safely administered in the community.
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Affiliation(s)
- Rebecca Gordon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Beth Payne
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC
| | - Tabassum Firoz
- Department of Medicine, University of British Columbia, Vancouver BC
| | - Diane Sawchuck
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Domena Tu
- Child and Family Research Institute, University of British Columbia, Vancouver BC
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Dane de Silva
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC; Child and Family Research Institute, University of British Columbia, Vancouver BC
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Rother HA. Communicating pesticide neurotoxicity research findings and risks to decision-makers and the public. Neurotoxicology 2014; 45:327-37. [PMID: 24642183 DOI: 10.1016/j.neuro.2014.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/22/2014] [Accepted: 03/06/2014] [Indexed: 11/17/2022]
Abstract
The extensive research findings on neurotoxic risks of pesticides tend to remain in academic publications rather than being comprehensibly communicated to decision-makers and the public. Protecting health and promoting risk reduction, particularly in developing countries, requires access to current findings in a format that can inform policy, regulations, behaviour change and risk reduction. Successfully communicating research findings may require multiple strategies depending on the target audience's varying comprehension skills (e.g., numeracy literacy, visual literacy) and ability to interpret scientific data. To illustrate the complexities of risk communication, a case study of exposure to neurotoxic street pesticides amongst poor, urban South African communities attempting to control poverty related pests, is presented. What remains a challenge is how to communicate neurotoxicity research findings consistently and in a meaningful manner for a lay audience, consisting of both the general public and decision makers. A further challenge is to identify who will monitor and evaluate the ways in which these findings are communicated to ensure quality is maintained. Ultimately, researchers should carry the responsibility of knowledge translation and engaging with communication specialists when appropriate. Additionally, institutions should reward this as part of promotion and academic accolade systems, and funders should fund the translational process. Ethics review boards should also play an instrumental role in ensuring that knowledge translation is part of the ethics review requirement, while professional societies should take more responsibility for disseminating research findings to non-academics.
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Affiliation(s)
- Hanna-Andrea Rother
- Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town 7925, South Africa.
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Orem JN, Mafigiri DK, Nabudere H, Criel B. Improving knowledge translation in Uganda: more needs to be done. Pan Afr Med J 2014; 17 Suppl 1:14. [PMID: 24624247 PMCID: PMC3946259 DOI: 10.11694/pamj.supp.2014.17.1.3482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/09/2013] [Indexed: 11/16/2022] Open
Abstract
Introduction Meeting the health-related Millennium Development Goals in Africa calls for better access to and higher utilisation of quality evidence. The mechanisms through which research evidence can effectively guide public health policy and implementation of health programmes are not fully understood. Challenges to the use of evidence to inform policy and practice include the lack of a common understanding of what constitutes evidence and limited insight on the effectiveness of different research uptake activities. Available Knowledge Translation (KT) models have mainly been developed in high income countries and may not be directly applicable in resource-limited settings. In this study we examine the uptake of evidence in public health policy making in Uganda. Methods We conducted a cross-sectional qualitative study consisting of in-depth interviews with 17 purposively-selected health policy makers and researchers. The study explored respondents’ perceptions of the role of evidence in public health policy development, their understanding of KT and their views on the appropriateness of different KT activities that are currently implemented in Uganda. Results Although all respondents stated that evidence should inform health policies and programmes, they noted that this occurred infrequently. We noted a lack of conceptual clarity about KT and what precisely constitutes evidence. Respondents reported having been involved in different KT activities, including partnerships and platforms created for knowledge sharing between researchers and end users, but with very mixed results. Conclusion There is need for conceptual clarity on the notion of KT and an understanding of the most appropriate KT strategies in low-income settings.
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Affiliation(s)
- Juliet Nabyonga Orem
- WHO Uganda office, Health Systems and Services Cluster P. O. Box 24578, Kampala, Uganda
| | | | - Harriet Nabudere
- Regional East African Community Health (REACH) Policy Initiative, Uganda and Support the Use of Research Evidence (SURE) for Policy in African Health Systems Project; College of Health Sciences, Makerere University Medical School, P.O. Box 7072 Kampala, Uganda
| | - Bart Criel
- Institute of Tropical Medicine Antwerp-Belgium; Nationalestraat 155; 2000 Antwerp; Belgium
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A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res 2014; 14:2. [PMID: 24383766 PMCID: PMC3909454 DOI: 10.1186/1472-6963-14-2] [Citation(s) in RCA: 541] [Impact Index Per Article: 54.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022] Open
Abstract
Background The gap between research and practice or policy is often described as a problem. To identify new barriers of and facilitators to the use of evidence by policymakers, and assess the state of research in this area, we updated a systematic review. Methods Systematic review. We searched online databases including Medline, Embase, SocSci Abstracts, CDS, DARE, Psychlit, Cochrane Library, NHSEED, HTA, PAIS, IBSS (Search dates: July 2000 - September 2012). Studies were included if they were primary research or systematic reviews about factors affecting the use of evidence in policy. Studies were coded to extract data on methods, topic, focus, results and population. Results 145 new studies were identified, of which over half were published after 2010. Thirteen systematic reviews were included. Compared with the original review, a much wider range of policy topics was found. Although still primarily in the health field, studies were also drawn from criminal justice, traffic policy, drug policy, and partnership working. The most frequently reported barriers to evidence uptake were poor access to good quality relevant research, and lack of timely research output. The most frequently reported facilitators were collaboration between researchers and policymakers, and improved relationships and skills. There is an increasing amount of research into new models of knowledge transfer, and evaluations of interventions such as knowledge brokerage. Conclusions Timely access to good quality and relevant research evidence, collaborations with policymakers and relationship- and skills-building with policymakers are reported to be the most important factors in influencing the use of evidence. Although investigations into the use of evidence have spread beyond the health field and into more countries, the main barriers and facilitators remained the same as in the earlier review. Few studies provide clear definitions of policy, evidence or policymaker. Nor are empirical data about policy processes or implementation of policy widely available. It is therefore difficult to describe the role of evidence and other factors influencing policy. Future research and policy priorities should aim to illuminate these concepts and processes, target the factors identified in this review, and consider new methods of overcoming the barriers described.
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Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res 2014; 14:2. [PMID: 24383766 PMCID: PMC3909454 DOI: 10.1186/1472-6963-14-2#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/20/2013] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The gap between research and practice or policy is often described as a problem. To identify new barriers of and facilitators to the use of evidence by policymakers, and assess the state of research in this area, we updated a systematic review. METHODS Systematic review. We searched online databases including Medline, Embase, SocSci Abstracts, CDS, DARE, Psychlit, Cochrane Library, NHSEED, HTA, PAIS, IBSS (Search dates: July 2000 - September 2012). Studies were included if they were primary research or systematic reviews about factors affecting the use of evidence in policy. Studies were coded to extract data on methods, topic, focus, results and population. RESULTS 145 new studies were identified, of which over half were published after 2010. Thirteen systematic reviews were included. Compared with the original review, a much wider range of policy topics was found. Although still primarily in the health field, studies were also drawn from criminal justice, traffic policy, drug policy, and partnership working. The most frequently reported barriers to evidence uptake were poor access to good quality relevant research, and lack of timely research output. The most frequently reported facilitators were collaboration between researchers and policymakers, and improved relationships and skills. There is an increasing amount of research into new models of knowledge transfer, and evaluations of interventions such as knowledge brokerage. CONCLUSIONS Timely access to good quality and relevant research evidence, collaborations with policymakers and relationship- and skills-building with policymakers are reported to be the most important factors in influencing the use of evidence. Although investigations into the use of evidence have spread beyond the health field and into more countries, the main barriers and facilitators remained the same as in the earlier review. Few studies provide clear definitions of policy, evidence or policymaker. Nor are empirical data about policy processes or implementation of policy widely available. It is therefore difficult to describe the role of evidence and other factors influencing policy. Future research and policy priorities should aim to illuminate these concepts and processes, target the factors identified in this review, and consider new methods of overcoming the barriers described.
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Affiliation(s)
- Kathryn Oliver
- School of Social Sciences, University of Manchester, Bridgeford Street, M13 9PL Manchester, UK
| | - Simon Innvar
- Faculty of Social Sciences, Oslo University College, P.B. 4, St. Olavs Plass, NO-0130 Oslo, Norway
| | - Theo Lorenc
- Department of Science, Technology, Engineering, and Public Policy (UCL STEaPP), University College London, 66-72 Gower Street, London WC1E 6EA, UK
| | - Jenny Woodman
- MRC Centre of Epidemiology for Child Health, Institute of Child Health, London WC1N 1EH, UK
| | - James Thomas
- University of London, Institute of Education, 20 Bedford Way, London WC1H 0AL, UK
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Syed SB, Dadwal V, Storr J, Riley P, Rutter P, Hightower JD, Gooden R, Kelley E, Pittet D. Strengthening the evidence-policy interface for patient safety: enhancing global health through hospital partnerships. Global Health 2013; 9:47. [PMID: 24131652 PMCID: PMC3842804 DOI: 10.1186/1744-8603-9-47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 08/02/2013] [Indexed: 11/16/2022] Open
Abstract
Strengthening the evidence-policy interface is a well-recognized health system challenge in both the developed and developing world. Brokerage inherent in hospital-to-hospital partnerships can boost relationships between “evidence” and “policy” communities and move developing countries towards evidence based patient safety policy. In particular, we use the experience of a global hospital partnership programme focused on patient safety in the African Region to explore how hospital partnerships can be instrumental in advancing responsive decision-making, and the translation of patient safety evidence into health policy and planning. A co-developed approach to evidence-policy strengthening with seven components is described, with reflections from early implementation. This rapidly expanding field of enquiry is ripe for shared learning across continents, in keeping with the principles and spirit of health systems development in a globalized world.
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Affiliation(s)
- Shamsuzzoha B Syed
- African Partnerships for Patient Safety, Patient Safety Programme, World Health Organization, Geneva, Switzerland.
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Nabyonga Orem J, Marchal B, Mafigiri D, Ssengooba F, Macq J, Da Silveira VC, Criel B. Perspectives on the role of stakeholders in knowledge translation in health policy development in Uganda. BMC Health Serv Res 2013; 13:324. [PMID: 23958173 PMCID: PMC3751734 DOI: 10.1186/1472-6963-13-324] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stakeholder roles in the application of evidence are influenced by context, the nature of the evidence, the policy development process, and stakeholder interactions. Past research has highlighted the role of stakeholders in knowledge translation (KT) without paying adequate attention to the peculiarities of low-income countries. Here we identify the roles, relations, and interactions among the key stakeholders involved in KT in Uganda and the challenges that they face. METHODS This study employed qualitative approaches to examine the roles of and links among various stakeholders in KT. In-depth interviews were conducted with 21 key informants and focused on the key actors in KT, their perceived roles, and challenges. RESULTS Major stakeholders included civil society organizations with perceived roles of advocacy, community mobilization, and implementation. These stakeholders may ignore unconvincing evidence. The community's role was perceived as advocacy and participation in setting research priorities. The key role of the media was perceived as knowledge dissemination, but respondents noted that the media may misrepresent evidence if it is received in a poorly packaged form. The perceived roles of policy makers were evidence uptake, establishing platforms for KT and stewardship; negative roles included ignoring or even misrepresenting evidence that is not in their favor. The roles of parliamentarians were perceived as advocacy and community mobilization, but they were noted to pursue objectives that may not be supported by the evidence. The researchers' main role was defined as evidence generation, but focusing disproportionately on academic interests was cited as a concern. The donors' main role was defined as funding research and KT, but respondents were concerned about the local relevance of donor-supported research. Respondents reported that links among stakeholders were weak due to the absence of institutionalized, inclusive platforms. Challenges facing the stakeholders in the process of KT were identified. CONCLUSIONS Our investigation revealed the need to consider the roles that various stakeholders are best placed to play. Links and necessary platforms must be put in place to achieve synergy in KT. Relevant capacities need to be built to overcome the challenges faced by the various stakeholders.
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Affiliation(s)
- Juliet Nabyonga Orem
- WHO Uganda office, Health systems and services cluster, P. O. Box 24578, Kampala, Uganda.
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Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 2013; 170:1-7. [PMID: 23746796 DOI: 10.1016/j.ejogrb.2013.05.005] [Citation(s) in RCA: 789] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/18/2013] [Accepted: 05/06/2013] [Indexed: 11/26/2022]
Abstract
Reduction of maternal mortality is a target within the Millennium Development Goals. Data on the incidence of preeclampsia and eclampsia, one of the main causes of maternal deaths, are required at both national and regional levels to inform policies. We conducted a systematic review of the incidence of hypertensive disorders of pregnancy (HDP) with the objective of evaluating its magnitude globally and in different regions and settings. We selected studies using pre-specified criteria, recorded database characteristics and assessed methodological quality of the eligible studies reporting incidence of any HDP during the period 2002-2010. A logistic model was then developed to estimate the global and regional incidence of HDP using pre-specified predictor variables where empiric data were not available. We found 129 studies meeting the inclusion criteria, from which 74 reports with 78 datasets reporting HDP were analysed. This represents nearly 39 million women from 40 countries. When the model was applied, the overall estimates are 4.6% (95% uncertainty range 2.7-8.2), and 1.4% (95% uncertainty range 1.0-2.0) of all deliveries for preeclampsia and eclampsia respectively, with a wide variation across regions. The figures we obtained give a general idea of the magnitude of the problem and suggest that some regional variations might exist. The absence of data in many countries is of concern, however, and efforts should be made to implement data collection and reporting for substantial statistics. The implementation of large scale surveys conducted during a short period of time could provide more reliable and up-to-date estimations to inform policy.
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Affiliation(s)
- Edgardo Abalos
- Centro Rosarino de Estudios Perinatales, Moreno 878, P6, 2000 Rosario, Argentina.
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Knight HE, Self A, Kennedy SH. Why are women dying when they reach hospital on time? A systematic review of the 'third delay'. PLoS One 2013; 8:e63846. [PMID: 23704943 PMCID: PMC3660500 DOI: 10.1371/journal.pone.0063846] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/04/2013] [Indexed: 11/13/2022] Open
Abstract
Background The ‘three delays model’ attempts to explain delays in women accessing emergency obstetric care as the result of: 1) decision-making, 2) accessing services and 3) receipt of appropriate care once a health facility is reached. The third delay, although under-researched, is likely to be a source of considerable inequity in access to emergency obstetric care in developing countries. The aim of this systematic review was to identify and categorise specific facility-level barriers to the provision of evidence-based maternal health care in developing countries. Methods and Findings Five electronic databases were systematically searched using a 4-way strategy that combined search terms related to: 1) maternal health care; 2) maternity units; 3) barriers, and 4) developing countries. Forty-three original research articles were eligible to be included in the review. Thirty-two barriers to the receipt of timely and appropriate obstetric care at the facility level were identified and categorised into six emerging themes (Drugs and equipment; Policy and guidelines; Human resources; Facility infrastructure; Patient-related and Referral-related). Two investigators independently recorded the frequency with which barriers relating to the third delay were reported in the literature. The most commonly cited barriers were inadequate training/skills mix (86%); drug procurement/logistics problems (65%); staff shortages (60%); lack of equipment (51%) and low staff motivation (44%). Conclusions This review highlights how a focus on patient-side delays in the decision to seek care can conceal the fact that many health facilities in the developing world are still chronically under-resourced and unable to cope effectively with serious obstetric complications. We stress the importance of addressing supply-side barriers alongside demand-side factors if further reductions in maternal mortality are to be achieved.
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Affiliation(s)
- Hannah E Knight
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, United Kingdom.
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Bigdeli M, Zafar S, Assad H, Ghaffar A. Health system barriers to access and use of magnesium sulfate for women with severe pre-eclampsia and eclampsia in Pakistan: evidence for policy and practice. PLoS One 2013; 8:e59158. [PMID: 23555626 PMCID: PMC3608621 DOI: 10.1371/journal.pone.0059158] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/12/2013] [Indexed: 12/02/2022] Open
Abstract
Severe pre-eclampsia and eclampsia are rare but serious complications of pregnancy that threaten the lives of mothers during childbirth. Evidence supports the use of magnesium sulfate (MgSO4) as the first line treatment option for severe pre-eclampsia and eclampsia. Eclampsia is the third major cause of maternal mortality in Pakistan. As in many other Low- and Middle-Income Countries (LMIC), it is suspected that MgSO4 is critically under-utilized in the country. There is however a lack of information on context-specific health system barriers that prevent optimal use of this life-saving medicine in Pakistan. Combining quantitative and qualitative methods, namely policy document review, key informant interviews, focus group discussions and direct observation at health facility, we explored context-specific health system barriers and enablers that affect access and use of MgSO4 for severe pre-eclampsia and eclampsia in Pakistan. Our study finds that while international recommendations on MgSO4 have been adequately translated in national policies in Pakistan, the gap remains in implementation of national policies into practice. Barriers to access to and effective use of MgSO4 occur at health facility level where the medicine was not available and health staff was reluctant to use it. Low price of the medicine and the small market related to its narrow indications acted as disincentives for effective marketing. Results of our survey were further discussed in a multi-stakeholder round-table meeting and an action plan for increasing access to this life-saving medicine was identified.
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Affiliation(s)
- Maryam Bigdeli
- Alliance for Health Policy and System Research, World Health Organization, Geneva, Switzerland.
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van Dijk MG, Díaz Olavarrieta C, Zuñiga PU, Gordillo RL, Gutiérrez MER, García SG. Use of magnesium sulfate for treatment of pre-eclampsia and eclampsia in Mexico. Int J Gynaecol Obstet 2013; 121:110-4. [DOI: 10.1016/j.ijgo.2012.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 11/15/2012] [Accepted: 01/15/2013] [Indexed: 11/25/2022]
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Pharmacotherapy for Preeclampsia in Low and Middle Income Countries: An Analysis of Essential Medicines Lists. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:215-223. [DOI: 10.1016/s1701-2163(15)30993-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chaturvedi S, Randive B, Mistry N. Availability of treatment for eclampsia in public health institutions in Maharashtra, India. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2013; 31:86-95. [PMID: 23617209 PMCID: PMC3702363 DOI: 10.3329/jhpn.v31i1.14753] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Severe pre-eclampsia and eclampsia are common causes of maternal deaths worldwide and more so in developing countries. Magnesium sulphate (MgSO4) is now the most-recommended drug of choice to treat these conditions. Despite favourable policies for the use of MgSO4 treatment in India, eclampsia continues to take a high toll. This study examined the availability and use of MgSO4 treatment in the public health system and poor women's recent experiences with eclampsia treatment in Maharashtra state. A mix of qualitative and quantative methods was used. A facility-based survey of all secondary and tertiary healthcare facilities (n = 44) in 3 selected districts and interviews with public and contracted-in private sector obstetricians, health officials, and programme managers were conducted. A list of recently-delivering women from marginalized communities, with up to two livebirths, was drawn through a community-level survey in 272 villages covered by 60 subcentres selected at random. Mothers were selected for interviews, using maximum variation sampling, and interviews were conducted with 17% of the mothers who reported having experienced eclampsia; 61% of facilities had no stock of MgSO4, the stock-out position continuing from a period ranging from 3 months to 3 years while another 20% had some stock, although less than the expected minimum quantity. No treatment for eclampsia was provided in the recent 3 months at 73% facilities. Our survey of recently-delivering mothers recorded a history of eclampsia in 3.2% pregnancies/ deliveries. Interviews with 10 such mothers revealed that treatment for eclampsia has been sought from public as well as private hospitals and from traditional healers. However, facilities where women have received medical treatment are exclusively in the private sector. Almost all public and private care providers were aware of MgSO4 as the gold standard to treat eclampsia; however, it is unclear if they knew of its use to treat severe pre-eclampsia. The private care providers routinely used MgSO4 for eclampsia treatment while the public care providers seemed hesitant to use it fearing risks of complications. We stress the need for improved inventory control practices to ensure sustained availability of supplies and building confidence of care providers in using MgSO4 treatment for severe pre-eclampsia and eclampsia in public facilities, in addition to teaching expectant mothers how to recognize symptoms of these conditions.
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An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management. BMC Pregnancy Childbirth 2013; 13:34. [PMID: 23383864 PMCID: PMC3570392 DOI: 10.1186/1471-2393-13-34] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/29/2013] [Indexed: 11/30/2022] Open
Abstract
Background Pre-eclampsia/eclampsia is one of the most common causes of maternal and perinatal morbidity and mortality in low and middle income countries. Magnesium sulfate is the drug of choice for prevention of seizures as part of comprehensive management of the disease. Despite the compelling evidence for the effectiveness of magnesium sulfate, concern has been expressed about its safety and potential for toxicity, particularly among providers in low- and middle-income countries. The purpose of this review was to determine whether the literature published in these global settings supports the concerns about the safety of use of magnesium sulfate. Methods An integrative review of the literature was conducted to document the known incidences of severe adverse reactions to magnesium sulphate, and specific outcomes of interest related to its use. All types of prospective clinical studies were included if magnesium sulfate was used to manage pre-eclampsia or eclampsia, the study was conducted in a low- or middle-income country, and the study included the recording of the incidence of any adverse side effect resulting from magnesium sulfate use. Results A total of 24 studies that compared a magnesium sulfate regimen against other drug regimens and examined side effects among 34 subject groups were included. The overall rate of absent patellar reflex among all 9556 aggregated women was 1.6%, with a range of 0-57%. The overall rate of respiratory depression in 25 subject groups in which this outcome was reported was 1.3%, with a range of 0–8.2%. Delay in repeat administration of magnesium sulfate occurred in 3.6% of cases, with a range of 0-65%. Calcium gluconate was administered at an overall rate of less than 0.2%. There was only one maternal death that was attributed by the study authors to the use of magnesium sulfate among the 9556 women in the 24 studies. Conclusion Concerns about safety and toxicity from the use of magnesium sulfate should be mitigated by findings from this integrative review, which indicates a low incidence of the most severe side effects, documented in studies that used a wide variety of standard and modified drug regimens. Adverse effects of concern to providers occur infrequently, and when they occurred, a delay of repeat administration was generally sufficient to mitigate the effect. Early screening and diagnosis of the disease, appropriate treatment with proven drugs, and reasonable vigilance for women under treatment should be adopted as global policy and practice.
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Nabyonga Orem J, Bataringaya Wavamunno J, Bakeera SK, Criel B. Do guidelines influence the implementation of health programs?--Uganda's experience. Implement Sci 2012; 7:98. [PMID: 23068082 PMCID: PMC3534441 DOI: 10.1186/1748-5908-7-98] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 10/09/2012] [Indexed: 11/19/2022] Open
Abstract
Background A guideline contains processes and procedures intended to guide health service delivery. However, the presence of guidelines may not guarantee their implementation, which may be a result of weaknesses in the development process. This study was undertaken to describe the processes of developing health planning, services management, and clinical guidelines within the health sector in Uganda, with the goal of understanding how these processes facilitate or abate the utility of guidelines. Methods Qualitative and quantitative research methods were used to collect and analyze data. Data collection was undertaken at the levels of the central Ministry of Health, the district, and service delivery. Qualitative methods included review of documents, observations, and key informant interviews, as well as quantitative aspects included counting guidelines. Quantitative data were analyzed with Microsoft Excel, and qualitative data were analyzed using deductive content thematic analysis. Results There were 137 guidelines in the health sector, with programs related to Millennium Development Goals having the highest number (n = 83). The impetus for guideline development was stated in 78% of cases. Several guidelines duplicated content, and some conflicted with each other. The level of consultation varied, and some guidelines did not consider government-wide policies and circumstances at the service delivery level. Booklets were the main format of presentation, which was not tailored to the service delivery level. There was no framework for systematic dissemination, and target users were defined broadly in most cases. Over 60% of guidelines available at the central level were not available at the service delivery level, but there were good examples in isolated cases. There was no framework for systematic monitoring of use, evaluation, and review of guidelines. Suboptimal performance of the supervision framework that would encourage the use of guidelines, assess their utilization, and provide feedback was noted. Conclusions Guideline effectiveness is compromised by the development process. To ensure the production of high-quality guidelines, efforts must be employed at the country and regional levels. The regional level can facilitate pooling resources and expertise in knowledge generation, methodology development, guideline repositories, and capacity building. Countries should establish and enforce systems and guidance on guideline development.
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Affiliation(s)
- Juliet Nabyonga Orem
- Health systems and services cluster, WHO Uganda office, P.O. Box 24578, Kampala, Uganda.
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El-Jardali F, Lavis JN, Ataya N, Jamal D, Ammar W, Raouf S. Use of health systems evidence by policymakers in eastern Mediterranean countries: views, practices, and contextual influences. BMC Health Serv Res 2012; 12:200. [PMID: 22799440 PMCID: PMC3476435 DOI: 10.1186/1472-6963-12-200] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 07/16/2012] [Indexed: 11/10/2022] Open
Abstract
Background Health systems evidence can enhance policymaking and strengthen national health systems. In the Middle East, limited research exists on the use of evidence in the policymaking process. This multi-country study explored policymakers’ views and practices regarding the use of health systems evidence in health policymaking in 10 eastern Mediterranean countries, including factors that influence health policymaking and barriers and facilitators to the use of evidence. Methods This study utilized a survey adapted and customized from a similar tool developed in Canada. Health policymakers from 10 countries (Algeria, Bahrain, Jordan, Lebanon Oman, Pakistan, Palestine, Sudan, Tunisia, and Yemen) were surveyed. Descriptive and bi-variate analyses were performed for quantitative questions and thematic analysis was done for qualitative questions. Results A total of 237 policymakers completed the survey (56.3% response rate). Governing parties, limited funding for the health sector and donor organizations exerted a strong influence on policymaking processes. Most (88.5%) policymakers reported requesting evidence and 43.1% reported collaborating with researchers. Overall, 40.1% reported that research evidence is not delivered at the right time. Lack of an explicit budget for evidence-informed health policymaking (55.3%), lack of an administrative structure for supporting evidence-informed health policymaking processes (52.6%), and limited value given to research (35.9%) all limited the use of research evidence. Barriers to the use of evidence included lack of research targeting health policy, lack of funding and investments, and political forces. Facilitators included availability of health research and research institutions, qualified researchers, research funding, and easy access to information. Conclusions Health policymakers in several countries recognize the importance of using health systems evidence. Study findings are important in light of changes unfolding in some Arab countries and can help undertake an analysis of underlying transformations and their respective health policy implications including the way evidence will be used in policy decisions.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Room 107C, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
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Orem JN, Mafigiri DK, Marchal B, Ssengooba F, Macq J, Criel B. Research, evidence and policymaking: the perspectives of policy actors on improving uptake of evidence in health policy development and implementation in Uganda. BMC Public Health 2012; 12:109. [PMID: 22316003 PMCID: PMC3305540 DOI: 10.1186/1471-2458-12-109] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 02/09/2012] [Indexed: 11/16/2022] Open
Abstract
Background Use of evidence in health policymaking plays an important role, especially in resource-constrained settings where informed decisions on resource allocation are paramount. Several knowledge translation (KT) models have been developed, but few have been applied to health policymaking in low income countries. If KT models are expected to explain evidence uptake and implementation, or lack of it, they must be contextualized and take into account the specificity of low income countries for example, the strong influence of donors. The main objective of this research is to elaborate a Middle Range Theory (MRT) of KT in Uganda that can also serve as a reference for other low- and middle income countries. Methods This two-step study employed qualitative approaches to examine the principal barriers and facilitating factors to KT. Step 1 involved a literature review and identification of common themes. The results informed the development of the initial MRT, which details the facilitating factors and barriers to KT at the different stages of research and policy development. In Step 2, these were further refined through key informant interviews with policymakers and researchers in Uganda. Deductive content and thematic analysis was carried out to assess the degree of convergence with the elements of the initial MRT and to identify other emerging issues. Results Review of the literature revealed that the most common emerging facilitating factors could be grouped under institutional strengthening for KT, research characteristics, dissemination, partnerships and political context. The analysis of interviews, however, showed that policymakers and researchers ranked institutional strengthening for KT, research characteristics and partnerships as the most important. New factors emphasized by respondents were the use of mainstreamed structures within MoH to coordinate and disseminate research, the separation of roles between researchers and policymakers, and the role of the community and civil society in KT. Conclusions This study refined an initial MRT on KT in policymaking in the health sector in Uganda that was based on a literature review. It provides a framework that can be used in empirical research of the process of KT on specific policy issues.
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Affiliation(s)
- Juliet Nabyonga Orem
- WHO Uganda office, Health systems and services cluster, P, O, Box 24578, Kampala, Uganda.
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Barua A, Mundle S, Bracken H, Easterling T, Winikoff B. Facility and personnel factors influencing magnesium sulfate use for eclampsia and pre-eclampsia in 3 Indian hospitals. Int J Gynaecol Obstet 2011; 115:231-4. [PMID: 21930268 DOI: 10.1016/j.ijgo.2011.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 07/06/2011] [Accepted: 08/17/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify factors at the health facility and health professional levels that might hinder or facilitate the appropriate use of magnesium sulfate for the treatment of pre-eclampsia and eclampsia. METHODS Seven focus group discussions were conducted with a purposively sampled group of obstetricians/gynecologists, medical residents, and nurses at 3 hospitals in Nagpur, India. Data were collected on facility and drug availability, criteria for diagnosis and management of pre-eclampsia and eclampsia, attitudes about magnesium sulfate use, and perceived barriers to the treatment of pre-eclampsia and eclampsia. RESULTS Senior gynecologists seemed to encourage the use of magnesium sulfate, especially management prior to transfer to a higher facility. However, clinicians noted a lack of specific institutional guidelines on dose, timing, and indications, particularly in cases in which delivery was not imminent. In all facilities, service providers noted that their clinical care decisions were sometimes influenced by political and social factors, making management of eclampsia and pre-eclampsia cases difficult. Care was further challenged by limited drug availability, particularly at the tertiary-care center. CONCLUSION Limited drug supply and lack of specific institutional guidelines, equipment, and trained staff hinder the translation of evidence-based policy on magnesium sulfate into practice.
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Crichton J, Theobald S. Strategies and tensions in communicating research on sexual and reproductive health, HIV and AIDS: a qualitative study of the experiences of researchers and communications staff. Health Res Policy Syst 2011; 9 Suppl 1:S4. [PMID: 21679385 PMCID: PMC3121135 DOI: 10.1186/1478-4505-9-s1-s4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Sexual and Reproductive Health (SRH) and HIV issues are often controversial and neglected, leading to challenges with engaging policy actors. Research evidence is complex, posing further challenges for ensuring that policy and practice are evidence-based. Many health researchers are adopting innovative approaches to engaging stakeholders in their research, yet these experiences are not often shared. This qualitative study focuses on the research communication and policy influencing objectives, strategies and experiences of four research consortia working on SRH, HIV and AIDS. Methods We carried out 22 in-depth interviews with researchers and communications specialists (research actors) from the four consortia and their partners, working in nine countries in sub-Saharan Africa and Asia. Using the ‘framework’ approach to qualitative data analysis, we identified factors that affect the interaction of research evidence with policy and practice. We used the ODI RAPID analytical framework to present these results, adapting this tool by incorporating the actions, strategies and positionality of research actors. Results The characteristics of researchers and their institutions, policy context, the multiplicity of actors, and the nature of the research evidence all play a role in policy influencing processes. Research actors perceived a trend towards increasingly intensive and varied communication approaches. Effective influencing strategies include making strategic alliances and coalitions and framing research evidence in ways that are most attractive to particular policy audiences. Tensions include the need to identify and avoid unnecessary communication or unintended impacts, challenges in assessing and attributing impact and the need for adequate resources and skills for communications work. Conclusions We contend that the adapted RAPID framework can serve as a tool for research actors to use in resolving these tensions, through facilitating a reflexive approach to considering their own combination of attributes, skills, networks and objectives and the ways these relate to policy contexts, actors and processes.
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Affiliation(s)
- Joanna Crichton
- Dr, Sally Theobald, International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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