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Baker MM, Janmohamed A, Toure D, Dissieka R, Ndiaye F, Khassanova R, Fofana ML, Doledec D. COVID-19 concerns among caregivers and vitamin A supplementation coverage among children aged 6-59 months in four countries in Western sub-Saharan Africa. Public Health Nutr 2023; 26:1935-1943. [PMID: 37395173 PMCID: PMC10564591 DOI: 10.1017/s1368980023001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/12/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To assess child vitamin A supplementation (VAS) coverage in 2019 and 2020 and explore key factors, including COVID-19 concerns, that influenced VAS status in four sub-Saharan African countries. DESIGN Data from eight representative household surveys were used to assess VAS coverage. Multivariable logistic regression models examined the effect of rural/urban residence, child sex and age, caregiver education, COVID-19 concern and household wealth on VAS status. SETTING Nine (2019) and 12 (2020) districts in Burkina Faso, Côte d'Ivoire, Guinea and Mali. PARTICIPANTS 28 283 caregivers of children aged 6-59 months. RESULTS Between 2019 and 2020, VAS coverage increased in Burkina Faso (82·2-93·1 %), Côte d'Ivoire (90·3-93·3 %) and Mali (76·1-79·3 %) and decreased in Guinea (86·0 % to 81·7 %). Rural children had a higher likelihood of VAS uptake compared with urban children in Burkina Faso (adjusted OR (aOR) = 4·22; 95 % CI: 3·11, 5·72), Côte d'Ivoire (aOR = 5·19; 95 % CI: 3·10, 8·70) and Mali (aOR = 1·41; 95 % CI: 1·15, 1·74). Children aged 12-59 months had a higher likelihood of VAS uptake compared with children aged 6-11 months in Côte d'Ivoire (aOR = 1·67; 95 % CI: 1·12, 2·48) and Mali (aOR = 1·74; 95 % CI: 1·34, 2·26). Moderate-to-high COVID-19 concern was associated with a lower likelihood of VAS uptake in Côte d'Ivoire (aOR = 0·55; 95 % CI: 0·37, 0·80). CONCLUSION The increase in VAS coverage from 2019 to 2020 suggests that COVID-19 concerns may not have limited VAS uptake in some African countries, though geographic inequities should be considered.
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Affiliation(s)
- Melissa M Baker
- Helen Keller International, P.O. Box 14195 – 00800, Nairobi, Kenya
| | | | | | | | | | | | | | - David Doledec
- Helen Keller International, P.O. Box 14195 – 00800, Nairobi, Kenya
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Shintouo CM, Shey RA, Yengo BN, Yaah NE, Teh RN, Ngwese RA, Ayong L, Vanhamme L, Souopgui J, Ghogomu SM, Njemini R. Effects of the suspension of mass drug administration during the COVID-19 pandemic on onchocerciasis prevalence in the Bandjoun and Massangam health districts, West Region of Cameroon. Acta Trop 2023; 246:106999. [PMID: 37549841 DOI: 10.1016/j.actatropica.2023.106999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
Onchocerciasis is an infectious disease of public health and socio-economic importance in most parts of Sub-Saharan Africa. The objective of this study was to evaluate the effects of the suspension of implementation activities towards combating onchocerciasis in the Bandjoun and Massangam health districts in the West Region of Cameroon as a consequence of the COVID-19 pandemic. Data on socio-demographic and clinical characteristics were obtained using a structured questionnaire. All participants in both health districts were examined for the presence of clinical manifestations of onchocerciasis. In addition, two skin snips were obtained from the knee of each participant and examined for the presence of microfilaria. All data were categorized, coded, entered in a database, and analysed using SPSS version 23.0. A total of 229 participants in the Bandjoun health district and 378 in the Massangam health district were recruited for the study. In both health districts, there was no significant difference between male and female participants in terms of the clinical manifestations of onchocerciasis. The prevalence of nodules was 8.7% in the Bandjoun health district and 20.6% in the Massangam health district while the prevalence of microfilaria carriers in Bandjoun and Massangam health districts was 3.5% and 3.7%, respectively. Except for the Tsesse and Lemgo communities in the Bandjoun health district, there was a reduction in the prevalence of microfilaria in the communities that were studied when compared to previous data obtained before the disruption of control programmes activities. Overall, in both health districts, elderly individuals bear the largest burden of onchocerciasis. Based on the results obtained, we conclude that the temporary suspension of Neglected Tropical Disease control programme activities by the World Head Organization as a result of COVID-19 may have resulted to recrudescence of O. volvulus transmission in hypoendemic communities in the Bandjoun health district.
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Affiliation(s)
- Cabirou Mounchili Shintouo
- Department of Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Robert Adamu Shey
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon; Department of Molecular Biology, Institute of Biology and Molecular Medicine, IBMM, Université Libre de Bruxelles, Gosselies Campus, 126040 Gosselies, Belgium
| | - Bernis Neneyoh Yengo
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Ntang Emmaculate Yaah
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Rene Ning Teh
- Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon
| | - Roland Akwelle Ngwese
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon
| | - Lawrence Ayong
- Malaria Research Unit, Centre Pasteur Cameroon, Yaounde´, Cameroon
| | - Luc Vanhamme
- Department of Molecular Biology, Institute of Biology and Molecular Medicine, IBMM, Université Libre de Bruxelles, Gosselies Campus, 126040 Gosselies, Belgium
| | - Jacob Souopgui
- Department of Molecular Biology, Institute of Biology and Molecular Medicine, IBMM, Université Libre de Bruxelles, Gosselies Campus, 126040 Gosselies, Belgium.
| | - Stephen Mbigha Ghogomu
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63 Buea, Cameroon.
| | - Rose Njemini
- Department of Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
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Cherif MS, Keita M, Dahal P, Guilavogui T, Beavogui AH, Diassy L, Conde M, Touré A, Delamou A. Neglected tropical diseases in Republic of Guinea: disease endemicity, case burden and the road towards the 2030 target. Int Health 2023; 15:490-504. [PMID: 37232124 PMCID: PMC10472893 DOI: 10.1093/inthealth/ihad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/02/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023] Open
Abstract
Neglected tropical diseases (NTDs) predominantly affect vulnerable and marginalized populations in tropical and subtropical areas and globally affect more than one billion people. In Guinea, the burden of NTDs is estimated to be >7.5 disability-adjusted life years per million inhabitants. Currently the Guinea NTDs master plan (2017-2020) has identified eight diseases as public health problems: onchocerciasis, lymphatic filariasis, trachoma, schistosomiasis and soil-transmitted helminthiasis, leprosy, human African trypanosomiasis and Buruli ulcer. In this review we discuss the past and the current case burden of the priority NTDs in Guinea, highlight the major milestones and discuss current and future areas of focus for achieving the 2030 target outlined by the World Health Organization.
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Affiliation(s)
- Mahamoud Sama Cherif
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Direction Regionale de la Santé de Faranah, Ministère de la santé et de l'hygiène publique, Faranah, Guinea
- Service de Pediatrie, Hospital National Ignace Deen, Ministère de la santé et de l'Hygiène Publique, Conakry, Guinea
| | - Mory Keita
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Prabin Dahal
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Timothé Guilavogui
- Management and Programmes Coordination, Ministry of Health, Conakry, Guinea
| | - Abdoul Habib Beavogui
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea
| | - Lamine Diassy
- World Health Organization, Guinea office, Landreah, Corniche Nord, Boîte postale 817, Conakry, Guinea
| | - Mohamed Conde
- Service de Pediatrie, Hospital National Ignace Deen, Ministère de la santé et de l'Hygiène Publique, Conakry, Guinea
| | - Abdoulaye Touré
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Institut National de Santé Publique, Ministère de la Santé et de l'Hygiène Publique, Conakry, Guinea
| | - Alexandre Delamou
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea
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Trippler L, Knopp S, Welsche S, Webster BL, Stothard JR, Blair L, Allan F, Ame SM, Juma S, Kabole F, Ali SM, Rollinson D, Pennance T. The long road to schistosomiasis elimination in Zanzibar: A systematic review covering 100 years of research, interventions and control milestones. ADVANCES IN PARASITOLOGY 2023; 122:71-191. [PMID: 37657854 DOI: 10.1016/bs.apar.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Zanzibar is among the few places in sub-Saharan Africa where interruption of Schistosoma transmission seems an achievable goal. Our systematic review identifies and discusses milestones in schistosomiasis research, control and elimination efforts in Zanzibar over the past 100 years. The search in online databases, libraries, and the World Health Organization Archives revealed 153 records published between May 1928 and August 2022. The content of records was summarised to highlight the pivotal work leading towards urogenital schistosomiasis elimination and remaining research gaps. The greatest achievement following 100 years of schistosomiasis interventions and research is undoubtedly the improved health of Zanzibaris, exemplified by the reduction in Schistosoma haematobium prevalence from>50% historically down to<5% in 2020, and the absence of severe morbidities. Experiences from Zanzibar have contributed to global schistosomiasis guidelines, whilst also revealing challenges that impede progression towards elimination. Challenges include: transmission heterogeneity requiring micro-targeting of interventions, post-treatment recrudescence of infections in transmission hotspots, biological complexity of intermediate host snails, emergence of livestock Schistosoma species complicating surveillance whilst creating the risk for interspecies hybridisation, insufficient diagnostics performance for light intensity infections and female genital schistosomiasis, and a lack of acceptable sanitary alternatives to freshwater bodies. Our analysis of the past revealed that much can be achieved in the future with practical implementation of integrated interventions, alongside operational research. With continuing national and international commitments, interruption of S. haematobium transmission across both islands is within reach by 2030, signposting the future demise of urogenital schistosomiasis across other parts of sub-Saharan Africa.
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Affiliation(s)
- Lydia Trippler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | | | - Bonnie L Webster
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Fiona Allan
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; University of St Andrews, St Andrews, United Kingdom
| | - Shaali Makame Ame
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Saleh Juma
- Neglected Diseases Programme, Zanzibar Ministry of Health, Mkoroshoni, Pemba, United Republic of Tanzania
| | - Fatma Kabole
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Said Mohammed Ali
- Public Health Laboratory - Ivo de Carneri, Wawi, Chake Chake, Pemba, United Republic of Tanzania
| | - David Rollinson
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Global Schistosomiasis Alliance, London, United Kingdom
| | - Tom Pennance
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Western University of Health Sciences, Lebanon, OR, United States.
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Itaye T, Matendechero SH, Mbonigaba JB, Gebretsadik FS, Molefi TL, Baayenda G, Ruberanziza E, Kollie KK, Zilabumba J, Dembele M, Deribe K, Adrien EM, Polo MR. "Our interventions are still here to support communities during the pandemic": Resuming mass drug administration for neglected tropical diseases after COVID-19 implementation delays. PLoS Negl Trop Dis 2023; 17:e0011368. [PMID: 37363911 PMCID: PMC10328222 DOI: 10.1371/journal.pntd.0011368] [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: 07/29/2022] [Revised: 07/07/2023] [Accepted: 05/09/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic disrupted essential health services, including those provided by national neglected tropical disease (NTD) programs. Most mass drug administration (MDA) programs were postponed for 6-12 months following World Health Organization guidance released in April 2020 to temporarily halt NTD programs and launch necessary COVID-19 precautions. While NTD-endemic countries have since resumed MDA activities, it is critical to understand implementers' perspectives on the key challenges and opportunities for program relaunch, as these insights are critical for maximizing gains towards disease control and elimination during public health emergencies. Using data from using online surveys and focus group discussions, this mixed-methods study sought perspectives from Ministry of Health NTD Program Managers and implementing partners from non-governmental organizations working in sub-Saharan Africa. Data analysis revealed that findings converged around several main themes: disruptions for MDA programs included resource shortages due to prioritization of pandemic response, challenges adhering to COVID-19 safety protocols, and community hesitancy due to coronavirus transmission fears. Identified solutions for restarting MDA programs focused on adapting intervention delivery and packaging to minimize disease transmission, embracing technology to optimize intervention planning and delivery, and identifying opportunities to promote program integration between pandemic response strategies and NTD campaign delivery. Findings identifies key challenges due to disruptions to NTD program delivery and provide strategic recommendations for endemic countries to build resilient programs that can continue to perform during and beyond global pandemics.
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Affiliation(s)
- Tikhala Itaye
- Department of Global Health, University of Washington, Washington, Seattle, United States of America
| | | | - Jean Bosco Mbonigaba
- Rwanda NTD and Other Parasitic Diseases Program, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | | | | | | | | | | | | | - Massitan Dembele
- National Lymphatic Filariasis Elimination Program, Ministry of Health, Bamako, Mali
| | - Kebede Deribe
- Expanded Special Project on the Elimination of Neglected Tropical Diseases, World Health Organization -African Region, Brazzaville, Republic of Congo
| | - Elia Muhima Adrien
- Expanded Special Project on the Elimination of Neglected Tropical Diseases, World Health Organization -African Region, Brazzaville, Republic of Congo
| | - Maria Rebollo Polo
- Expanded Special Project on the Elimination of Neglected Tropical Diseases, World Health Organization -African Region, Brazzaville, Republic of Congo
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Mogaji HO, Okoh HI, Lawal AM, Ojo KH, Marcus AJ, Aaron NO, Adeleye DR, Olamiju FO, Ekpo UF. A Post-Lockdown Assessment of Albendazole Treatment Coverage in Mass Drug Administration Campaigns Implemented Before and During COVID-19 Pandemic in Ekiti, Southwest Nigeria. Int J Public Health 2023; 68:1605510. [PMID: 36846154 PMCID: PMC9948738 DOI: 10.3389/ijph.2023.1605510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
Objective: This study assessed the coverage of albendazole (ALB) in mass drug administration (MDA) programs implemented before (2019) and during the (2020 and 2021) COVID-19 pandemic in Ekiti State, Nigeria. Methods: Standardized questionnaires were administered to 1,127 children across three peri-urban communities to ascertain if they received and swallowed ALB across the years. Reasons, why ALB was not received, were documented and analyzed in SPSS. 20.0. Results: In 2019, the medicine reach was between 42.2%-57.8%, however, during the pandemic, the reach significantly reduced to 12.3%-18.6%, and increased to 28.5%-35.2% in 2021 (p < 0.000). About 19.6%-27.2% of the participants have missed 1 MDA, while 26.9%-37.8% and 22.4%-32.8% have missed 2 and 3 MDAs, respectively. The majority who did not receive ALB (60.8%-75%) claimed drug distributors never came, while about 14.9%-20.3% mentioned they did not hear about MDA. However, individual compliance towards swallowing was above 94% across the study years (p < 0.00). Conclusion: These results highlight the need to explore the perceptions of those who have consistently missed MDAs, and also understand the health-system-related issues including those imposed by the pandemic affecting MDA.
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Affiliation(s)
- Hammed O. Mogaji
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria,*Correspondence: Hammed O. Mogaji,
| | - Hilary I. Okoh
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Abiodun M. Lawal
- Clinical Psychology Unit, Department of Psychology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Kayode H. Ojo
- Neglected Tropical Diseases Unit, Ekiti State Primary Healthcare and Development Agency, Ado Ekiti, Nigeria
| | | | - Nwana O. Aaron
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Damilola R. Adeleye
- Clinical Psychology Unit, Department of Psychology, Federal University Oye-Ekiti, Oye, Nigeria
| | | | - Uwem F. Ekpo
- Parasitology and Epidemiology Unit, Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Abeokuta, Nigeria,Bioscience Research Programme, Institute of Food Security, Environmental Resource and Agricultural Research (IFSERAR), Federal University of Agriculture, Abeokuta, Nigeria
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Borlase A, Le Rutte EA, Castaño S, Blok DJ, Toor J, Giardina F, Davis EL. Evaluating and mitigating the potential indirect effect of COVID-19 on control programmes for seven neglected tropical diseases: a modelling study. Lancet Glob Health 2022; 10:e1600-e1611. [PMID: 36240827 PMCID: PMC9579354 DOI: 10.1016/s2214-109x(22)00360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
Background In line with movement restrictions and physical distancing essential for the control of the COVID-19 pandemic, WHO recommended postponement of all neglected tropical disease (NTD) control activities that involve community-based surveys, active case finding, and mass drug administration in April, 2020. Following revised guidance later in 2020, and after interruptions to NTD programmes of varying lengths, NTD programmes gradually restarted in the context of an ongoing pandemic. However, ongoing challenges and service gaps have been reported. This study aimed to evaluate the potential effect of the programmatic interruptions and strategies to mitigate this effect. Methods For seven NTDs, namely soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis, trachoma, visceral leishmaniasis, and human African trypanosomiasis, we used mathematical transmission models to simulate the effect of programme interruptions on the dynamics of each of these diseases in different endemic settings. We also explored the potential benefit of implementing mitigation strategies, primarily in terms of minimising the delays to control targets. Findings We show that the effect of the COVID-19-induced interruption in terms of delay to achieving elimination goals might in some cases be much longer than the duration of the interruption. For schistosomiasis, onchocerciasis, trachoma, and visceral leishmaniasis, a mean delay of 2–3 years for a 1-year interruption is predicted in areas of highest prevalence. We also show that these delays can largely be mitigated by measures such as additional mass drug administration or enhanced case-finding. Interpretation The COVID-19 pandemic has brought infectious disease control to the forefront of global consciousness. It is essential that the NTDs, so long neglected in terms of research and financial support, are not overlooked, and remain a priority in health service planning and funding. Funding Bill & Melinda Gates Foundation, Medical Research Council, and the UK Foreign, Commonwealth & Development Office.
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Affiliation(s)
- Anna Borlase
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Epke A Le Rutte
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Soledad Castaño
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; LYO-X, Allschwil, Switzerland
| | - David J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jaspreet Toor
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Federica Giardina
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Emma L Davis
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK; Mathematics Institute, University of Warwick, Coventry, UK.
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