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Lyus R, Buamah C, Pollock A, Cosgrove L, Brhlikova P. Global Burden of Disease 2017 estimates for Major Depressive Disorder: a critical appraisal of the epidemiological evidence. JRSM Open 2023; 14:20542704231197594. [PMID: 37719088 PMCID: PMC10501079 DOI: 10.1177/20542704231197594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Objectives To critically appraise the quality of the studies underpinning the Global Burden of Disease (GBD) 2017 estimates for Major Depressive Disorder (MDD) with respect to i) the GBD 2017 inclusion criteria and ii) population coverage. Design Systematic critical appraisal. Setting Not applicable. Participants Not applicable. Main outcome measures Each study was critically appraised with respect to the four GBD 2017 inclusion criteria: representativeness, study method and sample, diagnostic criteria and publication from 1980 onwards. Population coverage was calculated. Results Less than half of studies (221/467, 47.3%) were nationally representative. Only 262/467 (56.1%) of studies reported specifically on MDD and more than a third did not use DSM or ICD diagnostic criteria: 94/467 (20.1%) did not specify any diagnostic criteria and 68/467 (14.6%) relied on self-reported depression for diagnosis. Only 62/467 (13.3%) of studies were conducted during the period 2011-2017. Only 107/195 (54.9%) of countries had one or more prevalence studies. Conclusions GBD 2017 estimates for MDD are based on incomplete country and population coverage. The inclusion of studies with non-representative populations, that do not use diagnostic criteria and the lack of specific data on MDD reduces the reliability of estimates and limits their value for policy making.
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Affiliation(s)
- R. Lyus
- Population Health Sciences Institute, Newcastle University, UK
| | - C. Buamah
- Population Health Sciences Institute, Newcastle University, UK
| | - A.M. Pollock
- Population Health Sciences Institute, Newcastle University, UK
| | | | - P. Brhlikova
- Population Health Sciences Institute, Newcastle University, UK
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2
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Miranda JJ, Beran D, Diez-Canseco F, Buse K, Mendoza W, Peiris D. [How does research influence health policies?]. Gac Sanit 2022; 36:201-203. [PMID: 34998573 DOI: 10.1016/j.gaceta.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/04/2022]
Affiliation(s)
- J Jaime Miranda
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú; The George Institute for Global Health, University of New South Wales, Sidney, Australia; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Londres, Reino Unido.
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, and Geneva University Hospitals, Ginebra, Suiza
| | - Francisco Diez-Canseco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, Londres, Reino Unido. https://twitter.com/kentbuse
| | - Walter Mendoza
- Fondo de Población de las Naciones Unidas (UNFPA), Lima, Perú
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sidney, Australia. https://twitter.com/davidpeiris
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D'Ambruoso L, Price J, Cowan E, Goosen G, Fottrell E, Herbst K, van der Merwe M, Sigudla J, Davies J, Kahn K. Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making. Glob Health Action 2021; 14:2000091. [PMID: 35377291 PMCID: PMC8986216 DOI: 10.1080/16549716.2021.2000091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Recognising that the causes of over half the world's deaths pass unrecorded, the World Health Organization (WHO) leads development of Verbal Autopsy (VA): a method to understand causes of death in otherwise unregistered populations. Recently, VA has been developed for use outside research environments, supporting countries and communities to recognise and act on their own health priorities. We developed the Circumstances of Mortality Categories (COMCATs) system within VA to provide complementary circumstantial categorisations of deaths. OBJECTIVES Refine the COMCAT system to (a) support large-scale population assessment and (b) inform public health decision-making. METHODS We analysed VA data for 7,980 deaths from two South African Health and Socio-Demographic Surveillance Systems (HDSS) from 2012 to 2019: the Agincourt HDSS in Mpumalanga and the Africa Health Research Institute HDSS in KwaZulu-Natal. We assessed the COMCAT system's reliability (consistency over time and similar conditions), validity (the extent to which COMCATs capture a sufficient range of key circumstances and events at and around time of death) and relevance (for public health decision-making). RESULTS Plausible results were reliably produced, with 'emergencies', 'recognition, 'accessing care' and 'perceived quality' characterising the majority of avoidable deaths. We identified gaps and developed an additional COMCAT 'referral', which accounted for a significant proportion of deaths in sub-group analysis. To support decision-making, data that establish an impetus for action, that can be operationalised into interventions and that capture deaths outside facilities are important. CONCLUSIONS COMCAT is a pragmatic, scalable approach enhancing functionality of VA providing basic information, not available from other sources, on care seeking and utilisation at and around time of death. Continued development with stakeholders in health systems, civil registration, community and research environments will further strengthen the tool to capture social and health systems drivers of avoidable deaths and promote use in practice settings.
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Affiliation(s)
- Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Public Healtlh, National Health Service (NHS), Scotland
| | - Jessica Price
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eilidh Cowan
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland.,School of Geosciences, College of Science and Engineering, University of Edinburgh, Scotland
| | | | | | - Kobus Herbst
- Africa Health Research Institute, Durban, South Africa.,DSI-MRC South African Population Research Infrastructure Network (SAPRIN), South Africa
| | - Maria van der Merwe
- Aberdeen Centre for Health Data Science (ACHDS), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Independent Consultant, South Africa
| | | | - Justine Davies
- Institute for Applied Health Research, University of Birmingham, UK
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,International Network for the Demographic Evaluation of Populations and Their Health (Indepth), Accra, Ghana
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4
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Hinga A, Marsh V, Nyaguara A, Wamukoya M, Molyneux S. The ethical implications of verbal autopsy: responding to emotional and moral distress. BMC Med Ethics 2021; 22:118. [PMID: 34481510 DOI: 10.1186/s12910-021-00683-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Verbal autopsy is a pragmatic approach for generating cause-of-death data in contexts without well-functioning civil registration and vital statistics systems. It has primarily been conducted in health and demographic surveillance systems (HDSS) in Africa and Asia. Although significant resources have been invested to develop the technical aspects of verbal autopsy, ethical issues have received little attention. We explored the benefits and burdens of verbal autopsy in HDSS settings and identified potential strategies to respond to the ethical issues identified. Methods This research was based on a case study approach centred on two contrasting HDSS in Kenya and followed the Mapping-Framing-Shaping Framework for empirical bioethics research. Data were collected through individual interviews, focus group discussions, document reviews and non-participant observations. 115 participants were involved, including 86 community members (HDSS residents and community representatives), and 29 research staff (HDSS managers, researchers, census field workers and verbal autopsy interviewers). Results The use of verbal autopsy data for research and public health was described as the most common potential benefit of verbal autopsy in HDSS. Community members mentioned the potential uses of verbal autopsy data in addressing immediate public health problems for the local population while research staff emphasized the benefits of verbal autopsy to research and the wider public. The most prominent burden associated with the verbal autopsy was emotional distress for verbal autopsy interviewers and respondents. Moral events linked to the interview, such as being unsure of the right thing to do (moral uncertainty) or knowing the right thing to do and being constrained from acting (moral constraint), emerged as key causes of emotional distress for verbal autopsy interviewers. Conclusions The collection of cause-of-death data through verbal autopsy in HDSS settings presents important ethical and emotional challenges for verbal autopsy interviewers and respondents. These challenges include emotional distress for respondents and moral distress for interviewers. This empirical ethics study provides detailed accounts of the distress caused by verbal autopsy and highlights ethical tensions between potential population benefits and risks to individuals. It includes recommendations for policy and practice to address emotional and moral distress in verbal autopsy. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00683-7.
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Pisani E, Hasnida A, Rahmi M, Kok MO, Harsono S, Anggriani Y. Substandard and Falsified Medicines: Proposed Methods for Case Finding and Sentinel Surveillance. JMIR Public Health Surveill 2021; 7:e29309. [PMID: 34181563 PMCID: PMC8406122 DOI: 10.2196/29309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/09/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
The World Health Organization and others warn that substandard and falsified medicines harm health and waste money, especially in low- and middle-income countries. However, no country has measured the market-wide extent of the problem, and no standardized methods exist to estimate the prevalence of either substandard or falsified medicines. This is, in part, because the task seems overwhelming; medicine markets are huge and diverse, and testing medicines is expensive. Many countries do operate some form of postmarket surveillance of medicine, but their methods and goals differ. There is currently no clear guidance on which surveillance method is most appropriate to meet specific public health goals. In this viewpoint, we aimed to discuss the utility of both case finding and risk-based sentinel surveillance for substandard and falsified medicines, linking each to specific public health goals. We posit that choosing the system most appropriate to the goal, as well as implementing it with a clear understanding of the factors driving the production and sale of substandard and falsified medicines, will allow for surveillance resources to be concentrated most efficiently. We adapted principles used for disease outbreak responses to suggest a case-finding system that uses secondary data to flag poor-quality medicines, proposing risk-based indicators that differ for substandard and falsified medicines. This system potentially offers a cost-effective way of identifying “cases” for market withdrawal, enhanced oversight, or another immediate response. We further proposed a risk-based sentinel surveillance system that concentrates resources on measuring the prevalence of substandard and falsified medicines in the risk clusters where they are most likely to be found. The sentinel surveillance system provides base data for a transparent, spreadsheet-based model for estimating the national prevalence of substandard and falsified medicines. The methods we proposed are based on ongoing work in Indonesia, a large and diverse middle-income country currently aiming to achieve universal health coverage. Both the case finding and the sentinel surveillance system are designed to be adaptable to other resource-constrained settings.
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Affiliation(s)
- Elizabeth Pisani
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands.,School of Public Health, Imperial College, London, United Kingdom.,Faculty of Pharmacy, Universitas Pancasila, Jakarta, Indonesia
| | - Amalia Hasnida
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Mawaddati Rahmi
- Faculty of Pharmacy, Universitas Pancasila, Jakarta, Indonesia
| | - Maarten Olivier Kok
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands.,Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Yusi Anggriani
- Faculty of Pharmacy, Universitas Pancasila, Jakarta, Indonesia
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6
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Mijumbi-Deve R, Parkhurst J, Jones C, Juma PA, Sobngwi-Tambekou JL, Wenham C. Beyond the metrics of health research performance in African countries. BMJ Glob Health 2021; 6:e006019. [PMID: 34315777 PMCID: PMC8317117 DOI: 10.1136/bmjgh-2021-006019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
While it is important to be able to evaluate and measure a country's performance in health research (HR), HR systems are complex and multifaceted in nature. As such, attempts at measurement can suffer several limitations which risk leading to inadequate indices or representations. In this study, we critically review common indicators of HR capacity and performance and explore their strengths and limitations. The paper is informed by review of data sources and documents, combined with interviews and peer-to-peer learning activities conducted with officials working in health and education ministries in a set of nine African countries. We find that many metrics that can assess HR performance have gaps in the conceptualisation or fail to address local contextual realities, which makes it a challenge to interpret them in relation to other theoretical constructs. Our study identified several concepts that are excluded from current definitions of indicators and systems of metrics for HR performance. These omissions may be particularly important for interpreting HR performance within the context and processes of HR in African countries, and thus challenging the relevance, utility, appropriateness and acceptability of universal measures of HR in the region. We discuss the challenges that scholars may find in conceptualising such a complex phenomenon-including the different and competing viewpoints of stakeholders, in setting objectives of HR measurement work, and in navigating the realities of empirical measurement where missing or partial data may necessitate that proxies or alternative indicators may be chosen. These findings are important to ensure that the global health community does not rely on over-simplistic evaluations of HR when analysing and planning for improvements in low-income and middle-income countries.
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Affiliation(s)
- Rhona Mijumbi-Deve
- LSE Health, The London School of Economics and Political Science, London, UK
- The Center for Rapid Evidence Synthesis (ACRES), Makerere University College of Health Sciences, Kampala, Uganda
| | - Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Catherine Jones
- LSE Health, The London School of Economics and Political Science, London, UK
| | - Pamela A Juma
- LSE Health, The London School of Economics and Political Science, London, UK
| | - Joelle L Sobngwi-Tambekou
- LSE Health, The London School of Economics and Political Science, London, UK
- Office of the Director, Recherche-Santé & Développement (RSD Institute), Yaounde, Cameroon
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, UK
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7
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Hinga AN, Molyneux S, Marsh V. Towards an appropriate ethics framework for Health and Demographic Surveillance Systems (HDSS): learning from issues faced in diverse HDSS in sub-Saharan Africa. BMJ Glob Health 2021; 6:bmjgh-2020-004008. [PMID: 33408190 PMCID: PMC7789450 DOI: 10.1136/bmjgh-2020-004008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Health and Demographic Surveillance Systems (HDSS) collect data on births, deaths and migration from relatively small, geographically defined populations primarily in Africa and Asia. HDSS occupy a grey area between research, healthcare and public health practice and it is unclear how ethics guidance that rely on a research-practice distinction apply to HDSS. This topic has received little attention in the literature. In this paper, based on empirical research across sub-Saharan Africa, we map out key ethical issues for HDSS and assess the relevance of current ethics guidance in relation to these findings. Methods We conducted a qualitative study across seven HDSS sites in sub-Saharan Africa, including individual in-depth interviews and informal discussions with 68 research staff, document reviews and non-participant observations of surveillance activities. Qualitative data analysis drew on a framework approach led by a priori and emergent themes, drawing on the wider ethics and social science literature. Results There were diverse views on core ethical issues in HDSS, including regarding the strengths and challenges of community engagement, informed consent and data sharing processes. A key emerging issue was unfairness in the overall balance of benefits and burdens for residents and front-line staff when compared with other stakeholders, particularly given the socioeconomic contexts in which HDSS are generally conducted. Conclusion We argue that HDSS operate as non-traditional epidemiologic research projects but are often governed using ethics guidance developed for traditional forms of health research. There is a need for specific ethics guidance for HDSS which prioritises considerations around fairness, cost-effectiveness, ancillary care responsibilities, longitudinality and obligations of the global community to HDSS residents.
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Affiliation(s)
- Alex Nginyo Hinga
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sassy Molyneux
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Vicki Marsh
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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8
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Ndlovu-Teijema MT, Kok MO, van Elsland SL, Smeets H, Barstow D, van Rooyen L, van Furth AM. Setting the global research agenda for community-based HIV service delivery through the faith sector. Health Res Policy Syst 2021; 19:81. [PMID: 34001142 PMCID: PMC8127184 DOI: 10.1186/s12961-021-00718-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While leading AIDS organizations expect faith and health collaborations to play a crucial role in organizing and scaling up community-based HIV services, it is unclear how this can be realized. Little primary research has been conducted into which strategies for collaboration and service provision are most effective, efficient, scalable and sustainable. Seeking to align research with urgent needs, enhance coordination and increase the likelihood that results are used, this study aimed to set an inclusive global research agenda that reflects priority research questions from key stakeholders at the intersection of HIV healthcare and faith. METHODS In order to develop this global research agenda, we drew from document analyses, focus group discussions, interviews with purposively selected key informants from all continents (policy-makers, healthcare providers, faith leaders, academics and HIV activists), an online questionnaire, and expert meetings at several global conferences. We carried out focus group discussions and interviews with faith leaders in South Africa. Other stakeholder focus groups and interviews were carried out online or in person in France, Switzerland, the Netherlands and South Africa, and virtual questionnaires were distributed to stakeholders worldwide. Respondents were purposively sampled. RESULTS We interviewed 53 participants, and 110 stakeholders responded to the online questionnaire. The participants worked in 54 countries, with the majority having research experience (84%), experience with policy processes (73%) and/or experience as a healthcare provider (60%) and identifying as religious (79%). From interviews (N = 53) and questionnaires (N = 110), we identified 10 research themes: addressing sexuality, stigma, supporting specific populations, counselling and disclosure, agenda-setting, mobilizing and organizing funding, evaluating faith-health collaborations, advantage of faith initiatives, gender roles, and education. Respondents emphasized the need for more primary research and prioritized two themes: improving the engagement of faith communities in addressing sexuality and tackling stigma. CONCLUSIONS A wide range of respondents participated in developing the research agenda. To align research to the prioritized themes and ensure that results are used, it is essential to further engage key users, funders, researchers and other stakeholders, strengthen the capacity for locally embedded research and research uptake and contextualize priorities to diverse religious traditions, key populations and local circumstances.
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Affiliation(s)
- Martha T Ndlovu-Teijema
- Desmond and Leah Tutu Legacy Foundation, Cape Town, South Africa. .,Department of Paediatric Infectious Diseases and Immunology, AI&II, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Maarten O Kok
- Erasmus School of Health Policy and Management at Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sabine L van Elsland
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch, University, Cape Town, South Africa.,MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Hilleen Smeets
- Department of Paediatric Infectious Diseases and Immunology, AI&II, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David Barstow
- HIV and AIDS in 2030: A Choice Between Two Futures 2019, Corvallis, OR, USA
| | | | - A M van Furth
- Department of Paediatric Infectious Diseases and Immunology, AI&II, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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9
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Abstract
In 2014, Indonesia reinvigorated its commitment to the provision of a universal health care system by introducing the National Health Insurance Program (Jaminan Kesehatan Nasional, JKN), with the aim of increasing access to health care for all sectors of society. A key question that emerges in the current climate is: how can Indonesia ensure people can access HIV health care? This question is critically important given Indonesia is on the verge of passing a law criminalising all sex outside of marriage. If passed, anyone presenting with HIV will be suspected ipso facto of involvement in criminal activity (e.g. them or their partner having sex outside of marriage and/or using intravenous drugs). In this environment, preventing transmission of HIV from mother to child becomes more difficult. In exploring these issues, we argue that, in a time of populist morality, Indonesia must give significant attention to how universal health coverage can prevent HIV transmission, particularly from mother to child. We offer three key strategies for Indonesia to implement in this regard: removing health care provision from a moral framework; de-idealising the category of woman; and repositioning shame and stigma around HIV.
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Affiliation(s)
- Sharyn Graham Davies
- Director of the Herb Feith Indonesia Engagement Centre, Monash University, Melbourne, Australia
| | - Najmah
- Lecturer in Public Health, Sriwijaya University, Palembang, Indonesia
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10
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Affiliation(s)
- Jeremy Shiffman
- Bloomberg School of Public Health, Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA.
| | - Yusra Ribhi Shawar
- Bloomberg School of Public Health, Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
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Bright T, Mulwafu W, Phiri M, Jiang F, Swanepoel DW, Kuper H, Mactaggart I, Yip JLY, Polack S. Field test of the Rapid Assessment of Hearing Loss survey protocol in Ntcheu district, Malawi. Int J Audiol 2020; 59:574-582. [PMID: 32180476 DOI: 10.1080/14992027.2020.1739764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: (1) To test the feasibility of the Rapid Assessment of Hearing Loss (RAHL) survey protocol in Malawi (Ntcheu); (2) To estimate the prevalence and probable causes of hearing loss (adults 50+).Design: Cross-sectional population-based survey.Study sample: Clusters (n = 38) were selected using probability-proportionate-to-size-sampling. Within each cluster, 30 people aged 50+ were selected using compact-segment-sampling. All participants completed smartphone-based audiometry (hearTest). Prevalence was estimated using WHO definitions (PTA of thresholds 0.5, 1, 2, 4 kHz in the better ear of >25 dB HL (any) and >40 dB HL (≥moderate)). Otoscopy and questionnaire were used to assess probable causes. Participants with hearing loss and/or ear disease were asked about care-seeking and barriers.Results: Four teams completed the survey in 24 days. 1080 of 1153 (93.7%) participants were examined. The median time to complete the protocol was 24 min/participant. Prevalence of hearing loss was 35.9% (95% CI = 31.6-40.2) (any level); and 10.0% (95% CI = 7.9-12.5) (≥moderate). The majority was classified as probable sensorineural. Nearly one third of people (30.9%) needed diagnostic audiology services and possible hearing aid fitting. Hearing aid coverage was <1%. Lack of perceived need was a key barrier.Conclusion: The RAHL is simple, fast and provides information about the magnitude and probable causes of hearing loss to plan services.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, Blantyre, Malawi
| | - Mwanaisha Phiri
- Audiology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Fan Jiang
- School of Public Health, Shandong University, Jinan, China
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer L Y Yip
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
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12
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Bright T, Shan X, Xu J, Liang J, Xiao B, Ensink R, Mactaggart I, Polack S, Yip JLY. Field-testing of a rapid survey method to assess the prevalence and causes of hearing loss in Gao'an, Jiangxi province, China. Arch Public Health 2020; 78:16. [PMID: 32166026 PMCID: PMC7059708 DOI: 10.1186/s13690-020-0398-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/31/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Rapid Assessment of Hearing Loss (RAHL) survey protocol aims to measure the prevalence and causes of hearing loss in a low cost and rapid manner, to inform planning of ear and hearing services. This paper reports on the first field-test of the RAHL in Gao'an County, Jiangxi Province, China. This study aimed to 1) To report on the feasibility of RAHL; 2) report on the estimated prevalence and causes of hearing loss in Gao'an. METHODS A cross-sectional population-based survey was conducted in September-October 2018. Forty-seven clusters in Gao'an County were selected using probability-proportionate-to-size sampling. Within clusters, compact segment sampling was conducted to select 30 people aged 50+. A questionnaire was completed covering sociodemographics, hearing health, and risk factors. Automated pure-tone audiometry was completed for all participants, using smartphone-based audiometry (hearTest), at 0.5, 1, 2, 4 kHz (kHz). All participants had their ears examined by an Ear Nose and Throat (ENT) doctor, using otoscopy, and probable causes of hearing loss assigned. Prevalence estimates were age and sex standardised to the Jiangxi population. Feasibility of a cluster size of 30 was examined by assessing the response rate, and the proportion of clusters completed in 1 day. RESULTS 1344 of 1421 eligible participants completed the survey (94.6%). 100% of clusters were completed in 1 day. The survey was completed in 4.5 weeks. The prevalence of moderate or greater hearing loss (pure-tone average of 0.5, 1, 2, 4 kHz of > = 41dBHL in the better ear) was 16.3% (95% CI = 14.3, 18.5) and for any level of hearing loss (pure-tone average of > = 26dBHL in the better ear) the prevalence was 53.2% (95% CI = 49.2, 57.1). The majority of hearing loss was due to acquired sensorineural causes (91.7% left; 92.1% right). Overall 54.0% of the population aged 50+ (108,000 people) are in need of diagnostic audiology services, 3.4% were in need of wax removal (7000 people), and 4.8% were in need of surgical services (9500 people). Hearing aid coverage was 0.4%. CONCLUSION The RAHL survey protocol is feasible, demonstrated through the number of people examined per day, and the high response rate. The survey was completed in a much shorter period than previous all-age surveys in China. Some remaining challenges included assignment of causes of probable sensorineural loss. The data obtained from this survey can be used to scale-up hearing services in Gao'an.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1 E7HT United Kingdom
| | - Xin Shan
- Gao’an City People’s Hospital, Gao’an, Jiangxi China
| | - Jinling Xu
- Gao’an City People’s Hospital, Gao’an, Jiangxi China
| | - Jianguo Liang
- Gao’an City People’s Hospital, Gao’an, Jiangxi China
| | - Baixiang Xiao
- Zhongshan Opthalmic Centre, Sun Yatsen University, Guangzhou, Guangdong China
| | - Robbert Ensink
- Department of Oto-rhino-laryngology, Gelre Hospitals, Zutphen, The Netherlands
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1 E7HT United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1 E7HT United Kingdom
| | - Jennifer L. Y. Yip
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1 E7HT United Kingdom
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Affiliation(s)
| | - Ties Boerma
- b Department of Information, Evidence and Research , WHO , Geneva , Switzerland.,c Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
| | - Peter Byass
- d Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.,e School of Public Health , University of the Witwatersrand , Johannesburg , South Africa.,f Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , UK
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Boerma T, Victora C, Abouzahr C. Monitoring country progress and achievements by making global predictions: is the tail wagging the dog? Lancet 2018; 392:607-609. [PMID: 29661480 DOI: 10.1016/s0140-6736(18)30586-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 02/18/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Ties Boerma
- University of Manitoba, Winnipeg, MB, Canada.
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Kok MO, Bal R, Roelefs CD, Schuit AJ. Improving health promotion through central rating of interventions: the need for Responsive Guidance. Health Res Policy Syst 2017; 15:100. [PMID: 29169403 PMCID: PMC5701454 DOI: 10.1186/s12961-017-0258-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 10/10/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In several countries, attempts are made to improve health promotion by centrally rating the effectiveness of health promotion interventions. The Dutch Effectiveness Rating System (ERS) for health promotion interventions is an improvement-oriented approach in which multi-disciplinary expert committees rate available health promotion interventions as 'theoretically sound', 'probably effective' or 'proven effective'. The aim of this study is to explore the functioning of the ERS and the perspective of researchers, policy-makers and practitioners regarding its contribution to improvement. METHODS We interviewed 53 selected key informants from research, policy and practice in the Netherlands and observed the assessment of 12 interventions. RESULTS Between 2008 and 2012, a total of 94 interventions were submitted to the ERS, of which 23 were rejected, 58 were rated as 'theoretically sound', 10 were rated as 'probably effective' and 3 were rated as 'proven effective'. According to participants, the ERS was intended to facilitate both the improvement of available interventions and the improvement of health promotion in practice. While participants expected that describing and rating interventions promoted learning and enhanced the transferability of interventions, they were concerned that the ERS approach was not suitable for guiding intervention development and improving health promotion in practice. The expert committees that assessed the interventions struggled with a lack of norms for the relevance of effects and questions about how effects should be studied and rated. Health promotion practitioners were concerned that the ERS neglected the local adaptation of interventions and did not encourage the improvement of aspects like applicability and costs. Policy-makers and practitioners were worried that the lack of proven effectiveness legitimised cutbacks rather than learning and advancing health promotion. CONCLUSION While measuring and centrally rating the effectiveness of interventions can be beneficial, the evidence based-inspired ERS approach is too limited to guide both intervention development and the improvement of health promotion in practice. To better contribute to improving health promotion, a more reflexive and responsive guidance approach is required, namely one which stimulates the improvement of different intervention aspects, provides targeted recommendations to practitioners and provides feedback to those who develop and rate interventions.
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Affiliation(s)
- Maarten Olivier Kok
- Erasmus School for Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
- Amsterdam Public Health Institute, VU University, Amsterdam, The Netherlands
| | - Roland Bal
- Erasmus School for Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
| | - Caspar David Roelefs
- Science and Society, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
| | - Albertine Jantine Schuit
- Amsterdam Public Health Institute, VU University, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Kothari A, Peter N, Donskov M, Luciani T. Research impact of systems-level long-term care research: a multiple case study. Health Res Policy Syst 2017; 15:23. [PMID: 28327150 PMCID: PMC5361734 DOI: 10.1186/s12961-017-0185-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional reporting of research outcomes and impacts, which tends to focus on research product publications and grant success, does not capture the value, some contributions, or the complexity of research projects. The purpose of this study was to understand the contributions of five systems-level research projects as they were unfolding at the Bruyère Centre for Learning, Research and Innovation (CLRI) in long-term care (LTC) in Ottawa, Ontario, Canada. The research questions were, (1) How are partnerships with research end-users (policymakers, administrators and other public/private organisations) characterised? (2) How have interactions with the CLRI Management Committee and Steering Committee influenced the development of research products? (3) In what way have other activities, processes, unlinked actors or organisations been influenced by the research project activities? METHODS The study was guided by Kok and Schuit's concept of research impacts, using a multiple case study design. Data were collected through focus groups and interviews with research teams, a management and a steering committee, research user partners, and unlinked actors. Documents were collected and analysed for contextual background. RESULTS Cross-case analysis revealed four major themes: (1) Benefits and Perceived Tensions: Working with Partners; (2) Speaking with the LTC Community: Interactions with the CLRI Steering Committee; (3) The Knowledge Broker: Interactions with the Management Committee; and (4) All Forms of Research Contributions. CONCLUSIONS Most contributions were focused on interactions with networks and stimulating important conversations in the province about LTC issues. These contributions were well-supported by the Steering and Management Committees' research-to-action platform, which can be seen as a type of knowledge brokering model. It was also clear that researcher-user partnerships were beneficial and important.
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Affiliation(s)
- Anita Kothari
- School of Health Studies, The University of Western Ontario, Labatt Health Sciences Building, Room 222, London, ON N6A 5B9 Canada
| | - Nedra Peter
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON N6G 1H1 Canada
| | - Melissa Donskov
- Long-Term Care, Bruyère Continuing Care, Ottawa, ON K1N 5C8 Canada
| | - Tracy Luciani
- Long-Term Care, Bruyère Continuing Care, Ottawa, ON K1N 5C8 Canada
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Abstract
BACKGROUND The MDG era relied on global health estimates to fill data gaps and ensure temporal and cross-country comparability in reporting progress. Monitoring the Sustainable Development Goals will present new challenges, requiring enhanced capacities to generate, analyse, interpret and use country produced data. OBJECTIVE To summarize the development of global health estimates and discuss their utility and limitations from global and country perspectives. DESIGN Descriptive paper based on findings of intercountry workshops, reviews of literatureon and synthesis of experiences. RESULTS Producers of global health estimates focus on the technical soundness of estimation methods and comparability of the results across countries and over time. By contrast, country users are more concerned about the extent of their involvement in the estimation process and hesitate to buy into estimates derived using methods their technical staff cannot explain and that differ from national data sources. Quantitative summaries of uncertainty may be of limited practical use in policy discussions where decisions need to be made about what to do next. CONCLUSIONS Greater transparency and involvement of country partners in the development of global estimates will help improve ownership, strengthen country capacities for data production and use, and reduce reliance on externally produced estimates.
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Affiliation(s)
| | - Ties Boerma
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Daniel Hogan
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
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