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Uneke CJ, Okedo-Alex IN, Uneke BI, Akamike IC, Chukwu OE, Eze II. An assessment of the experiences, and perceptions of the collateral effects of the COVID-19 lockdown measures in Southeast Nigeria: implications for policy and action. Pan Afr Med J 2023; 46:122. [PMID: 38465015 PMCID: PMC10924611 DOI: 10.11604/pamj.2023.46.122.36414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/12/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction there is limited evidence from developing countries including Nigeria on the collateral effects of the COVID-19 lockdown on the socioeconomic lives of citizens. The aim of this study was to explore citizens´ experiences and perceptions of the impact of COVID-19 lockdown measures on daily living in Southeast Nigeria. Methods this was a cross-sectional descriptive study conducted among policymakers, researchers, non-governmental organizations (NGO) officials, and health practitioners in Southeast Nigeria. Data were collected using short message sending (SMS), emails, and key informant interviews. Results although the COVID-19 lockdown measures had both positive and negative effects, it was largely negative. Some of the effects on family and social life were more quality time with family and improved family ties, increased social vices, reduced social and religious interaction, and disrupted academic calendars and educational pursuits. On economic life, the lockdown provided an additional source of income for those involved in the sales of facemasks and related commodities, while for others it reduced income and increased expenditures. Regarding work/career, the lockdown promoted the use of new technologies and skill acquisition, while remote work relieved work-related stress. The health effects were mostly negative including loneliness, depression, and anxiety, however, it improved health consciousness and personal hygiene. Other systemic effects stated were reduced air pollution and poor patronage at health facilities. Conclusion without intending to, the COVID-19 lockdown in Nigeria had mixed effects on family and socioeconomic life, negatively impacting mental health but improving work-related life among others. These findings are a call to policy action to mitigate the negative effects whilst sustaining the positive gains from the lockdown.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University PMB 053 Abakaliki, Abakaliki, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University PMB 053 Abakaliki, Abakaliki, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Bilikis Iyabo Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University PMB 053 Abakaliki, Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University PMB 053 Abakaliki, Abakaliki, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Onyedika Echefu Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University PMB 053 Abakaliki, Abakaliki, Nigeria
| | - Irene Ifeyinwa Eze
- African Institute for Health Policy and Health Systems, Ebonyi State University PMB 053 Abakaliki, Abakaliki, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
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Uneke CJ, Okedo-Alex IN, Akamike IC, Uneke BI, Eze II, Chukwu OE, Otubo KI, Urochukwu HC. Institutional roles, structures, funding and research partnerships towards evidence-informed policy-making: a multisector survey among policy-makers in Nigeria. Health Res Policy Syst 2023; 21:36. [PMID: 37237324 DOI: 10.1186/s12961-023-00971-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Evidence-informed policy-making aims to ensure that the best and most relevant evidence is systematically generated and used for policy-making. The aim of this study was to assess institutional structures, funding, policy-maker perspectives on researcher-policy-maker interactions and the use of research evidence in policy-making in five states in Nigeria. METHODS This was a cross-sectional study carried out among 209 participants from two geopolitical zones in Nigeria. Study participants included programme officers/secretaries, managers/department/facility heads and state coordinators/directors/presidents/chairpersons in various ministries and the National Assembly. A pretested semi-structured self-administered questionnaire on a five-point Likert scale was used to collect information on institutional structures for policy and policy-making in participants' organizations, the use of research evidence in policy and policy-making processes, and the status of funding for policy-relevant research in the participants' organizations. Data were analysed using IBM SPSS version 20 software. RESULTS The majority of the respondents were older than 45 years (73.2%), were male (63.2) and had spent 5 years or less (74.6%) in their present position. The majority of the respondents' organizations had a policy in place on research involving all key stakeholders (63.6%), integration of stakeholders' views within the policy on research (58.9%) and a forum to coordinate the setting of research priorities (61.2%). A high mean score of 3.26 was found for the use of routine data generated from within the participants' organizations. Funding for policy-relevant research was captured in the budget (mean = 3.47) but was inadequate (mean = 2.53) and mostly donor-driven (mean = 3.64). Funding approval and release/access processes were also reported to be cumbersome, with mean scores of 3.74 and 3.89, respectively. The results showed that capacity existed among career policy-makers and the Department of Planning, Research and Statistics to advocate for internal funds (mean = 3.55) and to attract external funds such as grants (3.76) for policy-relevant research. Interaction as part of the priority-setting process (mean = 3.01) was the most highly rated form of policy-maker-researcher interaction, while long-term partnerships with researchers (mean = 2.61) had the lower mean score. The agreement that involving policy-makers in the planning and execution of programmes could enhance the evidence-to-policy process had the highest score (mean = 4.40). CONCLUSION The study revealed that although institutional structures such as institutional policies, fora and stakeholder engagement existed in the organizations studied, there was suboptimal use of evidence obtained from research initiated by both internal and external researchers. Organizations surveyed had budget lines for research, but this funding was depicted as inadequate. There was suboptimal actual participation of policy-makers in the co-creation, production and dissemination of evidence. The implementation of contextually relevant and sustained mutual institutional policy-maker-researcher engagement approaches is needed to promote evidence-informed policy-making. Thus there is a need for institutional prioritization and commitment to research evidence generation.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria.
| | - Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Bilikis Iyabo Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Irene Ifeyinwa Eze
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Onyekachi Echefu Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Kingsley Igboji Otubo
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Henry C Urochukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
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Eze II, Ossai EN, Akamike IC, Okedo-Alex IN, Ogbonnaya LU, Uneke CJ. Males' perceptions and practices towards maternity care in rural southeast Nigeria: Policy implication of participatory action research for safe motherhood. PLoS One 2023; 18:e0282469. [PMID: 36996090 PMCID: PMC10062587 DOI: 10.1371/journal.pone.0282469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/16/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION High maternal death is attributable to developing countries' health systems and sociocultural factors This study assessed the effect of participatory-action research on males' perception and practice towards maternity care and safe motherhood in rural southeast Nigeria. METHODS A pre-post-intervention study design was employed to study 396 male partners of pregnant women selected through cluster sampling in rural communities in southeast Nigeria. Males' perceptions and practices towards maternity care and safe motherhood were assessed using an interviewer-administered five-point Likert scale questionnaire. A community-participatory intervention was implemented comprising advocacy, and training of community volunteers, who then educated male partners of pregnant women on safe motherhood and facilitated emergency saving and transport schemes. A post-intervention assessment was conducted six months later, using the same questionnaire. Good perception and good practices were determined by mean scores >3.0. Continuous variables were summarised using mean and standard deviation, and categorical variables using frequencies and proportions. A comparison of the mean scores pre- and post-intervention mean scores were compared, and the mean difference was determined using paired T-test. Statistical significance was set at a p-value <0.05. RESULTS The perception that male partners should accompany pregnant women for antenatal care had the least mean score at the pre-intervention stage, 1.92 (0.83). However, the mean score increased for most variables after the intervention (p<0.05). The mean score for maternity care practices increased post-intervention for accompanying pregnant women to antenatal care, facility delivery, and helping with household chores (p<0.001), with a composite mean difference of 0.36 (p<0.001). Birth preparedness/complication readiness practices-saving money, identifying transport, skilled providers, health facilities, blood donors and preparing birth kits, were good, with a composite mean score that increased from 3.68(0.99) at pre-intervention to 4.47(0.82) at post-intervention (p<0.001). CONCLUSIONS Males' perceptions and practices towards safe motherhood improved after the intervention. This highlights that a community-participatory strategy can enhance males' involvement in maternal health and should be explored. Male partners accompanying pregnant women to clinics should be advocated for inclusion in maternal health policy. Government should integrate community health influencers/promoters into the healthcare systems to help in the provision of health services.
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Affiliation(s)
- Irene Ifeyinwa Eze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
- African Institute for Health Policy and Health System, Abakaliki, Ebonyi State, Nigeria
| | - Edmund Ndudi Ossai
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
- African Institute for Health Policy and Health System, Abakaliki, Ebonyi State, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
- African Institute for Health Policy and Health System, Abakaliki, Ebonyi State, Nigeria
| | - Lawrence Ulu Ogbonnaya
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
- African Institute for Health Policy and Health System, Abakaliki, Ebonyi State, Nigeria
| | - Chigozie Jesse Uneke
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
- African Institute for Health Policy and Health System, Abakaliki, Ebonyi State, Nigeria
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Akamike IC, Okedo-Alex IN, Uneke CJ, Madubueze UC, Agbo UN, Okeke IM, Ogbonnaya LU. Health workers' knowledge and practice of Isoniazid preventive treatment guidelines in health facilities in Ebonyi State, Nigeria. Malawi Med J 2022; 34:184-191. [PMID: 36406103 PMCID: PMC9641607 DOI: 10.4314/mmj.v34i3.7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Isoniazid preventive therapy is recommended as part of a comprehensive HIV and AIDS care strategy. IPT is used as prophylaxis to reduce the incidence of TB in HIV-infected persons. However, its implementation has been very slow and has been influenced by several factors. This study assessed health workers' knowledge and adherence to Isoniazid Preventive Therapy guidelines. Methods This was a cross-sectional study in six health facilities providing HIV care in Ebonyi State using a semi-structured, self-administered questionnaire. Data were collected from 85 health workers working in the HIV clinics. Data were also extracted from 200 patient treatment cards. Data analysis was carried out using SPSS version 20 software. Chi-square statistics and logistic regression were carried out to determine the association between socio-demographic characteristics and knowledge as well as self-reported practice of the guideline. Result Slightly over half of the respondents (58.8%) had good knowledge of the guideline, and the majority (75.3%) self-reported that they practiced the guideline. Only 17% of the treatment cards had isoniazid prescribed and only 11% of these had patient adherence assessed. The most common challenges to implementation of the guideline cited by health workers were unavailability of isoniazid, poor awareness, patient non-adherence, poor resources, high pill burden, and lack of training. Being a doctor and more than 3 years duration of work in the clinic were predictors of good knowledge. There was no predictor of practice. Conclusion There was good knowledge and practice of the guideline from health worker self-reports, however, review of treatment card showed prescription was low. Further studies to explore and understand why there is such low prescription of INH/IPT to HIV patients despite good knowledge of healthcare professionals are recommended.
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Affiliation(s)
- Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Ugochukwu Chinyem Madubueze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, Alex Ekwueme Federal University, Ndufu Alike Ikwo, Ebonyi State, Nigeria
| | - Urudinachi Nnenne Agbo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Ifeyinwa Maureen Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Lawrence Ulu Ogbonnaya
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria, Alex Ekwueme Federal University, Ndufu Alike Ikwo, Ebonyi State, Nigeria
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Ogbonnaya LU, Okedo-Alex IN, Akamike IC, Azuogu B, Urochukwu H, Ogbu O, Uneke CJ. Assessing the usefulness of policy brief and policy dialogue as knowledge translation tools towards contextualizing the accountability framework for routine immunization at a subnational level in Nigeria. Health Res Policy Syst 2021; 19:154. [PMID: 34969398 PMCID: PMC8717671 DOI: 10.1186/s12961-021-00804-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Evidence suggests that implementing an accountability mechanism such as the accountability framework for routine immunization in Nigeria (AFRIN) will improve routine immunization (RI) performance. The fact that the AFRIN, which was developed in 2012, still had not been operationalized at the subnational level (Ebonyi State) by 2018 may in part account for the poor RI coverage (33%) in 2017. Knowledge translation (KT) is defined as the methods for closing the gaps from knowledge to practice. Policy briefs (useful in communicating research findings to policy-makers) and policy dialogues (that enable stakeholders to understand research evidence and create context-resonant implementation plans) are two KT tools. This study evaluated their usefulness in enabling policy-makers to contextualize AFRIN in Ebonyi State, Nigeria. Methods The study design was cross-sectional descriptive with mixed-methods data collection. A policy brief developed from AFRIN guided deliberations in a 1-day multi-stakeholder policy dialogue by 30 policy actors. The usefulness of the KT tools in contextualizing policy recommendations in the AFRIN was assessed using validated questionnaires developed at McMaster University, Canada. Results At the end of the policy dialogue, the policy options in the policy brief were accepted but their implementation strategies were altered to suit the local context. The respondents’ mean ratings (MNR) of the overall usefulness of the policy brief and the policy dialogue in contextualizing the implementation strategies were 6.39 and 6.67, respectively, on a seven-point Likert scale (very useful). The MNR of the different dimensions of the policy brief and policy dialogue ranged from 6.17 to 6.60 and from 6.10 to 6.83, respectively (i.e. moderately helpful to very helpful). Conclusion The participants perceived the KT tools (policy brief and policy dialogue) as being very useful in contextualizing policy recommendations in a national policy document into state context-resonant implementable recommendations. We recommend the use of these KT tools in operationalizing AFRIN at the subnational level in Nigeria.
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Affiliation(s)
- Lawrence Ulu Ogbonnaya
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria. .,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Benedict Azuogu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Henry Urochukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria
| | - Ogbonnaya Ogbu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Applied Microbiology, Faculty of Science, Ebonyi State University, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Medical Microbiology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
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Okedo-Alex IN, Akamike IC, Uneke CJ, Abateneh DD. Community Attitudes Towards Violence Against Women, and Lived Experiences of Family Violence and Abuse During Childhood in Rural Eastern Nigeria: Implications for Policy and Programming. Risk Manag Healthc Policy 2021; 14:4983-4990. [PMID: 34934373 PMCID: PMC8684412 DOI: 10.2147/rmhp.s342584] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Violence against women (VAW) has remained an increasingly significant public health problem globally. This study explored childhood experiences of abuse and attitude towards violence against women among adults in a rural community in South-east Nigeria. Methods This was a cross-sectional study conducted in a rural community in Ebonyi, Nigeria. Data were collected from 280 respondents using interviewer-administered questionnaires. Data analysis was performed using SPSS version 25. Results The mean age of the male participants was 46.5±16.8, while that for the female participants was 43.3±16.9. Most were females (203/280, 72.5%), out of which (83/203, 40.9%) had secondary school as the highest level of education attained. Most participants were females (203/280, 72.5%), married (225/280, 80.4%) with secondary school education (124/280, 44.3%). More than one-tenth (33/280, 11.8%) had ever witnessed parental violence, while 46.4% had been physically abused in childhood. Forced touching and penetrative sex was experienced sometimes by 11.4% (32/280) and 21.8% (61/289), respectively. Overall, the majority (258/280, 92.8%) had a disapproving attitude towards gender-based violence. Most participants disagreed that hitting or insulting woman was not wrong (246/280, 87.9%). The majority of the respondents agreed that women were inferior to men from a cultural perspective (175/280, 62.5%). Almost half strongly agreed (125/2280, 44.6%) and agreed (118/280, 42.1%) that a woman is a man’s possession. The predictors of attitude were secondary school education (AOR = 7.74, 95% CI = 1.69–35.54) and monogamous marital setting (AOR = 2.83, 95% CI = 1.08–7.42). Conclusion This study showed that Nigerian adults had high levels of childhood exposures to family violence, physical and sexual abuse. Overall, the majority disapproved of VAW; however, there were gaps that endorsed patriarchal ideologies. Interventions to address VAW should include components targeted at children exposed to violence and de-bunking patriarchal ideologies that encourage VAW.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Dejene Derseh Abateneh
- Department of Medical Laboratory Sciences, Menelik II College of Medicine and Health Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia
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Uneke CJ, Obeka I, Uneke BI, Umeokonkwo A, Nweze CA, Otubo KI, Uguru OE. An assessment of nursing mothers' and young people's access to proprietary and patent medicine vendors' services in rural communities of south-eastern Nigeria: implication for review of national drug policy. J Pharm Policy Pract 2021; 14:92. [PMID: 34784979 PMCID: PMC8594071 DOI: 10.1186/s40545-021-00334-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patent and proprietary medicine vendors (PPMVs) form part of the informal healthcare system and are the first point of call for 75% of Nigerians who live in rural and underserved areas where there is limited access to healthcare services. This group of healthcare providers are located close to communities and are easily accessible to the people. This study seeks to determine how PPMVs influence access to medicines among nursing mothers and young people and how this progresses South Eastern Nigeria towards universal health coverage. Methods A cross-sectional descriptive study was conducted using a purposive sampling technique. Two slightly different pre-tested and validated 5-point Likert scale questionnaires were used to survey the nursing mothers and young people (18–20 years old). The questionnaire for nursing mothers assessed the perception regarding PPMV services and community access to medicines used for the treatment of childhood infections. The questionnaire for young people assessed the services rendered by the PPMVs including family planning, and major enablers/barriers towards to access to medicine. Results A total of 159 nursing mothers and 148 youths participated in the study. Up to 60% of both population had a minimum of secondary school qualification. About 90% of the nursing mothers were married and 88% were nursing babies from 1 to 12 months. Results show that the PPMVs were the first point of call for healthcare needs among the respondents and they are easily accessible and sell affordable medicines. The nursing mothers frequently treat their children’s cough with antibiotics with a mean rating (MNR) of 4.7 out of 5 points and most source these antibiotics from PPMV shops. Up to 90% of the nursing mothers reported that the children got well after the treatment. The drugs mostly purchased by the youths from the PPMVs included antimalarials (95%), analgesics (87.7%) and antibiotics (81.3%). Only 25.5% of the respondents purchased family planning commodities. Most of the respondents sought health care from PPMVs with a MNR of 3.4. Patronage of PPMVs for and usage of family planning products by the respondents had MNRs ranging from 1.4 to 1.8. Conclusion PPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.
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Affiliation(s)
- C J Uneke
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria.
| | - I Obeka
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria
| | - B I Uneke
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria
| | - A Umeokonkwo
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria
| | - C A Nweze
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria
| | - K I Otubo
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria
| | - O E Uguru
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria
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Akamike IC, Okedo-Alex IN, Alo C, Agu AP, Uneke CJ, Ogbonnaya LU. Effect of mobile-phone messaging on patient and health-worker knowledge and adherence to the isoniazid preventive therapy guideline in HIV clinics in Southeast, Nigeria. BMC Infect Dis 2021; 21:1080. [PMID: 34666686 PMCID: PMC8527690 DOI: 10.1186/s12879-021-06759-4] [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: 05/21/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-infected persons are at increased risk of developing tuberculosis and Isoniazid preventive therapy has been shown to reduce the occurrence of tuberculosis among this group of persons. M-health technology has been reported to increase both knowledge and implementation of various health services including Isoniazid preventive therapy implementation. This study aimed to determine the effect of m-health on health worker knowledge and adherence to isoniazid preventive therapy (IPT) guidelines and on patient knowledge and adherence to isoniazid treatment. METHODS This was a quasi-experimental study that was carried out in six health facilities in Ebonyi State, southeast Nigeria. Three health facilities were assigned to each arm (intervention and control arms) and all eligible health workers (total population of 45 and 41 in intervention and control arms respectively) were recruited. Data were also collected from 200 patients (100 per arm). The intervention consisted of mobile phone messages and reminders for health workers on the IPT guideline. Chi-square test was carried out at p < 0.05 and 95% confidence interval. RESULTS At baseline, 54.5% and 63.4% of health workers in intervention and control arms respectively had good knowledge which improved significantly to 90.2% in the intervention arm after the intervention (χ2 = 14.22, p < 0.0001). At baseline, 61.4% and 90.2% of health workers had good adherence to the guideline in intervention and control arms respectively which also improved in the intervention arm by 28.8% after intervention although not significant(χ2 = 0.37, p = 0.54). More than 50% of the patients in both study arms had poor knowledge, with the intervention arm having a significantly higher proportion of respondents (68.0%) with poor knowledge at baseline (χ2 = 4.71, p = 0.03). The proportion of patients with good knowledge however increased significantly (88.8%) in the intervention arm after intervention (χ2 = 25.65, p < 0.001). Patients had good adherence to IPT in intervention and control arms before (100% and 84.2% respectively) and after (96.6% and 100% respectively) the study. There was no significant difference in adherence among patients in both arms. CONCLUSIONS Health worker knowledge and practice of guidelines as well as patient knowledge improved in the intervention arm in this study. These findings suggest the consideration for the inclusion of mobile phone reminders in the guideline for tuberculosis prevention among HIV patients.
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Affiliation(s)
- Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria. .,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Chihurumnanya Alo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
| | - Adaoha Pearl Agu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Lawrence Ulu Ogbonnaya
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.,Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Okedo-Alex IN, Akamike IC, Uneke CJ. Does Spousal Engagement Improve Cervical Cancer Screening Discussions and Uptake? Lessons from a Before-After Study in a Rural Nigerian Community. J Health Care Poor Underserved 2021; 32:1566-1583. [PMID: 34421049 DOI: 10.1353/hpu.2021.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study determined spousal involvement and the effect of community-based spousal engagement on cervical cancer screening-related discussions and uptake in a rural Nigerian community. METHODS A before-after mixed methods study was conducted among 245 married men in a rural Nigerian community. Spousal engagement involved advocacy to men groups, awareness creation, and monthly meeting-based announcements/reminders about screening. Three months post-intervention, uptake was determined from facility registers. Thematic analysis and SPSS were used for data analysis. RESULTS A large minority of respondents were aged 29-39 years (95/245, 38.8%). At baseline, respondents generally had poor spousal involvement. Post-intervention, inter-spousal discussion on screening increased from 17.2% to 46.9% (p<.001). There was no significant increase in uptake post-intervention. Having more than 5 children was a predictor of screening discussions (AOR=2.017; CI=1.196-3.403; p=.009). CONCLUSION Despite increased inter-spousal discussions on cervical cancer screening, uptake remained low. We recommend community-driven interventions on cervical cancer screening with a gender-transformative perspective.
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Okedo-Alex IN, Akamike IC, Olisaekee GO, Okeke CC, Uneke CJ. Identifying advocacy strategies, challenges and opportunities for increasing domestic health policy and health systems research funding in Nigeria: Perspectives of researchers and policymakers. Health Res Policy Syst 2021; 19:41. [PMID: 33752682 PMCID: PMC7983353 DOI: 10.1186/s12961-021-00701-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Poor funding for Health Policy and Systems Research (HPSR) is a major constraint to the development, generation and uptake of HPSR evidence in Low and Middle-Income countries. The study assessed the status of HPSR domestic funding and advocacy strategies for improving HPSR funding in Nigeria. It equally explored the knowledge and perception of the domestic funding status of HPSR and the effect of capacity building on the knowledge of domestic funding for HPSR in Nigeria. Methods This was a sub-national study involving policymakers and researchers from Enugu and Ebonyi States in Southeast Nigeria who participated in the sub-national Health Systems Global convening for the African region. A before-after study design (workshop) was utilized. Data collection employed semi-structured questionnaires, group and panel discussions. The workshop facilitated knowledge of HPSR, funding processes, and advocacy strategies for increased domestic funding for HPSR. Pre and immediate post-workshop knowledge assessments were done. Data were analyzed using SPSS version 25 and thematic analysis. Results Twenty-six participants were involved in the study. Half were females (50.0%) and 46.2% were aged 35–44 years. Policymakers constituted 23.1% of the participants. Domestic funding for HPSR in Nigeria was adjudged to be grossly inadequate. Identified barriers to domestic funding of HPSR included bureaucratic bottlenecks, political and policy transitions, and corruption. Potential opportunities centered on existing policy documents and emerging private sector willingness to fund health research. Multi-stakeholder advocacy coalitions, continuous advocacy and researcher skill-building on advocacy with active private sector involvement were the strategies proffered by the participants. Pre-workshop, understanding of the meaning of HPSR had the highest mean ratings while knowledge of budgeting processes and use of legal action to enable opportunities for budget advocacy for HPSR funding had the lowest mean ratings. Following the capacity-building workshop, all knowledge and understanding parameters markedly improved (percentage increase of 12.5%–71.0%). Conclusion This study found that there was paucity of domestic funding for HPSR in Nigeria alongside poor knowledge of budgeting and advocacy strategies among both policymakers and researchers. We recommend the deployment of these identified strategies and wider national and regional stakeholder engagement towards prioritizing and improving domestic funding for HPSR.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria. .,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | | | | | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
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Ikeagwulonu CR, Uneke CJ, Uchejeso OM. Ethical issues in biomedical research in Nigeria: a systematic review. Bangladesh J Bioethics (BJBio) 2021. [DOI: 10.3329/bioethics.v12i1.51904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The use of human subjects in research comes with lots of ethical challenges. The purpose of this review is to assess the various ethical issues that have been associated with biomedical research in Nigeria. This article also finds out the possible ways of improvement of this scenario. Pubmed/Medline, Google Scholar, JSTOR, and AJOL search were the possible search engine for literature from 2000 to 2020. Key words were used including, ethical issues, biomedical research and Nigeria. Of the 113 publications were found., A total of 18(15.9%) articles fulfilled the study inclusion criteria and were included in this review. Twelve ethical issues were highlighted including Informed consent (12 studies), autonomy and voluntariness (8 studies), beneficence (8 studies), counseling (5 studies), compensation (4 studies), professional behavior and attitudes (2 studies), confidentiality (2 studies), social, cultural and religious practices (2 studies), scientific integrity (1 study), communitarianism (1 study), equity (1 study), and trust (1 study). We found that there are ethical issues in biomedical research in Nigeria of which informed consent is most widely studied. Also, participants had varying degree of understanding of their rights as research subjects. As a result, there is need to enhance the capacity of investigators to better understand these issues and also increase their explanatory skill to help participants achieve complete understanding of their various rights and process.
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Uneke CJ, Sombie I, Johnson E, Uneke BI. Lessons Learned from Strategies for Promotion of Evidence-to-Policy Process in Health Interventions in the ECOWAS Region: A Rapid Review. Niger Med J 2021; 61:227-236. [PMID: 33487844 PMCID: PMC7808283 DOI: 10.4103/nmj.nmj_188_20] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/04/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Context: The West African Health Organization (WAHO) is vigorously supporting evidence-informed policymaking (EIPM) in the countries of West Africa. EIPM is increasingly recognized as one of the key strategies that can contribute to health systems strengthening and the improvement of health outcomes. The purpose of this rapid review is to examine two key examples of evidence-based strategies used to successfully implement health interventions in each of the West African countries and to highlight the lessons learned. Methods: A rapid review technique, defined as a type of knowledge synthesis in which systematic review processes are accelerated and methods are streamlined to complete the review more quickly, was used. A PubMed search was conducted using the combination of the following keywords: Health, policy making, evidence, plus name of each of the 15 countries to identify studies that described the process of use of evidence in policymaking in health interventions. Two examples of the publications that fulfilled the study inclusion criteria were selected. Results: Among the key processes used by the countries to promote EIPM in health interventions include policy cycle mechanism and political prioritization, rapid response services, technical advisory group and steering committees (SCs), policy dialog, capacity-strengthening mechanisms, local context evidence and operational guidelines, multisectoral action and consultative process. Conclusion: Various degrees of success have been achieved in by West African countries in the promotion of EIPM. As the science of EIPM continues to evolve and better understanding of the process is gained among policymakers, more studies on effective strategies to improve the evidence-to-policy process are advocated.
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Affiliation(s)
- Chigozie Jesse Uneke
- Department of Health Policy/Systems, African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, Nigeria
| | - Issiaka Sombie
- Department of Public Health and Research, West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01 01 BP 153, Burkina Faso
| | - Ermel Johnson
- Department of Public Health and Research, West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01 01 BP 153, Burkina Faso
| | - Bilikis Iyabo Uneke
- Department of Health Policy/Systems, African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, Nigeria
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Okedo-Alex IN, Uneke CJ, Uro-Chukwu HC, Akamike IC, Chukwu OE. "It is what I tell her that she will do": a mixed methods study of married men's knowledge and attitude towards supporting their wives' cervical cancer screening in rural South-East Nigeria. Pan Afr Med J 2020; 36:156. [PMID: 32874420 PMCID: PMC7436653 DOI: 10.11604/pamj.2020.36.156.21157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/11/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction cervical cancer is a leading cause of death among Nigerian women. Women often require spousal support before attending cervical cancer screening services. This study assessed married men´s knowledge and attitude towards male involvement in cervical cancer screening of their wives. Methods a cross-sectional study using a mixed methods approach was conducted among 245 married men in Izzi, Local Government Area of Ebonyi State, South-East Nigeria. Quantitative data collected using structured, interviewer-administered questionnaires and qualitative data from focus group discussions were triangulated. Data analysis was done using IBM SPSS version 20. Qualitative findings were analysed using thematic analysis. Results the mean knowledge of cervical cancer was 2.06±0.55. Only 2.9% of the respondents had adequate knowledge of risk factors for cervical cancer. Up to 89.8% were willing to approve screening for their spouses. Majority (76.3%) considered screening important in cervical cancer prevention, while 91.4% were willing to pay for the screening test. Most of them exhibited patriarchal tendencies and insisted that their wives must obtain their consent before screening as depicted by the statement “It is what I tell her that she will do”. Previous spousal screening was a predictor of good knowledge (OR = 10.94, 95% CI = 2.44-48.93; P=0.002). Conclusion married men in this study had poor knowledge of cervical cancer. However, they were willing to support cervical cancer screening conditional on their pre-information and consent. Awareness creation activities on cervical cancer screening should incorporate active engagement of husbands in order to promote screening uptake by their wives.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria.,Department of Community Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Henry Chukwuemeka Uro-Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria.,Department of Community Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Onyedikachi Echefu Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
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Okedo-Alex IN, Akamike IC, Nwafor JI, Abateneh DD, Uneke CJ. Multi-stakeholder Perspectives on the Maternal, Provider, Institutional, Community, and Policy Drivers of Disrespectful Maternity Care in South-East Nigeria. Int J Womens Health 2020; 12:1145-1159. [PMID: 33324116 PMCID: PMC7733334 DOI: 10.2147/ijwh.s277827] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/25/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Understanding the contextualized perspectives of stakeholders involved in maternal health care is critical to promoting respectful maternity care. This study explored maternal, provider, institutional, community, and policy level drivers of disrespectful maternity care in Southeast Nigeria. This study also identified multi-stakeholder perspectives on solutions to implementing respectful maternity care in health facilities. Materials and Methods This was a mixed-methods cross-sectional study conducted in two urban cities of Ebonyi State, South-eastern Nigeria. Data were collected using semi-structured questionnaires, focus group discussions, and key informant interviews with mothers, providers, senior facility obstetric decision-makers, ministry of health policymaker, and community members. Quantitative data and qualitative data were analysed using SPSS version 20 and manual thematic analysis, respectively. Results Maternal level drivers were poor antenatal clinic attendance, uncooperative clients, non-provision of birthing materials, and low awareness of rights. Provider factors included work overload/stress, training gaps, desire for good obstetric outcome, under-remuneration and under-appreciation. Institutional drivers were poor work environments including poorly designed wards for privacy, stressful hospital protocols, and non-provision of work equipment. Community-level drivers were poor female autonomy, empowerment, and normalization of disrespect and abuse during childbirth. The absence of targeted policies and the high cost of maternal health services were identified as policy-related drivers. Conclusion A variety of multi-level drivers of disrespectful maternity care were identified. A diverse and inclusive multi-stakeholder approach should underline efforts to mitigate disrespectful maternity care and promote respectful, equitable, and quality maternal health care.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.,African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Johnbosco Ifunanya Nwafor
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Dejene Derseh Abateneh
- Department of Medical Laboratory Sciences, Menelik II College of Medicine and Health Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
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Uneke CJ, Ogbu O, Nwojiji V. Potential risk of induced malaria by blood transfusion in South-eastern Nigeria. Mcgill J Med 2020. [DOI: 10.26443/mjm.v9i1.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Induced malaria by blood transfusion is a potential health hazard but is often neglected in many malaria endemic areas. Standard parasitological technique was used to determine the prevalence of malaria among blood donors in the South-eastern Nigeria. Of the total 325 blood donors (310 males and 15 females) screened, 133 (40.9%, CI 95%: 35.6-46.2%) were infected with malaria parasite, 78 (58.6%) had 1-10 parasites per 100 thick film fields ('+' or 4-40 parasites per mm3) while 55 (41.4%) had 11-100 parasites per 100 thick film fields ('++' or 41-400 parasites per mm3). P. falciparum was identified in all the infected cases, however 3 (2.3%) persons had mixed infection with P. malariae. Males were more infected (41.3%, CI 95%: 35.8-46.8%) than females (33.3%, CI 95%: 9.4-57.2%). The infection decreased with age with highest prevalence of 48.5% among those aged 20-25 years. The infection significantly varied with age but not with sex (P<0.05). Individuals with blood group B were slightly more infected (42.1%, 95%CI., 19.6-64.6%) than those of groups O (41.0%,CI 95%: 35.3-46.7%) and A (40.0%, CI 95%: 20.8-59.2%) but there was no significant difference (P < 0.05). Highest prevalence of infection was recorded in the month of April corresponding to the onset of the wet season. An overhaul of existing blood donation policies in many health facilities in the sub-Saharan Africa to incorporate malaria screening is advocated. Curative antimalarial drugs followed by prophylactic drugs should be given to all recipients of Parasitized blood.
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Okedo-Alex IN, Akamike IC, Alo CN, Agu AP, Nzeh CB, Ndukwe CD, Okoro OO, Abateneh DD, Uneke CJ. Reaching the unreached: effectiveness and satisfaction with community-directed distribution of sulfadoxine-pyrimethamine for preventing malaria in pregnancy in rural South-East, Nigeria. Malar J 2020; 19:394. [PMID: 33160375 PMCID: PMC7648974 DOI: 10.1186/s12936-020-03468-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Innovative community strategies to increase intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) coverage is advocated particularly in rural areas, where health infrastructure is weakest and malaria transmission highest. This study involved proof-of-concept implementation research to determine satisfaction with and effectiveness of community-directed distribution of IPTp-SP on uptake among pregnant women in Ebonyi State, Nigeria. METHODS This before-and-after study was carried out in 2019 in a rural community in Ebonyi State Nigeria. The intervention involved advocacy visits, community-wide sensitizations on malaria prevention, house-to-house directly observed IPTp-SP administration, and follow-up visits by trained community-selected community-directed distributors (CDDs). Monthly IPTp-SP coverage was assessed over 5 months and data analysed using SPSS version 20. RESULTS During the study, 229 women received the first dose of IPTp while 60 pregnant women received 5 or more doses of IPTp. The uptake of ≥ 3 IPTp doses increased from 31.4% before the community-directed distribution of IPTp to 71.6% (P < 0.001) by the fourth month post-initiation of the community-directed distribution of IPTp. Sleeping under insecticide-treated net (ITN) the night before the survey increased from 62.4 to 84.3% (P < 0.001) while reporting of fever during pregnancy decreased from 64.9 to 17.0% (P < 0.001). Although antenatal clinic utilization increased in the primary health centre serving the community, traditional birth attendants and patent medicine vendors in the community remained more patronized. Post-intervention, most mothers rated CDD services well (93.6%), were satisfied (97.6%), and preferred community IPTp administration to facility administration (92.3%). CONCLUSION Community-directed distribution of IPTp-SP improved uptake of IPTp-SP and ITN use. Mothers were satisfied with the services. The authors recommend sustained large-scale implementation of community-directed distribution of IPTp with active community engagement.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki , Abakaliki, Ebonyi State, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki , Abakaliki, Ebonyi State, Nigeria
| | - Chihurumnanya Nwachi Alo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki , Abakaliki, Ebonyi State, Nigeria
| | - Adaoha Pearl Agu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki , Abakaliki, Ebonyi State, Nigeria
| | - Chinyere Benedicta Nzeh
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Chinwendu Daniel Ndukwe
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Odii Ogonna Okoro
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Dejene Derseh Abateneh
- Menelik II College of Medicine and Health Sciences, Kotebe Metropolitan University, P.O.Box 3268, Addis Ababa, Ethiopia.
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Akamike IC, Okedo-Alex IN, Eze II, Ezeanosike OB, Uneke CJ. Why does uptake of family planning services remain sub-optimal among Nigerian women? A systematic review of challenges and implications for policy. Contracept Reprod Med 2020; 5:30. [PMID: 33292842 PMCID: PMC7603738 DOI: 10.1186/s40834-020-00133-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/21/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Over the years, family planning uptake in Nigeria has remained low and this is as a result of the various challenges and barriers faced by women. The aim of this study was to systematically review studies on family planning services undertaken in Nigeria in order to understand the challenges to uptake of the services and the policy implications. METHODS A PubMed search was performed in June 2020 and studies that investigated challenges of family planning uptake in Nigeria published in English between 2006 and 2020 were sought. A combination of the search terms family planning, contraceptives, challenges, barriers, Nigeria was used. Review articles, case reports, and case studies were excluded. Studies that did not report barriers or challenges to family planning or contraceptives were excluded. RESULT Twenty seven studies carried out in Nigeria which provided sufficient information were identified and used for this review. The Uptake of family planning recorded in the reviewed studies ranges from 10.3 to 66.8%. Challenges that are client related include education, desire for more children, uncertainty about its need, partner disapproval, previous side effects, religious beliefs, culture disapproval, age, marital status, and wealth index, residence, ignorance, embarrassment, domestic violence and sexual factor. Health service related factors identified include cost, difficulty accessing services, and procurement difficulties. Recommendations for family planning propram and policy include targeting of health service delivery for improvement, focus on gender issues and male involvement, involvement of religious leaders, targeting of younger women for better education and counseling, and continuous awareness creation and counseling among others. CONCLUSION The review has shown that uptake of family planning remains low in Nigeria and challenges abound. We recommend that strategies that are multi-sectoral should be applied to address the multi-pronged challenges facing uptake of family planning services.
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Affiliation(s)
- Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Irene Ifeyinwa Eze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | | | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Ugwu NI, Uneke CJ, Ugwu CN, Oti WJO, Agbo UN, Akamike IC. Effect of Blood Donor Educational intervention on the knowledge and Attitude towards Voluntary Blood Donation among Medical Students at a Nigerian University. Niger Med J 2020; 61:163-168. [PMID: 33100469 PMCID: PMC7547758 DOI: 10.4103/nmj.nmj_177_19] [Citation(s) in RCA: 5] [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: 09/29/2019] [Revised: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 11/06/2022] Open
Abstract
Background: Blood is a veritable tool in many life-saving situations. Despite the increased demand for blood, the supply of safe blood has been inadequate. This study was aimed to determine the effect of educational intervention on the knowledge and attitude of medical students of a Nigerian University to voluntary blood donation. Materials and Methods: This was a cross-sectional study involving 158 undergraduate medical students of Ebonyi State University in South-East Nigeria. Participants were recruited by stratified sampling technique. A pretested semi-structured participant administered questionnaire was used to baseline knowledge and attitude to voluntary blood donation. This was followed by educational intervention in the form of a workshop by experts in blood transfusion medicine. Then, postintervention assessment was done using the initial questionnaire 30 days later. The study was approved by the Research and Ethics Committee of Ebonyi State University, Abakaliki. Data obtained were analyzed using SPSS 20 software, and P value was set at ≤0.05. Results: Of the 158 medical students who participated in the study, there were 90 (57%) males and 68 (43%) females. Baseline proportion of the participants who had good knowledge was high (72.8%), while baseline attitude of the participants was positive to most aspects of voluntary blood donation. Post intervention, the level of knowledge about voluntary blood donation increased to 99.4%, and similarly attitude to voluntary blood donation improved. Conclusion: Educational intervention was effective in improving the knowledge and attitude towards voluntary blood donation among medical students. Continuous enlightenment will influence potential blood donors to have better knowledge and positive attitude toward voluntary blood donation.
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Affiliation(s)
- Ngozi Immaculata Ugwu
- Department of Haematology and Immunology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Collins Nwachi Ugwu
- Department of Internal Medicine, Faculty of Clinical Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Wilberforce John Otu Oti
- Department of Industrial Chemistry, Faculty of Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Urudinachi Nnenne Agbo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
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Abstract
Anemia in pregnancy is a public health problem in Nigeria and it is more than likely that iron deficiency is the major cause. This study aimed to review relevant publications in order to summarize the prevalence of iron deficiency anemia, risk factors associated with iron deficiency, anemia in pregnancy as well as factors associated with compliance to routine iron therapy. MEDLINE Entrez PubMed search was performed in August 2017 and studies that investigated iron deficiency anemia in pregnancy in Nigeria from 1968 to 2017 were sought. Search keywords included "iron deficiency anemia, pregnancy, Nigeria." Only studies that provided information on the prevalence of iron deficiency anemia, risk factors associated with iron deficiency anemia and risk factors associated with compliance to routine iron therapy in pregnancy in Nigeria were eligible and were selected. Inclusion criteria were original scientific investigations, not reviews, studies conducted in Nigeria between 1968 and 2017 and studies written in the English language. A total of six relevant studies that fulfilled the study inclusion criteria were identified out of 36 studies found. All the studies reported a high prevalence of iron deficiency anemia among pregnant women and risk factors associated with iron deficiency anemia in pregnancy include multiparity, third trimester of pregnancy, and low socioeconomic status. Risk factors associated with noncompliance to routine iron therapy include poor utilization of antenatal services, low educational attainment, distance to a health facility, single or teenage pregnancy, increasing age of the pregnant women, and living in the rural areas. The prevalence of iron deficiency anemia among pregnant women was reported to be high. Awareness creation and education on the importance of family planning and proper utilization of antenatal care services should be encouraged. There should be economic empowerment of women, provision of health facilities to areas where they are absent to encourage early booking and utilization of antenatal care services.
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Affiliation(s)
- N I Ugwu
- Department of Haematology and Immunology, Faculty of Clinical Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - C J Uneke
- Directorate of Research, Innovation and Commercialisation, Ebonyi State University, Abakaliki, Nigeria
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Chizoba Akamike I, Nkem Okedo-Alex I, Jesse Uneke C, Chukwuemeka Uro-Chukwu H, Echefu Chukwu O, Immaculata Ugwu N, Nnenne Agbo U, Ebeh Ezeoha A. Evaluation of the effect of an educational intervention on knowledge and adherence to HIV guidelines among frontline health workers in Alex-Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. Afr Health Sci 2020; 20:1080-1089. [PMID: 33402953 PMCID: PMC7751513 DOI: 10.4314/ahs.v20i3.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to appraise the implementation of the National HIV guidelines and determine the effect of an educational intervention on health worker knowledge and practice of the guidelines. METHODS A before and after study design without control was carried out using a self-administered questionnaire and key informant interviews. Data was also collected from client record cards. An educational intervention was carried out using pamphlets containing summarized information on the guideline. Data analysis was carried out using IBM-SPSS version 20. RESULT Results showed that 54.5% of the respondents were males and 76% were medical doctors. Baseline knowledge level of respondents was high with 97% of respondents having good knowledge with a mean score of 3.9. This increased to 4.1 out of 5 post-intervention. All respondents had good practice of the guidelines before and after intervention with a mean score of 4.5 out of 5. Client records also showed good practice. Barriers to guideline implementation include: poor knowledge, inadequate training, guideline unavailability, poor functioning of the laboratory equipment, poor funding. CONCLUSION HIV guidelines are being implemented in the clinic to a large extent; however, trainings, funding and provision of the guideline in the clinics are recommended.
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Uneke CJ, Sombie I, Johnson E, Uneke BI, Okolo S. Promoting the use of evidence in health policymaking in the ECOWAS region: the development and contextualization of an evidence-based policymaking guidance. Global Health 2020; 16:73. [PMID: 32762759 PMCID: PMC7409627 DOI: 10.1186/s12992-020-00605-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/27/2020] [Indexed: 01/02/2023] Open
Abstract
Background The Economic Commission of the West African States (ECOWAS), through her specialised health Institution, the West African Health Organization (WAHO) is supporting Members States to improve health outcomes in West Africa. There is a global recognition that evidence-based health policies are vital towards achieving continued improvement in health outcomes. The need to have a tool that will provide systematic guide on the use of evidence in policymaking necessitated the production of the evidence-based policy-making (EBPM) Guidance. Methods Google search was performed to identify existing guidance on EBPM. Lessons were drawn from the review of identified guidance documents. Consultation, interaction and interviews were held with policymakers from the 15 West African countries during WAHO organized regional meetings in Senegal, Nigeria, and Burkina Faso. The purpose was to elicit their views on the strategies to promote the use of evidence in policymaking to be included in the EBPM Guidance. A regional Guidance Validation Meeting for West African policymakers was thereafter convened by WAHO to review findings from review of existing guidance documents and validate the EBPM Guidance. Results Out of the 250 publications screened, six publications fulfilled the study inclusion criteria and were reviewed. Among the important issues highlighted include: what evidence informed decision-making is; different types of research methods, designs and approaches, and how to judge the quality of research. The identified main target end users of the EBPM Guidance are policy/decision makers in the West African sub-region, at local, sub-national, national and regional levels. Among the key recommendations included in the EBPM Guidance include: properly defining/refining policy problem; reviewing contextual issues; initiating policy priority setting; considering political acceptability of policy; commissioning research; use of rapid response services, use of policy advisory/technical/steering committees; and use of policy briefs and policy dialogue. Conclusion The EBPM Guidance is one of the emerging tools that can enhance the understanding of evidence to policy process. The strategies to facilitate the use of evidence in policymaking outlined in the Guidance, can be adapted to local context, and incorporated validated approaches that can be used to promote evidence-to-policy-to-practice process in West Africa.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, PMB 053, Nigeria.
| | - Issiaka Sombie
- West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso, 01 01 BP 153, Burkina Faso
| | - Ermel Johnson
- West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso, 01 01 BP 153, Burkina Faso
| | - Bilikis Iyabo Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, PMB 053, Nigeria
| | - Stanley Okolo
- West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso, 01 01 BP 153, Burkina Faso
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Eze II, Mbachu CO, Ossai EN, Nweze CA, Uneke CJ. Unlocking community capabilities for addressing social norms/practices: behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria. BMC Pregnancy Childbirth 2020; 20:369. [PMID: 32571247 PMCID: PMC7310128 DOI: 10.1186/s12884-020-03061-0] [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: 03/23/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background Maternal mortality is attributed to combination of contextual factors that cause delay in seeking care, leading to poor utilization of skilled health services. Community participation is one of the acknowledged strategies to improve health services utilization amongst the poor and rural communities. The study aimed at assessing the potentials of improving birth preparedness and complication readiness (BP/CR) using community-driven behavioural change intervention among pregnant women in rural Nigeria. Methods A pre-post intervention study was conducted from June 2018 to October 2019 on 158 pregnant women selected through multi-stage sampling technique from 10 villages. Data on knowledge and practices of birth preparedness and utilization of facility health services were collected through interviewer-administered pre-tested structured questionnaire. Behavioural change intervention comprising of stakeholders’ engagement, health education, facilitation of emergency transport and fund saving system, and distribution of educational leaflets/posters were delivered by twenty trained volunteer community health workers. The intervention activities focused on sensitization on danger signs of pregnancy, birth preparedness and complication readiness practices and emergency response. Means, standard deviations, and percentages were calculated for descriptive statistics; and T-test and Chi square statistical tests were carried out to determine associations between variables. Statistical significance was set at p-value < 0.05. Results The result showed that after the intervention, mean knowledge score of danger signs of pregnancy increased by 0.37 from baseline value of 3.94 (p < 0.001), and BP/CR elements increased by 0.27 from baseline value of 4.00 (p < 0.001). Mean score for BP/CR practices increased significantly by 0.22 for saving money. The proportion that had antenatal care (76.6%) and had facility delivery (60.0%) increased significantly by 8.2 and 8.3% respectively. Participation in Community-related BP/CR activities increased by 11.6% (p = 0.012). Conclusion With the improvements recorded in the community-participatory intervention, birth preparedness and complication readiness should be promoted through community, household and male-partner inclusive strategies. Further evaluation will be required to ascertain the sustainability and impact of the programme.
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Affiliation(s)
- Irene Ifeyinwa Eze
- Department of Community Medicine, College of Medicine, Ebonyi State University, Abakaliki, Nigeria. .,African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Chinyere Ojiugo Mbachu
- Department of Community Medicine, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria
| | - Edmund Ndudi Ossai
- Department of Community Medicine, College of Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Celestina Adaeze Nweze
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Obi E, Okoh F, Blaufuss S, Olapeju B, Akilah J, Okoko OO, Okechukwu A, Maire M, Popoola K, Yahaya MA, Uneke CJ, Awolola S, Pigeon O, Babalola S, Koenker H, Kilian A. Monitoring the physical and insecticidal durability of the long-lasting insecticidal net DawaPlus ® 2.0 in three States in Nigeria. Malar J 2020; 19:124. [PMID: 32228592 PMCID: PMC7106771 DOI: 10.1186/s12936-020-03194-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background Following guidance from the US President’s Malaria Initiative, durability monitoring of DawaPlus® 2.0 brand of long-lasting insecticidal net (LLIN) distributed during the 2015/16 mass campaign was set up in three ecologically different states: Zamfara, Ebonyi and Oyo. Methods This was a prospective cohort study of representative samples of households from each location, recruited at baseline, 1 to 6 months after the mass campaign. All campaign nets in the households were labelled and followed up over a period of 36 months in Zamfara and Ebonyi and 24 months in Oyo. Primary outcome was the “proportion of nets surviving in serviceable condition” based on attrition and integrity measures and the median survival in years. The outcome for insecticidal durability was determined by bio-assay from sub-samples of campaign nets. Results A total of 439 households (98% of target) and 1096 campaign nets (106%) were included in the study. Definite outcomes could be determined for 92% of the cohort nets in Zamfara, 88% in Ebonyi and 75% in Oyo. All-cause attrition was highest in Oyo with 47% no longer present after 24 months, 53% in Ebonyi and 28% in Zamfara after 36 months. Overall only 1% of all campaign nets were used for other purposes. Estimated survival in serviceable condition of the campaign nets was 80% in Zamfara, 55% in Ebonyi (36 months follow-up) and 75% in Oyo (24 months follow-up) corresponding to median survival of 5.3, 3.3, 3.2 years, respectively. Factors associated with better survival were exposure to social messaging combined with a positive net-care attitude and only adult users. Failing to fold the net when hanging and having children under 5 years of age in the household negatively impacted net survival. Insecticidal effectiveness testing at final survey showed knock-down rates of 50–69%, but 24-h mortality above 95% resulting in 100% optimal performance in Ebonyi and Oyo and 97% in Zamfara. Conclusions Results confirm the strong influence of net-use environment and behavioural factors in the physical survival of the same LLIN brand, which can increase the time until 50% of nets are no longer serviceable by up to 2 years.
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Affiliation(s)
- Emmanuel Obi
- PMI VectorWorks Project, Tropical Health LLP, Abuja, Nigeria
| | - Festus Okoh
- National Malaria Elimination Programme, Abuja, Nigeria
| | - Sean Blaufuss
- PMI VectorWorks Project, JHU Center for Communication Programs, Baltimore, MD, USA
| | - Bolanle Olapeju
- PMI VectorWorks Project, JHU Center for Communication Programs, Baltimore, MD, USA
| | - Joel Akilah
- National Malaria Elimination Programme, Abuja, Nigeria
| | | | - Abidemi Okechukwu
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Abuja, Nigeria
| | - Mark Maire
- U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Abuja, Nigeria
| | | | | | - Chigozie Jesse Uneke
- Dept. of Medical Microbiology/Parasitology, Ebonyi State University, Abakaliki, Nigeria
| | | | | | - Stella Babalola
- PMI VectorWorks Project, JHU Center for Communication Programs, Baltimore, MD, USA
| | - Hannah Koenker
- PMI VectorWorks Project, JHU Center for Communication Programs, Baltimore, MD, USA
| | - Albert Kilian
- PMI VectorWorks Project, Tropical Health LLP, Montagut, Spain.
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Uneke CJ, Sombie I, Uro-Chukwu HC, Johnson E. Developing equity-focused interventions for maternal and child health in Nigeria: an evidence synthesis for policy, based on equitable impact sensitive tool (EQUIST). Pan Afr Med J 2019; 34:158. [PMID: 32153698 PMCID: PMC7046112 DOI: 10.11604/pamj.2019.34.158.16622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/12/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Among the most critical health systems components that requires strengthening to improve maternal, newborn and child health (MNCH) outcomes in Nigeria is the concept of equity. UNICEF has designed the equitable impact sensitive tool (EQUIST) to enable policymakers improve equity in MNCH and reduce disparities between the most marginalized mothers and young children and the better-off. Methods Using the latest available DHS data sets, we conducted EQUIST situation and scenario analysis of MNCH outcomes in Nigeria by sub-national categorization, wealth and by residence. We then identified the intervention package, the bottlenecks and strategies to address them and the number of deaths avertible. Results EQUIST profile analysis showed that the number of under-five deaths was considerably higher among the poorest and rural population in Nigeria, and was highest in North-West region. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Highest maternal mortality was recorded in the North-West Nigeria. Ante-partum, intrapartum and postpartum haemorrhages and hypertensive disorder, were responsible for highest maternal deaths. EQUIST scenario analysis showed that an intervention package of insecticide treated net can avert more than 20,000 under-five deaths and delivery by skilled professionals can avert nearly 17,000 under-five deaths. While as many as 3,370 maternal deaths can be averted by deployment of skilled professionals. Conclusion Scaling up integrated packages of essential interventions across the continuum of care, addressing the human resource shortages in rural area and economic/social empowerment of women are policy recommendations that can improve MNCH outcomes in Nigeria.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | - Issiaka Sombie
- West African Health Organization, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo Dioulasso 01, Burkina Faso
| | | | - Ermel Johnson
- West African Health Organization, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo Dioulasso 01, Burkina Faso
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Ugwu NI, O Oti WJ, Ugwu CN, Uneke CJ. Voluntary non-remunerated blood donation: Awareness, perception, and attitude among potential blood donors in Abakaliki, Nigeria. Niger J Clin Pract 2019; 22:1509-1515. [PMID: 31719272 DOI: 10.4103/njcp.njcp_159_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/04/2022]
Abstract
Background Blood is the most donated tissue in medical practice and a veritable tool in many life-saving situations if used appropriately and judiciously. Despite the increased demand for blood, the supply of safe blood has been inadequate. Objective The aim of this study is to determine the perception and attitude toward voluntary non-remunerated blood donation among medical students in Abakaliki. Subjects and Methods This was a cross-sectional study carried out at Federal Teaching Hospital, Abakaliki, between October 2017 and March 2018. Stratified and simple random sampling technique was used to recruit participants from among medical students using pretested, semi-structured, self-administered questionnaire. Data were analyzed using SPSS software version 20. Results A total of 158 medical students who participated in the study were made up of 90 (57%) males and 68 (43%) females. The most prevalent age group was 20-25 years. Most of the participants, 151 (95.6%), were single. The proportion of the participants who had good knowledge about voluntary blood donation was 72.8%, while the attitudes of the respondents were positive to most aspects of blood donation considered. However, participants were found to have poor practice of voluntary blood donation as only 56 of 158 (35.4%) had ever donated blood. Conclusion The majority of the participants have good knowledge and positive attitude toward voluntary non-remunerated blood donation. However, their practice of voluntary blood donation was poor. Sustained awareness creation and enlightenment is relevant to influence the masses to have better knowledge and positive attitudes toward voluntary non-remunerated blood donation with improved blood donation practices.
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Affiliation(s)
- N I Ugwu
- Department of Haematology and Immunology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - W J O Oti
- Department of Industrial Chemistry, Faculty of Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - C N Ugwu
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
| | - C J Uneke
- Director, Directorate of Research, Innovation and Commercialization (DRIC), Ebonyi State University, Abakaliki, Nigeria
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Abstract
OBJECTIVES To identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa. DESIGN Systematic review. DATA SOURCES Databases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science. ELIGIBILITY CRITERIA Primary studies reporting on determinants of ANC utilisation following multivariate analysis, conducted in sub-Saharan Africa and published in English language between 2008 and 2018. DATA EXTRACTION AND SYNTHESIS A data extraction form was used to extract the following information: name of first author, year of publication, study location, study design, study subjects, sample size and determinants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for reporting a systematic review or meta-analysis protocol was used to guide the screening and eligibility of the studies. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of the studies while the Andersen framework was used to report findings. RESULTS 74 studies that met the inclusion criteria were fully assessed. Most studies identified socioeconomic status, urban residence, older/increasing age, low parity, being educated and having an educated partner, being employed, being married and Christian religion as predictors of ANC attendance and timeliness. Awareness of danger signs, timing and adequate number of antenatal visits, exposure to mass media and good attitude towards ANC utilisation made attendance and initiation of ANC in first trimester more likely. Having an unplanned pregnancy, previous pregnancy complications, poor autonomy, lack of husband's support, increased distance to health facility, not having health insurance and high cost of services negatively impacted the overall uptake, timing and frequency of antenatal visits. CONCLUSION A variety of predisposing, enabling and need factors affect ANC utilisation in sub-Saharan Africa. Intersectoral collaboration to promote female education and empowerment, improve geographical access and strengthened implementation of ANC policies with active community participation are recommended.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | | | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
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Uneke CJ, Uro-Chukwu HC, Chukwu OE. Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review. Pan Afr Med J 2019; 33:318. [PMID: 31692720 PMCID: PMC6815483 DOI: 10.11604/pamj.2019.33.318.16405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/12/2019] [Indexed: 12/31/2022] Open
Abstract
Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and InterVA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | | | - Onyedikachi Echefu Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
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Okedo-Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ. A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage. Int J Health Plann Manage 2019; 34:e1387-e1404. [PMID: 31311065 DOI: 10.1002/hpm.2847] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the Nigerian context, preconditions for financial catastrophe are operational as there is high out-of-pocket spending (OOPS) on health with low capacity to pay, presence of user fees, and poor prepayment insurance coverage. We reviewed the incidence and determinants of catastrophic health expenditure (CHE) in Nigeria. METHODS Databases including PubMed, OVID, EMBASE, CINAHL, and Web of Science were searched for primary research studies on the incidence and determinants of CHE in Nigeria published between 2003 and 2018. Search terms used include household, out-of-pocket expenditure, catastrophic health expenditure, and Nigeria. RESULTS Twenty studies that met the inclusion criteria were included in the review. At 10% of total household and nonfood expenditure, the incidence of CHE was 8.2% to 50%, while 3.2% to 100% households incurred CHE at 40% of nonfood expenditure. The incidence of CHE was higher among inpatients and studies with lower threshold definitions. Outpatient CHE was highest for type 2 diabetes and tuberculosis while human immunodeficiency virus (HIV) care incurred the most CHE among inpatients. Determinants of CHE include wealth status, age, gender, place of residence/geographical location, household size/composition, educational status, health insurance status, illness, and health provider types. CONCLUSION There is a high incidence of CHE across various common health conditions in Nigeria. CHE was more among the poor, elderly, rural dwellers, private facility utilization, female gender, and noninsured among others. We recommend expansion of the National Health Insurance Scheme via informal social and financing networks platforms. Increased budgetary allocation to health and intersectoral collaboration will also play a significant role in CHE reduction.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme University Teaching Hospital Abakaliki Ebonyi State Nigeria, Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme University Teaching Hospital Abakaliki Ebonyi State Nigeria, Abakaliki, Nigeria
| | - Obumneme Benaiah Ezeanosike
- Department of Paediatrics, Alex Ekwueme University Teaching Hospital Abakaliki Ebonyi State Nigeria, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Uneke CJ, Langlois EV, Uro-Chukwu HC, Chukwu J, Ghaffar A. Fostering access to and use of contextualised knowledge to support health policy-making: lessons from the Policy Information Platform in Nigeria. Health Res Policy Syst 2019; 17:38. [PMID: 30961649 PMCID: PMC6454691 DOI: 10.1186/s12961-019-0431-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background Contextualising evidence to inform policy-making is increasingly recognised as key to developing and implementing effective health policies. Creating a one-stop shop for evidence is an approach that can facilitate timely access to the best evidence to inform policy decisions. We report outcomes after implementation of the Policy Information Platform (PIP), a pilot one-stop evidence repository in Nigeria designed to alleviate barriers to accessing policy-relevant knowledge. Methods This cross-sectional study involved five phases, namely (1) consultation with Nigerian policy-makers to identify priority policy issues, areas of health policy information needs, and challenges and capacity constraints in accessing evidence for policy-making; (2) a stakeholder engagement workshop to formally launch the PIP; (3) extraction of data and other information from scientific articles, policy briefs, evaluation reports, grey literature and health policy documents relevant to policy-making in Nigeria (identified by Google and PubMed searches and by examination of websites of relevant Nigerian government ministries, agencies and parastatals), for use in developing the PIP website; (4) promotion of the PIP in national and state health policy meetings; and (5) evaluation of the PIP using a stakeholder survey questionnaire distributed via email and critical appraisal of the grey literature included in the PIP using the authority, accuracy, coverage, objectivity, date and significance (AACODS) checklist. Results Priority policy areas identified by policy-makers were disease control and prevention, population health issues and health administration. Challenges identified by policy-makers were a lack of adequate capacity to access policy-relevant evidence and transform the evidence into policy. Policy-makers suggested using systematic reviews, policy briefs and rapid response mechanisms and involving policy-makers in research as ways of increasing evidence uptake for policy. A total of 126 policy-relevant, peer-reviewed scientific articles, 85 health policy documents and 201 policy-relevant grey literature documents were selected for inclusion in the PIP. Of the 195 individuals contacted via email to evaluate the PIP, 31 (15.9%) provided a response. Respondents noted that the PIP facilitated access to information based on local evidence and context-sensitive data. Barriers identified included lack of knowledge about the PIP and limited capacity of end-users to use the data compiled in the platform. Conclusion An easily accessible one-stop shop of policy-relevant evidence can considerably improve policy-makers’ access to evidence for use in policy-making and practice. Electronic supplementary material The online version of this article (10.1186/s12961-019-0431-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy & Health Systems, Ebonyi State University, Abakaliki, Nigeria.
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Henry C Uro-Chukwu
- African Institute for Health Policy & Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Jeremiah Chukwu
- African Institute for Health Policy & Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland
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Uneke CJ, Sombie I, Uro-Chukwu HC, Johnson E. Using equitable impact sensitive tool (EQUIST) to promote implementation of evidence informed policymaking to improve maternal and child health outcomes: a focus on six West African Countries. Global Health 2018; 14:104. [PMID: 30400931 PMCID: PMC6219200 DOI: 10.1186/s12992-018-0422-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/12/2018] [Indexed: 01/05/2023] Open
Abstract
Background United Nations Children’s Fund (UNICEF) designed EQUitable Impact Sensitive Tool (EQUIST) to enable global health community address the issue of equity in maternal, newborn and child health (MNCH) and minimize health disparities between the most marginalized population and the better-off. The purpose of this study was to use EQUIST to provide reliable evidence, based on demographic health surveys (DHS) on cost–effectiveness and equitable impact of interventions that can be implemented to improve MNCH outcomes in Benin, Burkina Faso, Ghana, Mali, Nigeria and Senegal. Methods Using the latest available DHS data sets, we conducted EQUIST Situation Analysis of maternal and child health outcomes in the six countries by sub-national categorization, wealth and by residence. We then identified the poorest population class within each country with the highest maternal and child mortality and performed EQUIST Scenario Analysis of this population to identify intervention package, bottlenecks and strategies to address them, cost of the intervention and strategies as well as the number of deaths avertible. Results Under-five mortality was highest in Atlantique (Benin), Sahel (Burkina Faso), Northern (Ghana), Sikasso (Mali), North-West (Nigeria), and Diourbel (Senegal). The number of under-five deaths was considerably higher among the poorest and rural population. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Ante-partum, intra-partum, and post-partum haemorrhages, and hypertensive disorder, were responsible for highest maternal deaths. The national average for improved water source was highest in Ghana (82%). Insecticide treated nets ownership percentage national average was highest in Benin (73%). Delivery by skilled professional is capable of averting the highest number of under-five and maternal deaths in the six countries. Redeployment/relocation of existing staff was the strategy with highest costs in Burkina Faso, Nigeria and Senegal. Ghana recorded the least cost per capita ($0.39) while the highest cost per capita was recorded in Benin ($4.0). Conclusion EQUIST highlights the most vulnerable and deprived children and women needing urgent health interventions as a matter of priority. It will continue to serve as a tool for maximizing the number of lives saved; decreasing health disparities and improving overall cost effectiveness. Electronic supplementary material The online version of this article (10.1186/s12992-018-0422-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, PMB 053, Nigeria.
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01, 01 BP 153, Burkina Faso
| | - Henry Chukwuemeka Uro-Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, PMB 053, Nigeria
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01, 01 BP 153, Burkina Faso
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Uneke CJ, Ezeoha AE, Uro-Chukwu HC, Ezeonu CT, Igboji J. Promoting Researchers and Policy-Makers Collaboration in Evidence-Informed Policy-Making in Nigeria: Outcome of a Two-Way Secondment Model between University and Health Ministry. Int J Health Policy Manag 2018; 7:522-531. [PMID: 29935129 PMCID: PMC6015510 DOI: 10.15171/ijhpm.2017.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/07/2017] [Indexed: 12/02/2022] Open
Abstract
Background: There is need to strengthen institutions and mechanisms that can more systematically promote interactions between researchers, policy-makers and other stakeholders who can influence the uptake of research findings. In this article, we report the outcome of a two-way secondment model between Ebonyi State University (EBSU) and Ebonyi State Ministry of Health (ESMoH) in Nigeria as an innovative collaborative strategy to promote capacity enhancement for evidence-to-policy-to-action.
Methods: This study was an exploratory design with a quantitative cross-sectional survey technique. A secondment memorandum of understanding (MOU) was signed between heads of EBSU and ESMoH. The secondment program lasted six months with ten researchers and ten policy-makers spending up to two days per week in each other’s organization. The secondee researchers got engaged in policy-making and implementation activities in ESMoH, while the policy-maker secondees got involved in research activities in EBSU. Secondees evidence-to-policy capacity enhancement meetings were held and questionnaires designed in 5-point Likert scale were used to assess their impact.
Results: The secondee policy-makers and researchers admitted having considerable knowledge of secondment with mean ratings (MNRs) of 3.40 and 3.74 respectively on the 5 points scale. Secondment appeared to be more common in the policy-makers’ organization (MNRs: 2.80-3.07) than in the researchers’ institution (MNRs: 2.58-2.84). The secondee policy-makers participated in some academic and research activities including serving in research ethics committee in EBSU and provided policy-making perspective to the activities. The secondee researchers supported the policymaking process in ESMoH through policy advisory roles, and provided capacity enhancement for staff of the ministry on the use of research evidence in policy-making. There was a noteworthy increase on knowledge of policy analysis and contextualization among the secondees ranging from 20.7% to 50.4% and 31.3% to 42.8% respectively following a training session. A Society for Health Policy Research and Knowledge Translation was established by mutual agreement of secondees as a platform to permanently institutionalize the collaboration.
Conclusion: The outcome of this study clearly suggests that secondment has great potential in promoting evidence informed policy-making and merits further consideration.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy & Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Medical Microbiology/Parasitology, Faculty of Medicine, Ebonyi State University, Abakaliki, Nigeria
| | - Abel Ebeh Ezeoha
- African Institute for Health Policy & Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Accountancy & Banking/Finance, Faculty of Management Sciences, Ebonyi State University, Abakaliki, Nigeria
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Uneke CJ, Uro-Chukwu HC. Improving quality of antenatal care through provision of medical supply kits. Lancet Glob Health 2018; 6:e4-e5. [PMID: 29241614 DOI: 10.1016/s2214-109x(17)30471-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria; Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, PMB 053 Abakaliki, Nigeria.
| | - Henry Chukwuemeka Uro-Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria; National Obstetrics Fistula Centre, Abakaliki, Nigeria
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Uneke CJ, Ezeoha AE, Uro-Chukwu HC. Promoting evidence-informed policymaking through capacity enhancement in implementation research for health researchers and policymakers in Nigeria: A cross-sectional study. J Educ Health Promot 2018; 7:28. [PMID: 29629389 PMCID: PMC5852993 DOI: 10.4103/jehp.jehp_103_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/07/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND Capacity constraints on implementation research among policymakers and researchers are a major challenge to the evidence to policy link. This study was designed to bring together senior policymakers and researchers in Nigeria to consider issues around research-to-policy interface and enhance their capacity on implementation research. METHODS The design was a cross-sectional study. A 3-day joint implementation research workshop was held for policymakers and researchers using World Health Organization/TDR Implementation Research Toolkit. Assessment of participants' capacity for evidence-informed policymaking and knowledge on implementation research was done using a 5-point Likert scale questionnaire. A postworkshop key informant interview was also conducted. RESULTS A total of 20 researchers and 15 policymakers participated in the study. The interaction/partnership between policymakers and researchers was generally rare in terms of priority-setting process, involvement as coinvestigators, and executing strategies to support policymakers' use of research findings. The mean ratings (MNRs) recorded mostly ranged from 1.80 to 1.89 on the 5-point scale. Researchers were rarely involved in the generation of policy-relevant research that satisfies policymakers' needs with MNR very low at 1.74. The MNRs for capacity to acquire, assess, and adapt research were generally considerably higher among researchers (3.16-3.82) than policymakers (2.27-3.20). There was a general consensus that the training tremendously improved participants' understanding and use of implementation research. CONCLUSION Policymakers and researchers are increasingly recognizing their need to work with each other in the interest of the health systems. There is a need to create more capacity enhancement platforms that will facilitate the interface between them.
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Affiliation(s)
- Chigozie Jesse Uneke
- Department of Health Policy and Knowledge Translation, African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Abel Ebeh Ezeoha
- Department of Health Policy and Knowledge Translation, African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
| | - Henry Chukwuemeka Uro-Chukwu
- Department of Health Policy and Knowledge Translation, African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria
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Uneke CJ, Sombie I, Uro-Chukwu HC, Mohammed YG, Johnson E. Promoting evidence informed policymaking for maternal and child health in Nigeria: lessons from a knowledge translation workshop. Health Promot Perspect 2018; 8:63-70. [PMID: 29423364 PMCID: PMC5797310 DOI: 10.15171/hpp.2018.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 11/06/2017] [Indexed: 11/09/2022] Open
Abstract
Background: Knowledge translation (KT) is a process that ensures that research evidence gets translated into policy and practice. In Nigeria, reports indicate that research evidence rarely gets into policymaking process. A major factor responsible for this is lack of KT capacity enhancement mechanisms. The objective of this study was to improve KT competence of an implementation research team (IRT), policymakers and stakeholders in maternal and child health to enhance evidence-informed policymaking. Methods: This study employed a “before and after” design, modified as an intervention study. The study was conducted in Bauchi, north-eastern Nigeria. A three-day KT training workshop was organized and 15 modules were covered including integrated and end-of-grant KT; KT models, measures, tools and strategies; priority setting; managing political interference; advocacy and consensus building/negotiations; inter-sectoral collaboration; policy analysis, contextualization and legislation. A 4-point Likert scale pre-/post-workshop questionnaires were administerd to evaluate the impact of the training, it was designed in terms of extent of adequacy; with “grossly inadequate” representing 1 point, and “very adequate” representing 4 points. Results: A total of 45 participants attended the workshop. There was a noteworthy improvement in the participants’ understanding of KT processes and strategies. The range of the preworkshop mean of participants knowledge of modules taught was from 2.04-2.94, the range for the postworkshop mean was from 3.10–3.70 on the 4-point Likert scale. The range of percentage increase in mean for participants’ knowledge at the end of the workshop was from 13.3%–55.2%. Conclusion: The outcome of this study suggests that using a KT capacity building programme e.g., workshop, health researchers, policymakers and other stakeholders can acquire capacity and skill that will facilitate evidence-to-policy link.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | | | | | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P, Uro-Chukwu HC. Promoting evidence informed policy making in Nigeria: a review of the maternal, newborn and child health policy development process. Health Promot Perspect 2017; 7:181-189. [PMID: 29085794 PMCID: PMC5647352 DOI: 10.15171/hpp.2017.33] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/10/2017] [Indexed: 11/09/2022] Open
Abstract
Background: There is increasing recognition worldwide that health policymaking process should be informed by best available evidence. The purpose of this study was to review the policy documents on maternal, newborn and child health (MNCH) in Nigeria to assess the extent evidence informed policymaking mechanism was employed in the policy formulation process. Methods: A comprehensive literature search of websites of the Federal Ministry of Health(FMOH) Nigeria and other related ministries and agencies for relevant health policy documents related to MNCH from year 2000 to 2015 was undertaken. The following terms were used interchangeably for the literature search: maternal, child, newborn, health, policy, strategy,framework, guidelines, Nigeria. Results: Of the 108 policy documents found, 19 (17.6%) of them fulfilled the study inclusion criteria. The policy documents focused on the major aspects of maternal health improvements in Nigeria such as reproductive health, anti-malaria treatment, development of adolescent and young people health, mid wives service scheme, prevention of mother to child transmission of HIV and family planning. All the policy documents indicated that a consultative process of collection of input involving multiple stakeholders was employed, but there was no rigorous scientific process of assessing, adapting, synthesizing and application of scientific evidence reported in the policy development process. Conclusion: It is recommended that future health policy development process on MNCH should follow evidence informed policy making process and clearly document the process of incorporating evidence in the policy development.
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Affiliation(s)
- Chigozie Jesse Uneke
- Knowledge Translation Platform, African Institute for Health Policy & Health Systems Studies, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Namoudou Keita
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Virgil Lokossou
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Pierre Ongolo-Zogo
- Hopital Central Yaounde, CDBPH Lawrence VERGNE Building 2nd Floor, Avenue Henry Dunant Messa, Yaoundé, Cameroon
| | - Henry Chukwuemeka Uro-Chukwu
- Knowledge Translation Platform, African Institute for Health Policy & Health Systems Studies, Ebonyi State University, PMB 053 Abakaliki, Nigeria
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Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abebo TA, Abera SF, Aboyans V, Abu-Raddad LJ, Ackerman IN, Adamu AA, Adetokunboh O, Afarideh M, Afshin A, Agarwal SK, Aggarwal R, Agrawal A, Agrawal S, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akinyemi RO, Akseer N, Al Lami FH, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alasfoor D, Alene KA, Ali R, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Maskari F, Al-Raddadi R, Alsharif U, Alsowaidi S, Altirkawi KA, Amare AT, Amini E, Ammar W, Amoako YA, Andersen HH, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Assadi R, Atey TM, Atnafu NT, Atre SR, Avila-Burgos L, Avokphako EFGA, Awasthi A, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Bannick MS, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Basu S, Battista B, Battle KE, Baune BT, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bennett DA, Bensenor IM, Benson J, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhatt S, Bhutta ZA, Biadgilign S, Bicer BK, Bienhoff K, Bikbov B, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Boneya DJ, Boufous S, Bourne RRA, Brazinova A, Brugha TS, Buchbinder R, Bulto LNB, Bumgarner BR, Butt ZA, Cahuana-Hurtado L, Cameron E, Car M, Carabin H, Carapetis JR, Cárdenas R, Carpenter DO, Carrero JJ, Carter A, Carvalho F, Casey DC, Caso V, Castañeda-Orjuela CA, Castle CD, Catalá-López F, Chang HY, Chang JC, Charlson FJ, Chen H, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Christopher DJ, Ciobanu LG, Cirillo M, Colombara D, Cooper C, Cortesi PA, Criqui MH, Crump JA, Dadi AF, Dalal K, Dandona L, Dandona R, das Neves J, Davitoiu DV, de Courten B, De Leo DD, Defo BK, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Des Jarlais DC, Dey S, Dharmaratne SD, Dhillon PK, Dicker D, Ding EL, Djalalinia S, Do HP, Dorsey ER, dos Santos KPB, Douwes-Schultz D, Doyle KE, Driscoll TR, Dubey M, Duncan BB, El-Khatib ZZ, Ellerstrand J, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Fanuel FBB, Farinha CSES, Faro A, Farzadfar F, Fazeli MS, Feigin VL, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Flor LS, Foigt N, Foreman KJ, Franklin RC, Fullman N, Fürst T, Furtado JM, Futran ND, Gakidou E, Ganji M, Garcia-Basteiro AL, Gebre T, Gebrehiwot TT, Geleto A, Gemechu BL, Gesesew HA, Gething PW, Ghajar A, Gibney KB, Gill PS, Gillum RF, Ginawi IAM, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gold AL, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goto A, Goulart AC, Griswold M, Gugnani HC, Gupta R, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Hailu GB, Hailu AD, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hanson SW, Hao Y, Harb HL, Hareri HA, Haro JM, Harvey J, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, Hay RJ, Henry NJ, Heredia-Pi IB, Hernandez JM, Heydarpour P, Hoek HW, Hoffman HJ, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Htet AS, Hu G, Huang H, Huynh C, Iburg KM, Igumbor EU, Ikeda C, Irvine CMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jassal SK, Javanbakht M, Jayaraman SP, Jeemon P, Jensen PN, Jha V, Jiang G, John D, Johnson SC, Johnson CO, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Kan H, Karam NE, Karch A, Karema CK, Kasaeian A, Kassa GM, Kassaw NA, Kassebaum NJ, Kastor A, Katikireddi SV, Kaul A, Kawakami N, Keiyoro PN, Kengne AP, Keren A, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kim YJ, Kim D, Kim P, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishnaswami S, Krohn KJ, Kumar GA, Kumar P, Kumar S, Kyu HH, Lal DK, Lalloo R, Lambert N, Lan Q, Larsson A, Lavados PM, Leasher JL, Lee PH, Lee JT, Leigh J, Leshargie CT, Leung J, Leung R, Levi M, Li Y, Li Y, Li Kappe D, Liang X, Liben ML, Lim SS, Linn S, Liu PY, Liu A, Liu S, Liu Y, Lodha R, Logroscino G, London SJ, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Macarayan ERK, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahdavi M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Manhertz T, Mantilla A, Mantovani LG, Mapoma CC, Marczak LB, Martinez-Raga J, Martins-Melo FR, Martopullo I, März W, Mathur MR, Mazidi M, McAlinden C, McGaughey M, McGrath JJ, McKee M, McNellan C, Mehata S, Mehndiratta MM, Mekonnen TC, Memiah P, Memish ZA, Mendoza W, Mengistie MA, Mengistu DT, Mensah GA, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Mills EJ, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mitchell PB, Mohammad KA, Mohammadi A, Mohammed KE, Mohammed S, Mohanty SK, Mokdad AH, Mollenkopf SK, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Mori R, Morozoff C, Morrison SD, Moses M, Mountjoy-Venning C, Mruts KB, Mueller UO, Muller K, Murdoch ME, Murthy GVS, Musa KI, Nachega JB, Nagel G, Naghavi M, Naheed A, Naidoo KS, Naldi L, Nangia V, Natarajan G, Negasa DE, Negoi RI, Negoi I, Newton CR, Ngunjiri JW, Nguyen TH, Nguyen QL, Nguyen CT, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nolte S, Nong VM, Norrving B, Noubiap JJN, O'Donnell MJ, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju TO, Olagunju AT, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortiz A, Osgood-Zimmerman A, Osman M, Owolabi MO, PA M, Pacella RE, Pana A, Panda BK, Papachristou C, Park EK, Parry CD, Parsaeian M, Patten SB, Patton GC, Paulson K, Pearce N, Pereira DM, Perico N, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Plass D, Pletcher MA, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Prasad NM, Prasad N, Purcell C, Qorbani M, Quansah R, Quintanilla BPA, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman M, Rai RK, Rajsic S, Ram U, Ranabhat CL, Rankin Z, Rao PC, Rao PV, Rawaf S, Ray SE, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Ribeiro AL, Ronfani L, Roshandel G, Roth GA, Roy A, Rubagotti E, Ruhago GM, Saadat S, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Salama J, Saleem HOB, Salomon JA, Salvi SS, Samy AM, Sanabria JR, Santomauro D, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Servan-Mori EE, Setegn T, Shackelford KA, Shaheen A, Shaikh MA, Shamsipour M, Shariful Islam SM, Sharma J, Sharma R, She J, Shi P, Shields C, Shifa GT, Shigematsu M, Shinohara Y, Shiri R, Shirkoohi R, Shirude S, Shishani K, Shrime MG, Sibai AM, Sigfusdottir ID, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh NP, Sinha DN, Skiadaresi E, Skirbekk V, Slepak EL, Sligar A, Smith DL, Smith M, Sobaih BHA, Sobngwi E, Sorensen RJD, Sousa TCM, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein MB, Stein DJ, Steiner TJ, Steiner C, Steinke S, Stokes MA, Stovner LJ, Strub B, Subart M, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Taffere GR, Takala JS, Tandon N, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekelab T, Terkawi AS, Tesfaye DJ, Tesssema B, Thamsuwan O, Thomas KE, Thrift AG, Tiruye TY, Tobe-Gai R, Tollanes MC, Tonelli M, Topor-Madry R, Tortajada M, Touvier M, Tran BX, Tripathi S, Troeger C, Truelsen T, Tsoi D, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Updike R, Uthman OA, Uzochukwu BSC, van Boven JFM, Varughese S, Vasankari T, Venkatesh S, Venketasubramanian N, Vidavalur R, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Wadilo F, Wakayo T, Wang YP, Weaver M, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Wolfe CDA, Woodbrook R, Woolf AD, Workicho A, Xavier D, Xu G, Yadgir S, Yaghoubi M, Yakob B, Yan LL, Yano Y, Ye P, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zegeye EA, Zenebe ZM, Zhang X, Zhou M, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1211-1259. [PMID: 28919117 PMCID: PMC5605509 DOI: 10.1016/s0140-6736(17)32154-2] [Citation(s) in RCA: 4400] [Impact Index Per Article: 628.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/22/2017] [Accepted: 07/26/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. METHODS We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228). INTERPRETATION The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. FUNDING Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abera SF, Aboyans V, Abu-Raddad LJ, Abu-Rmeileh NME, Abyu GY, Adedeji IA, Adetokunboh O, Afarideh M, Agrawal A, Agrawal S, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Akinyemi RO, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alasfoor D, Alene KA, Ali K, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Ansari H, Antó JM, Antonio CAT, Anwari P, Arian N, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Atey TM, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Ballew SH, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Batis C, Battle KE, Baumgarner BR, Baune BT, Beardsley J, Bedi N, Beghi E, Bell ML, Bennett DA, Bennett JR, Bensenor IM, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhansali A, Bhutta ZA, Bicer BK, Bikbov B, Birungi C, Biryukov S, Blosser CD, Boneya DJ, Bou-Orm IR, Brauer M, Breitborde NJK, Brenner H, Brugha TS, Bulto LNB, Butt ZA, Cahuana-Hurtado L, Cárdenas R, Carrero JJ, Castañeda-Orjuela CA, Catalá-López F, Cercy K, Chang HY, Charlson FJ, Chimed-Ochir O, Chisumpa VH, Chitheer AA, Christensen H, Christopher DJ, Cirillo M, Cohen AJ, Comfort H, Cooper C, Coresh J, Cornaby L, Cortesi PA, Criqui MH, Crump JA, Dandona L, Dandona R, das Neves J, Davey G, Davitoiu DV, Davletov K, de Courten B, Defo BK, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Deshpande A, Dharmaratne SD, Ding EL, Djalalinia S, Do HP, Dokova K, Doku DT, Donkelaar AV, Dorsey ER, Driscoll TR, Dubey M, Duncan BB, Duncan S, Ebrahimi H, El-Khatib ZZ, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Faraon EJA, Farinha CSES, Faro A, Farzadfar F, Fay K, Feigin VL, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Foreman KJ, Frostad JJ, Fullman N, Fürst T, Furtado JM, Ganji M, Garcia-Basteiro AL, Gebrehiwot TT, Geleijnse JM, Geleto A, Gemechu BL, Gesesew HA, Gething PW, Ghajar A, Gibney KB, Gill PS, Gillum RF, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gona PN, Goodridge A, Gopalani SV, Goryakin Y, Goulart AC, Graetz N, Gugnani HC, Guo J, Gupta R, Gupta T, Gupta V, Gutiérrez RA, Hachinski V, Hafezi-Nejad N, Hailu GB, Hamadeh RR, Hamidi S, Hammami M, Handal AJ, Hankey GJ, Hanson SW, Harb HL, Hareri HA, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, Hedayati MT, Hendrie D, Heredia-Pi IB, Hernandez JCM, Hoek HW, Horita N, Hosgood HD, Hostiuc S, Hoy DG, Hsairi M, Hu G, Huang JJ, Huang H, Ibrahim NM, Iburg KM, Ikeda C, Inoue M, Irvine CMS, Jackson MD, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jauregui A, Javanbakht M, Jeemon P, Johansson LRK, Johnson CO, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Karch A, Karema CK, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kawakami N, Keiyoro PN, Kelbore SG, Kemmer L, Kengne AP, Kesavachandran CN, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kim JY, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Knibbs LD, Knudsen AK, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kromhout H, Kumar GA, Kutz M, Kyu HH, Lal DK, Lalloo R, Lallukka T, Lan Q, Lansingh VC, Larsson A, Lee PH, Lee A, Leigh J, Leung J, Levi M, Levy TS, Li Y, Li Y, Liang X, Liben ML, Linn S, Liu P, Lodha R, Logroscino G, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Macarayan ERK, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Mantovani LG, Mapoma CC, Martin RV, Martinez-Raga J, Martins-Melo FR, Mathur MR, Matsushita K, Matzopoulos R, Mazidi M, McAlinden C, McGrath JJ, Mehata S, Mehndiratta MM, Meier T, Melaku YA, Memiah P, Memish ZA, Mendoza W, Mengesha MM, Mensah GA, Mensink GBM, Mereta ST, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohammad KA, Mohammed KE, Mohammed S, Mohan MBV, Mokdad AH, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Morrison SD, Mountjoy-Venning C, Mueller UO, Mullany EC, Muller K, Murthy GVS, Musa KI, Naghavi M, Naheed A, Nangia V, Natarajan G, Negoi RI, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nomura M, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Ota E, Owolabi MO, PA M, Pacella RE, Pana A, Panda BK, Panda-Jonas S, Pandian JD, Papachristou C, Park EK, Parry CD, Patten SB, Patton GC, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Pillay JD, Piradov MA, Pishgar F, Plass D, Pletcher MA, Polinder S, Popova S, Poulton RG, Pourmalek F, Prasad N, Purcell C, Qorbani M, Radfar A, Rafay A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahman M, Rai RK, Rajsic S, Ram U, Rawaf S, Rehm CD, Rehm J, Reiner RC, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Reynales-Shigematsu LM, Rezaei S, Ribeiro AL, Rivera JA, Roba KT, Rojas-Rueda D, Roman Y, Room R, Roshandel G, Roth GA, Rothenbacher D, Rubagotti E, Rushton L, Sadat N, Safdarian M, Safi S, Safiri S, Sahathevan R, Salama J, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Sánchez-Pimienta TG, Santomauro D, Santos IS, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Shariful Islam SM, Sharma J, Sharma R, She J, Shen J, Shi P, Shibuya K, Shields C, Shiferaw MS, Shigematsu M, Shin MJ, Shiri R, Shirkoohi R, Shishani K, Shoman H, Shrime MG, Sigfusdottir ID, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh V, Sinha DN, Skiadaresi E, Slepak EL, Smith DL, Smith M, Sobaih BHA, Sobngwi E, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Srinivasan V, Steel N, Stein DJ, Steiner C, Steinke S, Stokes MA, Strub B, Subart M, Sufiyan MB, Suliankatchi RA, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Takahashi K, Takala JS, Tandon N, Tanner M, Tarekegn YL, Tavakkoli M, Tegegne TK, Tehrani-Banihashemi A, Terkawi AS, Tesssema B, Thakur JS, Thamsuwan O, Thankappan KR, Theis AM, Thomas ML, Thomson AJ, Thrift AG, Tillmann T, Tobe-Gai R, Tobollik M, Tollanes MC, Tonelli M, Topor-Madry R, Torre A, Tortajada M, Touvier M, Tran BX, Truelsen T, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Uneke CJ, Updike R, Uthman OA, van Boven JFM, Varughese S, Vasankari T, Veerman LJ, Venkateswaran V, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wadilo F, Wakayo T, Wallin MT, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Workicho A, Xavier D, Xu G, Yadgir S, Yakob B, Yan LL, Yaseri M, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zavala-Arciniega L, Zhang X, Zimsen SRM, Zipkin B, Zodpey S, Lim SS, Murray CJL. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1345-1422. [PMID: 28919119 PMCID: PMC5614451 DOI: 10.1016/s0140-6736(17)32366-8] [Citation(s) in RCA: 1554] [Impact Index Per Article: 222.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. METHODS We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. FINDINGS Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. INTERPRETATION Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. FUNDING The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
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Fullman N, Barber RM, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abera SF, Aboyans V, Abu-Raddad LJ, Abu-Rmeileh NME, Adedeji IA, Adetokunboh O, Afshin A, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akinyemi RO, Akseer N, Al-Aly Z, Alam K, Alam N, Alasfoor D, Alene KA, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Ansari H, Antonio CAT, Anwari P, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Assadi R, Atey TM, Atre SR, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Bannick MS, Barac A, Barker-Collo SL, Bärnighausen T, Barrero LH, Basu S, Battle KE, Baune BT, Beardsley J, Bedi N, Beghi E, Béjot Y, Bell ML, Bennett DA, Bennett JR, Bensenor IM, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhatt S, Bhutta ZA, Bicer BK, Bidgoli HH, Bikbov B, Bilal AI, Birungi C, Biryukov S, Bizuayehu HM, Blosser CD, Boneya DJ, Bose D, Bou-Orm IR, Brauer M, Breitborde NJK, Brugha TS, Bulto LNB, Butt ZA, Cahuana-Hurtado L, Cameron E, Campuzano JC, Carabin H, Cárdenas R, Carrero JJ, Carter A, Casey DC, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cercy K, Chang HY, Chang JC, Charlson FJ, Chew A, Chisumpa VH, Chitheer AA, Christensen H, Christopher DJ, Cirillo M, Cooper C, Criqui MH, Cromwell EA, Crump JA, Dandona L, Dandona R, Dargan PI, das Neves J, Davitoiu DV, de Courten B, De Steur H, Defo BK, Degenhardt L, Deiparine S, Deribe K, deVeber GA, Ding EL, Djalalinia S, Do HP, Dokova K, Doku DT, Donkelaar AV, Dorsey ER, Driscoll TR, Dubey M, Duncan BB, Ebel BE, Ebrahimi H, El-Khatib ZZ, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Faraon EJA, Farinha CSES, Faro A, Farzadfar F, Fazeli MS, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Foreman KJ, Frank T, Franklin RC, Friedman J, Frostad JJ, Fürst T, Furtado JM, Gakidou E, Garcia-Basteiro AL, Gebrehiwot TT, Geleijnse JM, Geleto A, Gemechu BL, Gething PW, Gibney KB, Gill PS, Gillum RF, Giref AZ, Gishu MD, Giussani G, Glenn SD, Godwin WW, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goryakin Y, Griswold M, Gugnani HC, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Hailu GB, Hamadeh RR, Hammami M, Hankey GJ, Harb HL, Hareri HA, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, He J, Hendrie D, Henry NJ, Heredia-Pi IB, Hoek HW, Holmberg M, Horita N, Hosgood HD, Hostiuc S, Hoy DG, Hsairi M, Htet AS, Huang JJ, Huang H, Huynh C, Iburg KM, Ikeda C, Inoue M, Irvine CMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jauregui A, Javanbakht M, Jeemon P, Jha V, John D, Johnson CO, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Karch A, Karema CK, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kawakami N, Keiyoro PN, Kelbore SG, Kemmer L, Kengne AP, Kesavachandran CN, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kieling C, Kim JY, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kulikoff XR, Kumar GA, Kumar Lal D, Kutz MJ, Kyu HH, Lalloo R, Lansingh VC, Larsson A, Lazarus JV, Lee PH, Leigh J, Leung J, Leung R, Levi M, Li Y, Liben ML, Linn S, Liu PY, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Mackay MT, Maddison ER, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Mantovani LG, Manyazewal T, Mapoma CC, Marks GB, Martin RV, Martinez-Raga J, Martins-Melo FR, Martopullo I, Mathur MR, Mazidi M, McAlinden C, McGaughey M, McGrath JJ, McKee M, Mehata S, Mehndiratta MM, Meier T, Meles KG, Memish ZA, Mendoza W, Mengesha MM, Mengistie MA, Mensah GA, Mensink GBM, Mereta ST, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mitchell PB, Mohammad KA, Mohammed KE, Mohammed S, Mohan MBV, Mokdad AH, Mollenkopf SK, Monasta L, Montañez Hernandez JC, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Morrison SD, Moses MW, Mountjoy-Venning C, Mueller UO, Muller K, Murthy GVS, Musa KI, Naghavi M, Naheed A, Naidoo KS, Nangia V, Natarajan G, Negoi RI, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nomura M, Nong VM, Norheim OF, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Oren E, Ortiz A, Owolabi MO, PA M, Pana A, Panda BK, Panda-Jonas S, Papachristou C, Park EK, Patton GC, Paulson K, Pereira DM, Perico DN, Pesudovs K, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Piradov MA, Pishgar F, Poulton RG, Pourmalek F, Qorbani M, Radfar A, Rafay A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahman M, Rai RK, Rajsic S, Ram U, Ranabhat CL, Rao PC, Rawaf S, Reidy P, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rios Blancas MJ, Rivas JC, Roba KT, Rojas-Rueda D, Rokni MB, Roshandel G, Roth GA, Roy A, Rubagotti E, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Salama J, Salomon JA, Samy AM, Sanabria JR, Santomauro D, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Saylan MI, Schmidt MI, Schneider IJC, Schneider MT, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Shariful Islam SM, Sharma J, Sharma R, She J, Shi P, Shibuya K, Shields C, Shifa GT, Shiferaw MS, Shigematsu M, Shin MJ, Shiri R, Shirkoohi R, Shirude S, Shishani K, Shoman H, Shrime MG, Silberberg DH, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh V, Sinha DN, Skiadaresi E, Slepak EL, Sligar A, Smith DL, Smith A, Smith M, Sobaih BHA, Sobngwi E, Soljak M, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein DJ, Steiner C, Steinke S, Stokes MA, Strub B, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Sylte DO, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Tandon N, Tao T, Tarekegn YL, Tavakkoli M, Taveira N, Tegegne TK, Terkawi AS, Tessema GA, Thakur JS, Thankappan KR, Thrift AG, Tiruye TY, Tobe-Gai R, Topor-Madry R, Torre A, Tortajada M, Tran BX, Troeger C, Truelsen T, Tsoi D, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Uneke CJ, Updike R, Uthman OA, van Boven JFM, Varughese S, Vasankari T, Venketasubramanian N, Vidavalur R, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wadilo F, Wakayo T, Wallin MT, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Xavier D, Xu G, Yadgir S, Yakob B, Yan LL, Yano Y, Yaseri M, Ye P, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zavala-Arciniega L, Zhang X, Zipkin B, Zodpey S, Lim SS, Murray CJL. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017; 390:1423-1459. [PMID: 28916366 PMCID: PMC5603800 DOI: 10.1016/s0140-6736(17)32336-x] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. METHODS We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment. FINDINGS Globally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past. INTERPRETATION GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations. FUNDING Bill & Melinda Gates Foundation.
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Uneke CJ, Sombie I, Uro-Chukwu HC, Johnson E, Okonofua F. Using equitable impact sensitive tool (EQUIST) and knowledge translation to promote evidence to policy link in maternal and child health: report of first EQUIST training workshop in Nigeria. Pan Afr Med J 2017; 28:37. [PMID: 29158860 PMCID: PMC5687877 DOI: 10.11604/pamj.2017.28.37.13269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 11/11/2022] Open
Abstract
The Equitable Impact Sensitive Tool (EQUIST) designed by UNICEF and knowledge translation (KT) are important strategies that can help policymakers to improve equity and evidence-informed policy making in maternal, newborn and child health (MNCH). The purpose of this study was to improve the knowledge and capacity of an MNCH implementation research team (IRT) and policy makers to use EQUIST and KT. A modified “before and after” intervention study design was used in which outcomes were measured on the target participants both before the intervention (workshop) is implemented and after. A 5-point likert scale according to the degree of adequacy was employed. A three -day intensive EQUIST and KT training workshop was organized in Edo State, Nigeria with 45 participants in attendance. Some of the topics covered included: (i) Knowledge translation models, measures & tools; (ii) Policy review, analysis and contextualization; (iii) Policy formulation and legislation process; (iv) EQUIST Overview & Theory of change; (v) EQUIST's situation analysis, scenario analysis and scenario comparison. The pre-workshop mean of understanding of use of KT ranged from 2.02-3.41, while the post-workshop mean ranged from 3.24-4.30. Pre-workshop mean of understanding of use of EQUIST ranged from 1.66-2.41, while the post-workshop mean ranged from 3.56-4.54 on the 5point scale. The percentage increase in mean of KT and EQUIST at the end of the workshop ranged from 8.0%-88.1% and 65.6%-158.4% respectively. Findings of this study suggest that policymakers' and researchers KT and EQUSIT use competence relevant to evidence-informed policymaking can be enhanced through training workshop.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems Studies, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Henry Chukwuemeka Uro-Chukwu
- African Institute for Health Policy and Health Systems Studies, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Friday Okonofua
- Women's Health and Action Research Centre Benin City Nigeria
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P, Uro-Chukwu HC. Assessment of policy makers' individual and organizational capacity to acquire, assess, adapt and apply research evidence for maternal and child health policy making in Nigeria: a cross-sectional quantitative survey. Afr Health Sci 2017; 17:700-711. [PMID: 29085397 PMCID: PMC5656188 DOI: 10.4314/ahs.v17i3.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Throughout the world, there is increasing awareness and acknowledgement of the value of research evidence in the development of effective health policy and in quality health care practice and administration. Among the major challenges associated with the lack of uptake of research evidence into policy and practice in Nigeria is the capacity constraints of policymakers to use research evidence in policy making. Objective To assess the capacity of maternal and child health policy makers to acquire, access, adapt and apply available research evidence. Methods This cross-sectional quantitative survey was conducted at a national maternal, newborn and child health (MNCH) stakeholders' engagement event. An evidence to policy self-assessment questionnaire was used to assess the capacity of forty MNCH policy makers to acquire, assess, adapt and apply research evidence for policy making. Results Low mean ratings were observed ranging from 2.68–3.53 on a scale of 5 for knowledge about initiating/conducting research and capacity to assess authenticity, validity, reliability, relevance and applicability of research evidence and for organizational capacity for promoting and using of research for policy making. Conclusion There is need to institute policy makers' capacity development programmes to improve evidence-informed policymaking.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053 Abakaliki Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Namoudou Keita
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Virgil Lokossou
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Pierre Ongolo-Zogo
- Hopital Central Yaounde, CDBPH Lawrence VERGNE Building 2nd Floor, Avenue Henry Dunant Messa Yaoundé, Cameroon
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Barber RM, Fullman N, Sorensen RJD, Bollyky T, McKee M, Nolte E, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abdurahman AA, Abera SF, Abraham B, Abreha GF, Adane K, Adelekan AL, Adetifa IMO, Afshin A, Agarwal A, Agarwal SK, Agarwal S, Agrawal A, Kiadaliri AA, Ahmadi A, Ahmed KY, Ahmed MB, Akinyemi RO, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam N, Alam SS, Alemu ZA, Alene KA, Alexander L, Ali R, Ali SD, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amo-Adjei J, Amoako YA, Anderson BO, Androudi S, Ansari H, Ansha MG, Antonio CAT, Ärnlöv J, Artaman A, Asayesh H, Assadi R, Astatkie A, Atey TM, Atique S, Atnafu NT, Atre SR, Avila-Burgos L, Avokpaho EFGA, Quintanilla BPA, Awasthi A, Ayele NN, Azzopardi P, Saleem HOB, Bärnighausen T, Bacha U, Badawi A, Banerjee A, Barac A, Barboza MA, Barker-Collo SL, Barrero LH, Basu S, Baune BT, Baye K, Bayou YT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Bernal OA, Beyene AS, Beyene TJ, Bhutta ZA, Biadgilign S, Bikbov B, Birlik SM, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bose D, Brainin M, Brauer M, Brazinova A, Breitborde NJK, Brenner H, Butt ZA, Cárdenas R, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Carrero JJ, Casey D, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cecilio P, Cercy K, Charlson FJ, Chen AZ, Chew A, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Coggeshall MS, Cooper LT, Cortinovis M, Crump JA, Dalal K, Danawi H, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, De Leo D, Del Gobbo LC, del Pozo-Cruz B, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dicker D, Ding EL, Dokova K, Dorsey ER, Doyle KE, Dubey M, Ehrenkranz R, Ellingsen CL, Elyazar I, Enayati A, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fürst T, Faghmous IDA, Fanuel FBB, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Fischer F, Fitzmaurice C, Fleming TD, Foigt N, Foreman KJ, Forouzanfar MH, Franklin RC, Frostad J, G/hiwot TT, Gakidou E, Gambashidze K, Gamkrelidze A, Gao W, Garcia-Basteiro AL, Gebre T, Gebremedhin AT, Gebremichael MW, Gebru AA, Gelaye AA, Geleijnse JM, Genova-Maleras R, Gibney KB, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gold A, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goto A, Graetz N, Greaves F, Griswold M, Guban PI, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Habtewold TD, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Hakuzimana A, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hankey GJ, Hao Y, Harb HL, Hareri HA, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, Hendrie D, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Htet AS, Hu G, Huang H, Huang JJ, Huntley BM, Huynh C, Iburg KM, Ileanu BV, Innos K, Irenso AA, Jahanmehr N, Jakovljevic MB, James P, James SL, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jeemon P, Jha V, John D, Johnson C, Johnson SC, Jonas JB, Juel K, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kazanjan K, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Kerbo AA, Kereselidze M, Kesavachandran CN, Khader YS, Khalil I, Khan AR, Khan EA, Khan G, Khang YH, Khoja ATA, Khonelidze I, Khubchandani J, Kibret GD, Kim D, Kim P, Kim YJ, Kimokoti RW, Kinfu Y, Kissoon N, Kivipelto M, Kokubo Y, Kolk A, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishnaswami S, Krohn KJ, Defo BK, Bicer BK, Kuipers EJ, Kulkarni VS, Kumar GA, Kumsa FA, Kutz M, Kyu HH, Lager ACJ, Lal A, Lal DK, Lalloo R, Lallukka T, Lan Q, Langan SM, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Latif AA, Lawrynowicz AEB, Leasher JL, Leigh J, Leinsalu M, Leshargie CT, Leung J, Leung R, Levi M, Liang X, Lim SS, Lind M, Linn S, Lipshultz SE, Liu P, Liu Y, Lo LT, Logroscino G, Lopez AD, Lorch SA, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Macarayan ERK, Mackay MT, El Razek HMA, El Razek MMA, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marcenes W, Marks GB, Marquez N, Martinez-Raga J, Marzan MB, Massano J, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McNellan C, Meaney PA, Mehari A, Mehndiratta MM, Meier T, Mekonnen AB, Meles KG, Memish ZA, Mengesha MM, Mengiste DT, Mengistie MA, Menota BG, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mezgebe HB, Micha R, Millear A, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Mock CN, Mohammad KA, Mohammed S, Mohanty SK, Mokdad AH, Mola GLD, Molokhia M, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Moses M, Mueller UO, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naheed A, Naldi L, Nangia V, Nascimento BR, Negoi I, Neupane SP, Newton CR, Ng M, Ngalesoni FN, Ngunjiri JW, Nguyen G, Ningrum DNA, Nolte S, Nomura M, Norheim OF, Norrving B, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osborne RH, Osman M, Owolabi MO, PA M, Pain AW, Pakhale S, Castillo EP, Pana A, Papachristou C, Parsaeian M, Patel T, Patton GC, Paudel D, Paul VK, Pearce N, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pesudovs K, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Polinder S, Pond CD, Prakash V, Purwar M, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rai RK, Ram U, Rana SM, Rankin Z, Rao PV, Rao PC, Rawaf S, Rego MAS, Reitsma M, Remuzzi G, Renzaho AMNN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Roba HS, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy NK, Sachdev PS, Sackey BB, Saeedi MY, Safiri S, Sagar R, Sahraian MA, Saleh MM, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Sandar L, Santos IS, Santos JV, Milicevic MMS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Saylan MI, Schöttker B, Schutte AE, Schwebel DC, Seedat S, Seid AM, Seifu CN, Sepanlou SG, Serdar B, Servan-Mori EE, Setegn T, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shakh-Nazarova M, Shamsipour M, Islam SMS, Sharma J, Sharma R, She J, Sheikhbahaei S, Shen J, Shi P, Shigematsu M, Shin MJ, Shiri R, Shoman H, Shrime MG, Sibamo ELS, Sigfusdottir ID, Silva DAS, Silveira DGA, Sindi S, Singh A, Singh JA, Singh OP, Singh PK, Singh V, Sinke AH, Sinshaw AE, Skirbekk V, Sliwa K, Smith A, Sobngwi E, Soneji S, Soriano JB, Sousa TCM, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steel N, Steiner C, Steinke S, Stokes MA, Stranges S, Strong M, Stroumpoulis K, Sturua L, Sufiyan MB, Suliankatchi RA, Sun J, Sur P, Swaminathan S, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Taffere GR, Talongwa RT, Tarajia M, Tavakkoli M, Taveira N, Teeple S, Tegegne TK, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Shifa GT, Terkawi AS, Tesema AG, Thakur JS, Thomson AJ, Tillmann T, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Tortajada M, Troeger C, Truelsen T, Tura AK, Uchendu US, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Boven JFM, Van Dingenen R, Varughese S, Vasankari T, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wagner JA, Wakayo T, Waller SG, Walson JL, Wang H, Wang YP, Watkins DA, Weiderpass E, Weintraub RG, Wen CP, Werdecker A, Wesana J, Westerman R, Whiteford HA, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Won S, Workicho A, Workie SB, Wubshet M, Xavier D, Xu G, Yadav AK, Yaghoubi M, Yakob B, Yan LL, Yano Y, Yaseri M, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zambrana-Torrelio C, Zapata T, Zenebe ZM, Zodpey S, Zoeckler L, Zuhlke LJ, Murray CJL. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390:231-266. [PMID: 28528753 PMCID: PMC5528124 DOI: 10.1016/s0140-6736(17)30818-8] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. METHODS We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. FINDINGS Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. INTERPRETATION This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. FUNDING Bill & Melinda Gates Foundation.
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. An Assessment of National Maternal and Child Health Policy-Makers' Knowledge and Capacity for Evidence- Informed Policy-Making in Nigeria. Int J Health Policy Manag 2017; 6:309-316. [PMID: 28812823 PMCID: PMC5458792 DOI: 10.15171/ijhpm.2016.132] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/25/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is increasing interest globally in the use of more rigorous processes to ensure that maternal, newborn, and child health (MNCH) care recommendations are informed by the best available research evidence use. The purpose of this study was to engage Nigerian MNCH policy-makers and other stakeholders to consider issues around research to policy and practice interface and to assess their existing knowledge and capacity on the use of research evidence for policy-making and practice. METHODS The study design is a cross-sectional evaluation of MNCH stakeholders' knowledge as it pertains different dimensions of research to practice. This was undertaken during a national MNCH stakeholders' engagement event convened under the auspices of the West African Health Organization (WAHO) and the Federal Ministry of Health (FMoH) in Abuja, Nigeria. A questionnaire was administered to participants, which was designed to assess participants' knowledge, capacity and organizational process of generation, synthesis and utilization of research evidence in policy-making regarding MNCH. RESULTS A total of 40 participants signed the informed consent form and completed the questionnaire. The mean ratings (MNRs) of participants' knowledge of electronic databases and capacity to identify and obtain relevant research evidence from electronic databases ranged from 3.62-3.68 on the scale of 5. The MNRs of participants' level of understanding of a policy brief, a policy dialogue and the role of researchers in policy-making ranged from 3.50-3.86. The MNRs of participants' level of understanding of evidence in policy-making context, types and sources of evidence, capacity to identify, select, adapt, and transform relevant evidence into policy ranged from 3.63-4.08. The MNRs of the participants' organization's capacity to cover their geographical areas of operation were generally low ranging from 3.32-3.38 in terms of manpower, logistics, facilities, and external support. The lowest MNR of 2.66 was recorded in funding. CONCLUSION The outcomes of this study suggest that a stakeholders' engagement event can serve as an important platform to assess policy-makers' knowledge and capacity for evidence-informed policy-making and for the promotion of evidence use in the policy process.
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Affiliation(s)
- Chigozie Jesse Uneke
- Knowledge Translation Platform, African Institute for Health Policy and Health Systems Studies, Ebonyi State University, Abakaliki, Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Namoudou Keita
- Organisation Ouest Africaine de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Virgil Lokossou
- Organisation Ouest Africaine de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, Bobo-Dioulasso, Burkina Faso
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. An assessment of policymakers' engagement initiatives to promote evidence informed health policy making in Nigeria. Pan Afr Med J 2017; 27:57. [PMID: 28819479 PMCID: PMC5554684 DOI: 10.11604/pamj.2017.27.57.9844] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/30/2016] [Indexed: 11/11/2022] Open
Abstract
In most developing countries including Nigeria, one of the most challenging issues associated with evidence-to-policy link is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence. The purpose of this review is to assess the efforts and various initiatives that have been undertaken to deliberately engage policymakers and other stakeholders in the health sector in Nigeria for the promotion of evidence informed policymaking. A MEDLINE Entrez Pubmed search was performed and studies that investigated policy making process, evidence to policy link, research to policy mechanism, and researchers/policymakers interaction in Nigeria in relation to health policy were sought. Of the 132 publications found, 14(10.6%) fulfilled the study inclusion criteria and were selected and included in the review. Of the fourteen scientific publications identified, 11 of the studies targeted both researchers and policymakers and the principal tool of intervention was training workshops which focused on various aspects of evidence informed policymaking. All the studies indicated positive outcomes and impacts in relation to quantifiable improvement in policymakers' knowledge and competence in evidence to policy process. Capacity strengthening engagement mechanism is needed for both researchers to generate better evidence and for policymakers and health-care professionals to better use available evidence.
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Affiliation(s)
- Chigozie Jesse Uneke
- Knowledge Translation Platform, African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Namoudou Keita
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Virgil Lokossou
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Pierre Ongolo-Zogo
- Hopital Central Yaounde, CDBPH Lawrence VERGNE Building 2nd Floor, Avenue Henry Dunant Messa Yaoundé
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SM, Schmidhuber J, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford K, Shaheen A, Shaikh MA, Levy TS, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shey M, Shi P, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silpakit N, Silva DAS, Silverberg JI, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Singh OP, Singh PK, Skirbekk V, Sligar A, Soneji S, Søreide K, Sorensen RJD, Soriano JB, Soshnikov S, Sposato LA, Sreeramareddy CT, Stahl HC, Stanaway JD, Stathopoulou V, Steckling N, Steel N, Stein DJ, Steiner C, Stöckl H, Stranges S, Strong M, Sun J, Sunguya BF, Sur P, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tabb KM, Talongwa RT, Tarawneh MR, Tavakkoli M, Taye B, Taylor HR, Tedla BA, Tefera W, Tegegne TK, Tekle DY, Shifa GT, Terkawi AS, Tessema GA, Thakur JS, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran BX, Truelsen T, Dimbuene ZT, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Donkelaar A, Varakin YY, Vasankari T, Vasconcelos AMN, Veerman JL, Venketasubramanian N, Verma RK, Violante FS, Vlassov VV, Volkow P, Vollset SE, Wagner GR, Wallin MT, Wang L, Wanga V, Watkins DA, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wilkinson JD, Wiysonge CS, Wolfe CDA, Wolfe I, Won S, Woolf AD, Workie SB, Wubshet M, Xu G, Yadav AK, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zambrana-Torrelio C, Zapata T, Zegeye EA, Zhao Y, Zhou M, Zodpey S, Zonies D, Murray CJL. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. Lancet 2016; 388:1813-1850. [PMID: 27665228 PMCID: PMC5055583 DOI: 10.1016/s0140-6736(16)31467-2] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 08/13/2016] [Accepted: 08/16/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). METHODS We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. FINDINGS In 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8-61·8) and varied widely by country, ranging from 85·5 (84·2-86·5) in Iceland to 20·4 (15·4-24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r2=0·88) and the MDG index (r2=0·92), whereas the non-MDG index had a weaker relation with SDI (r2=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0-10·4), and gains on the MDG index (a median change of 10·0 [6·7-13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1-8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. INTERPRETATION GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs. FUNDING Bill & Melinda Gates Foundation.
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Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, Brauer M, Burnett R, Cercy K, Charlson FJ, Cohen AJ, Dandona L, Estep K, Ferrari AJ, Frostad JJ, Fullman N, Gething PW, Godwin WW, Griswold M, Hay SI, Kinfu Y, Kyu HH, Larson HJ, Liang X, Lim SS, Liu PY, Lopez AD, Lozano R, Marczak L, Mensah GA, Mokdad AH, Moradi-Lakeh M, Naghavi M, Neal B, Reitsma MB, Roth GA, Salomon JA, Sur PJ, Vos T, Wagner JA, Wang H, Zhao Y, Zhou M, Aasvang GM, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abera SF, Abraham B, Abu-Raddad LJ, Abyu GY, Adebiyi AO, Adedeji IA, Ademi Z, Adou AK, Adsuar JC, Agardh EE, Agarwal A, Agrawal A, Kiadaliri AA, Ajala ON, Akinyemiju TF, Al-Aly Z, Alam K, Alam NKM, Aldhahri SF, Aldridge RW, Alemu ZA, Ali R, Alkerwi A, Alla F, Allebeck P, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Asayesh H, Asghar RJ, Assadi R, Atique S, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Bahit MC, Balakrishnan K, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Basu S, Batis C, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Bell B, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhansali A, Bhatt S, Biadgilign S, Bikbov B, Bisanzio D, Bjertness E, Blore JD, Borschmann R, Boufous S, Bourne RRA, Brainin M, Brazinova A, Breitborde NJK, Brenner H, Broday DM, Brugha TS, Brunekreef B, Butt ZA, Cahill LE, Calabria B, Campos-Nonato IR, Cárdenas R, Carpenter DO, Carrero JJ, Casey DC, Castañeda-Orjuela CA, Rivas JC, Castro RE, Catalá-López F, Chang JC, Chiang PPC, Chibalabala M, Chimed-Ochir O, Chisumpa VH, Chitheer AA, Choi JYJ, Christensen H, Christopher DJ, Ciobanu LG, Coates MM, Colquhoun SM, Manzano AGC, Cooper LT, Cooperrider K, Cornaby L, Cortinovis M, Crump JA, Cuevas-Nasu L, Damasceno A, Dandona R, Darby SC, Dargan PI, das Neves J, Davis AC, Davletov K, de Castro EF, De la Cruz-Góngora V, De Leo D, Degenhardt L, Del Gobbo LC, del Pozo-Cruz B, Dellavalle RP, Deribew A, Jarlais DCD, Dharmaratne SD, Dhillon PK, Diaz-Torné C, Dicker D, Ding EL, Dorsey ER, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Elyazar I, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fischer F, Fitchett JRA, Fleming T, Foigt N, Foreman K, Fowkes FGR, Franklin RC, Fürst T, Futran ND, Gakidou E, Garcia-Basteiro AL, Gebrehiwot TT, Gebremedhin AT, Geleijnse JM, Gessner BD, Giref AZ, Giroud M, Gishu MD, Giussani G, Goenka S, Gomez-Cabrera MC, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Gugnani HC, Guillemin F, Guo Y, Gupta R, Gupta R, Gutiérrez RA, Haagsma JA, Hafezi-Nejad N, Haile D, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hassanvand MS, Hassen TA, Havmoeller R, Heredia-Pi IB, Hernández-Llanes NF, Heydarpour P, Hoek HW, Hoffman HJ, Horino M, Horita N, Hosgood HD, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Husseini A, Hutchings SJ, Huybrechts I, Iburg KM, Idrisov BT, Ileanu BV, Inoue M, Jacobs TA, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jansen HAFM, Jassal SK, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jee SH, Jeemon P, Jha V, Jiang Y, Jibat T, Jin Y, Johnson CO, Jonas JB, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimkhani C, Kasaeian A, Kaul A, Kawakami N, Kazi DS, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khan G, Khang YH, Khatibzadeh S, Khera S, Khoja TAM, Khubchandani J, Kieling C, Kim CI, Kim D, Kimokoti RW, Kissoon N, Kivipelto M, Knibbs LD, Kokubo Y, Kopec JA, Koul PA, Koyanagi A, Kravchenko M, Kromhout H, Krueger H, Ku T, Defo BK, Kuchenbecker RS, Bicer BK, Kuipers EJ, Kumar GA, Kwan GF, Lal DK, Lalloo R, Lallukka T, Lan Q, Larsson A, Latif AA, Lawrynowicz AEB, Leasher JL, Leigh J, Leung J, Levi M, Li X, Li Y, Liang J, Liu S, Lloyd BK, Logroscino G, Lotufo PA, Lunevicius R, MacIntyre M, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Manamo WAA, Mapoma CC, Marcenes W, Martin RV, Martinez-Raga J, Masiye F, Matsushita K, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Medina C, Mehari A, Mejia-Rodriguez F, Mekonnen AB, Melaku YA, Memish ZA, Mendoza W, Mensink GBM, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Millear A, Miller TR, Mills EJ, Mirarefin M, Misganaw A, Mock CN, Mohammadi A, Mohammed S, Mola GLD, Monasta L, Hernandez JCM, Montico M, Morawska L, Mori R, Mozaffarian D, Mueller UO, Mullany E, Mumford JE, Murthy GVS, Nachega JB, Naheed A, Nangia V, Nassiri N, Newton JN, Ng M, Nguyen QL, Nisar MI, Pete PMN, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olsen H, Olusanya BO, Olusanya JO, Opio JN, Oren E, Orozco R, Ortiz A, Ota E, PA M, Pana A, Park EK, Parry CD, Parsaeian M, Patel T, Caicedo AJP, Patil ST, Patten SB, Patton GC, Pearce N, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Plass D, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Poulton RG, Pourmalek F, Prasad NM, Qorbani M, Rabiee RHS, Radfar A, Rafay A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajsic S, Raju M, Ram U, Rana SM, Ranganathan K, Rao P, García CAR, Refaat AH, Rehm CD, Rehm J, Reinig N, Remuzzi G, Resnikoff S, Ribeiro AL, Rivera JA, Roba HS, Rodriguez A, Rodriguez-Ramirez S, Rojas-Rueda D, Roman Y, Ronfani L, Roshandel G, Rothenbacher D, Roy A, Saleh MM, Sanabria JR, Sanchez-Riera L, Sanchez-Niño MD, Sánchez-Pimienta TG, Sandar L, Santomauro DF, Santos IS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schmidhuber J, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Servan-Mori EE, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Levy TS, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shi P, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Shishani K, Shiue I, Shrime MG, Sigfusdottir ID, Silva DAS, Silveira DGA, Silverberg JI, Simard EP, Sindi S, Singh A, Singh JA, Singh PK, Slepak EL, Soljak M, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steckling N, Steel N, Stein DJ, Stein MB, Stöckl H, Stranges S, Stroumpoulis K, Sunguya BF, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tavakkoli M, Taye BW, Taylor HR, Tedla BA, Tefera WM, Tegegne TK, Tekle DY, Terkawi AS, Thakur JS, Thomas BA, Thomas ML, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobe-Gai R, Tobollik M, Topor-Madry R, Topouzis F, Towbin JA, Tran BX, Dimbuene ZT, Tsilimparis N, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Donkelaar A, van Os J, Varakin YY, Vasankari T, Veerman JL, Venketasubramanian N, Violante FS, Vollset SE, Wagner GR, Waller SG, Wang JL, Wang L, Wang Y, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Wolfe CDA, Won S, Woolf AD, Wubshet M, Xavier D, Xu G, Yadav AK, Yakob B, Yalew AZ, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zhu J, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1659-1724. [PMID: 27733284 PMCID: PMC5388856 DOI: 10.1016/s0140-6736(16)31679-8] [Citation(s) in RCA: 2646] [Impact Index Per Article: 330.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/13/2016] [Accepted: 08/19/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. METHODS We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). FINDINGS Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. INTERPRETATION Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. FUNDING Bill & Melinda Gates Foundation.
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Kassebaum NJ, Arora M, Barber RM, Bhutta ZA, Brown J, Carter A, Casey DC, Charlson FJ, Coates MM, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kemmer L, Khalil IA, Kinfu Y, Kutz MJ, Kyu HH, Leung J, Liang X, Lim SS, Lozano R, Mensah GA, Mikesell J, Mokdad AH, Mooney MD, Naghavi M, Nguyen G, Nsoesie E, Pigott DM, Pinho C, Rankin Z, Reinig N, Salomon JA, Sandar L, Smith A, Sorensen RJD, Stanaway J, Steiner C, Teeple S, Troeger C, Truelsen T, VanderZanden A, Wagner JA, Wanga V, Whiteford HA, Zhou M, Zoeckler L, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Achoki T, Ackerman IN, Adebiyi AO, Adedeji IA, Adsuar JC, Afanvi KA, Afshin A, Agardh EE, Agarwal A, Agarwal SK, Ahmed MB, Kiadaliri AA, Ahmadieh H, Akseer N, Al-Aly Z, Alam K, Alam NKM, Aldhahri SF, Alegretti MA, Aleman AV, Alemu ZA, Alexander LT, Ali R, Alkerwi A, Alla F, Allebeck P, Allen C, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Anderson GM, Anderson BO, Antonio CAT, Anwari P, Ärnlöv J, Arsenijevic VSA, Artaman A, Asayesh H, Asghar RJ, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Barrero LH, Basu S, Bayou TA, Beardsley J, Bedi N, Beghi E, Bell B, Bell ML, Benjet C, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhansali A, Bhatt S, Biadgilign S, Bienhoff K, Bikbov B, Abdulhak AAB, Biryukov S, Bisanzio D, Bjertness E, Blore JD, Borschmann R, Boufous S, Bourne RRA, Brainin M, Brazinova A, Breitborde NJK, Brugha TS, Buchbinder R, Buckle GC, Butt ZA, Calabria B, Campos-Nonato IR, Campuzano JC, Carabin H, Carapetis JR, Cárdenas R, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Chang JC, Chiang PPC, Chibalabala M, Chibueze CE, Chisumpa VH, Choi JYJ, Choudhury L, Christensen H, Ciobanu LG, Colistro V, Colomar M, Colquhoun SM, Cortinovis M, Crump JA, Damasceno A, Dandona R, Dargan PI, das Neves J, Davey G, Davis AC, Leo DD, Degenhardt L, Gobbo LCD, Derrett S, Jarlais DCD, deVeber GA, Dharmaratne SD, Dhillon PK, Ding EL, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Ebrahimi H, Ellenbogen RG, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fahimi S, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Fischer F, Fitchett JRA, Foigt N, Fowkes FGR, Franklin RC, Friedman J, Frostad J, Fürst T, Futran ND, Gabbe B, Gankpé FG, Garcia-Basteiro AL, Gebrehiwot TT, Gebremedhin AT, Geleijnse JM, Gibney KB, Gillum RF, Ginawi IAM, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin WW, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Gugnani H, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hammami M, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haro JM, Hassanvand MS, Hassen TA, Havmoeller R, Hay RJ, Hedayati MT, Heredia-Pi IB, Heydarpour P, Hoek HW, Hoffman DJ, Horino M, Horita N, Hosgood HD, Hoy DG, Hsairi M, Huang H, Huang JJ, Iburg KM, Idrisov BT, Innos K, Inoue M, Jacobsen KH, Jauregui A, Jayatilleke AU, Jeemon P, Jha V, Jiang G, Jiang Y, Jibat T, Jimenez-Corona A, Jin Y, Jonas JB, Kabir Z, Kajungu DK, Kalkonde Y, Kamal R, Kan H, Kandel A, Karch A, Karema CK, Karimkhani C, Kasaeian A, Katibeh M, Kaul A, Kawakami N, Kazi DS, Keiyoro PN, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khang YH, Khoja TAM, Khubchandani J, Kieling C, Kim CI, Kim D, Kim YJ, Kissoon N, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Koul PA, Koyanagi A, Defo BK, Kuchenbecker RS, Bicer BK, Kuipers EJ, Kumar GA, Kwan GF, Lalloo R, Lallukka T, Larsson A, Latif AA, Lavados PM, Lawrynowicz AEB, Leasher JL, Leigh J, Leung R, Li Y, Li Y, Lipshultz SE, Liu PY, Liu Y, Lloyd BK, Logroscino G, Looker KJ, Lotufo PA, Lucas RM, Lunevicius R, Lyons RA, Razek HMAE, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Marcenes W, Martinez-Raga J, Masiye F, Mason-Jones AJ, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Mehari A, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Millear A, Miller TR, Mills EJ, Mirarefin M, Mirrakhimov EM, Mitchell PB, Mock CN, Mohammad KA, Mohammadi A, Mohammed S, Monasta L, Hernandez JCM, Montico M, Moradi-Lakeh M, Mori R, Mueller UO, Mumford JE, Murdoch ME, Murthy GVS, Nachega JB, Naheed A, Naldi L, Nangia V, Newton JN, Ng M, Ngalesoni FN, Nguyen QL, Nisar MI, Pete PMN, Nolla JM, Norheim OF, Norman RE, Norrving B, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olusanya BO, Olusanya JO, Oren E, Ortiz A, Ota E, Oyekale AS, PA M, Park EK, Parsaeian M, Patten SB, Patton GC, Pedro JM, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Pishgar F, Plass D, Polinder S, Popova S, Poulton RG, Pourmalek F, Prasad NM, Qorbani M, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai D, Rai RK, Rajsic S, Raju M, Ram U, Ranganathan K, Refaat AH, Reitsma MB, Remuzzi G, Resnikoff S, Reynolds A, Ribeiro AL, Ricci S, Roba HS, Rojas-Rueda D, Ronfani L, Roshandel G, Roth GA, Roy A, Sackey BB, Sagar R, Sanabria JR, Sanchez-Niño MD, Santos IS, Santos JV, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shahraz S, Shaikh MA, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Sigfusdottir ID, Silva DAS, Silverberg JI, Simard EP, Singh A, Singh JA, Singh PK, Skirbekk V, Skogen JC, Soljak M, Søreide K, Sorensen RJD, Sreeramareddy CT, Stathopoulou V, Steel N, Stein DJ, Stein MB, Steiner TJ, Stovner LJ, Stranges S, Stroumpoulis K, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tandon N, Tanne D, Tavakkoli M, Taye B, Taylor HR, Ao BJT, Tegegne TK, Tekle DY, Terkawi AS, Tessema GA, Thakur JS, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran BX, Truelsen T, Dimbuene ZT, Tsilimbaris M, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Gool CH, van Os J, Vasankari T, Vasconcelos AMN, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Wallin MT, Wang L, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Wijeratne T, Wilkinson JD, Williams HC, Wiysonge CS, Woldeyohannes SM, Wolfe CDA, Won S, Xu G, Yadav AK, Yakob B, Yan LL, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zeeb H, Zodpey S, Zonies D, Zuhlke LJ, Vos T, Lopez AD, Murray CJL. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1603-1658. [PMID: 27733283 PMCID: PMC5388857 DOI: 10.1016/s0140-6736(16)31460-x] [Citation(s) in RCA: 1387] [Impact Index Per Article: 173.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING Bill & Melinda Gates Foundation.
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. An assessment of maternal, newborn and child health implementation studies in Nigeria: implications for evidence informed policymaking and practice. Health Promot Perspect 2016; 6:119-27. [PMID: 27579255 PMCID: PMC5002878 DOI: 10.15171/hpp.2016.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/27/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The introduction of implementation science into maternal, newborn and child health (MNCH) research has facilitated better methods to improve uptake of research findings into practices. With increase in implementation research related to MNCH world-wide, stronger scientific evidence are now available and have improved MNCH policies in many countries including Nigeria. The purpose of this study was to review MNCH implementation studies undertaken in Nigeria in order to understand the extent the evidence generated informed better policy. METHODS This study was a systematic review. A MEDLINE Entrez PubMed search was performed in August 2015 and implementation studies that investigated MNCH in Nigeria from 1966 to 2015 in relation to health policy were sought. Search key words included Nigeria, health policy, maternal, newborn, and child health. Only policy relevant studies that were implementation or intervention research which generated evidence to improve MNCH in Nigeria were eligible and were selected. RESULTS A total of 18 relevant studies that fulfilled the study inclusion criteria were identified out of 471 studies found. These studies generated high quality policy relevance evidence relating to task shifting, breastfeeding practices, maternal nutrition, childhood immunization, kangaroo mother care (KMC), prevention of maternal to child transmission of HIV, etc. These indicated significant improvements in maternal health outcomes in localities and health facilities where the studies were undertaken. CONCLUSION There is a dire need for more implementation research related to MNCH in low income settings because the priority for improved MNCH outcome is not so much the development of new technologies but solving implementation issues, such as how to scale up and evaluate interventions within complex health systems.
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Affiliation(s)
- Chigozie Jesse Uneke
- Knowledge Translation Platform, African Institute for Health Policy & Health Systems Studies, Ebonyi State University, PMB 053 Abakaliki Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Namoudou Keita
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Virgil Lokossou
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, avenue Ouezzin Coulibaly, 01 BP 153 Bobo-Dioulasso 01, Burkina Faso
| | - Pierre Ongolo-Zogo
- Hospital Central Yaounde, CDBPH Lawrence VERGNE Building 2nd Floor, Avenue Henry Dunant, Messa, Yaoundé, Cameroon
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Wang H, Wolock TM, Carter A, Nguyen G, Kyu HH, Gakidou E, Hay SI, Mills EJ, Trickey A, Msemburi W, Coates MM, Mooney MD, Fraser MS, Sligar A, Salomon J, Larson HJ, Friedman J, Abajobir AA, Abate KH, Abbas KM, Razek MMAE, Abd-Allah F, Abdulle AM, Abera SF, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Abyu GY, Adebiyi AO, Adedeji IA, Adelekan AL, Adofo K, Adou AK, Ajala ON, Akinyemiju TF, Akseer N, Lami FHA, Al-Aly Z, Alam K, Alam NKM, Alasfoor D, Aldhahri SFS, Aldridge RW, Alegretti MA, Aleman AV, Alemu ZA, Alfonso-Cristancho R, Ali R, Alkerwi A, Alla F, Mohammad R, Al-Raddadi S, Alsharif U, Alvarez E, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Ammar W, Amrock SM, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Asayesh H, Asghar RJ, Assadi R, Atique S, Atkins LS, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Bacha U, Badawi A, Barac A, Bärnighausen T, Basu A, Bayou TA, Bayou YT, Bazargan-Hejazi S, Beardsley J, Bedi N, Bennett DA, Bensenor IM, Betsu BD, Beyene AS, Bhatia E, Bhutta ZA, Biadgilign S, Bikbov B, Birlik SM, Bisanzio D, Brainin M, Brazinova A, Breitborde NJK, Brown A, Burch M, Butt ZA, Campuzano JC, Cárdenas R, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Chang HY, Chang JC, Chavan L, Chen W, Chiang PPC, Chibalabala M, Chisumpa VH, Choi JYJ, Christopher DJ, Ciobanu LG, Cooper C, Dahiru T, Damtew SA, Dandona L, Dandona R, das Neves J, de Jager P, De Leo D, Degenhardt L, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dharmaratne SD, Ding EL, Doshi PP, Doyle KE, Driscoll TR, Dubey M, Elshrek YM, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Faghmous IDA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Fereshtehnejad SM, Fernandes JC, Fischer F, Fitchett JRA, Foigt N, Fullman N, Fürst T, Gankpé FG, Gebre T, Gebremedhin AT, Gebru AA, Geleijnse JM, Gessner BD, Gething PW, Ghiwot TT, Giroud M, Gishu MD, Glaser E, Goenka S, Goodridge A, Gopalani SV, Goto A, Gugnani HC, Guimaraes MDC, Gupta R, Gupta R, Gupta V, Haagsma J, Hafezi-Nejad N, Hagan H, Hailu GB, Hamadeh RR, Hamidi S, Hammami M, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Harun KM, Havmoeller R, Hedayati MT, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Hoy DG, Hsairi M, Hu G, Huang H, Huang JJ, Iburg KM, Idrisov BT, Innos K, Iyer VJ, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayatilleke AU, Jeemon P, Jha V, Jiang G, Jiang Y, Jibat T, Jonas JB, Kabir Z, Kamal R, Kan H, Karch A, Karema CK, Karletsos D, Kasaeian A, Kaul A, Kawakami N, Kayibanda JF, Keiyoro PN, Kemp AH, Kengne AP, Kesavachandran CN, Khader YS, Khalil I, Khan AR, Khan EA, Khang YH, Khubchandani J, Kim YJ, Kinfu Y, Kivipelto M, Kokubo Y, Kosen S, Koul PA, Koyanagi A, Defo BK, Bicer BK, Kulkarni VS, Kumar GA, Lal DK, Lam H, Lam JO, Langan SM, Lansingh VC, Larsson A, Leigh J, Leung R, Li Y, Lim SS, Lipshultz SE, Liu S, Lloyd BK, Logroscino G, Lotufo PA, Lunevicius R, Razek HMAE, Mahdavi M, Mahesh PA, Majdan M, Majeed A, Makhlouf C, Malekzadeh R, Mapoma CC, Marcenes W, Martinez-Raga J, Marzan MB, Masiye F, Mason-Jones AJ, Mayosi BM, McKee M, Meaney PA, Mehndiratta MM, Mekonnen AB, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mhimbira FA, Miller TR, Mikesell J, Mirarefin M, Mohammad KA, Mohammed S, Mokdad AH, Monasta L, Moradi-Lakeh M, Mori R, Mueller UO, Murimira B, Murthy GVS, Naheed A, Naldi L, Nangia V, Nash D, Nawaz H, Nejjari C, Ngalesoni FN, de Dieu Ngirabega J, Nguyen QL, Nisar MI, Norheim OF, Norman RE, Nyakarahuka L, Ogbo FA, Oh IH, Ojelabi FA, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ota E, Park HY, Park JH, Patil ST, Patten SB, Paul VK, Pearson K, Peprah EK, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Pillay JD, Plass D, Polinder S, Pourmalek F, Prokop DM, Qorbani M, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajsic S, Ram U, Rana SM, Rao PV, Remuzzi G, Rojas-Rueda D, Ronfani L, Roshandel G, Roy A, Ruhago GM, Saeedi MY, Sagar R, Saleh MM, Sanabria JR, Santos IS, Sarmiento-Suarez R, Sartorius B, Sawhney M, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shaikh MA, Sharma R, She J, Sheikhbahaei S, Shen J, Shibuya K, Shin HH, Sigfusdottir ID, Silpakit N, Silva DAS, Silveira DGA, Simard EP, Sindi S, Singh JA, Singh OP, Singh PK, Skirbekk V, Sliwa K, Soneji S, Sorensen RJD, Soriano JB, Soti DO, Sreeramareddy CT, Stathopoulou V, Steel N, Sunguya BF, Swaminathan S, Sykes BL, Tabarés-Seisdedos R, Talongwa RT, Tavakkoli M, Taye B, Tedla BA, Tekle T, Shifa GT, Temesgen AM, Terkawi AS, Tesfay FH, Tessema GA, Thapa K, Thomson AJ, Thorne-Lyman AL, Tobe-Gai R, Topor-Madry R, Towbin JA, Tran BX, Dimbuene ZT, Tsilimparis N, Tura AK, Ukwaja KN, Uneke CJ, Uthman OA, Venketasubramanian N, Vladimirov SK, Vlassov VV, Vollset SE, Wang L, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Wijeratne T, Wilkinson JD, Wiysonge CS, Wolfe CDA, Won S, Wong JQ, Xu G, Yadav AK, Yakob B, Yalew AZ, Yano Y, Yaseri M, Yebyo HG, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Yu S, Zaidi Z, Zaki MES, Zeeb H, Zhang H, Zhao Y, Zodpey S, Zoeckler L, Zuhlke LJ, Lopez AD, Murray CJL. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. Lancet HIV 2016; 3:e361-e387. [PMID: 27470028 PMCID: PMC5056319 DOI: 10.1016/s2352-3018(16)30087-x] [Citation(s) in RCA: 405] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/09/2016] [Accepted: 06/17/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. INTERPRETATION Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. FUNDING Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health.
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Uneke CJ, Ezeoha AE, Uro-Chukwu H, Ezeonu CT, Ogbu O, Onwe F, Edoga C. Improving Nigerian health policymakers' capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop. Pan Afr Med J 2015; 21:212. [PMID: 26448807 PMCID: PMC4587084 DOI: 10.11604/pamj.2015.21.212.6375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/01/2015] [Indexed: 11/24/2022] Open
Abstract
Information and communication technology (ICT) tools are known to facilitate communication and processing of information and sharing of knowledge by electronic means. In Nigeria, the lack of adequate capacity on the use of ICT by health sector policymakers constitutes a major impediment to the uptake of research evidence into the policymaking process. The objective of this study was to improve the knowledge and capacity of policymakers to access and utilize policy relevant evidence. A modified “before and after” intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point likert scale according to the degree of adequacy; 1 = grossly inadequate, 4 = very adequate was employed. This study was conducted in Ebonyi State, south-eastern Nigeria and the participants were career health policy makers. A two-day intensive ICT training workshop was organized for policymakers who had 52 participants in attendance. Topics covered included: (i). intersectoral partnership/collaboration; (ii). Engaging ICT in evidence-informed policy making; use of ICT for evidence synthesis; (iv) capacity development on the use of computer, internet and other ICT. The pre-workshop mean of knowledge and capacity for use of ICT ranged from 2.19-3.05, while the post-workshop mean ranged from 2.67-3.67 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 8.3%-39.1%. Findings of this study suggest that policymakers’ ICT competence relevant to evidence-informed policymaking can be enhanced through training workshop.
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Affiliation(s)
- Chigozie Jesse Uneke
- Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University Abakaliki, Nigeria ; Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria
| | - Abel Ebeh Ezeoha
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; Department of Banking & Finance, Ebonyi State University Abakaliki, Nigeria
| | - Henry Uro-Chukwu
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; National Obstetrics Fistula Centre, Abakaliki, Nigeria
| | - Chinonyelum Thecla Ezeonu
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; Department of Paediatrics, Ebonyi State University Abakaliki, Nigeria
| | - Ogbonnaya Ogbu
- Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University Abakaliki, Nigeria ; Department of Applied Microbiology, Ebonyi State University Abakaliki, Nigeria
| | - Friday Onwe
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; Department of Sociology/Anthropology, Ebonyi State University Abakaliki, Nigeria
| | - Chima Edoga
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki, Nigeria ; Catholic Relief Services (Nigeria Program), Abakaliki, Nigeria
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Uneke CJ, Ebeh Ezeoha A, Uro-Chukwu H, Ezeonu CT, Ogbu O, Onwe F, Edoga C. Promoting Evidence to Policy Link on the Control of Infectious Diseases of Poverty in Nigeria: Outcome of A Multi-Stakeholders Policy Dialogue. Health Promot Perspect 2015; 5:104-15. [PMID: 26290826 DOI: 10.15171/hpp.2015.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/31/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In Nigeria, malaria, schistosomiasis and lymphatic filariasis are among infectious diseases of poverty (IDP) with severe health burden and require effective policy strategies for their control. In this study, we investigated the value of policy brief and policy dialogue as excellent policymaking mechanisms that enable policymakers to adapt effective evidence informed policy for IDP control. METHODS A policy brief was developed on the control of malaria, schistosomiasis and lymphatic filariasis and subjected to deliberations in a one-day multi-stakeholder policy dialogue held in Ebonyi State Nigeria. A modified cross sectional intervention study design was used in this investigation. Structured pre-tested questionnaires were used to evaluate the policy brief document and policy dialogue process at the end of the policy dialogue. RESULTS Forty-seven policymakers participated in the dialogue. An analysis of the response on the policy brief regarding context, different features of the problem; policy options and key implementation considerations indicated the mean ratings (MNRs) mostly ranged from 6.40-6.85 on 7 point scale. The over-all assessment of the policy brief had MNR at 6.54. The analysis of the response on the policy dialogue regarding the level of priority of policy issue, opportunity to discuss different features of the problem and options for addressing the problem, and the MNRs mostly ranged from 6.50-6.82. The overall assessment of the policy dialogue had MNR at 6.72. CONCLUSION Policy dialogues can allow research evidence to be considered together with views, experiences and tacit knowledge of policymakers and can enhance evidence-to-policy link.
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Affiliation(s)
- Chigozie Jesse Uneke
- Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University Abakaliki Nigeria ; Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki Nigeria
| | - Abel Ebeh Ezeoha
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki Nigeria ; Department of Banking & Finance, Ebonyi State University Abakaliki, Nigeria
| | - Henry Uro-Chukwu
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki Nigeria ; National Obstetrics Fistula Centre, Abakaliki, Nigeria
| | - Chinonyelum Thecla Ezeonu
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki Nigeria ; Department of Paediatrics, Ebonyi State University Abakaliki, Nigeria
| | - Ogbonnaya Ogbu
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki Nigeria ; Department of Applied Microbiology, Ebonyi State University Abakaliki Nigeria
| | - Friday Onwe
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki Nigeria ; Department of Sociology/Anthropology, Ebonyi State University Abakaliki, Nigeria
| | - Chima Edoga
- Health Policy & systems Research Project (Knowledge Translation Platform), Ebonyi State University Abakaliki Nigeria ; Catholic Relief Services (Nigeria Program) Abakaliki, Nigeria
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