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Kazibwe J, Tran PB, Kaiser AH, Kasagga SP, Masiye F, Ekman B, Sundewall J. The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence. BMC Health Serv Res 2024; 24:432. [PMID: 38580960 PMCID: PMC10996233 DOI: 10.1186/s12913-024-10815-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Low- and middle-income countries have committed to achieving universal health coverage (UHC) as a means to enhance access to services and improve financial protection. One of the key health financing reforms to achieve UHC is the introduction or expansion of health insurance to enhance access to basic health services, including maternal and reproductive health care. However, there is a paucity of evidence of the extent to which these reforms have had impact on the main policy objectives of enhancing service utilization and financial protection. The aim of this systematic review is to assess the existing evidence on the causal impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search included six databases: Medline, Embase, Web of Science, Cochrane, CINAHL, and Scopus as of 23rd May 2023. The keywords included health insurance, impact, utilisation, financial protection, and maternal and reproductive health. The search was followed by independent title and abstract screening and full text review by two reviewers using the Covidence software. Studies published in English since 2010, which reported on the impact of health insurance on maternal and reproductive health utilisation and or financial protection were included in the review. The ROBINS-I tool was used to assess the quality of the included studies. RESULTS A total of 17 studies fulfilled the inclusion criteria. The majority of the studies (82.4%, n = 14) were nationally representative. Most studies found that health insurance had a significant positive impact on having at least four antenatal care (ANC) visits, delivery at a health facility and having a delivery assisted by a skilled attendant with average treatment effects ranging from 0.02 to 0.11, 0.03 to 0.34 and 0.03 to 0.23 respectively. There was no evidence that health insurance had increased postnatal care, access to contraception and financial protection for maternal and reproductive health services. Various maternal and reproductive health indicators were reported in studies. ANC had the greatest number of reported indicators (n = 10), followed by financial protection (n = 6), postnatal care (n = 5), and delivery care (n = 4). The overall quality of the evidence was moderate based on the risk of bias assessment. CONCLUSION The introduction or expansion of various types of health insurance can be a useful intervention to improve ANC (receiving at least four ANC visits) and delivery care (delivery at health facility and delivery assisted by skilled birth attendant) service utilization in low- and lower-middle-income countries. Implementation of health insurance could enable countries' progress towards UHC and reduce maternal mortality. However, more research using rigorous impact evaluation methods is needed to investigate the causal impact of health insurance coverage on postnatal care utilization, contraceptive use and financial protection both in the general population and by socioeconomic status. TRIAL REGISTRATION This study was registered with Prospero (CRD42021285776).
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Affiliation(s)
- Joseph Kazibwe
- Department of Clinical Sciences, Lund University, Jan Waldenströms Gata, 35205 02, Malmö, Sweden.
| | - Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Andrea Hannah Kaiser
- Department of Clinical Sciences, Lund University, Jan Waldenströms Gata, 35205 02, Malmö, Sweden
| | | | - Felix Masiye
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Björn Ekman
- Department of Clinical Sciences, Lund University, Jan Waldenströms Gata, 35205 02, Malmö, Sweden
| | - Jesper Sundewall
- Department of Clinical Sciences, Lund University, Jan Waldenströms Gata, 35205 02, Malmö, Sweden
- HEARD, University of KwaZulu-Natal, Durban, South Africa
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Tran PB, Nikolaidis GF, Abatih E, Bos P, Berete F, Gorasso V, Van der Heyden J, Kazibwe J, Tomeny EM, Van Hal G, Beutels P, van Olmen J. Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study). Health Res Policy Syst 2024; 22:35. [PMID: 38519938 PMCID: PMC10960468 DOI: 10.1186/s12961-024-01113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The complex management of health needs in multimorbid patients, alongside limited cost data, presents challenges in developing cost-effective patient-care pathways. We estimated the costs of managing 171 dyads and 969 triads in Belgium, taking into account the influence of morbidity interactions on costs. METHODS We followed a retrospective longitudinal study design, using the linked Belgian Health Interview Survey 2018 and the administrative claim database 2017-2020 hosted by the Intermutualistic Agency. We included people aged 15 and older, who had complete profiles (N = 9753). Applying a system costing perspective, the average annual direct cost per person per dyad/triad was presented in 2022 Euro and comprised mainly direct medical costs. We developed mixed models to analyse the impact of single chronic conditions, dyads and triads on healthcare costs, considering two-/three-way interactions within dyads/triads, key cost determinants and clustering at the household level. RESULTS People with multimorbidity constituted nearly half of the study population and their total healthcare cost constituted around three quarters of the healthcare cost of the study population. The most common dyad, arthropathies + dorsopathies, with a 14% prevalence rate, accounted for 11% of the total national health expenditure. The most frequent triad, arthropathies + dorsopathies + hypertension, with a 5% prevalence rate, contributed 5%. The average annual direct costs per person with dyad and triad were €3515 (95% CI 3093-3937) and €4592 (95% CI 3920-5264), respectively. Dyads and triads associated with cancer, diabetes, chronic fatigue, and genitourinary problems incurred the highest costs. In most cases, the cost associated with multimorbidity was lower or not substantially different from the combined cost of the same conditions observed in separate patients. CONCLUSION Prevalent morbidity combinations, rather than high-cost ones, made a greater contribution to total national health expenditure. Our study contributes to the sparse evidence on this topic globally and in Europe, with the aim of improving cost-effective care for patients with diverse needs.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
- Department of Epidemiology and public health, Brussels, Belgium.
| | | | - Emmanuel Abatih
- Department of Applied Mathematics, Computer Sciences and Statistics, Ghent University, Ghent, Belgium
| | - Philippe Bos
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Finaba Berete
- Department of Epidemiology and public health, Brussels, Belgium
| | - Vanessa Gorasso
- Department of Epidemiology and public health, Brussels, Belgium
| | | | - Joseph Kazibwe
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Ewan Morgan Tomeny
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Guido Van Hal
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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Kazibwe J, Gad M, Abassah-Konadu E, Amankwah I, Owusu R, Gulbi G, Torres-Rueda S, Asare B, Vassall A, Ruiz F. The epidemiological and economic burden of diabetes in Ghana: A scoping review to inform health technology assessment. PLOS Glob Public Health 2024; 4:e0001904. [PMID: 38470940 DOI: 10.1371/journal.pgph.0001904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
Diabetes remains one of the four major causes of morbidity and mortality globally among non-communicable diseases (NCDs. It is predicted to increase in sub-Saharan Africa by over 50% by 2045. The aim of this study is to identify, map and estimate the burden of diabetes in Ghana, which is essential for optimising NCD country policy and understanding existing knowledge gaps to guide future research in this area. We followed the Arksey and O'Malley framework for scoping reviews. We searched electronic databases including Medline, Embase, Web of Science, Scopus, Cochrane and African Index Medicus following a systematic search strategy. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews was followed when reporting the results. A total of 36 studies were found to fulfil the inclusion criteria. The reported prevalence of diabetes at national level in Ghana ranged between 2.80%- 3.95%. At the regional level, the Western region reported the highest prevalence of diabetes: 39.80%, followed by Ashanti region (25.20%) and Central region at 24.60%. The prevalence of diabetes was generally higher in women in comparison to men. Urban areas were found to have a higher prevalence of diabetes than rural areas. The mean annual financial cost of managing one diabetic case at the outpatient clinic was estimated at GHS 540.35 (2021 US $194.09). There was a paucity of evidence on the overall economic burden and the regional prevalence burden. Ghana is faced with a considerable burden of diabetes which varies by region and setting (urban/rural). There is an urgent need for effective and efficient interventions to prevent the anticipated elevation in burden of disease through the utilisation of existing evidence and proven priority-setting tools like Health Technology Assessment (HTA).
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Affiliation(s)
- Joseph Kazibwe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mohamed Gad
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | | | - Ivy Amankwah
- Pharmacy Directorate, Ministry of Health, Accra, Ghana
| | - Richmond Owusu
- School of Public Health, University of Ghana, Accra, Ghana
| | - Godwin Gulbi
- School of Public Health, University of Ghana, Accra, Ghana
| | - Sergio Torres-Rueda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Brian Asare
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Francis Ruiz
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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Kazibwe R, Singleton MJ, Ahmad MI, Kaze AD, Chevli PA, Namutebi JH, Kasozi RN, Asiimwe DD, Kazibwe J, Shapiro MD, Yeboah J. Association between weight variability, weight change and clinical outcomes in hypertension. Am J Prev Cardiol 2023; 16:100610. [PMID: 37942025 PMCID: PMC10630599 DOI: 10.1016/j.ajpc.2023.100610] [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: 07/28/2023] [Revised: 08/30/2023] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The effect of body weight variability (BWV) and body weight change (BWC) in high-risk individuals with hypertension, but without diabetes mellitus (DM) remains unclear. We examined the effect of BWV and BWC on the primary outcome [the composite of myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure (HF), or cardiovascular (CV) death] and all-cause mortality in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods In this post-hoc analysis, we used multivariate Cox regression models to examine the risk associated with BWV and BWC for the primary outcome in SPRINT. BWV was defined as the intra-individual average successive variability (ASV). BWC was defined as baseline weight minus final weight. Results A total of 8714 SPRINT participants (mean age 67.8 ± 9.4 years, 35.1 % women, 58.9 % Whites) with available data on body weight were included. The median follow-up was about 3.9 years (IQR, 3.3-4.4). In multivariable-adjusted Cox models, each 1 unit standard deviation (SD) of BWV was significantly associated with a higher risk for the primary outcome, all-cause mortality, HF, MI, and stroke [HR(95 % CI)]: 1.13 (1.07-1.19; p < 0.0001), 1.22 (1.14-1.30; p < 0.0001), 1.16 (1.07-1.26; p < 0.001), 1.10 (1.00-1.20; p = 0.047), and 1.15 (1.05-1.27; p = 0.005), respectively. Similarly, each 1 unit SD of BWC was significantly associated with a higher risk of the primary outcome, all-cause mortality, MI, and HF: 1.11(1.02-1.21; p = 0.017), 1.44 (1.26-1.65; p < 0.0001), 1.16 (1.01-1.32; p = 0.041) and 1.19 (1.02-1.40; p = 0.031) respectively. However, there was no significant association with CV death (for both BWV and BWC) or stroke (BWC). Conclusion In high-risk hypertension, BWV and BWC were both associated with higher risk of the primary outcome and all-cause mortality. These results further stress the clinical importance of sustained weight loss and minimizing fluctuations in weight in hypertension.
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Affiliation(s)
- Richard Kazibwe
- Department of Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Matthew J. Singleton
- Department of Medicine, Section on Cardiovascular Medicine, WellSpan Health, York, PA, USA
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | | | - Parag A. Chevli
- Department of Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Ramla N. Kasozi
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Joseph Kazibwe
- Department of Cardiology, Sheffield Teaching Hospital, Sheffield, UK
| | - Michael D. Shapiro
- Center for the Prevention of Cardiovascular Disease Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Joseph Yeboah
- Department of Medicine, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Mayora C, Kazibwe J, Ssempala R, Nakimuli B, Ssennyonjo A, Ekirapa E, Byakika S, Aliti T, Musila T, Gad M, Vassall A, Ruiz F, Ssengooba F. Health technology assessment (HTA) readiness in Uganda: stakeholder's perceptions on the potential application of HTA to support national universal health coverage efforts. Int J Technol Assess Health Care 2023; 39:e65. [PMID: 37905441 DOI: 10.1017/s0266462323002635] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Health technology assessment (HTA) is an area that remains less implemented in low- and lower middle-income countries. The aim of the study is to understand the perceptions of stakeholders in Uganda toward HTA and its role in decision making, in order to inform its potential implementation in the country. METHODS The study takes a cross-sectional mixed methods approach, utilizing an adapted version of the International Decision Support Initiative questionnaire with both semi-structured and open-ended questions. We interviewed thirty key informants from different stakeholder institutions in Uganda that support policy and decision making in the health sector. RESULTS All participants perceived HTA as an important tool for decision making. Allocative efficiency was regarded as the most important use of HTA receiving the highest average score (8.8 out of 10), followed by quality of healthcare (7.8/10), transparency (7.6/10), budget control (7.5/10), and equity (6.5/10). There was concern that some of the uses of HTA may not be achieved in reality if there was political interference during the HTA process. The study participants identified development partners as the most likely potential users of HTA (66.7 percent of participants), followed by Ministry of Health (43.3 percent). CONCLUSION Interviewed stakeholders in Uganda viewed the role of HTA positively, suggesting that there exists a promising environment for the establishment and operationalization of HTA as a tool for decision making within the health sector. However, sustainable development and application of HTA in Uganda will require adequate capacity both to undertake HTAs and to support their use and uptake.
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Affiliation(s)
- Chrispus Mayora
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Kazibwe
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Ssempala
- Department of Economic Theory and Analysis, Makerere University School of Economics, Kampala, Uganda
| | - Brenda Nakimuli
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Aloysius Ssennyonjo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Elizabeth Ekirapa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Sarah Byakika
- Department of Planning, Financing and Policy, Ministry of Health, Kampala, Uganda
| | - Tom Aliti
- Department of Planning, Financing and Policy, Ministry of Health, Kampala, Uganda
| | - Timothy Musila
- Department of Planning, Financing and Policy, Ministry of Health, Kampala, Uganda
| | - Mohamed Gad
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Francis Ruiz
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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Todd H, Hudson M, Grolmusova N, Kazibwe J, Pearman J, Skender K, Tran PB, Boccia D, Shete PB, Wingfield T. Social Protection Interventions for TB-Affected Households: A Scoping Review. Am J Trop Med Hyg 2023; 108:650-659. [PMID: 36806490 PMCID: PMC10076998 DOI: 10.4269/ajtmh.22-0470] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/28/2022] [Indexed: 02/22/2023] Open
Abstract
Tuberculosis (TB) and poverty are inextricably linked. Catastrophic costs of TB illness drive TB-affected households into worsening impoverishment and hamper treatment success. The WHO's End TB Strategy recommends social protection for TB-affected households to mitigate financial shock and improve TB outcomes. This scoping review maps the landscape of social protection interventions for people with TB and their households in low- and middle-income countries with high TB burden. A systematic search of Medline, Embase, PubMed, and Web of Science for relevant articles was performed, supplemented with a gray literature search of key databases. Articles were included if they described social protection available to people with TB and TB-affected households in a low- or middle-income country. Data were synthesized in tabular form, and descriptive narrative outlined the successes and challenges of the social protection interventions identified. The search identified 33,360 articles. After abstract screening, 74 articles underwent full text screening, and 49 were included in the final analysis. Forty-three types of social protection were identified, of which 24 were TB specific (i.e., only people with TB were eligible). Varying definitions were used to describe similar social protection interventions, which limited cross-study comparison. Intervention successes included acceptability and increased financial autonomy among recipients. Challenges included delays in intervention delivery and unexpected additional bank transfer fees. A wide range of acceptable social protection interventions are available, with cash transfer schemes predominating. Use of standardized definitions of social protection interventions would facilitate consolidation of evidence and enhance design and implementation in future.
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Affiliation(s)
- Heather Todd
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Mollie Hudson
- School of Nursing, University of California San Francisco, San Francisco, California
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Natalia Grolmusova
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joseph Kazibwe
- London School of Hygiene and Tropical Medicine, Liverpool, United Kingdom
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Joseph Pearman
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Kristina Skender
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Phuong B. Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Delia Boccia
- London School of Hygiene and Tropical Medicine, Liverpool, United Kingdom
| | - Priya B. Shete
- Center for Tuberculosis University of California, San Francisco, San Francisco, California
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, California
| | - Tom Wingfield
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Kazibwe J, Shah HA, Kuwawenaruwa A, Schell CO, Khalid K, Tran PB, Ghosh S, Baker T, Guinness L. Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review. BMJ Open 2022; 12:e060422. [PMID: 36414306 PMCID: PMC9684998 DOI: 10.1136/bmjopen-2021-060422] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Critical care is essential in saving lives of critically ill patients, however, provision of critical care across lower resource settings can be costly, fragmented and heterogenous. Despite the urgent need to scale up the provision of critical care, little is known about its availability and cost. Here, we aim to systematically review and identify reported resource use, availability and costs for the provision of critical care and the nature of critical care provision in Tanzania. DESIGN This is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Medline, Embase and Global Health databases were searched covering the period 2010 to 17 November 2020. ELIGIBILITY CRITERIA We included studies that reported on forms of critical care offered, critical care services offered and/or costs and resources used in the provision of care in Tanzania published from 2010. DATA EXTRACTION AND SYNTHESIS Quality assessment of the articles and data extraction was done by two independent researchers. The Reference Case for Estimating the Costs of Global Health Services and Interventions was used to assess quality of included studies. A narrative synthesis of extracted data was conducted. Costs were adjusted and reported in 2019 US$ and TZS using the World Bank GDP deflators. RESULTS A total 31 studies were found to fulfil the inclusion and exclusion criteria. Critical care identified in Tanzania was categorised into: intensive care unit (ICU) delivered critical care and non-ICU critical care. The availability of ICU delivered critical care was limited to urban settings whereas non-ICU critical care was found in rural and urban settings. Paediatric critical care equipment was more scarce than equipment for adults. 15 studies reported on the costs of services related to critical care yet no study reported an average or unit cost of critical care. Costs of medication, equipment (eg, oxygen, personal protective equipment), services and human resources were identified as inputs to specific critical care services in Tanzania. CONCLUSION There is limited evidence on the resource use, availability and costs of critical care in Tanzania. There is a strong need for further empirical research on critical care resources availability, utilisation and costs across specialties and hospitals of different level in low/middle-income countries like Tanzania to inform planning, priority setting and budgeting for critical care services. PROSPERO REGISTRATION NUMBER CRD42020221923.
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Affiliation(s)
- Joseph Kazibwe
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Hiral A Shah
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Center for Global Development, Washington, DC, USA
| | - August Kuwawenaruwa
- Health System Impact Evaluation and Policy Unit, Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Karima Khalid
- Department of Anaesthesia and Critical Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Srobana Ghosh
- Global Health Department, Center for Global Development, Washington, DC, USA
| | - Tim Baker
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Department of Emergency Medicine, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Lorna Guinness
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Center for Global Development, Washington, DC, USA
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Tran PB, Kazibwe J, Nikolaidis GF, Linnosmaa I, Rijken M, van Olmen J. Costs of multimorbidity: a systematic review and meta-analyses. BMC Med 2022; 20:234. [PMID: 35850686 PMCID: PMC9295506 DOI: 10.1186/s12916-022-02427-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multimorbidity is a rising global phenomenon, placing strains on countries' population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What "cost ingredients" are most commonly included in these multimorbidity studies? METHODS We conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$). RESULTS Fifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs. CONCLUSIONS Multimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Joseph Kazibwe
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ismo Linnosmaa
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Mieke Rijken
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.,Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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9
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Kazibwe J, Gheorghe A, Wilson D, Ruiz F, Chalkidou K, Chi YL. The Use of Cost-Effectiveness Thresholds for Evaluating Health Interventions in Low- and Middle-Income Countries From 2015 to 2020: A Review. Value Health 2022; 25:385-389. [PMID: 35227450 PMCID: PMC8885424 DOI: 10.1016/j.jval.2021.08.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Evidence-informed priority setting, in particular cost-effectiveness analysis (CEA), can help target resources better to achieve universal health coverage. Central to the application of CEA is the use of a cost-effectiveness threshold. We add to the literature by looking at what thresholds have been used in published CEA and the proportion of interventions found to be cost-effective, by type of threshold. METHODS We identified CEA studies in low- and middle-income countries from the Global Health Cost-Effectiveness Analysis Registry that were published between January 1, 2015, and January 6, 2020. We extracted data on the country of focus, type of interventions under consideration, funder, threshold used, and recommendations. RESULTS A total of 230 studies with a total 713 interventions were included in this review; 1 to 3× gross domestic product (GDP) per capita was the most common type of threshold used in judging cost-effectiveness (84.3%). Approximately a third of studies (34.2%) using 1 to 3× GDP per capita applied a threshold at 3× GDP per capita. We have found that no study used locally developed thresholds. We found that 79.3% of interventions received a recommendation as "cost-effective" and that 85.9% of studies had at least 1 intervention that was considered cost-effective. The use of 1 to 3× GDP per capita led to a higher proportion of study interventions being judged as cost-effective compared with other types of thresholds. CONCLUSIONS Despite the wide concerns about the use of 1 to 3× GDP per capita, this threshold is still widely used in the literature. Using this threshold leads to more interventions being recommended as "cost-effective." This study further explore alternatives to the 1 to 3× GDP as a decision rule.
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Affiliation(s)
- Joseph Kazibwe
- Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK
| | - Adrian Gheorghe
- Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK
| | - David Wilson
- Bill & Melinda Gates Foundation, London, England, UK
| | - Francis Ruiz
- Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK
| | - Kalipso Chalkidou
- Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK
| | - Y-Ling Chi
- International Decision Support Initiative, Center for Global Development, London, England, UK.
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Teerawattananon Y, Kc S, Chi YL, Dabak S, Kazibwe J, Clapham H, Lopez Hernandez C, Leung GM, Sharifi H, Habtemariam M, Blecher M, Nishtar S, Sarkar S, Wilson D, Chalkidou K, Gorgens M, Hutubessy R, Wibulpolprasert S. Recalibrating the notion of modelling for policymaking during pandemics. Epidemics 2022; 38:100552. [PMID: 35259693 PMCID: PMC8889889 DOI: 10.1016/j.epidem.2022.100552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
COVID-19 disease models have aided policymakers in low-and middle-income countries (LMICs) with many critical decisions. Many challenges remain surrounding their use, from inappropriate model selection and adoption, inadequate and untimely reporting of evidence, to the lack of iterative stakeholder engagement in policy formulation and deliberation. These issues can contribute to the misuse of models and hinder effective policy implementation. Without guidance on how to address such challenges, the true potential of such models may not be realised. The COVID-19 Multi-Model Comparison Collaboration (CMCC) was formed to address this gap. CMCC is a global collaboration between decision-makers from LMICs, modellers and researchers, and development partners. To understand the limitations of existing COVID-19 disease models (primarily from high income countries) and how they could be adequately support decision-making in LMICs, a desk review of modelling experience during the COVID-19 and past disease outbreaks, two online surveys, and regular online consultations were held among the collaborators. Three key recommendations from CMCC include: A ‘fitness-for-purpose’ flowchart, a tool that concurrently walks policymakers (or their advisors) and modellers through a model selection and development process. The flowchart is organised around the following: policy aims, modelling feasibility, model implementation, model reporting commitment. Holmdahl and Buckee (2020) A ‘reporting standards trajectory’, which includes three gradually increasing standard of reports, ‘minimum’, ‘acceptable’, and ‘ideal’, and seeks collaboration from funders, modellers, and decision-makers to enhance the quality of reports over time and accountability of researchers. Malla et al. (2018) A framework for “collaborative modelling for effective policy implementation and evaluation” which extends the definition of stakeholders to funders, ground-level implementers, public, and other researchers, and outlines how each can contribute to modelling. We advocate for standardisation of modelling processes and adoption of country-owned model through iterative stakeholder participation and discuss how they can enhance trust, accountability, and public ownership to decisions. COVID-19 models need appropriate adaptation to reflect contextual differences across settings. Upholding scientific standards is equally important as providing evidence for policymaking during pandemics. Wider stakeholder engagement with an iterative process for re-evaluating decisions is required for effective policy implementation.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand; Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | - Sarin Kc
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand.
| | - Y-Ling Chi
- Centre for Global Development Europe, Great Peter House, Abbey Gardens, Great College St, Westminster, London SW1P 3SE, UK
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Joseph Kazibwe
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London (ICL), Faculty of Medicine Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Hannah Clapham
- Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), 12 Science Drive 2, #10-01, 117549, Singapore
| | | | - Gabriel M Leung
- Li Ka Shing Faculty of Medicine (HKUMed), Hong Kong University, 21 Sassoon Rd, Pok Fu Lam, Hong Kong
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences (KMU), Kerman 7616911320, Iran
| | - Mahlet Habtemariam
- Africa Centres for Disease Control and Prevention, African Union Commission, Roosevelt Streeet, Addis Ababa, Ethiopia
| | - Mark Blecher
- National Treasury, 120 Plein Street, Cape Town, Republic of South Africa
| | - Sania Nishtar
- Poverty Alleviation and Social Safety Division, Government of Pakistan, Cabinet Secretariat, 4th Floor, Evacuee Trust Complex, F-5/1, Islamabad, Pakistan
| | - Swarup Sarkar
- Indian Council for Medical Research (ICMR), Government of India, V. Ramalingaswami Bhawan, P.O. Box No. 4911, Ansari Nagar, New Delhi 110029, India
| | - David Wilson
- Bill and Melinda Gates Foundation (BMGF), 500 5th Ave N, Seattle, WA 98109, USA
| | - Kalipso Chalkidou
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London (ICL), Faculty of Medicine Building, St Mary's Campus, Norfolk Place, London W2 1PG, UK; The Global Fund to Fight AIDS, Tuberculosis and Malaria, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex, Geneva, Switzerland
| | - Marelize Gorgens
- World Bank Group (WBG), 1818H Street, N.W., Washington, DC 20433, USA
| | - Raymond Hutubessy
- World Health Organisation (WHO), Avenue Appia 20, 1211 Geneva, Switzerland
| | - Suwit Wibulpolprasert
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, 6th Floor, 6th Building, Tiwanon Road, Nonthaburi 11000, Thailand; International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Rd., Nonthaburi 11000, Thailand
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11
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Kazibwe J, Shah HA, Kuwawenaruwa A, Schell CO, Khalid K, Tran PB, Ghosh S, Baker T, Guinness L. Resource availability, utilisation and cost in the provision of critical care in Tanzania: a protocol for a systematic review. BMJ Open 2021; 11:e050881. [PMID: 34433607 PMCID: PMC8388301 DOI: 10.1136/bmjopen-2021-050881] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/16/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Critical care is essential in saving lives of those that are critically ill, however, provision of critical care can be costly and heterogeneous across lower-resource settings. This paper describes the protocol for a systematic review of the literature that aims to identify the reported costs and resources available for the provision of critical care and the forms of critical care provision in Tanzania. METHODS AND ANALYSIS The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE, Embase and Global Health) will be searched to identify articles that report the forms of critical care, resources used in the provision of critical care in Tanzania, their availability and the associated costs. The search strategy will be developed from four key concepts; critical care provision, critical illness, resource use, Tanzania. The articles that fulfil the inclusion and exclusion criteria will be assessed for quality using the Reference Case for Estimating the Costs of Global Health Services and Interventions checklist. The extracted data will be summarised using descriptive statistics including frequencies, mean and median of the quantity and costs of resources used in the components of critical care services, depending on the data availability. This study will be carried out between February and November 2021. ETHICS AND DISSEMINATION This study is a review of secondary data and ethical clearance was sought from and granted by the Tanzanian National Institute of Medical Research (reference: NIMR/HQ/R.8a/Vol. IX/3537) and London School of Hygiene and Tropical Medicine (ethics ref: 22866). We will publish the review in a peer-reviewed journal as an open access article in addition to presenting the findings at conferences and public scientific gatherings. PROSPERO REGISTRATION NUMBER The protocol was registered with PROSPERO; registration number: CRD42020221923.
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Affiliation(s)
- Joseph Kazibwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Hiral A Shah
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Infectious Disease Epidemiology, Center for Global Development, London, UK
| | - A Kuwawenaruwa
- Health System Impact Evaluation and Policy Unit, Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health, Uppsala University, Uppsala, Sweden
| | - Karima Khalid
- Health System Impact Evaluation and Policy Unit, Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Department of Anaesthesia and Critical Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Phuong Bich Tran
- Department of Family and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Srobana Ghosh
- Global Health Department, Center for Global Development, London, UK
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lorna Guinness
- Global Health Department, Center for Global Development, London, UK
- Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
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12
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Gad M, Kazibwe J, Quirk E, Gheorghe A, Homan Z, Bricknell M. Civil-military cooperation in the early response to the COVID-19 pandemic in six European countries. BMJ Mil Health 2021; 167:234-243. [PMID: 33785587 PMCID: PMC8011427 DOI: 10.1136/bmjmilitary-2020-001721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/16/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has presented many countries with significant health system and economic challenges. The role of civil-military cooperation in a health crisis of the magnitude presented by COVID-19 remains virtually unexplored. This review aims to detect and identify typologies, if any, of associations between security or military systems and the national response measures during the COVID-19, as adopted by six European countries during the early phase of the outbreak (January to March 2020). METHODS We designed a structured qualitative literature review (qualitative evidence synthesis), primarily targeting open-source grey literature using a customised Google web search. Our target countries were UK, France, Spain, Italy, Belgium and Sweden. We employed a 'best fit' framework synthesis approach in qualitative analysis of the result records. RESULTS A total of 277 result records were included in our qualitative synthesis, with an overall search relevance yield of 46%. We identified 19 distinct descriptive categories of civil-military cooperation extending across seven analytical themes. Most prominent themes included how military support was incorporated in the national COVID-19 response, including support to national health systems, military repatriation and evacuation, and support to wider public systems. CONCLUSION Findings of this review show the significance of military systems in supporting an expansive response during the COVID-19 pandemic, and our proposed methodological approach for capturing military health data in a reproducible manner and providing a comparative view on common types of interventions provided by civil-military cooperation to inform lessons from the use of military capacities during current COVID-19 outbreak.
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Affiliation(s)
- Mohamed Gad
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - J Kazibwe
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - E Quirk
- Faculty of Medicine, Imperial College London, London, UK
| | - A Gheorghe
- Global Health and Development (GHD) Group, Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis; and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, UK
| | - Z Homan
- Centre for Science & Security Studies, Department of War Studies, King's College London, London, UK
| | - M Bricknell
- Conflict and Health Research Group, King's College London-Strand Campus, London, UK
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13
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Kazibwe J, Tran PB, Annerstedt KS. The household financial burden of non-communicable diseases in low- and middle-income countries: a systematic review. Health Res Policy Syst 2021; 19:96. [PMID: 34154609 PMCID: PMC8215836 DOI: 10.1186/s12961-021-00732-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/30/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The chronic nature of noncommunicable diseases (NCD) and costs associated with long-term care can result in catastrophic health expenditure for the patient and their household pushing them deeper into poverty and entrenching inequality in society. As the full financial burden of NCDs is not known, the objective of this study was to explore existing evidence on the financial burden of NCDs in low- and middle-income countries (LMICs), specifically estimating the cost incurred by patients with NCDs and their households to inform the development of strategies to protect such households from catastrophic expenditure. METHODS This systematic review followed the PRISMA guidelines, PROSPERO: CRD42019141088. Eligible studies published between 1st January 2000 to 7th May 2020 were systematically searched for in three databases: Medline, Embase and Web of Science. A two-step process, comprising of qualitative synthesis proceeded by quantitative (cost) synthesis, was followed. The mean costs are presented in 2018 USD. FINDINGS 51 articles were included, out of which 41 were selected for the quantitative cost synthesis. Most of the studies were cross-sectional cost-of-illness studies, of which almost half focused on diabetes and/or conducted in South-East Asia. The average total costs per year to a patient/household in LMICs of COPD, CVD, cancers and diabetes were $7386.71, $6055.99, $3303.81, $1017.05, respectively. CONCLUSION This review highlighted major data and methodological gaps when collecting data on costs of NCDs to households along the cascade of care in LMICs. More empirical data on cost of specific NCDs are needed to identify the diseases and contexts where social protection interventions are needed most. More rigorous and standardised methods of data collection and costing for NCDs should be developed to enable comprehensive and comparable evidence of the economic and financial burden of NCDs to patients and households in LMICs. The available evidence on costs reveals a large financial burden imposed on patients and households in seeking and receiving NCD care and emphasizes the need for adequate and reliable social protection interventions to be implemented alongside Universal Health Coverage.
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Affiliation(s)
- Joseph Kazibwe
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Phuong Bich Tran
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
- The Health and Social Protection Action Research and Knowledge Sharing Network (SPARKS), Solna, Sweden.
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14
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Nji E, Kazibwe J, Hambridge T, Joko CA, Larbi AA, Damptey LAO, Nkansa-Gyamfi NA, Stålsby Lundborg C, Lien LTQ. High prevalence of antibiotic resistance in commensal Escherichia coli from healthy human sources in community settings. Sci Rep 2021; 11:3372. [PMID: 33564047 PMCID: PMC7873077 DOI: 10.1038/s41598-021-82693-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 01/21/2021] [Indexed: 01/30/2023] Open
Abstract
Antibiotic resistance is a global health crisis that requires urgent action to stop its spread. To counteract the spread of antibiotic resistance, we must improve our understanding of the origin and spread of resistant bacteria in both community and healthcare settings. Unfortunately, little attention is being given to contain the spread of antibiotic resistance in community settings (i.e., locations outside of a hospital inpatient, acute care setting, or a hospital clinic setting), despite some studies have consistently reported a high prevalence of antibiotic resistance in the community settings. This study aimed to investigate the prevalence of antibiotic resistance in commensal Escherichia coli isolates from healthy humans in community settings in LMICs. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we synthesized studies conducted from 1989 to May 2020. A total of 9363 articles were obtained from the search and prevalence data were extracted from 33 articles and pooled together. This gave a pooled prevalence of antibiotic resistance (top ten antibiotics commonly prescribed in LMICs) in commensal E. coli isolates from human sources in community settings in LMICs of: ampicillin (72% of 13,531 isolates, 95% CI: 65-79), cefotaxime (27% of 6700 isolates, 95% CI: 12-44), chloramphenicol (45% of 7012 isolates, 95% CI: 35-53), ciprofloxacin (17% of 10,618 isolates, 95% CI: 11-25), co-trimoxazole (63% of 10,561 isolates, 95% CI: 52-73), nalidixic acid (30% of 9819 isolates, 95% CI: 21-40), oxytetracycline (78% of 1451 isolates, 95% CI: 65-88), streptomycin (58% of 3831 isolates, 95% CI: 44-72), tetracycline (67% of 11,847 isolates, 95% CI: 59-74), and trimethoprim (67% of 3265 isolates, 95% CI: 59-75). Here, we provided an appraisal of the evidence of the high prevalence of antibiotic resistance by commensal E. coli in community settings in LMICs. Our findings will have important ramifications for public health policy design to contain the spread of antibiotic resistance in community settings. Indeed, commensal E. coli is the main reservoir for spreading antibiotic resistance to other pathogenic enteric bacteria via mobile genetic elements.
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Affiliation(s)
- Emmanuel Nji
- BioStruct-Africa, Vårby, 143 43, Stockholm, Sweden.
| | - Joseph Kazibwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Carolyn Alia Joko
- BioStruct-Africa, Vårby, 143 43, Stockholm, Sweden
- Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - Amma Aboagyewa Larbi
- BioStruct-Africa, Vårby, 143 43, Stockholm, Sweden
- Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, PMB, Kumasi, Ghana
| | | | | | - Cecilia Stålsby Lundborg
- Health Systems and Policy (HSP): Improving the Use of Medicines, Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - La Thi Quynh Lien
- Department of Pharmaceutical Management and Pharmaco-Economics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, 110403, Vietnam
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15
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Tran PB, Hensing G, Wingfield T, Atkins S, Sidney Annerstedt K, Kazibwe J, Tomeny E, Biermann O, Thorpe J, Forse R, Lönnroth K. Income security during public health emergencies: the COVID-19 poverty trap in Vietnam. BMJ Glob Health 2020; 5:e002504. [PMID: 32540965 PMCID: PMC7299029 DOI: 10.1136/bmjgh-2020-002504] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Phuong Bich Tran
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Tom Wingfield
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Salla Atkins
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- New Social Research and Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Joseph Kazibwe
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Ewan Tomeny
- Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Thorpe
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rachel Forse
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- TB Programs, Friends for International TB Relief, Ho Chi Minh City, Viet Nam
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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16
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Nkansa-Gyamfi NA, Kazibwe J, Traore DAK, Nji E. Prevalence of multidrug-, extensive drug-, and pandrug-resistant commensal Escherichia coli isolated from healthy humans in community settings in low- and middle-income countries: a systematic review and meta-analysis. Glob Health Action 2019; 12:1815272. [PMID: 32909519 PMCID: PMC7782630 DOI: 10.1080/16549716.2020.1815272] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The majority of existing studies aimed at investigating the incidence and prevalence of multidrug-resistance by bacteria have been performed in healthcare settings. Relatively few studies have been conducted in community settings, but these have consistently shown a high prevalence of multidrug-resistant bacteria in low- and middle-income countries (LMICs). OBJECTIVES To provide an appraisal of the evidence on the high prevalence of multidrug-, extensive drug-, and pandrug-resistance in commensal Escherichia coli isolates from human sources in community settings in LMICs. METHODS Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, PubMed, EMBASE, MEDLINE, Web of Science, CINAHL, and Cochrane Library databases were systematically searched with the search string: 'Enterobacteriaceae', OR 'E. coli', OR 'Escherichia coli', AND 'antibiotic resistance', OR 'antimicrobial resistance', OR 'drug-resistance', AND 'prevalence', OR 'incidence', OR 'morbidity', OR 'odds ratio', OR 'risk ratio', OR 'confidence interval', OR 'p-value', OR 'rate'. Data were extracted and proportional meta-analysis was performed using the Freeman-Tukey transformation random effect model. RESULTS The prevalence of multidrug-, extensive drug- and pandrug-resistance were extracted from articles that met our inclusion criteria and pooled together after a systematic screening of 9,369 items. The prevalence of multidrug-resistance was 28% of 14,336 total cases of isolates tested, 95% CI: 23-32. Extensive drug-resistance was 24% of 8,686 total cases of isolates tested, 95% CI: 14-36. Lastly, pandrug-resistance was 5% of 5,670 total cases of isolates tested, 95% CI: 3-8. CONCLUSION This paper provides an appraisal of the evidence on the high prevalence of multidrug-, extensive drug- and pandrug-resistance by commensal E. coli in community settings in LMICs. Our results call for greater effort to be placed at the community level in the design of new and improved public health policies to counter the global threat of antibiotic-resistant infections and bacteria.
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Affiliation(s)
| | - Joseph Kazibwe
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Daouda A. K. Traore
- BioStruct-Africa, Vårby, Sweden
- Faculte ′ Des Sciences Et Techniques, Universite ′ Des Sciences, Des Techniques Et Des Technologies De Bamako (USTTB), Bamako, Mali
- Life Sciences Group, Institut Laue- Langevin, Grenoble, France
- School of Life Sciences, Faculty of Natural Sciences, Keele University, Staffordshire, UK
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