1
|
Katwan E, Bisoborwa G, Butron-Riveros B, Bychkov S, Dadji K, Fedkina N, Jayathilaka CA, Kumar D, Li Z, Mehta R, Raina N, Siddeeg K, Ferguson L, Handlos LN, Sheffel A, Kiarie J, Festin MR, Diaz T. Creating a Global Legal and Policy Database and Document Repository: Challenges and Lessons Learned From the World Health Organization Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey. Int J Health Policy Manag 2022; 11:2415-2421. [PMID: 34861763 PMCID: PMC9818120 DOI: 10.34172/ijhpm.2021.153] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/03/2021] [Indexed: 01/21/2023] Open
Abstract
The World Health Organization (WHO) has collected information on policies on sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) over many years. Creating a global survey that works for every country context is a well-recognized challenge. A comprehensive SRMNCAH policy survey was conducted by WHO from August 2018 through May 2019. WHO regional and country offices coordinated with Ministries of Health and/or national institutions who completed the questionnaire. The survey was completed by 150 of 194 WHO Member States using an online platform that allowed for submission of national source documents. A validation of the responses for selected survey questions against content of the national source documents was conducted for 101 countries (67%) for the first time in the administration of the survey. Data validation draws attention to survey questions that may have been misunderstood or where there was a lot of missing data, but varying methods for validating survey responses against source documents and separate analysis of laws from policies and guidelines may have hindered the overall conclusions of this process. The SRMNCAH policy survey both provided a platform for countries to track their progress in adopting WHO recommendations in national SRMNCAH-related legislation, policies, guidelines and strategies and was used to create a global database and searchable document repository. The outputs of the SRMNCAH policy survey are resources whose importance will be enriched through policy dialogues and wide utilization. Lessons learned from the methodology used for this survey can help to improve future updates and inform similar efforts.
Collapse
Affiliation(s)
- Elizabeth Katwan
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO), Geneva, Switzerland
| | - Geoffrey Bisoborwa
- Universal Health Coverage - Life Course, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Betzabe Butron-Riveros
- Department of Family, Health Promotion and Life Course, Pan American Health Organization, Washington, DC, USA
| | - Sergei Bychkov
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russia
| | - Kwami Dadji
- WHO Country Office for the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
| | - Natalia Fedkina
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russia
| | - C. Anoma Jayathilaka
- Department of Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing, WHO Regional Office for South-East Asia, New Delhi, India
| | - Dhiraj Kumar
- Department of Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing, WHO Regional Office for South-East Asia, New Delhi, India
| | - Zhao Li
- Division of Health Systems and Services, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Rajesh Mehta
- Department of Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing, WHO Regional Office for South-East Asia, New Delhi, India
| | - Neena Raina
- Department of Reproductive, Maternal, Newborn, Child, Adolescent Health and Ageing, WHO Regional Office for South-East Asia, New Delhi, India
| | - Khalid Siddeeg
- Department of Healthier Population, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ashley Sheffel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Mario R. Festin
- Department of Obstetrics and Gynecology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO), Geneva, Switzerland
| |
Collapse
|
2
|
Handlos LN. Training and accreditation of migrant healthcare personnel in Turkey. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- LN Handlos
- Danish Research Center for Migration, Ethnicity and Health, Copenhagen, Denmark
| |
Collapse
|
3
|
Handlos LN, Petersen JH, Bygbjerg IC, Norredam M. Role of disease and demographic factors as determinants of return migration: A nationwide register-based cohort study. Scand J Public Health 2017; 46:221-228. [PMID: 28992795 DOI: 10.1177/1403494817731008] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS A number of aspects of the health status of migrants who return to their country of origin have been explored in the literature; however, a more general description of the incidence of disease and demographic characteristics is lacking. The aim of this research was to contribute such a description. METHODS A nationwide cohort study was conducted of 114,331 migrants who obtained residence in Denmark between 1 January 1993 and 31 December 2010. Demographic characteristics and ten disease groups were included as explanatory variables and hazards ratios for the association between return migration and disease incidence, as well as demographic characteristics, were estimated using Cox regressions. RESULTS The tendency to return-migrate when ill was not the same among younger and elderly migrants; migrants <55 years of age had a significantly smaller propensity to return-migrate if they had suffered from a disease during the 18 years of follow-up compared with those who had not had a disease, whereas migrants ≥55 years of age were more prone to return if ill. The likelihood of returning decreased with increasing comorbidity in both age groups. Among those who were <55 years of age, the tendency to return increased with age at obtainment of residence; among those who were ≥55 years, more men than women return-migrated. CONCLUSIONS In Denmark, younger migrants are less inclined to return-migrate if they are ill compared with healthy migrants, whereas elderly migrants are more inclined to return if ill. The returnees also differ demographically from non-returnees in various ways.
Collapse
Affiliation(s)
- Line Neerup Handlos
- 1 Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Jorgen Holm Petersen
- 2 Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- 3 Section of Global Health, Department of Public Health, University of Copenhagen, Denmark
| | - Marie Norredam
- 4 Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark.,5 Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Denmark
| |
Collapse
|
4
|
Handlos LN, Norredam M. Health predictors for return migration: a nationwide historic prospective cohort study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
5
|
Lokdam N, Kristiansen M, Handlos LN, Norredam M. Use of healthcare services in the region of origin among patients with an immigrant background in Denmark: a qualitative study of the motives. BMC Health Serv Res 2016; 16:99. [PMID: 27001044 PMCID: PMC4802714 DOI: 10.1186/s12913-016-1346-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 04/08/2015] [Accepted: 03/16/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In Denmark, immigrants have been found to have a higher use of healthcare services abroad. Since this use may have an impact on both the individual patient and the healthcare system in the country of residence, research into underlying reasons is of increasing relevance. This study therefore investigates what motives patients with an immigrant background have for seeking healthcare services in their region of origin. METHODS The study was based on 10 semi-structured interviews with 10 patients who had an immigrant background, primarily originating from Turkey and the Middle East, recruited at a clinic of immigrant medicine in Denmark. The interviews were analysed thematically to elucidate motives for seeking healthcare services abroad, with focus on identifying push and pull factors. RESULTS Four motives for seeking healthcare in the region of origin were salient in the material: the perception of availability, in terms of quantity and access; familiarity, conceptualised as feeling comfortable within the healthcare system; perception of quality of services; and finally, the perceived need for a second opinion. All motives emerged simultaneously as push factors, motivating immigrants to explore healthcare services abroad, and pull factors, attracting them to their country of origin. Affordability did not emerge as an independent motive but influenced the other factors. CONCLUSION The use of healthcare services abroad by patients with an immigrant background constitutes active health-seeking behaviours shaped by a range of factors perceived to be limiting access to high-quality services in Denmark. Further research, including quantitative studies, should be initiated to investigate the importance of these motives among larger, more diverse immigrant groups, consequences for treatment regimes, and the healthcare professionals' perspective on the use of healthcare in the region of origin among immigrant patients.
Collapse
Affiliation(s)
- Nicoline Lokdam
- />Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Maria Kristiansen
- />Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Line Neerup Handlos
- />Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Marie Norredam
- />Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- />Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen K, Denmark
| |
Collapse
|
6
|
Affiliation(s)
- Line Neerup Handlos
- Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark
| |
Collapse
|
7
|
Handlos LN. Use of cross-border healthcare among elderly, chronically ill Bosnians who reside or have resided in Denmark. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv167.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
8
|
Lokdam N, Kristiansen M, Handlos LN, Norredam ML. Use of healthcare services in the region of origin among patients with an immigrant background. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv167.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Almdal TP, Handlos LN, Valerius M, Juul E, Nielsen KE, Vistisen D, Nielsen LB, Sheikh A, Belhadj M, Nadir D, Zinai S, Raposo J, Lund-Andersen H, Witte DR. Glycaemic threshold for diabetes-specific retinopathy among individuals from Saudi Arabia, Algeria and Portugal. Diabetes Res Clin Pract 2014; 103:e44-6. [PMID: 24485346 DOI: 10.1016/j.diabres.2013.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 10/10/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
Abstract
We studied the glycaemic threshold and prevalence of diabetic retinopathy in screen-detected diabetes in Saudi Arabia, Algeria and Portugal. The prevalence of diabetes-specific retinopathy started to increase at an HbA1c level of 6-6.4% (42-47 mmol/mol) and in individuals with HbA(1c) >7.0% the prevalence was 6.0%.
Collapse
Affiliation(s)
- T P Almdal
- Steno Diabetes Center A/S, Gentofte, Denmark; Copenhagen University Hospital Gentofte, Department of Medicine, Denmark
| | - L N Handlos
- Steno Diabetes Center A/S, Gentofte, Denmark.
| | - M Valerius
- Steno Diabetes Center A/S, Gentofte, Denmark
| | - E Juul
- Steno Diabetes Center A/S, Gentofte, Denmark
| | - K E Nielsen
- Steno Diabetes Center A/S, Gentofte, Denmark
| | - D Vistisen
- Steno Diabetes Center A/S, Gentofte, Denmark
| | | | - A Sheikh
- King Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | | | - D Nadir
- Algerian Ministry of Health, Algiers, Algeria
| | - S Zinai
- Novo Nordisk A/S, Algiers, Algeria
| | | | | | - D R Witte
- Steno Diabetes Center A/S, Gentofte, Denmark; Centre de Recherche Public de la Santé, Strassen, Luxembourg
| |
Collapse
|
10
|
Handlos LN, Witte DR, Almdal TP, Nielsen LB, Badawi SE, Sheikh ARA, Belhadj M, Nadir D, Zinai S, Vistisen D. Risk scores for diabetes and impaired glycaemia in the Middle East and North Africa. Diabet Med 2013; 30:443-51. [PMID: 23331167 DOI: 10.1111/dme.12118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 11/28/2022]
Abstract
AIMS To develop risk scores for diabetes and diabetes or impaired glycaemia for individuals living in the Middle East and North Africa region. In addition, to derive national risk scores for Algeria, Saudi Arabia and the United Arab Emirates and to compare the performance of the regional risk scores with the national risk scores. METHODS An opportunistic sample of 6588 individuals aged 30-75 years was screened. Screening consisted of a questionnaire and a clinical examination including measurement of HbA(1c). Two regional risk scores and national risk scores for each of the three countries were derived separately by stepwise backwards multiple logistic regression with diabetes [HbA(1c) ≥ 48 mmol/mol (≥ 6.5%)] and diabetes or impaired glycaemia [HbA(1c) ≥ 42 mmol/mol (≥ 6.0%)] as outcome. The performance of the regional and national risk scores was compared in data from each country by receiver operating characteristic analysis. RESULTS The eight risk scores all included age and BMI, while additional variables differed between the scores. The areas under the receiver operating characteristic curves were between 0.67 and 0.70, and for sensitivities approximately 75%; specificities varied between 50% and 57%. The regional and the national risk scores performed equally well in the three national samples. CONCLUSIONS Two regional risk scores for diabetes and diabetes or impaired glycaemia applicable to the Middle East and North Africa region were identified. The regional risk scores performed as well as the national risk scores derived in the same manner.
Collapse
Affiliation(s)
- L N Handlos
- Steno Diabetes Center A/S, Gentofte, Denmark.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
OBJECTIVE To summarize and evaluate all publications including cluster-randomized trials used for maternal and child health research in developing countries during the last 10 years. METHODS All cluster-randomized trials published between 1998 and 2008 were reviewed, and those that met our criteria for inclusion were evaluated further. The criteria for inclusion were that the trial should have been conducted in maternal and child health care in a developing country and that the conclusions should have been made on an individual level. Methods of accounting for clustering in design and analysis were evaluated in the eligible trials. RESULTS Thirty-five eligible trials were identified. The majority of them were conducted in Asia, used community as randomization unit, and had less than 10,000 participants. To minimize confounding, 23 of the 35 trials had stratified, blocked, or paired the clusters before they were randomized, while 17 had adjusted for confounding in the analysis. Ten of the 35 trials did not account for clustering in sample size calculations, and seven did not account for the cluster-randomized design in the analysis. The number of cluster-randomized trials increased over time, and the trials generally improved in quality. CONCLUSIONS Shortcomings exist in the sample-size calculations and in the analysis of cluster-randomized trials conducted during maternal and child health research in developing countries. Even though there has been improvement over time, further progress in the way that researchers utilize and analyse cluster-randomized trials in this field is needed.
Collapse
Affiliation(s)
- Line Neerup Handlos
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA.
| | | | | |
Collapse
|