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Antonio E, Alobo M, Bayona MT, Marsh K, Ariana P, Norton A. Funding and COVID-19 research in Africa: two years on, are the research needs of Africa being met? Open Res Afr 2023; 6:16. [PMID: 38174097 PMCID: PMC10762293 DOI: 10.12688/openresafrica.14185.1] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic caused significantly lower reported mortalities on the African continent as compared to other regions. Yet, many countries on the continent are still contending with the devastating economic, social and indirect health impacts. African researchers and policy makers have identified research priority areas which take cognisance of the unique research needs of African countries. A baseline assessment of the alignment of funded research in Africa to these priorities and World Health Organization's COVID-19 research priorities was undertaken in July, 2020. We present a two-year update to this analysis of funded COVID-19 research in Africa. METHODS Data captured in the UK Collaborative on Development Research and Global Research Collaboration for Infectious Disease Preparedness COVID-19 Research Project Tracker as of 15th July, 2022 was analysed. An additional analysis of institutions receiving funding for COVID-19 research is presented. We also analysed the change in funding for COVID-19 research in Africa since July, 2020. RESULTS The limited COVID-19 research identified in Africa early in the pandemic has persisted over the subsequent two-year period assessed. When number of projects are considered, governmental funders based in Europe and United States supported the most research. Only nine research funders based in Africa were identified. A number of partnerships between African institutions and institutions based on other continents were identified, however, most research projects were undertaken in research institutions based in Africa only. Our findings highlight the relevance of the WHO research priorities for the pandemic response in Africa. Many research questions raised by African researchers remain unaddressed, among which are questions related to clinical management of COVID-19 infections in Africa. CONCLUSIONS Two years after the identification of Africa's COVID-19 research priorities, the findings suggest a missed opportunity in new research funding to answer pertinent questions for the pandemic response in Africa.
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Affiliation(s)
- Emilia Antonio
- Pandemic Sciences Institute, University of Oxford, Oxford, England, UK
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Moses Alobo
- Science For Africa Foundation, Nairobi, Nairobi County, Kenya
| | | | - Kevin Marsh
- Science For Africa Foundation, Nairobi, Nairobi County, Kenya
| | - Proochista Ariana
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Alice Norton
- Pandemic Sciences Institute, University of Oxford, Oxford, England, UK
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Monnier AA, Do NTT, Asante KP, Afari-Asiedu S, Khan WA, Munguambe K, Sevene E, Tran TK, Nguyen CTK, Punpuing S, Gómez-Olivé FX, van Doorn HR, Caillet C, Newton PN, Ariana P, Wertheim HFL. Is this pill an antibiotic or a painkiller? Improving the identification of oral antibiotics for better use. Lancet Glob Health 2023; 11:e1308-e1313. [PMID: 37474237 DOI: 10.1016/s2214-109x(23)00258-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023]
Abstract
In this Viewpoint, we discuss how the identification of oral antibiotics and their distinction from other commonly used medicines can be challenging for consumers, suppliers, and health-care professionals. There is a large variation in the names that people use to refer to antibiotics and these often relate to their physical appearance, although antibiotics come in many different physical presentations. We also reflect on how the physical appearance of medicine influences health care and public health by affecting communication between patients and health-care professionals, dispensing , medicine use, and the public understanding of health campaigns. Furthermore, we report expert and stakeholder consultations on improving the identification of oral antibiotics and discuss next steps towards a new identification system for antibiotics. We propose to use the physical appearance as a tool to support and nudge awareness about antibiotics and their responsible use.
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Affiliation(s)
- Annelie A Monnier
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - Nga T T Do
- Oxford University Clinical Research Unit, Hanoi, Viet Nam
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division of Ghana Health Service, Kintampo, Ghana
| | - Samuel Afari-Asiedu
- Kintampo Health Research Centre, Research and Development Division of Ghana Health Service, Kintampo, Ghana
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Khátia Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique; Manhiça Health Research Centre, Manhiça, Mozambique
| | - Esperanca Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique; Manhiça Health Research Centre, Manhiça, Mozambique
| | - Toan K Tran
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Chuc T K Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Céline Caillet
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Infectious Diseases Data Observatory, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Infectious Diseases Data Observatory, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Proochista Ariana
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Heiman F L Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands.
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Kayem ND, Okogbenin S, Okoeguale J, Momoh M, Njoku A, Eifediyi R, Enodiana X, Ngwu H, Irhiogbe W, Ighodalo Y, Olokor T, Odigie G, Castle L, Duraffour S, Oestereich L, Dahal P, Ariana P, Gunther S, Horby P. Seroepidemiology of Lassa virus in pregnant women in Southern Nigeria: A prospective hospital-based cohort study. PLoS Negl Trop Dis 2023; 17:e0011354. [PMID: 37216412 DOI: 10.1371/journal.pntd.0011354] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/06/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND There is limited epidemiological evidence on Lassa fever in pregnant women with acute gaps on prevalence, infection incidence, and risk factors. Such evidence would facilitate the design of therapeutic and vaccine trials and the design of control programs. Our study sought to address some of these gaps by estimating the seroprevalence and seroconversion risk of Lassa fever in pregnant women. METHODOLOGY/PRINCIPAL FINDINGS We conducted a prospective hospital-based cohort between February and December 2019 in Edo State, Southern Nigeria, enrolling pregnant women at antenatal clinic and following them up at delivery. Samples were evaluated for IgG antibodies against Lassa virus. The study demonstrates a seroprevalence of Lassa IgG antibodies of 49.6% and a seroconversion risk of 20.8%. Seropositivity was strongly correlated with rodent exposure around homes with an attributable risk proportion of 35%. Seroreversion was also seen with a seroreversion risk of 13.4%. CONCLUSIONS/SIGNIFICANCE Our study suggests that 50% of pregnant women were at risk of Lassa infection and that 35.0% of infections might be preventable by avoiding rodent exposure and conditions which facilitate infestation and the risk of human-rodent contact. While the evidence on rodent exposure is subjective and further studies are needed to provide a better understanding of the avenues of human-rodent interaction; public health measures to decrease the risk of rodent infestation and the risk of spill over events may be beneficial. With an estimated seroconversion risk of 20.8%, our study suggests an appreciable risk of contracting Lassa fever during pregnancy and while most of these seroconversions may not be new infections, given the high risk of adverse outcomes in pregnancy, it supports the need for preventative and therapeutic options against Lassa fever in pregnancy. The occurrence of seroreversion in our study suggests that the prevalence obtained in this, and other cohorts may be an underestimate of the actual proportion of women of childbearing age who present at pregnancy with prior LASV exposure. Additionally, the occurrence of both seroconversion and seroreversion in this cohort suggests that these parameters would need to be considered for the development of Lassa vaccine efficacy, effectiveness, and utility models.
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Affiliation(s)
| | - Sylvanus Okogbenin
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Joseph Okoeguale
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Mojeed Momoh
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Antonia Njoku
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Reuben Eifediyi
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Xavier Enodiana
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Hilary Ngwu
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Wilfred Irhiogbe
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Yemisi Ighodalo
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Thomas Olokor
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - George Odigie
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Lyndsey Castle
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sophie Duraffour
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Lisa Oestereich
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Prabin Dahal
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Proochista Ariana
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephan Gunther
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Peter Horby
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Kayem ND, Okogbenin S, Okoeguale J, Eigbefoh J, Ikheloa J, Eifediyi R, Enodiana X, Olorogbogo OE, Aikpokpo I, Ighodalo Y, Olokor T, Odigie G, Castle L, Duraffour S, Oestereich L, Dahal P, Ariana P, Gunther S, Horby P. Transplacental transfer of Lassa IgG antibodies in pregnant women in Southern Nigeria: A prospective hospital-based cohort study. PLoS Negl Trop Dis 2023; 17:e0011209. [PMID: 37053304 PMCID: PMC10129015 DOI: 10.1371/journal.pntd.0011209] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/25/2023] [Accepted: 03/01/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Evidence from previous studies suggest that Lassa fever, a viral haemorrhagic fever endemic to West Africa has high case fatalities, particularly in pregnancy. While there have been remarkable innovations in vaccine development, with some Lassa vaccines undergoing early clinical trials. An understanding of Lassa antibody kinetics and immune responses will support vaccine design and development. However, there is currently no evidence on the antibody kinetics of Lassa (LASV) in pregnancy. Our study sought to estimate the efficiency of transplacental transfer of LASV IgG antibodies from the mother to the child. METHODOLOGY/PRINCIPAL FINDINGS The study made use of data from a prospective hospital-based cohort of pregnant women enrolled at the antenatal clinic and followed up at delivery between February and December 2019. Blood samples from mother-child pairs were evaluated for antibodies against Lassa virus. The study demonstrates a transplacental transfer of LASV IgG of 75.3% [60.0-94.0%], with a significant positive correlation between maternal and cord concentrations and a good level of agreement. The study also suggests that transfer may be more variable in women with 'de novo' antibodies compared to those with pre-existing antibodies. CONCLUSIONS/SIGNIFICANCE The study shows that maternal antibody levels play an important role in determining transfer efficiency of Lassa antibodies to the new-born; and while the evidence is preliminary, the study also suggests that transfer efficiency may be less stable in acute or recent infection, as such timing of vaccination before pregnancy, that is in women of childbearing age may be more appropriate for protection of both pregnant women and their neonates.
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Affiliation(s)
| | - Sylvanus Okogbenin
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Joseph Okoeguale
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Joseph Eigbefoh
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Joseph Ikheloa
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Reuben Eifediyi
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Xavier Enodiana
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | - Isoken Aikpokpo
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Yemisi Ighodalo
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Thomas Olokor
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - George Odigie
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Lyndsey Castle
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sophie Duraffour
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Lisa Oestereich
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Prabin Dahal
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Proochista Ariana
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephan Gunther
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Peter Horby
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Arena L, Zanamwe M, Halleux CM, Carrara V, Angus BJ, Ariana P, Humphreys GS, Richmond C, Stepniewska K, Guérin PJ, Olliaro PL. Malaria patient spectrum representation in therapeutic clinical trials of uncomplicated malaria: a scoping review of the literature. Malar J 2023; 22:50. [PMID: 36765317 PMCID: PMC9913008 DOI: 10.1186/s12936-023-04441-5] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND For the results of clinical trials to have external validity, the patients included in the study must be representative of the population presenting in the general clinical settings. A scoping literature review was performed to evaluate how the eligibility criteria used in anti-malarial efficacy and safety trials translate into patient selection. METHODS A search of the WorldWide Antimalarial Resistance Network (WWARN) Clinical Trials Publication Library, MEDLINE, The Cochrane Library, and clinicaltrials.gov was conducted to identify trials investigating anti-malarial efficacy and safety, published between 14th April 2001 and 31st December 2017. An updated search using the WWARN Clinical Trial Publication Library was undertaken to identify eligible publications from 1st January 2018 to 31st July 2021. The review included studies in patients of any age with uncomplicated malaria and any pharmaceutical therapeutic intervention administered. The proportion of trials with malaria-positive patients excluded was calculated and linked to the reported reason for exclusion. A subgroup analysis on eligibility criteria and trial baseline demographics was conducted to assess whether criteria are complied with when recruiting patients. RESULTS Out of 847 studies, 176 (21%) trials were included in the final synthesis, screening a total of 157,516 malaria-positive patients, of whom 56,293 (36%) were enrolled and treated. Across the 176 studies included, 84 different inclusion and exclusion criteria were identified. The reason for exclusion of patients who tested positive for malaria was reported in 144 (82%) studies. Three criteria account for about 70% of malaria-positive patients excluded: mixed-species malaria infections or other specific Plasmodium species, parasite counts outside the set study ranges, and refusal of consent. CONCLUSIONS Nearly two-thirds of the malaria-positive subjects who present to health facilities are systematically excluded from anti-malarial treatment trials. Reasons for exclusions are largely under-reported. Anti-malarial treatment in the general population is informed by studies on a narrow selection of patients who do not fully represent the totality of those seeking antimalarial treatment in routine practice. While entry criteria ensure consistency across trials, pragmatic trials are also necessary to supplement the information currently available and improve the external validity of the findings of malaria clinical trials.
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Affiliation(s)
- Lorenzo Arena
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Mazvita Zanamwe
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christine M. Halleux
- grid.3575.40000000121633745Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), Geneva, Switzerland
| | - Verena Carrara
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK ,grid.8591.50000 0001 2322 4988Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Brian J. Angus
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Proochista Ariana
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina S. Humphreys
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Caitlin Richmond
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Kasia Stepniewska
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Philippe J. Guérin
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Piero L. Olliaro
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948ISARIC Global Support Centre, International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
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Nasir N, Aderoba AK, Ariana P. Scoping review of maternal and newborn health interventions and programmes in Nigeria. BMJ Open 2022; 12:e054784. [PMID: 35168976 PMCID: PMC8852735 DOI: 10.1136/bmjopen-2021-054784] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To systematically scope and map research regarding interventions, programmes or strategies to improve maternal and newborn health (MNH) in Nigeria. DESIGN Scoping review. DATA SOURCES AND ELIGIBILITY CRITERIA Systematic searches were conducted from 1 June to 22 July 2020 in PubMed, Embase, Scopus, together with a search of the grey literature. Publications presenting interventions and programmes to improve maternal or newborn health or both in Nigeria were included. DATA EXTRACTION AND ANALYSIS The data extracted included source and year of publication, geographical setting, study design, target population(s), type of intervention/programme, reported outcomes and any reported facilitators or barriers. Data analysis involved descriptive numerical summaries and qualitative content analysis. We summarised the evidence using a framework combining WHO recommendations for MNH, the continuum of care and the social determinants of health frameworks to identify gaps where further research and action may be needed. RESULTS A total of 80 publications were included in this review. Most interventions (71%) were aligned with WHO recommendations, and half (n=40) targeted the pregnancy and childbirth stages of the continuum of care. Most of the programmes (n=74) examined the intermediate social determinants of maternal health related to health system factors within health facilities, with only a few interventions aimed at structural social determinants. An integrated approach to implementation and funding constraints were among factors reported as facilitators and barriers, respectively. CONCLUSION Using an integrated framework, we found most MNH interventions in Nigeria were aligned with the WHO recommendations and focused on the intermediate social determinants of health within health facilities. We determined a paucity of research on interventions targeting the structural social determinants and community-based approaches, and limited attention to pre-pregnancy interventions. To accelerate progress towards the sustainable development goal MNH targets, greater focus on implementing interventions and measuring context-specific challenges beyond the health facility is required.
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Affiliation(s)
- Naima Nasir
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- APIN Clinic, Infectious Diseases Unit, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Adeniyi Kolade Aderoba
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Department of Obstetrics and Gynaecology, Mother and Child Hospital, Akure, Ondo, Nigeria
| | - Proochista Ariana
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
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Kayem ND, Benson C, Aye CYL, Barker S, Tome M, Kennedy S, Ariana P, Horby P. Ebola virus disease in pregnancy: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 116:509-522. [PMID: 34865173 PMCID: PMC9157681 DOI: 10.1093/trstmh/trab180] [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: 04/30/2021] [Revised: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
This review synthesises and appraises evidence on the effects of Ebola virus disease (EVD) in pregnancy. We searched bibliographic databases from dates of inception to November 2020, yielding 28 included studies. The absolute risk of maternal death associated with EVD was estimated at 67.8% (95% confidence interval [CI] 49.8 to 83.7, I2=85%, p<0.01) and the relative risk of death in pregnant women compared with non-pregnant women was estimated at 1.18 (95% CI 0.59 to 2.35, I2=31.0%, p=0.230). The absolute risk for foetal losses was estimated at 76.9% (95% CI 45.0 to 98.3, I2=96%, p<0.01) and neonatal death was 98.5% (95% CI 84.9 to 100, I2=0.0%, p=0.40). The gap analysis suggests limited or no data on the clinical course, non-fatal perinatal outcomes and EVD management in pregnant women. The review suggests that EVD has a high maternal and perinatal mortality, underscoring the urgent need for preventative and therapeutic solutions and improved screening and follow-up of pregnant women and newborns during outbreaks. There is not enough evidence to conclusively rule out pregnancy as a risk factor for mortality and there is limited evidence on the disease course, outcomes and management of EVD in pregnancy, and this supports the need for robust clinical trials and prospective studies that include pregnant women.
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Affiliation(s)
- Nzelle D Kayem
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Charlotte Benson
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Christina Y L Aye
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah Barker
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Mariana Tome
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Stephen Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Proochista Ariana
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Peter Horby
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
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8
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Kayem ND, Benson C, Aye CYL, Barker S, Tome M, Kennedy S, Ariana P, Horby P. Lassa fever in pregnancy: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 114:385-396. [PMID: 32125412 PMCID: PMC7197258 DOI: 10.1093/trstmh/traa011] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 10/31/2019] [Revised: 12/12/2019] [Accepted: 02/13/2020] [Indexed: 12/29/2022] Open
Abstract
Lassa fever is a zoonotic infection endemic to West Africa and is known to have adverse effects in pregnancy. We sought to synthesize and critically appraise currently available evidence on the effects of Lassa fever in pregnancy. An exhaustive bibliographic search from dates of inception to 30 September 2019 yielded 13 studies, from which individual patient data were extracted. The absolute risk of maternal death associated with Lassa fever was estimated at 33.73% (95% CI 22.05 to 46.42%, I2=72.40%, p=0.0014). The relative risk of death in pregnant women compared with non-pregnant women was estimated at 2·86 (95% CI 1.77 to 4.63, I2=27.27%, p=0.239). The formal gap analysis shows imprecise data on the risk of Lassa-related maternal and perinatal mortality and insufficient data for other pregnancy outcomes. The currently available evidence for the use of ribavirin in pregnant patients is not conclusive. With a threefold increased risk of mortality, there is a need to prioritize pregnant women as a special subgroup of interest for Lassa research. Robust prospective studies estimating the true incidence of adverse maternal and perinatal outcomes and randomized controlled trials to evaluate the efficacy of therapeutics for maternal Lassa virus infection are urgently needed.
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Affiliation(s)
- Nzelle D Kayem
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| | - Charlotte Benson
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Christina Y L Aye
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, OX3 9DU, UK
| | - Sarah Barker
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Mariana Tome
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, HP21 8AL, UK
| | - Stephen Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, OX3 9DU, UK
| | - Proochista Ariana
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| | - Peter Horby
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
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Wedekind L, Noé A, Mokaya J, Tamandjou C, Kapulu M, Ruecker A, Kestelyn E, Zimba M, Khatamzas E, Eziefula AC, Mackintosh CL, Nascimento R, Ariana P, Best D, Gibbs E, Dunachie S, Hadley G, Ravenswood H, Young B, Kamau C, Marsh K, McShane H, Hale R, McPhilbin E, Ovseiko PV, Surender R, Worland C, White LJ, Matthews PC. Equity for excellence in academic institutions: a manifesto for change. Wellcome Open Res 2021; 6:142. [PMID: 34381874 PMCID: PMC8343400 DOI: 10.12688/wellcomeopenres.16861.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/20/2022] Open
Abstract
Higher academic institutions in the UK need to drive improvements in equity, diversity, and inclusion (EDI) through sustainable practical interventions. A broad view of inclusivity is based on an intersectional approach that considers race, geographical location, caring responsibilities, disability, neurodiversity, religion, and LGBTQIA+ identities. We describe the establishment of a diverse stakeholder group to develop practical grass-roots recommendations through which improvements can be advanced. We have developed a manifesto for change, comprising six domains through which academic institutions can drive progress through setting short, medium, and long-term priorities. Interventions will yield rewards in recruitment and retention of a diverse talent pool, leading to enhanced impact and output.
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Affiliation(s)
- Lauren Wedekind
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Andrés Noé
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jolynne Mokaya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Cynthia Tamandjou
- Division of Health Economics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Andrea Ruecker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Evelyn Kestelyn
- Oxford University Clinical Research Unit (OUCRU), Hanoi, Vietnam
| | - Machilu Zimba
- Equality and Diversity Unit, University of Oxford, Oxford, UK
| | - Elham Khatamzas
- Department of Medicine III, University Hospital, LMU, Munich, Germany
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | | | | | - Roger Nascimento
- International Health and Tropical Medicine, Centre for Tropical Medicine and Global Health, Medawar Building, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Proochista Ariana
- International Health and Tropical Medicine, Centre for Tropical Medicine and Global Health, Medawar Building, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Denise Best
- Oxford University Clinical Academic Graduate School (OUCAGS), John Radcliffe Hospital, Oxford, UK
| | - Edward Gibbs
- Department of Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Susanna Dunachie
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - Gina Hadley
- Department of Medicine, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
- Harris Manchester College, Oxford, UK
| | | | - Bernadette Young
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | | | - Kevin Marsh
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Africa Oxford Initiative, Medawar Building, University of Oxford, Oxford, UK
| | - Helen McShane
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
- NIHR BRC, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
| | - Rob Hale
- MaynardLeigh Associates, London, UK
| | - Elena McPhilbin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pavel V. Ovseiko
- Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - Oxford Equity in Academia consortium
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
- Division of Health Economics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- KEMRI Wellcome Trust, Kilifi, Kenya
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford University Clinical Research Unit (OUCRU), Hanoi, Vietnam
- Equality and Diversity Unit, University of Oxford, Oxford, UK
- Department of Medicine III, University Hospital, LMU, Munich, Germany
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
- University of Sussex, Falmer, Brighton, UK
- International Health and Tropical Medicine, Centre for Tropical Medicine and Global Health, Medawar Building, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Academic Graduate School (OUCAGS), John Radcliffe Hospital, Oxford, UK
- Department of Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
- Department of Medicine, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
- Harris Manchester College, Oxford, UK
- Africa Oxford Initiative, Medawar Building, University of Oxford, Oxford, UK
- NIHR BRC, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
- MaynardLeigh Associates, London, UK
- Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK
- Department of Social Policy, Social Sciences Division, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, UK
| | - Rebecca Surender
- Department of Social Policy, Social Sciences Division, University of Oxford, Oxford, UK
| | - Claire Worland
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lisa J. White
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Big Data Institute, University of Oxford, Oxford, UK
| | - Philippa C. Matthews
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK
- Harris Manchester College, Oxford, UK
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Do NTT, Vu HTL, Nguyen CTK, Punpuing S, Khan WA, Gyapong M, Asante KP, Munguambe K, Gómez-Olivé FX, John-Langba J, Tran TK, Sunpuwan M, Sevene E, Nguyen HH, Ho PD, Matin MA, Ahmed S, Karim MM, Cambaco O, Afari-Asiedu S, Boamah-Kaali E, Abdulai MA, Williams J, Asiamah S, Amankwah G, Agyekum MP, Wagner F, Ariana P, Sigauque B, Tollman S, van Doorn HR, Sankoh O, Kinsman J, Wertheim HFL. Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach. Lancet Glob Health 2021; 9:e610-e619. [PMID: 33713630 PMCID: PMC8050200 DOI: 10.1016/s2214-109x(21)00024-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [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: 06/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. METHODS We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016-Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. FINDINGS Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. INTERPRETATION Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. FUNDING Wellcome Trust and Volkswagen Foundation.
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Affiliation(s)
- Nga T T Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Huong T L Vu
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Chuc T K Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - Khatia Munguambe
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - F Xavier Gómez-Olivé
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Johannes John-Langba
- School of Applied Human Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Toan K Tran
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Esperanca Sevene
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Hanh H Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Phuc D Ho
- Institute of Mathematics, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | | | - Sabeena Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Olga Cambaco
- Manhiça Health Research Centre, Manhiça, Mozambique
| | | | | | | | | | | | | | | | - Fezile Wagner
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Proochista Ariana
- Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Stephen Tollman
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Osman Sankoh
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Statistics Sierra Leone, Freetown, Sierra Leone; University Secretariat, Njala University, Njala, Sierra Leone; Heidelberg Institute for Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands.
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Abstract
OBJECTIVE Since 2011 China's central government has committed to establishing a new 'general practitioner' (GP)-centred primary care system. To this end there have been great efforts to train an additional 300 000 GPs by 2020. This paper examines the perspective of practitioners in Henan, China, regarding general practice. DESIGN A mixed-methods approach using focus group discussions (FGD), and structured questionnaires. SETTING/PARTICIPANTS Seven FGDs and responses to 1887 questionnaires included medical students, primary care doctors and GP residents in Henan. RESULTS The three surveyed medical groups have some awareness of the attributes of general practice (eg, comprehensiveness, first contact and coordination), but often misinterpret what being a GP entails. Five themes were identified through the FGDs and tested quantitatively for their prevalence with structured questionnaires. First, the GPs' role as a comprehensive care provider was (mis)interpreted as an 'all-round doctor'. Second, the GP's responsibility as the first point of care was understood in two conflicting ways: private personal doctors of the rich and the powerful or village doctors for common people. Third, referral was understood as simply guiding patients to appropriate departments within the hospital while the gatekeeping role was interpreted to involve GPs being peoples' health protectors rather than being also gatekeepers of specialty services. Traditional Chinese medicine now further complicates the understanding of GPs. And lastly, the GPs' main responsibility was considered to be public health work. CONCLUSION The misunderstandings of the roles and responsibilities of GPs render problematic the policy foundation of China's GP-centred primary care system. Pursuing the quantity of GPs on its own is meaningless, since the number needed depends on the delineated role of GPs. Top priority is to establish clarity about the GP role, which requires reforming the health delivery system to address issues with fragmented care, strategically taking into account the development of GPs with work delegation and substitution and providing more clarity on the distinction between general practice and public health.
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Affiliation(s)
- Jiming Zhu
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Shenzhen, China
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12
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Marzouk M, Kelley M, Fadhil I, Slama S, Longuere KS, Ariana P, Carson G, Marsh V. "If I have a cancer, it is not my fault I am a refugee": A qualitative study with expert stakeholders on cancer care management for Syrian refugees in Jordan. PLoS One 2019; 14:e0222496. [PMID: 31560701 PMCID: PMC6764666 DOI: 10.1371/journal.pone.0222496] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 09/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Noncommunicable diseases including cancer are widespread amongst the 5.6 million Syrian refugees currently hosted in the Middle East. Given its prevalence as the third leading cause of death in Syria, cancer is likely to be an important health burden among Syrian refugees. Against this background, our aim was to describe the clinical, ethical and policy decision-making experiences of health actors working within the current refugee cancer care system; the impact of refugee cancer care health policies on health care providers and policy makers in this context; and provide suggestions for the way delivery of care should be optimised in a sustained emergency situation. METHODS From April-July 2016, we conducted in-depth interviews with 12 purposively sampled health officials and health care workers from the Jordanian Ministry of Health, multilateral donors and international non-governmental organisations. Data were analysed using a framework analysis approach to identify systemic, practical and ethical challenges to optimising care for refugees, through author agreement on issues emerging from the data and those linked more directly to areas of questioning. RESULTS As has been previously reported, central challenges for policy makers and health providers were the lack of quality cancer prevalence data to inform programming and care delivery for this refugee population, and insufficient health resource allocation to support services. In addition, limited access to international funding for the host country, the absence of long-term funding schemes, and barriers to coordination between institutions and frontline clinicians were seen as key barriers. In this context where economic priorities inevitably drive decision-making on public health policy and individual care provision, frontline healthcare workers and policy makers experienced significant moral distress where duties of care and humanitarian values were often impossible to uphold. CONCLUSIONS Our findings confirm and expand understanding of the challenges involved in resource allocation decisions for cancer care in refugee populations, and highlight these for the particular situation of long term Syrian refugees in Jordan. The insights offered by frontline clinicians and policy makers in this context reveal the unintended personal and moral impact of resource allocation decisions. With many countries facing similar challenges in the provision of cancer care for refugees, the lessons learned from Jordan suggest key areas for policy revision and international investment in developing cancer care policies for refugees internationally.
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Affiliation(s)
- Manar Marzouk
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Maureen Kelley
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ibtihal Fadhil
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Slim Slama
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | - Proochista Ariana
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gail Carson
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vicki Marsh
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
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13
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Haenssgen MJ, Charoenboon N, Zanello G, Mayxay M, Reed-Tsochas F, Lubell Y, Wertheim H, Lienert J, Xayavong T, Khine Zaw Y, Thepkhamkong A, Sithongdeng N, Khamsoukthavong N, Phanthavong C, Boualaiseng S, Vongsavang S, Wibunjak K, Chai-In P, Thavethanutthanawin P, Althaus T, Greer RC, Nedsuwan S, Wangrangsimakul T, Limmathurotsakul D, Elliott E, Ariana P. Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia. BMJ Open 2019; 9:e028224. [PMID: 31434769 PMCID: PMC6707701 DOI: 10.1136/bmjopen-2018-028224] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/20/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Low-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research. OBJECTIVE To (1) Describe antibiotic-related knowledge, attitudes and practices of the general population in two LMICs. (2) Assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers. DESIGN Observational study: cross-sectional rural health behaviour survey, representative of the population level. SETTING General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018. PARTICIPANTS 2141 adult members (≥18 years) of the general rural population, representing 712 000 villagers. OUTCOME MEASURES Antibiotic-related knowledge, attitudes and practices across sites and healthcare access channels. FINDINGS Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like 'anti-inflammatory medicine' in Chiang Rai (87.6%; 95% CI 84.9% to 90.0%) and 'ampi' in Salavan (75.6%; 95% CI 71.4% to 79.4%). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI 0.01 to 0.23) and 0.53 in Salavan (95% CI 0.16 to 0.90). CONCLUSIONS Locally specific conceptions and counterintuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming 'knowledge deficits' alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards 'AMR-sensitive interventions' that address context-specific upstream drivers of antimicrobial use (eg, unemployment insurance) and complement education and awareness campaigns. TRIAL REGISTRATION NUMBER Clinicaltrials.gov identifier NCT03241316.
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Affiliation(s)
- Marco J Haenssgen
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- School of Cross Faculty Studies, University of Warwick, Coventry, UK
- Green Templeton College, Oxford, United Kingdom
- Said Business School, University of Oxford, Oxford, UK
| | - Nutcha Charoenboon
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Giacomo Zanello
- School of Agriculture, Policy and Development, University of Reading, Reading, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health, London, London, UK
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Laos
| | - Felix Reed-Tsochas
- Green Templeton College, Oxford, United Kingdom
- Said Business School, University of Oxford, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
| | - Yoel Lubell
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Heiman Wertheim
- Medical Microbiology Department, Radbuod University, Nijmegen, The Netherlands
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Jeffrey Lienert
- Green Templeton College, Oxford, United Kingdom
- Said Business School, University of Oxford, Oxford, UK
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thipphaphone Xayavong
- Department of Peace and Conflict Studies, University for Peace, Ciudad Colon, Costa Rica
- Department of Political Science, Ateneo de Manila University, Quezon City, Philippines
| | - Yuzana Khine Zaw
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Amphayvone Thepkhamkong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Nicksan Sithongdeng
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Nid Khamsoukthavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Chanthasone Phanthavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Somsanith Boualaiseng
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Souksakhone Vongsavang
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | - Kanokporn Wibunjak
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Poowadon Chai-In
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Thomas Althaus
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Rachel Claire Greer
- Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Chiangrai Clinical Research Unit, Chiangrai Regional Hospital, Chiang Rai, Thailand
| | - Supalert Nedsuwan
- Primary Care Department, Chiangrai Regional Hospital, Chiang Rai, Thailand
| | - Tri Wangrangsimakul
- Chiangrai Clinical Research Unit, Chiangrai Regional Hospital, Chiang Rai, Thailand
- Microbiology, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Elizabeth Elliott
- UCL Anthropology, University College London, London, UK
- Institut de recherche pour le développement, Vientiane, Laos
| | - Proochista Ariana
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
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14
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Haenssgen MJ, Charoenboon N, Zanello G, Mayxay M, Reed-Tsochas F, Jones COH, Kosaikanont R, Praphattong P, Manohan P, Lubell Y, Newton PN, Keomany S, Wertheim HFL, Lienert J, Xayavong T, Warapikuptanun P, Khine Zaw Y, U-Thong P, Benjaroon P, Sangkham N, Wibunjak K, Chai-In P, Chailert S, Thavethanutthanawin P, Promsutt K, Thepkhamkong A, Sithongdeng N, Keovilayvanh M, Khamsoukthavong N, Phanthasomchit P, Phanthavong C, Boualaiseng S, Vongsavang S, Greer RC, Althaus T, Nedsuwan S, Intralawan D, Wangrangsimakul T, Limmathurotsakul D, Ariana P. Antibiotics and activity spaces: protocol of an exploratory study of behaviour, marginalisation and knowledge diffusion. BMJ Glob Health 2018; 3:e000621. [PMID: 29629190 PMCID: PMC5884330 DOI: 10.1136/bmjgh-2017-000621] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/01/2018] [Accepted: 02/14/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health priority. Leading UK and global strategy papers to fight AMR recognise its social and behavioural dimensions, but current policy responses to improve the popular use of antimicrobials (eg, antibiotics) are limited to education and awareness-raising campaigns. In response to conceptual, methodological and empirical weaknesses of this approach, we study people's antibiotic-related health behaviour through three research questions.RQ1: What are the manifestations and determinants of problematic antibiotic use in patients' healthcare-seeking pathways?RQ2: Will people's exposure to antibiotic awareness activities entail changed behaviours that diffuse or dissipate within a network of competing healthcare practices?RQ3: Which proxy indicators facilitate the detection of problematic antibiotic behaviours across and within communities? METHODS We apply an interdisciplinary analytical framework that draws on the public health, medical anthropology, sociology and development economics literature. Our research involves social surveys of treatment-seeking behaviour among rural dwellers in northern Thailand (Chiang Rai) and southern Lao PDR (Salavan). We sample approximately 4800 adults to produce district-level representative and social network data. Additional 60 cognitive interviews facilitate survey instrument development and data interpretation. Our survey data analysis techniques include event sequence analysis (RQ1), multilevel regression (RQ1-3), social network analysis (RQ2) and latent class analysis (RQ3). DISCUSSION Social research in AMR is nascent, but our unprecedentedly detailed data on microlevel treatment-seeking behaviour can contribute an understanding of behaviour beyond awareness and free choice, highlighting, for example, decision-making constraints, problems of marginalisation and lacking access to healthcare and competing ideas about desirable behaviour. TRIAL REGISTRATION NUMBER NCT03241316; Pre-results.
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Affiliation(s)
- Marco J Haenssgen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nutcha Charoenboon
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Giacomo Zanello
- School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Mayfong Mayxay
- Lao Oxford Mahosot Wellcome Trust Research Unit (LOMWRU), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos
| | - Felix Reed-Tsochas
- CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
- Institute for New Economic Thinking, Oxford Martin School, University of Oxford, Oxford, UK
- Department of Sociology, University of Oxford, Oxford, UK
| | - Caroline O H Jones
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Department of Health System and Research Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Romyen Kosaikanont
- School of Social Innovation, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Pathompong Manohan
- School of Social Innovation, Mae Fah Luang University, Chiang Rai, Thailand
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Lao Oxford Mahosot Wellcome Trust Research Unit (LOMWRU), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Heiman F L Wertheim
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Medical Microbiology Department, Radboudumc, Nijmegen, The Netherlands
| | - Jeffrey Lienert
- CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thipphaphone Xayavong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Penporn Warapikuptanun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yuzana Khine Zaw
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Patchapoom U-Thong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Patipat Benjaroon
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narinnira Sangkham
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kanokporn Wibunjak
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Poowadon Chai-In
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sirirat Chailert
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Krittanon Promsutt
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Amphayvone Thepkhamkong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicksan Sithongdeng
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Maipheth Keovilayvanh
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nid Khamsoukthavong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaengnitta Phanthasomchit
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chanthasone Phanthavong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Somsanith Boualaiseng
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Souksakhone Vongsavang
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rachel C Greer
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thomas Althaus
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supalert Nedsuwan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Daranee Intralawan
- Primary Care Department, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Tri Wangrangsimakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Proochista Ariana
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Wertheim HFL, Chuc NTK, Punpuing S, Khan WA, Gyapong M, Asante KP, Munguambe K, Gómez-Olivé FX, Ariana P, John-Langba J, Sigauque B, Toan TK, Tollman S, Cremers AJH, Do NTT, Nadjm B, van Doorn HR, Kinsman J, Sankoh O. Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use - an observational multi-centre study. Wellcome Open Res 2017; 2:58. [PMID: 29707652 PMCID: PMC5897850 DOI: 10.12688/wellcomeopenres.11985.1] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 01/21/2023] Open
Abstract
In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness.
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Affiliation(s)
- Heiman F L Wertheim
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7BN, UK.,Oxford University Clinical Research Unit, Hanoi, Vietnam.,Department of Medical Microbiology and Radboud Centre for Infectious Disease, Radboud University Nijmegen Medical Centre, Nijmegen, 6525, Netherlands
| | | | - Sureeporn Punpuing
- INDEPTH Network, Accra, Ghana.,Kanchanaburi HDSS, Institute for Population and Social Research, Mahidol University, Salaya, 73170, Thailand
| | - Wasif Ali Khan
- INDEPTH Network, Accra, Ghana.,International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, 1000, Bangladesh
| | - Margaret Gyapong
- INDEPTH Network, Accra, Ghana.,Dodowa INDEPTH Site, Dodowa, Ghana.,University of Health and Allied Sciences, Ho, Ghana
| | - Kwaku Poku Asante
- INDEPTH Network, Accra, Ghana.,Kintampo INDEPTH Site, Kintampo, Ghana
| | - Khatia Munguambe
- INDEPTH Network, Accra, Ghana.,Manhica Health Research Site, Manhica, Mozambique
| | - F Xavier Gómez-Olivé
- INDEPTH Network, Accra, Ghana.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Park Town, Johannesburg, 2193, South Africa
| | - Proochista Ariana
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | | | - Betuel Sigauque
- INDEPTH Network, Accra, Ghana.,Manhica Health Research Site, Manhica, Mozambique
| | - Tran Khanh Toan
- Hanoi Medical University, Hanoi, Vietnam.,INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- INDEPTH Network, Accra, Ghana.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Park Town, Johannesburg, 2193, South Africa
| | - Amelieke J H Cremers
- Department of Medical Microbiology and Radboud Centre for Infectious Disease, Radboud University Nijmegen Medical Centre, Nijmegen, 6525, Netherlands
| | - Nga T T Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Behzad Nadjm
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7BN, UK.,Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - H Rogier van Doorn
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7BN, UK.,Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - John Kinsman
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, SE-901 87, Sweden
| | - Osman Sankoh
- INDEPTH Network, Accra, Ghana.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, 2193, South Africa.,Department of Mathematics and Statistics, Njala University, Njala, Sierra Leone
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Affiliation(s)
- Marco J. Haenssgen
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- CABDyN Complexity Centre, Saïd Business School, University of Oxford, Oxford, UK
- Green Templeton College, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Proochista Ariana
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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17
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Abstract
It is widely accepted that healthcare-seeking behaviour is neither limited to nor terminated by access to one single healthcare provider. Yet the sequential conceptualisation of healthcare-seeking processes has not diffused into quantitative research, which continues to analyse healthcare access as a "one-off" event. The ensuing lack of understanding healthcare behaviour is problematic in light of the immense burden of premature death especially in low- and middle-income countries. This paper presents an alternative approach. Based on a novel survey instrument, we analyse original survey data from rural India and China that contain 119 unique healthcare pathways among 637 respondents. We offer three applications of how such sequential data can be analysed to enhance our understanding of people's health behaviour. First, descriptive analysis of sequential data enables more a comprehensive representation of people's health behaviours, for example the time spent in various healthcare activities, common healthcare pathways across different groups, or shifts in healthcare provider access during a typical illness. Second, by analysing the effect of mobile technology on healthcare-seeking process characteristics, we demonstrate that conventional, sequence-insensitive indicators are potentially inconsistent and misleading approximations when compared to a more precise, sequence-sensitive measure. Third, we describe how sequential data enable transparent and flexible evaluations of people's healthcare behaviour. The example of a sequence-insensitive evaluation suggests that household wealth has no statistical link to an illustrative "ideal" form of public healthcare utilisation. In contrast, sequence-sensitive evaluations demonstrate that household wealth is associated with an increased likelihood of bypassing referral processes and approaching unregulated and costly informal and private practitioners before accessing a public clinic. Sequential data therefore do not only reveal otherwise neglected locational idiosyncrasies, but they also yield deeper insights into the drivers of people's health behaviours compared to a conventional approach to "access to healthcare."
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Affiliation(s)
- Marco J Haenssgen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford OX3 7FZ, UK.,CABDyN Complexity Centre, Saïd Business School, University of Oxford, Park End Street, Oxford OX1 1HP, UK.,Technology and Management Centre for Development, Oxford Department of International Development, University of Oxford, 3 Mansfield Road, Oxford OX1 3TB, UK.,Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, UK.,Economics and Translational Research Group (ETRG), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 3/F, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok, Thailand
| | - Proochista Ariana
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford OX3 7FZ, UK.,Technology and Management Centre for Development, Oxford Department of International Development, University of Oxford, 3 Mansfield Road, Oxford OX1 3TB, UK
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Radin E, Ariana P, Broekel T, Tran TK. Analyzing demand-side efficiency in global health: an application to maternal care in Vietnam. Health Policy Plan 2016; 31:1281-90. [PMID: 27247328 DOI: 10.1093/heapol/czw063] [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] [Accepted: 04/20/2016] [Indexed: 11/14/2022] Open
Abstract
This article investigates demand-side efficiency in global health-or the efficiency with which health system users convert public health resources into health outcomes. We introduce and explain the concept of demand-side efficiency as well as quantitative methods to empirically estimate it. Using a robust nonparametric form of technical efficiency analysis, we estimate demand side efficiency and its social determinants. We pilot these methods looking at how efficiently pregnant women in Northern Vietnam convert public health resources into appropriate maternal care as defined by national policy. We find that women who live in non-mountainous geographies, who are formally employed, who are pregnant with a boy and who are ethnic minorities are all more likely to be efficient at achieving appropriate care. We find no significant association between wealth or education and efficiency. Our results suggest that, in the Vietnamese context, women who are the most likely to achieve appropriate maternal care, are not necessarily the most likely to do so efficiently. Women who live in non-mountainous geographies and who are formally employed are both more likely to achieve appropriate care and to do so efficiently. Yet ethnic minority women, who do not systematically achieve better care, are more likely to be efficient or to achieve better care when compared with those with the same endowment of public health resources. On the methodological level, the pilot highlights that this approach can provide useful information for policy by identifying which groups of people are more and less likely to be efficient. By understanding which groups are more likely to be efficient-and in turn how and why-it may be possible to devise policies to promote the drivers of, or conversely address the constraints to, optimizing demand-side efficiency.
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Affiliation(s)
- Elizabeth Radin
- Oxford Department of International Development, University of Oxford, Oxford, UK Columbia University Mailman School of Public Health, New York, NY USA
| | - Proochista Ariana
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tom Broekel
- Institute of Economic and Cultural Geography, Leibniz University of Hanover, Hanover, Germany
| | - Toan Khanh Tran
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
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Preston EC, Ariana P, Penny ME, Frost M, Plugge E. Prevalence of childhood overweight and obesity and associated factors in Peru. Rev Panam Salud Publica 2015; 38:472-478. [PMID: 27440095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 10/13/2015] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To determine the prevalence of and factors associated with childhood overweight and obesity among a cohort of children 7-8 years of age in Peru. METHODS This was a cross-sectional secondary analysis of data from the Young Lives longitudinal study of childhood poverty. The sample was a cohort of 1 737 children 7-8 years of age in 2009. Prevalence of overweight and obesity was assessed using body mass index-forage Z-scores. Logistic regression was used to determine associations with a number of individual, household, and community factors. RESULTS Prevalences of overweight and obesity were 19.2% and 8.6%, respectively. A prevalence of 32.0% and 23.5% overweight and obesity was found among males and females, respectively. High socioeconomic status, living in Lima, having a mother who was overweight or obese, being male, and being an only child or having only one sibling were associated with being overweight and obese at this age. CONCLUSIONS This study shows a high prevalence of childhood and maternal overweight and obesity in Peru. In contrast to findings in many high-income countries, the findings in Peru indicate that children from wealthier households were more likely to be overweight or obese than those from poorer households. In addition, there is something particularly obesogenic about the Lima environment that merits further investigation, and several key issues to consider when targeting future interventions and research.
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Affiliation(s)
- Emma C Preston
- Department of Public Health, University of Oxford, Oxford, United Kingdom,
| | - Proochista Ariana
- Department of International Development, University of Oxford, Oxford, United Kingdom
| | - Mary E Penny
- Instituto de Investigación Nutricional, Lima, Peru
| | - Melanie Frost
- Oxford Institute of Population Aging, University of Oxford, Oxford, United Kingdom
| | - Emma Plugge
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Nair M, Ariana P, Webster P. Impact of mothers' employment on infant feeding and care: a qualitative study of the experiences of mothers employed through the Mahatma Gandhi National Rural Employment Guarantee Act. BMJ Open 2014; 4:e004434. [PMID: 24694624 PMCID: PMC3987718 DOI: 10.1136/bmjopen-2013-004434] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore the experiences of mothers employed through the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) using focus group discussions (FGDs) to understand the impact of mothers' employment on infant feeding and care. The effects of mothers' employment on nutritional status of children could be variable. It could lead to increased household income, but could also compromise child care and feeding. SETTING The study was undertaken in the Dungarpur district of Rajasthan, India. PARTICIPANTS Mothers of infants <12 months of age. Ten FGDs, two in each of the five administrative blocks of the study district were conducted. The groups were composed of a minimum of 5 and maximum of 8 participants, giving a total of 62 mothers. Thematic analysis was conducted to assess patterns and generate emergent themes. RESULTS Four major themes were identified-'mothers' employment compromises infant feeding and care', 'caregivers' inability to substitute mothers' care', 'compromises related to childcare and feeding outweigh benefits from MGNREGA' and 'employment as disempowering'. Mothers felt that the comprises to infant care and feeding due to long hours of work, lack of alternative adequate care arrangements, low wages and delayed payments outweighed the benefits from the scheme. CONCLUSIONS This study provides an account of the trade-off between mothers' employment and child care. It provides an understanding of the household power relationships, societal and cultural factors that modulate the effects of mothers' employment. From the perspective of mothers, it helps to understand the benefits and problems related to providing employment to women with infants in the MGNREGA scheme and make a case to pursue policy changes to improve their working conditions.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Proochista Ariana
- Nuffield Department of Population Health and Department of International Development, University of Oxford, Oxford, UK
| | - Premila Webster
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxford, UK
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21
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Nair M, Ariana P, Ohuma EO, Gray R, De Stavola B, Webster P. Effect of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) on malnutrition of infants in Rajasthan, India: a mixed methods study. PLoS One 2013; 8:e75089. [PMID: 24086447 PMCID: PMC3783470 DOI: 10.1371/journal.pone.0075089] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/11/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives Analyse the effect of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), a wage-for-employment policy of the Indian Government, on infant malnutrition and delineate the pathways through which MGNREGA affects infant malnutrition. Hypothesis: MGNREGA could reduce infant malnutrition through positive effects on household food security and infant feeding. Method Mixed methods using cross-sectional study and focus group discussions conducted in Dungarpur district, Rajasthan, India. Participants: Infants aged 1 to <12 months and their mothers/caregivers. Final sample 528 households with 1056 participants, response rate 89.6%. Selected households were divided into MGNREGA-households and non-MGNREGA-households based on participation in MGNREGA between August-2010 and September-2011. Outcomes: Infant malnutrition measured using anthropometric indicators - underweight, stunting, and wasting (WHO criteria). Results We included 528 households with 1,056 participants. Out of 528, 281 households took part in MGNREGA between August’10, and September’11. Prevalence of wasting was 39%, stunting 24%, and underweight 50%. Households participating in MGNREGA were less likely to have wasted infants (OR 0·57, 95% CI 0·37–0·89, p = 0·014) and less likely to have underweight infants (OR 0·48, 95% CI 0·30–0·76, p = 0·002) than non-participating households. Stunting did not differ significantly between groups. We did 11 focus group discussions with 62 mothers. Although MGNREGA reduced starvation, it did not provide the desired benefits because of lower than standard wages and delayed payments. Results from path analysis did not support existence of an effect through household food security and infant feeding, but suggested a pathway of effect through low birth-weight. Conclusion Participation in MGNREGA was associated with reduced infant malnutrition possibly mediated indirectly via improved birth-weight rather than by improved infant feeding. Addressing factors such as lack of mothers’ knowledge and inappropriate feeding practices, over and above the social and economic policies, is key in efforts to reduce infant malnutrition.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Proochista Ariana
- Nuffield Department of Population Health, & Department of International Development, University of Oxford, Oxford, United Kingdom
| | - Eric O. Ohuma
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom
| | - Ron Gray
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Bianca De Stavola
- Department of Medical Statistics & Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Premila Webster
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Nair M, Ariana P, Webster P. What influences the decision to undergo institutional delivery by skilled birth attendants? A cohort study in rural Andhra Pradesh, India. Rural Remote Health 2012. [DOI: 10.22605/rrh2311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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23
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Nair M, Ariana P, Webster P. What influences the decision to undergo institutional delivery by skilled birth attendants? A cohort study in rural Andhra Pradesh, India. Rural Remote Health 2012; 12:2311. [PMID: 23148477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Despite continuing efforts to promote skilled institutional delivery, eight women die every hour in India due to causes related to pregnancy and child birth. The objectives of this study were to assess the prevalence and the determinants of institutional delivery by skilled birth attendants in a rural population in Andhra Pradesh, India. METHODS This cross-sectional study used data from 'Young Lives', a longitudinal study on childhood poverty, and the study population was a cohort of 1419 rural, economically deprived women (from the Young Lives study) in Andhra Pradesh, India. The data are from round-1 of Young Lives younger cohort recruited in 2002 and followed until 2015. The participation rate of households was 99.5%. RESULTS Prevalence of skilled institutional delivery was 36.8%. Women's education (odds ratio [OR] for secondary education 2.06; 95% confidence interval [95%CI] 1.33-3.19), desire to be pregnant (OR 1.89; 95% CI 1.12-3.22) and adequate prenatal care (OR 1.69; 95% CI 1.30-2.21) were found to be the positive determinants of skilled institutional delivery. High birth order (OR for second birth 0.44; 95% CI 0.32-0.60, OR for third birth 0.47; 95% CI 0.30-0.72 and OR for ≥fourth 0.47; 95% CI 0.27-0.81), schedule caste/schedule tribe social background (OR 0.70; 95% CI 0.53-0.93) and poor economic status of the household (OR for the poorest households 0.67; 95% CI 0.46-0.99) were negatively associated with skilled institutional delivery. CONCLUSIONS Despite existence of supporting schemes, the utilisation of skilled institutional delivery services was low in the study population. Educated women and women with adequate prenatal care who have a desired pregnancy were more likely to utilise health institutions and skilled delivery care. There is a need for integrated approaches through maternal health, family planning and education programs, and a focus on uneducated, poor women belonging to disadvantaged social groups.
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Affiliation(s)
- M Nair
- Department of Public Health, University of Oxford, Oxford, UK
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Barnett I, Ariana P, Petrou S, Penny ME, Duc LT, Galab S, Woldehanna T, Escobal JA, Plugge E, Boyden J. Cohort Profile: The Young Lives Study. Int J Epidemiol 2012; 42:701-8. [DOI: 10.1093/ije/dys082] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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McHardy K, Ariana P, Plugge E. Public Health in Practice: translating theory into action. Med Educ 2011; 45:1142. [PMID: 21936872 DOI: 10.1111/j.1365-2923.2011.04128.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Karina McHardy
- Department of Public Health, University of Oxford, Oxford, UK.
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Affiliation(s)
- Manisha Nair
- Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, OX3 7LF, England
| | - Premila Webster
- Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, OX3 7LF, England
| | - Proochista Ariana
- Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, OX3 7LF, England
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