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Akter K, Kuddus A, Jeny T, Nahar T, Shaha S, Ahmed N, King C, Pires M, Haghparast-Bidgoli H, Azad K, Fottrell E, Morrison J. Stakeholder perceptions on scaling-up community-led interventions for prevention and control of non-communicable diseases in Bangladesh: a qualitative study. BMC Public Health 2023; 23:719. [PMID: 37081438 PMCID: PMC10116471 DOI: 10.1186/s12889-023-15551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/28/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Engaging communities is an important component of multisectoral action to address the growing burden of non-communicable diseases (NCDs) in low- and middle-income countries. We conducted research with non-communicable disease stakeholders in Bangladesh to understand how a community-led intervention which was shown to reduce the incidence of type 2 diabetes in rural Bangladesh could be scaled-up. METHODS We purposively sampled any actor who could have an interest in the intervention, or that could affect or be affected by the intervention. We interviewed central level stakeholders from donor agencies, national health policy levels, public, non-governmental, and research sectors to identify scale-up mechanisms. We interviewed community health workers, policy makers, and non-governmental stakeholders, to explore the feasibility and acceptability of implementing the suggested mechanisms. We discussed scale-up options in focus groups with community members who had attended a community-led intervention. We iteratively developed our data collection tools based on our analysis and re-interviewed some participants. We analysed the data deductively using a stakeholder analysis framework, and inductively from codes identified in the data. RESULTS Despite interest in addressing NCDs, there was a lack of a clear community engagement strategy at the government level, and most interventions have been implemented by non-governmental organisations. Many felt the Ministry of Health and Family Welfare should lead on community engagement, and NCD screening and referral has been added to the responsibilities of community health workers and health volunteers. Yet there remains a focus on reproductive health and NCD diagnosis and referral instead of prevention at the community level. There is potential to engage health volunteers in community-led interventions, but their present focus on engaging women for reproductive health does not fit with community needs for NCD prevention. CONCLUSIONS Research highlighted the need for a preventative community engagement strategy to address NCDs, and the potential to utilise existing cadres to scale-up community-led interventions. It will be important to work with key stakeholders to address gender issues and ensure flexibility and responsiveness to community concerns. We indicate areas for further implementation research to develop scaled-up models of community-led interventions to address NCDs.
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Affiliation(s)
- Kohenour Akter
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Tasnova Jeny
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Sanjit Shaha
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Carina King
- Karolinska Institutet, K9 Global Folkhälsa, K9 GPH Stålsby Lundborg Alfvén, Stockholm, 171 77, Sweden
| | - Malini Pires
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | | | - Kishwar Azad
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Edward Fottrell
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Joanna Morrison
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
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King C, Pires M, Ahmed N, Akter K, Kuddus A, Copas A, Haghparast-Bidgoli H, Morrison J, Nahar T, Shaha SK, Khan AKA, Azad K, Fottrell E. Community participatory learning and action cycle groups to reduce type 2 diabetes in Bangladesh (D:Clare): an updated study protocol for a parallel arm cluster randomised controlled trial. Trials 2023; 24:218. [PMID: 36959617 PMCID: PMC10034243 DOI: 10.1186/s13063-023-07243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
The "Diabetes: Community-led Awareness, Response and Evaluation" (D:Clare) trial aims to scale up and replicate an evidence-based participatory learning and action cycle intervention in Bangladesh, to inform policy on population-level T2DM prevention and control.The trial was originally designed as a stepped-wedge cluster randomised controlled trial, with the interventions running from March 2020 to September 2022. Twelve clusters were randomly allocated (1:1) to implement the intervention at months 1 or 12 in two steps, and evaluated through three cross-sectional surveys at months 1, 12 and 24. However, due to the COVID-19 pandemic, we suspended project activities on the 20th of March 2020. As a result of the changed risk landscape and the delays introduced by the COVID-19 pandemic, we changed from the stepped-wedge design to a wait-list parallel arm cluster RCT (cRCT) with baseline data. We had four key reasons for eventually agreeing to change designs: equipoise, temporal bias in exposure and outcomes, loss of power and time and funding considerations.Trial registration ISRCTN42219712 . Registered on 31 October 2019.
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Affiliation(s)
- Carina King
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Malini Pires
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Andrew Copas
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | | | - Joanna Morrison
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - AKAzad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
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Fottrell E, King C, Ahmed N, Shaha SK, Morrison J, Pires M, Kuddus A, Nahar T, Haghparast-Bidgoli H, Khan AA, Azad K. Intermediate hyperglycaemia, diabetes and blood pressure in rural Bangladesh: five-year post-randomisation follow-up of the DMagic cluster-randomised controlled trial. Lancet Reg Health Southeast Asia 2023; 10:100122. [PMID: 36938333 PMCID: PMC10015271 DOI: 10.1016/j.lansea.2022.100122] [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] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
Background The DMagic trial showed that participatory learning and action (PLA) community mobilisation delivered through facilitated community groups, and mHealth voice messaging interventions improved diabetes knowledge in Bangladesh and the PLA intervention reduced diabetes occurrence. We assess intervention effects three years after intervention activities stopped. Methods Five years post-randomisation, we conducted a cross-sectional survey among a random sample of adults aged ≥30-years living in the 96 DMagic villages, and a cohort of individuals identified with intermediate hyperglycaemia at the start of the DMagic trial in 2016. Primary outcomes were: 1) the combined prevalence of intermediate hyperglycaemia and diabetes; 2) five-year cumulative incidence of diabetes among the 2016 cohort of individuals with intermediate hyperglycaemia. Secondary outcomes were: weight, BMI, waist and hip circumferences, blood pressure, knowledge and behaviours. Primary analysis compared outcomes at the cluster level between intervention arms relative to control. Findings Data were gathered from 1623 (82%) of the randomly selected adults and 1817 (87%) of the intermediate hyperglycaemia cohort. 2018 improvements in diabetes knowledge in mHealth clusters were no longer observable in 2021. Knowledge remains significantly higher in PLA clusters relative to control but no difference in primary outcomes of intermediate hyperglycaemia and diabetes prevalence (OR (95%CI) 1.23 (0.89, 1.70)) or five-year incidence of diabetes were observed (1.04 (0.78, 1.40)). Hypertension (0.73 (0.54, 0.97)) and hypertension control (2.77 (1.34, 5.75)) were improved in PLA clusters relative to control. Interpretation PLA intervention effect on intermediate hyperglycaemia and diabetes was not sustained at 3 years after intervention end, but benefits in terms of blood pressure reduction were observed. Funding Medical Research Council UK: MR/M016501/1 (DMagic trial); MR/T023562/1 (DClare study), under the Global Alliance for Chronic Diseases (GACD) Diabetes and Scale-up Programmes, respectively.
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Key Words
- ADS, Appraisal of Diabetes Scale
- BADAS, Diabetic Association of Bangladesh
- BMI, Body Mass Index
- Bangladesh
- CVD, Cardiovascular disease(s)
- Cardiovascular risk
- Cluster randomised controlled trial
- Community intervention
- Control
- DBP, Diastolic blood pressure
- DDS, Dietary Diversity Score
- Diabetes
- GAD-7, Generalised Anxiety Disorder Assessment
- IQR, Inter-quartile range
- NCD, Non-communicable disease(s)
- PHQ-9, Patient Health Questionnaire 9
- PLA, Participatory Learning and Action
- PP, Pulse pressure
- Prevention
- Rural
- SBP, Systolic blood pressure
- T2DM, Type-2 diabetesmellitus
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Affiliation(s)
- Edward Fottrell
- UCL Institute for Global Health, University College London, London, UK
- Corresponding author. UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Naveed Ahmed
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Sanjit Kumer Shaha
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- UCL Institute for Global Health, University College London, London, UK
| | - Malini Pires
- UCL Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A.K. Azad Khan
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Centre for Health Research & Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Rotherham M, Moradi Y, Nahar T, Mosses D, Telling N, El Haj AJ. Magnetic activation of TREK1 triggers stress signalling and regulates neuronal branching in SH-SY5Y cells. Front Med Technol 2022; 4:981421. [PMID: 36545473 PMCID: PMC9761330 DOI: 10.3389/fmedt.2022.981421] [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: 06/29/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
TWIK-related K+ 1 (TREK1) is a potassium channel expressed in the nervous system with multiple functions including neurotransmission and is a prime pharmacological target for neurological disorders. TREK1 gating is controlled by a wide range of external stimuli including mechanical forces. Previous work has demonstrated that TREK1 can be mechano-activated using magnetic nanoparticles (MNP) functionalised with antibodies targeted to TREK1 channels. Once the MNP are bound, external dynamic magnetic fields are used to generate forces on the TREK channel. This approach has been shown to drive cell differentiation in cells from multiple tissues. In this work we investigated the effect of MNP-mediated TREK1 mechano-activation on early stress response pathways along with the differentiation and connectivity of neuronal cells using the model neuronal cell line SH-SY5Y. Results showed that TREK1 is well expressed in SH-SY5Y and that TREK1-MNP initiate c-Myc/NF-κB stress response pathways as well as Nitrite production after magnetic stimulation, indicative of the cellular response to mechanical cues. Results also showed that TREK1 mechano-activation had no overall effect on neuronal morphology or expression of the neuronal marker βIII-Tubulin in Retinoic Acid (RA)/Brain-derived Neurotrophic factor (BDNF) differentiated SH-SY5Y but did increase neurite number. These results suggest that TREK1 is involved in cellular stress response signalling in neuronal cells, which leads to increased neurite production, but is not involved in regulating RA/BDNF mediated neuronal differentiation.
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Affiliation(s)
- Michael Rotherham
- Healthcare Technologies Institute, School of Chemical Engineering, University of Birmingham, Heritage Building, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom,School of Pharmacy and Bioengineering, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom,Correspondence: Michael Rotherham
| | - Yasamin Moradi
- School of Pharmacy and Bioengineering, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom
| | - Tasmin Nahar
- School of Pharmacy and Bioengineering, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom
| | - Dominic Mosses
- School of Pharmacy and Bioengineering, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom,Regenerative Medicine and Cellular Therapies, School of Pharmacy, Faculty of Science, University of Nottingham, Nottingham, United Kingdom
| | - Neil Telling
- School of Pharmacy and Bioengineering, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom
| | - Alicia J. El Haj
- Healthcare Technologies Institute, School of Chemical Engineering, University of Birmingham, Heritage Building, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom,School of Pharmacy and Bioengineering, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom
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Rotherham M, Nahar T, Broomhall TJ, Telling ND, El Haj AJ. Remote magnetic actuation of cell signalling for tissue engineering. Current Opinion in Biomedical Engineering 2022. [DOI: 10.1016/j.cobme.2022.100410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Pires M, Shaha S, King C, Morrison J, Nahar T, Ahmed N, Jennings HM, Akter K, Haghparast-Bidgoli H, Khan AKA, Costello A, Kuddus A, Azad K, Fottrell E. Equity impact of participatory learning and action community mobilisation and mHealth interventions to prevent and control type 2 diabetes and intermediate hyperglycaemia in rural Bangladesh: analysis of a cluster randomised controlled trial. J Epidemiol Community Health 2022; 76:586-594. [PMID: 35277436 PMCID: PMC9118071 DOI: 10.1136/jech-2021-217293] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/21/2022] [Indexed: 11/11/2022]
Abstract
Background A cluster randomised trial of mHealth and participatory learning and action (PLA) community mobilisation interventions showed that PLA significantly reduced the prevalence of intermediate hyperglycaemia and type 2 diabetes mellitus (T2DM) and the incidence of T2DM among adults in rural Bangladesh; mHealth improved knowledge but showed no effect on glycaemic outcomes. We explore the equity of intervention reach and impact. Methods Intervention reach and primary outcomes of intermediate hyperglycaemia and T2DM were assessed through interview surveys and blood fasting glucose and 2-hour oral glucose tolerance tests among population-based samples of adults aged ≥30 years. Age-stratified, gender-stratified and wealth-stratified intervention effects were estimated using random effects logistic regression. Results PLA participants were similar to non-participants, though female participants were younger and more likely to be married than female non-participants. Differences including age, education, wealth and marital status were observed between individuals exposed and those not exposed to the mHealth intervention. PLA reduced the prevalence of T2DM and intermediate hyperglycaemia in all age, gender and wealth strata. Reductions in 2-year incidence of T2DM of at least 51% (0.49, 95% CI 0.26 to 0.92) were observed in all strata except among the oldest and least poor groups. mHealth impact on glycaemic outcomes was observed only among the youngest group, where a 47% reduction in the 2-year incidence of T2DM was observed (0.53, 95% CI 0.28 to 1.00). Conclusion Large impacts of PLA across all strata indicate a highly effective and equitable intervention. mHealth may be more suitable for targeting higher risk, younger populations. Trial registration number ISRCTN41083256.
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Affiliation(s)
- Malini Pires
- Institute for Global Health, University College London, London, UK
| | - Sanjit Shaha
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | - Tasmin Nahar
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Naveed Ahmed
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Kohenour Akter
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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King C, Shaha SK, Morrison J, Ahmed N, Kuddus A, Pires M, Nahar T, Hossin R, Haghparast-Bidgoli H, Khan AKA, Davies J, Azad K, Fottrell E. Changes in non-communicable diseases, diet and exercise in a rural Bangladesh setting before and after the first wave of COVID-19. PLOS Glob Public Health 2022; 2:e0001110. [PMID: 36962614 PMCID: PMC10021158 DOI: 10.1371/journal.pgph.0001110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Prevalence of non-communicable diseases (NCDs) is high in rural Bangladesh. Given the complex multi-directional relationships between NCDs, COVID-19 infections and control measures, exploring pandemic impacts in this context is important. We conducted two cross-sectional surveys of adults ≥30-years in rural Faridpur district, Bangladesh, in February to March 2020 (survey 1, pre-COVID-19), and January to March 2021 (survey 2, post-lockdown). A new random sample of participants was taken at each survey. Anthropometric measures included: blood pressure, weight, height, hip and waist circumference and fasting and 2-hour post-glucose load blood glucose. An interviewer-administered questionnaire included: socio-demographics; lifestyle and behavioural risk factors; care seeking; self-rated health, depression and anxiety assessments. Differences in NCDs, diet and exercise were compared between surveys using chi2 tests, logistic and linear regression; sub-group analyses by gender, age and socio-economic tertiles were conducted. We recruited 950 (72.0%) participants in survey 1 and 1392 (87.9%) in survey 2. The percentage of the population with hypertension increased significantly from 34.5% (95% CI: 30.7, 38.5) to 41.5% (95% CI: 38.2, 45.0; p-value = 0.011); the increase was more pronounced in men. Across all measures of self-reported health and mental health, there was a significant improvement between survey 1 and 2. For self-rated health, we observed a 10-point increase (71.3 vs 81.2, p-value = 0.005). Depression reduced from 15.3% (95% CI: 8.4, 26.1) to 6.0% (95% CI: 2.7, 12.6; p-value = 0.044) and generalised anxiety from 17.9% (95% CI: 11.3, 27.3) to 4.0% (95% CI: 2.0, 7.6; p-value<0.001). No changes in fasting blood glucose, diabetes status, BMI or abdominal obesity were observed. Our findings suggest both positive and negative health outcomes following COVID-19 lockdown in a rural Bangladeshi setting, with a concerning increase in hypertension. These findings need to be further contextualised, with prospective assessments of indirect effects on physical and mental health and care-seeking.
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Affiliation(s)
- Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Joanna Morrison
- Institute for Global Health, University College London, London, United Kingdom
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Malini Pires
- Institute for Global Health, University College London, London, United Kingdom
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Raduan Hossin
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, United Kingdom
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Jennings HM, Morrison J, Akter K, Haghparast-Bidgoli H, King C, Ahmed N, Kuddus A, Shaha SK, Nahar T, Azad K, Fottrell E. Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study. BMC Public Health 2021; 21:1445. [PMID: 34294059 PMCID: PMC8299577 DOI: 10.1186/s12889-021-11395-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/11/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.
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Affiliation(s)
- Hannah Maria Jennings
- Department of Health Sciences, University of York and Hull York Medical School, York, UK. .,Institute for Global Health, University College London, London, UK.
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | | | - Carina King
- Institute for Global Health, University College London, London, UK.,Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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Morrison J, Akter K, Jennings H, Ahmed N, Kumer Shaha S, Kuddus A, Nahar T, King C, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K, Fottrell E. Learning from a diabetes mHealth intervention in rural Bangladesh: what worked, what did not and what next? Glob Public Health 2021; 17:1299-1313. [PMID: 33966607 PMCID: PMC9487863 DOI: 10.1080/17441692.2021.1923776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is an urgent need for population-based interventions to slow the growth of the diabetes epidemic in low-and middle-income countries. We tested the effectiveness of a population-based mHealth voice messaging intervention for T2DM prevention and control in rural Bangladesh through a cluster randomised controlled trial. mHealth improved knowledge and awareness about T2DM but there was no detectable effect on T2DM occurrence. We conducted mixed-methods research to understand this result. Exposure to messages was limited by technological faults, high frequency of mobile phone number changes, message fatigue and (mis)perceptions that messages were only for those who had T2DM. Persistent social norms, habits and desires made behaviour change challenging, and participants felt they would be more motivated by group discussions than mHealth messaging alone. Engagement with mHealth messages for T2DM prevention and control can be increased by (1) sending identifiable messages from a trusted source (2) using participatory design of mHealth messages to inform modelling of behaviours and increase relevance to the general population (3) enabling interactive messaging. mHealth messaging is likely to be most successful if implemented as part of a multi-sectoral, multi-component approach to address T2DM and non-communicable disease risk factors.
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Affiliation(s)
- Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | | | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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King C, Pires M, Ahmed N, Akter K, Kuddus A, Copas A, Haghparast-Bidgoli H, Morrison J, Nahar T, Shaha SK, Khan AKA, Azad K, Fottrell E. Community participatory learning and action cycle groups to reduce type 2 diabetes in Bangladesh (D:Clare trial): study protocol for a stepped-wedge cluster randomised controlled trial. Trials 2021; 22:235. [PMID: 33781315 PMCID: PMC8006505 DOI: 10.1186/s13063-021-05167-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/02/2021] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND An estimated 463 million people globally have diabetes, with the prevalence growing in low-and middle-income settings, such as Bangladesh. Given the need for context-appropriate interventions to prevent type 2 diabetes mellitus (T2DM), the 'Diabetes: Community-led Awareness, Response and Evaluation' (D:Clare) trial will rigorously evaluate the replication and scale-up of a participatory learning and action (PLA) cycle intervention in Bangladesh, to inform policy on population-level T2DM prevention and control. METHODS This is a stepped-wedge cluster randomised controlled trial, with integrated process and economic evaluations, conducted from March 2020 to September 2022. The trial will evaluate a community-based four-phase PLA cycle intervention focused on prevention and control of T2DM implemented over 18 months, against a control of usual care. Twelve clusters will be randomly allocated (1:1) to implement the intervention at project month 1 or 12. The intervention will be evaluated through three cross-sectional surveys at months 1, 12 and 24. The trial will be conducted in Alfadanga Upazila, Faridpur district, with an estimated population of 120,000. Clusters are defined as administrative geographical areas, with approximately equal populations. Each of the six unions in Alfadanga will be divided into two clusters, forming 12 clusters in total. Given the risk of inter-cluster contamination, evaluation surveys will exclude villages in border areas. Participants will be randomly sampled, independently for each survey, from a population census conducted in January 2020. The primary outcome is the combined prevalence of intermediate hyperglycaemia and T2DM, measured through fasting and 2-h post-glucose load blood tests. A total of 4680 participants provide 84% power to detect a 30% reduction in the primary outcome, assuming a baseline of 30% and an ICC of 0.07. The analysis will be by intention-to-treat, comparing intervention and control periods across all clusters, adjusting for geographical clustering. DISCUSSION This study will provide further evidence of effectiveness for community-based PLA to prevent T2DM at scale in a rural Bangladesh setting. However, we encountered several challenges in applying the stepped-wedge design to our research context, with particular consideration given to balancing seasonality, timing and number of steps and estimation of partial versus full effect. TRIAL REGISTRATION ISRCTN: ISRCTN42219712 . Registered on 31 October 2019.
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Affiliation(s)
- Carina King
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Malini Pires
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Andrew Copas
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | | | - Joanna Morrison
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | | | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH UK
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Bongaerts M, Aizel K, Secret E, Jan A, Nahar T, Raudzus F, Neumann S, Telling N, Heumann R, Siaugue JM, Ménager C, Fresnais J, Villard C, El Haj A, Piehler J, Gates MA, Coppey M. Parallelized Manipulation of Adherent Living Cells by Magnetic Nanoparticles-Mediated Forces. Int J Mol Sci 2020; 21:ijms21186560. [PMID: 32911745 PMCID: PMC7555211 DOI: 10.3390/ijms21186560] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022] Open
Abstract
The remote actuation of cellular processes such as migration or neuronal outgrowth is a challenge for future therapeutic applications in regenerative medicine. Among the different methods that have been proposed, the use of magnetic nanoparticles appears to be promising, since magnetic fields can act at a distance without interactions with the surrounding biological system. To control biological processes at a subcellular spatial resolution, magnetic nanoparticles can be used either to induce biochemical reactions locally or to apply forces on different elements of the cell. Here, we show that cell migration and neurite outgrowth can be directed by the forces produced by a switchable parallelized array of micro-magnetic pillars, following the passive uptake of nanoparticles. Using live cell imaging, we first demonstrate that adherent cell migration can be biased toward magnetic pillars and that cells can be reversibly trapped onto these pillars. Second, using differentiated neuronal cells we were able to induce events of neurite outgrowth in the direction of the pillars without impending cell viability. Our results show that the range of forces applied needs to be adapted precisely to the cellular process under consideration. We propose that cellular actuation is the result of the force on the plasma membrane caused by magnetically filled endo-compartments, which exert a pulling force on the cell periphery.
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Affiliation(s)
- Maud Bongaerts
- Laboratoire Physico Chimie Curie, Institut Curie, PSL Research University, Sorbonne Université, CNRS, 75005 Paris, France; (M.B.); (K.A.)
| | - Koceila Aizel
- Laboratoire Physico Chimie Curie, Institut Curie, PSL Research University, Sorbonne Université, CNRS, 75005 Paris, France; (M.B.); (K.A.)
| | - Emilie Secret
- Physico-chimie des Électrolytes et Nanosystèmes Interfaciaux, PHENIX, Sorbonne Université, CNRS, F-75005 Paris, France; (E.S.); (J.-M.S.); (C.M.); (J.F.)
| | - Audric Jan
- Laboratoire Physico Chimie Curie, Institut Pierre Gilles de Gène, Institut Curie, PSL Research University, Sorbonne Université, CNRS, 75005 Paris, France; (A.J.); (C.V.)
| | - Tasmin Nahar
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK; (T.N.); (N.T.)
| | - Fabian Raudzus
- Department of Biochemistry II – Molecular Neurobiochemistry, Faculty of Chemistry and Biochemistry, Ruhr-Universität Bochum, 44801 Bochum, Germany; (F.R.); (S.N.); (R.H.)
- Department of Clinical Application, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto 606-8507, Japan
| | - Sebastian Neumann
- Department of Biochemistry II – Molecular Neurobiochemistry, Faculty of Chemistry and Biochemistry, Ruhr-Universität Bochum, 44801 Bochum, Germany; (F.R.); (S.N.); (R.H.)
| | - Neil Telling
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK; (T.N.); (N.T.)
| | - Rolf Heumann
- Department of Biochemistry II – Molecular Neurobiochemistry, Faculty of Chemistry and Biochemistry, Ruhr-Universität Bochum, 44801 Bochum, Germany; (F.R.); (S.N.); (R.H.)
| | - Jean-Michel Siaugue
- Physico-chimie des Électrolytes et Nanosystèmes Interfaciaux, PHENIX, Sorbonne Université, CNRS, F-75005 Paris, France; (E.S.); (J.-M.S.); (C.M.); (J.F.)
| | - Christine Ménager
- Physico-chimie des Électrolytes et Nanosystèmes Interfaciaux, PHENIX, Sorbonne Université, CNRS, F-75005 Paris, France; (E.S.); (J.-M.S.); (C.M.); (J.F.)
| | - Jérôme Fresnais
- Physico-chimie des Électrolytes et Nanosystèmes Interfaciaux, PHENIX, Sorbonne Université, CNRS, F-75005 Paris, France; (E.S.); (J.-M.S.); (C.M.); (J.F.)
| | - Catherine Villard
- Laboratoire Physico Chimie Curie, Institut Pierre Gilles de Gène, Institut Curie, PSL Research University, Sorbonne Université, CNRS, 75005 Paris, France; (A.J.); (C.V.)
| | - Alicia El Haj
- Healthcare Technology Institute, Institute of Translational Medicine, University of Birmingham, Birmingham B15 2TT, UK;
| | - Jacob Piehler
- Department of Biology/Chemistry, University of Osnabrück, Barbarastr. 11, 49076 Osnabrück, Germany;
| | - Monte A. Gates
- Institute of Pharmacy and Bioengineering, School of Medicine, Keele University, Keele ST5 5BG, UK;
| | - Mathieu Coppey
- Laboratoire Physico Chimie Curie, Institut Curie, PSL Research University, Sorbonne Université, CNRS, 75005 Paris, France; (M.B.); (K.A.)
- Correspondence:
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Rotherham M, Nahar T, Goodman T, Telling N, Gates M, El Haj A. Magnetic Mechanoactivation of Wnt Signaling Augments Dopaminergic Differentiation of Neuronal Cells. ACTA ACUST UNITED AC 2020; 3:e1900091. [PMID: 32648650 DOI: 10.1002/adbi.201900091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/07/2019] [Indexed: 01/09/2023]
Abstract
Wnt signaling is a key developmental pathway that regulates dopaminergic progenitor cell proliferation and differentiation during neuronal development. This makes Wnt signaling an important therapeutic target for neurodegenerative conditions such as Parkinson's disease. Wnt signaling can be modulated using peptides such as UM206, which bind to the Wnt receptor Frizzled. Previous work has demonstrated remote activation of the Wnt pathway through Frizzled using peptide-functionalized magnetic nanoparticles (MNPs) with magnetic field stimulation. Using this technology, Wnt signaling is remotely activated in the neuronal cell line SH-SY5Y, and the phenotypic response to stimulation is assessed. Results indicate β-catenin translocalization and activation of TCF/LEF responsive transcription in response to MNP and magnetic fields, which result in dopaminergic marker expression when synergistically combined with differentiation factors retinoic acid and the phorbol ester phorbol 12-myristate 13-acetate. This approach is translated into ex vivo postnatal rat brain slices modeling the developing nigrostriatal pathway. Dopaminergic marker expression is maintained in MNP-labeled SH-SY5Y cells after injection and magnetic stimulation. These results demonstrate the translational value of remote control of signal transduction for controlling neuronal precursor cell behavior and highlight the potential applications for controlled cell differentiation as part of cell therapies for neurodegenerative disease.
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Affiliation(s)
- Michael Rotherham
- Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Stoke-on-Trent, ST4 7QB, UK
| | - Tasmin Nahar
- Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Stoke-on-Trent, ST4 7QB, UK
| | - Timothy Goodman
- Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Stoke-on-Trent, ST4 7QB, UK
| | - Neil Telling
- Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Stoke-on-Trent, ST4 7QB, UK
| | - Monte Gates
- Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Stoke-on-Trent, ST4 7QB, UK
| | - Alicia El Haj
- Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Thornburrow Drive, Stoke-on-Trent, ST4 7QB, UK.,Institute of Translational Medicine, University of Birmingham, Heritage Building, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
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Morrison J, Akter K, Jennings HM, Nahar T, Kuddus A, Shaha SK, Ahmed N, King C, Haghparast-Bidgoli H, Costello A, Khan AKA, Azad K, Fottrell E. Participatory learning and action to address type 2 diabetes in rural Bangladesh: a qualitative process evaluation. BMC Endocr Disord 2019; 19:118. [PMID: 31684932 PMCID: PMC6830002 DOI: 10.1186/s12902-019-0447-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/27/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetes is 7th largest cause of death worldwide, and prevalence is increasing rapidly in low-and middle-income countries. There is an urgent need to develop and test interventions to prevent and control diabetes and develop the theory about how such interventions can be effective. We conducted a participatory learning and action (PLA) intervention with community groups in rural Bangladesh which was evaluated through a cluster randomised controlled trial. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group. We present findings from qualitative process evaluation research to explore how this intervention was effective. METHODS We conducted group interviews and focus group discussions using photovoice with purposively sampled group attenders and non-attenders, and intervention implementers. Data were collected before the trial analysis. We used inductive content analysis to generate theory from the data. RESULTS The intervention increased the health literacy of individuals and communities - developing their knowledge, capacity and self-confidence to enact healthy behaviours. Community, household and individual capacity increased through social support and social networks, which then created an enabling community context, further strengthening agency and enabling community action. This increased opportunities for healthy behaviour. Community actions addressed lack of awareness about diabetes, gendered barriers to physical activity and lack of access to blood glucose testing. The interaction between the individual, household, and community contexts amplified change, and yet there was limited engagement with macro level, or 'state', barriers to healthy behaviour. CONCLUSIONS The participatory approach enabled groups to analyse how context affected their ability to have healthy behaviours and participants engaged with issues as a community in the ways that they felt comfortable. We suggest measuring health literacy and social networks in future interventions and recommend specific capacity strengthening to develop public accountability mechanisms and health systems strengthening to complement community-based interventions. TRIAL REGISTRATION Registered at ISRCTN on 30th March 2016 (Retrospectively Registered) Registration number: ISRCTN41083256 .
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Affiliation(s)
- Joanna Morrison
- University College London Institute for Global Health, London, UK
| | | | | | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- University College London Institute for Global Health, London, UK
| | | | - Anthony Costello
- University College London Institute for Global Health, London, UK
| | | | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- University College London Institute for Global Health, London, UK
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Jennings HM, Morrison J, Akter K, Kuddus A, Ahmed N, Kumer Shaha S, Nahar T, Haghparast-Bidgoli H, Khan AA, Azad K, Fottrell E. Developing a theory-driven contextually relevant mHealth intervention. Glob Health Action 2019; 12:1550736. [PMID: 31154988 PMCID: PMC6338268 DOI: 10.1080/16549716.2018.1550736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: mHealth interventions have huge potential to reach large numbers of people in resource poor settings but have been criticised for lacking theory-driven design and rigorous evaluation. This paper shares the process we developed when developing an awareness raising and behaviour change focused mHealth intervention, through applying behavioural theory to in-depth qualitative research. It addresses an important gap in research regarding the use of theory and formative research to develop an mHealth intervention. Objectives: To develop a theory-driven contextually relevant mHealth intervention aimed at preventing and managing diabetes among the general population in rural Bangladesh. Methods: In-depth formative qualitative research (interviews and focus group discussions) were conducted in rural Faridpur. The data were analysed thematically and enablers and barriers to behaviour change related to lifestyle and the prevention of and management of diabetes were identified. In addition to the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change we selected the Transtheoretical Domains Framework (TDF) to be applied to the formative research in order to guide the development of the intervention. Results: A six step-process was developed to outline the content of voice messages drawing on in-depth qualitative research and COM-B and TDF models. A table to inform voice messages was developed and acted as a guide to scriptwriters in the production of the messages. Conclusions: In order to respond to the local needs of a community in Bangladesh, a process of formative research, drawing on behavioural theory helped in the development of awareness-raising and behaviour change mHealth messages through helping us to conceptualise and understand behaviour (for example by categorising behaviour into specific domains) and subsequently identify specific behavioural strategies to target the behaviour.
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Affiliation(s)
| | - Joanna Morrison
- a Institute for Global Health , University College London , London , UK
| | - Kohenour Akter
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Abdul Kuddus
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Naveed Ahmed
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Sanjit Kumer Shaha
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Tasmin Nahar
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | | | - Ak Azad Khan
- c The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Kishwar Azad
- b Perinatal Care Project , The Diabetic Association of Bangladesh , Dhaka , Bangladesh
| | - Edward Fottrell
- a Institute for Global Health , University College London , London , UK
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Morrison J, Jennings H, Akter K, Kuddus A, Mannell J, Nahar T, Shaha SK, Ahmed N, Haghparast-Bidgoli H, Costello A, Khan AKA, Azad K, Fottrell E. Gendered perceptions of physical activity and diabetes in rural Bangladesh: a qualitative study to inform mHealth and community mobilization interventions. WHO South East Asia J Public Health 2019; 8:104-111. [PMID: 31441446 DOI: 10.4103/2224-3151.264855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Diabetes prevalence is increasing rapidly in Bangladesh, and there is an urgent need to promote preventive behaviours for type 2 diabetes, such as maintaining a healthy body weight, eating healthily, avoiding tobacco and being active for 150 minutes per week. Methods We used a qualitative methodology informed by the capability, opportunity, motivation theory of behaviour change to explore the factors affecting physical activity among men and women in rural Bangladesh. We conducted semi-structured interviews and focus group discussions with 64 purposively sampled participants with and without diabetes, and five health workers. From the results of descriptive content analysis, we identified key capabilities, opportunities and motivations to engage with in our mHealth and community mobilization interventions. Results Men and women without diabetes lacked awareness about the need to remain physically active to prevent diabetes, and most felt that their activity levels were sufficient. Housework was not commonly perceived as physical activity among all respondents. These knowledge and capability gaps could be addressed through mHealth messaging and community mobilization providing information on sufficiency and types of physical activity to prevent and control diabetes. Men were physically active while working outside the home, whereas women felt unsafe and conspicuous, and were constrained by family commitments and social expectations of appropriate behaviour. Women engaged in strategies to protect their own and their family’s reputations. These opportunity factors affecting physical activity indicated the need for strategies developed through participatory processes to challenge unhealthy gender norms and increase women’s safety. Conclusion Formative research data can enable the development of contextually relevant interventions. Data show that mHealth interventions should consider gendered barriers to physical activity, tailoring information to meet men’s and women’s needs, and that community mobilization interventions should enable unhealthy, gendered community norms to be challenged. Participatory interventions can enable communities to push the boundaries of socially acceptable behaviours to increase physical activity, helping to prevent and control diabetes.
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Affiliation(s)
- Joanna Morrison
- .University College London Institute for Global Health, London, United Kingdom
| | - Hannah Jennings
- .University College London Institute for Global Health, London, United Kingdom
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Jenevieve Mannell
- .University College London Institute for Global Health, London, United Kingdom
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Anthony Costello
- .University College London Institute for Global Health, London, United Kingdom
| | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- .University College London Institute for Global Health, London, United Kingdom
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Morrison J, Akter K, Jennings HM, Kuddus A, Nahar T, King C, Shaha SK, Ahmed N, Haghparast-Bidgoli H, Costello A, Khan AKA, Azad K, Fottrell E. Implementation and fidelity of a participatory learning and action cycle intervention to prevent and control type 2 diabetes in rural Bangladesh. Glob Health Res Policy 2019; 4:19. [PMID: 31312722 PMCID: PMC6610980 DOI: 10.1186/s41256-019-0110-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/18/2019] [Indexed: 01/30/2023] Open
Abstract
Introduction There is an urgent need to address the growing type 2 diabetes disease burden. 20–30% of adults in rural areas of Bangladesh have intermediate hyperglycaemia and about 10% have diabetes. We report on the implementation and fidelity of a Participatory Learning and Action (PLA) intervention, evaluated through a three-arm cluster randomised controlled trial which reduced the incidence of diabetes and intermediate hyperglycaemia in rural Bangladesh. PLA interventions have been effective in addressing population level health problems in low income country contexts, and therefore we sought to use this approach to engage communities to identify and address community barriers to prevention and control of type 2 diabetes. Methods We used a mixed methods approach collecting quantitative data through field reports and qualitative data through observations and focus group discussions. Through descriptive analysis, we considered fidelity to the participatory approach and implementation plans. Results One hundred twenty-two groups per month were convened by 16 facilitators and supervised by two coordinators. Groups worked through a four phase PLA cycle of problem identification, planning together, implementation and evaluation to address the risk factors for diabetes – diet, physical activity, smoking and stress. Groups reported a lack of awareness about diabetes prevention and control, the prohibitive cost of care and healthy eating, and gender barriers to exercise for women. Groups set targets to encourage physical activity, kitchen-gardening, cooking with less oil, and reduced tobacco consumption. Anti-tobacco committees operated in 90 groups. One hundred twenty-two groups arranged blood glucose testing and 74 groups organized testing twice. Forty-one women’s groups established funds, and 61 communities committed not to ridicule women exercising. Experienced and committed supervisors enabled fidelity to a participatory methodology. A longer intervention period and capacity building could enable engagement with systems barriers to behaviour change. Conclusion Our complex intervention was implemented as planned and is likely to be valid in similar contexts given the flexibility of the participatory approach to contextually specific barriers to prevention and control of type 2 diabetes. Fidelity to the participatory approach is key to implementing the intervention and effectively addressing type 2 diabetes in a low-income country.
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Affiliation(s)
- Joanna Morrison
- 1University College London Institute for Global Health, London, UK
| | | | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- 1University College London Institute for Global Health, London, UK.,3Department for Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Anthony Costello
- 1University College London Institute for Global Health, London, UK
| | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- 1University College London Institute for Global Health, London, UK
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Fottrell E, Ahmed N, Morrison J, Kuddus A, Shaha SK, King C, Jennings H, Akter K, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. Community groups or mobile phone messaging to prevent and control type 2 diabetes and intermediate hyperglycaemia in Bangladesh (DMagic): a cluster-randomised controlled trial. Lancet Diabetes Endocrinol 2019; 7:200-212. [PMID: 30733182 PMCID: PMC6381080 DOI: 10.1016/s2213-8587(19)30001-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Strategies are needed to prevent and control type 2 diabetes and intermediate hyperglycaemia, which together affect roughly a third of adults in Bangladesh. We aimed to assess the effects of mHealth and community mobilisation on the prevalence of intermediate hyperglycaemia and diabetes among the general adult population in rural Bangladesh, and to assess the effect of these interventions on the incidence of type 2 diabetes among people with intermediate hyperglycaemia within the study population. METHODS DMagic was a three-arm, cluster-randomised trial of participatory community mobilisation, mHealth mobile phone messaging, and usual care (control) in 96 villages (population roughly 125 000) in Bangladesh. Community mobilisation involved 18 monthly group meetings, led by lay facilitators, applying a participatory learning and action (PLA) cycle focused on diabetes prevention and control. mHealth involved twice-weekly voice messages over 14 months promoting behaviour change to reduce diabetes risk. The primary outcomes were the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the overall population at the end of the intervention implementation period, and 2-year cumulative incidence of type 2 diabetes in a cohort with intermediate hyperglycaemia at baseline. Primary outcomes were assessed through fasting blood glucose concentrations and 2-h oral glucose tolerance tests among a cross-section of adults aged 30 years and older and a cohort of individuals identified with intermediate hyperglycaemia. Prevalence findings are based on a cross-sectional survey at the end of the study; incidence findings are based on 2-year follow-up survey of a cohort of individuals identified with intermediate hyperglycaemia through a cross-sectional survey at baseline. We also assessed the cost-effectiveness of the interventions. This trial is registered with the ISRCTN registry, number ISRCTN41083256, and is completed. FINDINGS The study took place between June 27, 2015, and June 28, 2018, with the PLA intervention running in 32 villages from June, 2016, to December, 2017, and the mHealth intervention running in 32 villages from Oct 21, 2016, to Dec 24, 2017. End-of study prevalence was assessed in 11 454 individuals and incidence in 2100 individuals. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group at the end of the study (adjusted [for stratification, clustering, and wealth] odds ratio [aOR] 0·36 [0·27-0·48]), with an absolute reduction of 20·7% (95% CI 14·6-26·7). Among 2470 adults with intermediate hyperglycaemia at baseline, 2100 (85%) were followed-up at 2 years. The 2-year cumulative incidence of diabetes in this cohort was significantly lower in the PLA group compared with control (aOR 0·39, 0·24-0·65), representing an absolute incidence reduction of 8·7% (3·5-14·0). There was no evidence of effect of mHealth on combined prevalence of intermediate hyperglycaemia and diabetes (aOR 0·93, 0·74-1·16) or the incidence of diabetes (1·02, 0·73-1·43). The incremental cost-effectiveness ratios for PLA were INT$316 per case of intermediate hyperglycaemia or type 2 diabetes prevented and $6518 per case of type 2 diabetes prevented among individuals with intermediate hyperglycaemia. INTERPRETATION Our data provide strong evidence to support the use of community mobilisation based on PLA to prevent type 2 diabetes in this rural Bangladeshi population. Despite raising knowledge and awareness of diabetes, the mHealth intervention did not change disease outcomes in our population. Replication studies in other populations should be a priority. FUNDING UK Medical Research Council.
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Affiliation(s)
- Edward Fottrell
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK.
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Carina King
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Hannah Jennings
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Hassan Haghparast-Bidgoli
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- UCL Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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Fottrell E, Ahmed N, Shaha SK, Jennings H, Kuddus A, Morrison J, Akter K, Nahar B, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. Distribution of diabetes, hypertension and non-communicable disease risk factors among adults in rural Bangladesh: a cross-sectional survey. BMJ Glob Health 2018; 3:e000787. [PMID: 30498584 PMCID: PMC6242007 DOI: 10.1136/bmjgh-2018-000787] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/14/2018] [Accepted: 09/24/2018] [Indexed: 12/27/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing in low-income settings. We conducted a survey of risk factors, blood pressure and blood glucose in rural Bangladesh and assessed variations by age, sex and wealth. Methods We surveyed a random sample of 12 280 adults aged >30 years in 96 villages in rural Bangladesh. Fieldworkers measured blood glucose and conducted an glucose tolerance test with a repeat blood test 120 min post glucose ingestion. Blood pressure, anthropometric, socioeconomic, lifestyle and behavioural risk factors data were also collected. Data were analysed to describe the prevalence of diabetes, intermediate hyperglycaemia, hypertension and NCD risk factors by age, sex and wealth. Results Women had higher levels of overweight or obesity and lower levels of physical activity and fruit and vegetable consumption than men; 63% of men used tobacco compared with 41.3% of women. Overweight or obesity and abdominal obesity (waist to hip ratio) increased with socioeconomic status (least poor vs most poor: OR (95% CI) 3.21 (2.51 to 4.11) for men and 2.83 (2.28 to 3.52) for women). Tobacco use, passive smoke exposure and salt consumption fell with increasing socioeconomic status in both sexes. Clustering of risk factors showed more than 70% of men and women reported at least three risk factors. Women in the least poor group were 33% more likely to have three or more risk factors compared with women in the most poor group (1.33 (95% CI 1.17 to 1.58)). The combined prevalence of impaired fasting glucose, impaired glucose tolerance and diabetes was 26.1% among men and 34.9% among women, and increased with age. The prevalence of prehypertension and hypertension was 30.7% and 15.9% among men and 27.2% and 22.5% among women, with similar rising prevalence with age. Conclusion NCD risk factors, hyperglycaemia and raised blood pressure are an immediate health threat in rural Bangladesh. Initiatives to improve detection, treatment and prevention strategies are needed.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, London, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK.,Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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19
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Fottrell E, Ahmed N, Nahar B, Shaha SK, Kuddus A, Grijalva-Eternod CS, Nahar T, Fall C, Osmond C, Govoni V, Finer S, Yajnik C, Khan AKA, Costello A, Azad K, Hitman GA. Growth and body composition of children aged 2-4 years after exposure to community mobilisation women's groups in Bangladesh. J Epidemiol Community Health 2018; 72:888-895. [PMID: 29907704 DOI: 10.1136/jech-2017-210134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/24/2018] [Accepted: 05/16/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Women's groups interventions in Bangladesh reduced neonatal deaths by 38% and improved hygienic delivery, newborn care practices and breast feeding. We explore the longer-term impact of exposure to women's groups during pregnancy on child growth at 2-4 years. METHODS We performed a cross-sectional survey of child anthropometric measures (analysed as z-scores) among children born to women who had participated in the women's groups interventions while pregnant, compared with an age-matched and sex-matched sample of children born to control mothers. Results were stratified by maternal body mass index (BMI) and adjusted for possible confounding effects of maternal education, household asset ownership and, in a separate model, mother-child height difference, a proxy for improved survival of small babies in intervention groups. RESULTS Data were obtained from 2587 mother-child pairs (91% response). After adjustment for asset ownership, maternal education and potential survival effects, children whose mothers were exposed to the women's group intervention had higher head (0.16 (0.04 to 0.28)), mid-upper arm (0.11 (0.04 to 0.19)), abdominal (0.13 (0.00 to 0.26)) and chest (0.18 (0.08 to 0.29)) circumferences than their control counterparts. No significant differences in subcutaneous fat (subscapular and triceps skinfold thickness) were observed. When stratified by maternal BMI, intervention children had higher weight, BMI and circumferences, and these effects decreased with increasing maternal BMI category. CONCLUSIONS Women's groups appear to have had a lasting, positive impact on child anthropometric outcomes, with most significant results clustering in children of underweight mothers. Observed differences are likely to be of public health significance in terms of the nutritional and metabolic development of children.
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Affiliation(s)
- Edward Fottrell
- Institute For Global Health, University College London, London, UK
| | - Naveed Ahmed
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Badrun Nahar
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Sanjit Kumer Shaha
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Tasmin Nahar
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Virginia Govoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Finer
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - A K Azad Khan
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute For Global Health, University College London, London, UK
- WHO Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Graham A Hitman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Haghparast-Bidgoli H, Shaha SK, Kuddus A, Chowdhury MAR, Jennings H, Ahmed N, Morrison J, Akter K, Nahar B, Nahar T, King C, Skordis-Worrall J, Batura N, Khan JA, Mansaray A, Hunter R, Khan AKA, Costello A, Azad K, Fottrell E. Protocol of economic evaluation and equity impact analysis of mHealth and community groups for prevention and control of diabetes in rural Bangladesh in a three-arm cluster randomised controlled trial. BMJ Open 2018; 8:e022035. [PMID: 30127051 PMCID: PMC6104763 DOI: 10.1136/bmjopen-2018-022035] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is one of the leading causes of death and disability worldwide, generating substantial economic burden for people with diabetes and their families, and to health systems and national economies. Bangladesh has one of the largest numbers of adults with diabetes in the South Asian region. This paper describes the planned economic evaluation of a three-arm cluster randomised control trial of mHealth and community mobilisation interventions to prevent and control T2DM and non-communicable diseases' risk factors in rural Bangladesh (D-Magic trial). METHODS AND ANALYSIS The economic evaluation will be conducted as a within-trial analysis to evaluate the incremental costs and health outcomes of mHealth and community mobilisation interventions compared with the status quo. The analyses will be conducted from a societal perspective, assessing the economic impact for all parties affected by the interventions, including implementing agencies (programme costs), healthcare providers, and participants and their households. Incremental cost-effectiveness ratios (ICERs) will be calculated in terms of cost per case of intermediate hyperglycaemia and T2DM prevented and cost per case of diabetes prevented among individuals with intermediate hyperglycaemia at baseline and cost per mm Hg reduction in systolic blood pressure. In addition to ICERs, the economic evaluation will be presented as a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Robustness of the results will be assessed through sensitivity analyses. In addition, an analysis of equity impact of the interventions will be conducted. ETHICS AND DISSEMINATION The approval to conduct the study was obtained by the University College London Research Ethics Committee (4766/002) and by the Ethical Review Committee of the Diabetic Association of Bangladesh (BADAS-ERC/EC/t5100246). The findings of this study will be disseminated through different means within academia and the wider policy sphere. TRIAL REGISTRATION NUMBER ISRCTN41083256; Pre-results.
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Affiliation(s)
| | | | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | | | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | - Kohenour Akter
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Carina King
- Institute for Global Health, University College London, London, UK
| | | | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | | | | | - Rachael Hunter
- Institute of Epidemiology & Health, University College London, London, UK
| | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
- World Health Organization, Geneva, Switzerland
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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21
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Fottrell E, Ahmed N, Shaha SK, Jennings H, Kuddus A, Morrison J, Akter K, Nahar B, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. Diabetes knowledge and care practices among adults in rural Bangladesh: a cross-sectional survey. BMJ Glob Health 2018; 3:e000891. [PMID: 30057800 PMCID: PMC6058170 DOI: 10.1136/bmjgh-2018-000891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/25/2018] [Accepted: 06/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Population knowledge of how to prevent, detect and control diabetes is critical to public health initiatives to tackle the disease. We undertook a cross-sectional survey of adults in rural Bangladesh to estimate knowledge and practices related to diabetes. Methods In 96 villages in Faridpur district, trained fieldworkers surveyed 12 140 randomly selected men and women aged ≥30. They collected data on sociodemographic status, knowledge of diabetes and history of blood and urine glucose testing. Fasting and 2-hour post-glucose load capillary blood tests ascertained the diabetic status of respondents. Levels of knowledge and practices were analysed by sociodemographic characteristics and diabetic status. Results The population showed low levels of diabetes knowledge overall, with only one in three adults able to report any valid causes of the disease. Knowledge of diabetes causes, symptoms, complications, prevention and control was significantly associated with age, education, wealth and employment. Only 14% of respondents reported ever having had a blood glucose test and strong associations with wealth were observed (least poor relative to most poor 2.91 (2.32–3.66)). 78.4% of known diabetics (ie, with a prior diagnosis) reported that they did not monitor their blood glucose levels on at least a monthly basis. However, they had better knowledge of the causes (odds relative to normoglycaemic individuals 1.62 (1.23–2.09)), symptoms (5.17 (3.41–7.82)), complications (5.18 (3.75–7.14)), prevention (4.18 (3.04–5.74)) and control (8.43 (4.83–14.71)). Conclusion Knowledge of diabetes among rural adults in Faridpur is extremely poor. Levels of diabetes testing are low and monitoring of blood glucose among known diabetics infrequent. Diabetes prevention and control efforts in this population must include large-scale awareness initiatives which focus not only on high-risk individuals but the whole population. Trial registration number ISRCTN41083256; Pre-results.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, London, UK
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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22
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Clarke K, Azad K, Kuddus A, Shaha S, Nahar T, Aumon BH, Hossen MM, Beard J, Costello A, Houweling TAJ, Prost A, Fottrell E. Correction: Impact of a Participatory Intervention with Women's Groups on Psychological Distress among Mothers in Rural Bangladesh: Secondary Analysis of a Cluster-Randomised Controlled Trial. PLoS One 2017; 12:e0183203. [PMID: 28796842 PMCID: PMC5552076 DOI: 10.1371/journal.pone.0183203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0110697.].
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23
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Fottrell E, Jennings H, Kuddus A, Ahmed N, Morrison J, Akter K, Shaha SK, Nahar B, Nahar T, Haghparast-Bidgoli H, Khan AKA, Costello A, Azad K. The effect of community groups and mobile phone messages on the prevention and control of diabetes in rural Bangladesh: study protocol for a three-arm cluster randomised controlled trial. Trials 2016; 17:600. [PMID: 27993166 PMCID: PMC5170893 DOI: 10.1186/s13063-016-1738-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/03/2016] [Indexed: 12/14/2022] Open
Abstract
Background Increasing rates of type 2 diabetes mellitus place a substantial burden on health care services, communities, families and individuals living with the disease or at risk of developing it. Estimates of the combined prevalence of intermediate hyperglycaemia and diabetes in Bangladesh vary, and can be as high as 30% of the adult population. Despite such high prevalence, awareness and control of diabetes and its risk factors are limited. Prevention and control of diabetes and its complications demand increased awareness and action of individuals and communities, with positive influences on behaviours and lifestyle choices. In this study, we will test the effect of two different interventions on diabetes occurrence and its risk factors in rural Bangladesh. Methods/design A three-arm cluster randomised controlled trial of mobile health (mHealth) and participatory community group interventions will be conducted in four rural upazillas in Faridpur District, Bangladesh. Ninety-six clusters (villages) will be randomised to receive either the mHealth intervention or the participatory community group intervention, or be assigned to the control arm. In the mHealth arm, enrolled individuals will receive twice-weekly voice messages sent to their mobile phone about prevention and control of diabetes. In the participatory community group arm, facilitators will initiate a series of monthly group meetings for men and women, progressing through a Participatory Learning and Action cycle whereby group members and communities identify, prioritise and tackle problems associated with diabetes and the risk of developing diabetes. Both interventions will run for 18 months. The primary outcomes of the combined prevalence of intermediate hyperglycaemia and diabetes and the cumulative 2-year incidence of diabetes among individuals identified as having intermediate hyperglycaemia at baseline will be evaluated through baseline and endline sample surveys of permanent residents aged 30 years or older in each of the study clusters. Data on blood glucose level, blood pressure, body mass index and hip-to-waist ratio will be gathered through physical measurements by trained fieldworkers. Demographic and socioeconomic data, as well as data on knowledge of diabetes, chronic disease risk factor prevalence and quality of life, will be gathered through interviews with sampled respondents. Discussion This study will increase our understanding of diabetes and other non-communicable disease burdens and risk factors in rural Bangladesh. By documenting and evaluating the delivery, impact and cost-effectiveness of participatory community groups and mobile phone voice messaging, study findings will provide evidence on how population-level strategies of community mobilisation and mHealth can be implemented to prevent and control noncommunicable diseases and risk factors in this population. Trial registration ISRCTN41083256. Registered on 30 Mar 2016 (Retrospectively Registered). Trial acronym D-Magic: Diabetes Mellitus – Action through Groups or mobile Information for better Control.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, London, UK.
| | - Hannah Jennings
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | | | - Badrun Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK.,World Health Organisation, Geneva, Switzerland
| | - Kishwar Azad
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
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24
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Harris-Fry HA, Azad K, Younes L, Kuddus A, Shaha S, Nahar T, Hossen M, Costello A, Fottrell E. Formative evaluation of a participatory women's group intervention to improve reproductive and women's health outcomes in rural Bangladesh: a controlled before and after study. J Epidemiol Community Health 2016; 70:663-70. [PMID: 26739272 PMCID: PMC4941186 DOI: 10.1136/jech-2015-205855] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 04/01/2015] [Accepted: 12/14/2015] [Indexed: 01/25/2023]
Abstract
Background Women's groups using participatory methods reduced newborn mortality in rural areas of low income countries. Our study assessed a participatory women's group intervention that focused on women's health, nutrition and family planning. Methods The study was conducted in three districts in Bangladesh between October 2011 and March 2013, covering a population of around 230 000. On the basis of allocation for the preceding cluster randomised trials, three unions per district were randomly allocated to receive a women's group intervention and three per district were control clusters. Outcomes included unmet need for family planning, morbidity, dietary diversity, night blindness, healthcare decision-making and knowledge of sexual and reproductive health, nutrition and anaemia. A difference-in-difference analysis was used to adjust for secular trends and baseline differences between women taking part in the intervention and a random sample from control clusters. Results We interviewed 5355 (91% response rate) women before the intervention and 5128 after (96% response rate). There were significant improvements in women's dietary diversity score (increase of 0.2 (95% CI 0.1 to 0.3)) and participation in healthcare decision-making (proportion increase (95% CI) 14.0% (10.6% to 17.4%)). There were also increases in knowledge about: contraception (4.2% (2.0% to 6.3%)), ways to treat (55.4% (52.2% to 58.5%)) and prevent (71.0% (68.0% to 74.1%)) sexually transmitted infections, nutrition (46.6% (43.6% to 49.6%)) and anaemia prevention (62.8% (60.9% to 64.6%)). There were no significant differences in unmet need for family planning, morbidity or night blindness. Conclusions Participatory women's groups have considerable potential to improve women's health knowledge, but evidence of impact on certain outcomes is lacking. Further formative work and intervention development is needed to optimise the impact of this approach for women's health.
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Affiliation(s)
| | - Kishwar Azad
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Leila Younes
- UCL Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Sanjit Shaha
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Munir Hossen
- Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Anthony Costello
- UCL Institute for Global Health, University College London, London, UK
| | - Edward Fottrell
- UCL Institute for Global Health, University College London, London, UK
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25
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Younes L, Houweling TAJ, Azad K, Kuddus A, Shaha S, Haq B, Nahar T, Hossen M, Beard J, Copas A, Prost A, Costello A, Fottrell E. The effect of participatory women's groups on infant feeding and child health knowledge, behaviour and outcomes in rural Bangladesh: a controlled before-and-after study. J Epidemiol Community Health 2014; 69:374-81. [PMID: 25472635 PMCID: PMC4392217 DOI: 10.1136/jech-2014-204271] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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] [Indexed: 11/09/2022]
Abstract
Background Despite efforts to reduce under-5 mortality rates worldwide, an estimated 6.6 million under-5 children die every year. Community mobilisation through participatory women's groups has been shown to improve maternal and newborn health in rural settings, but little is known about the potential of this approach to improve care and health in children after the newborn period. Methods Following on from a cluster-randomised controlled trial to assess the effect of participatory women's groups on maternal and neonatal health outcomes in rural Bangladesh, 162 women's groups continued to meet between April 2010 and December 2011 to identify, prioritise and address issues that affect the health of children under 5 years. A controlled before-and-after study design and difference-in-difference analysis was used to assess morbidity outcomes and changes in knowledge and practices related to child feeding, hygiene and care-seeking behaviour. Findings Significant improvements were measured in mothers’ knowledge of disease prevention and management, danger signs and hand washing at critical times. Significant increases were seen in exclusive breast feeding for at least 6 months (15.3% (4.2% to 26.5%)), and mean duration of breast feeding (37.9 days (17.4 to 58.3)). Maternal reports of under-5 morbidities fell in intervention compared with control areas, including reports of fever (−10.5% (−15.1% to −6.0%)) and acute respiratory infections (−12.2% (−15.6% to −8.8%)). No differences were observed in dietary diversity scores or immunisation uptake. Conclusions Community mobilisation through participatory women's groups can be successfully adapted to address health knowledge and practice in relation to child's health, leading to improvements in a number of child health indicators and behaviours.
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Affiliation(s)
- Leila Younes
- UCL Institute for Global Health, University College London, London, UK
| | - Tanja A J Houweling
- UCL Institute for Global Health, University College London, London, UK Department of Public Health, ErasmusMC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kishwar Azad
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Sanjit Shaha
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Bedowra Haq
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Tasmin Nahar
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - Munir Hossen
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | - James Beard
- UCL Institute for Global Health, University College London, London, UK
| | - Andrew Copas
- Department of Infection and Population Health, University College London, London, UK
| | - Audrey Prost
- UCL Institute for Global Health, University College London, London, UK
| | - Anthony Costello
- UCL Institute for Global Health, University College London, London, UK
| | - Edward Fottrell
- UCL Institute for Global Health, University College London, London, UK
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26
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Clarke K, Azad K, Kuddus A, Shaha S, Nahar T, Aumon BH, Hossen MM, Beard J, Costello A, Houweling TAJ, Prost A, Fottrell E. Impact of a participatory intervention with women's groups on psychological distress among mothers in rural Bangladesh: secondary analysis of a cluster-randomised controlled trial. PLoS One 2014; 9:e110697. [PMID: 25329470 PMCID: PMC4199763 DOI: 10.1371/journal.pone.0110697] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 02/03/2014] [Accepted: 09/25/2014] [Indexed: 11/20/2022] Open
Abstract
Background Perinatal common mental disorders (PCMDs) are a major cause of disability among women and disproportionately affect lower income countries. Interventions to address PCMDs are urgently needed in these settings, and group-based and peer-led approaches are potential strategies to increase access to mental health interventions. Participatory women’s health groups led by local women previously reduced postpartum psychological distress in eastern India. We assessed the effect of a similar intervention on postpartum psychological distress in rural Bangladesh. Method We conducted a secondary analysis of data from a cluster-randomised controlled trial with 18 clusters and an estimated population of 532,996. Nine clusters received an intervention comprising monthly meetings during which women’s groups worked through a participatory learning and action cycle to develop strategies for improving women’s and children’s health. There was one group for every 309 individuals in the population, 810 groups in total. Mothers in nine control clusters had access to usual perinatal care. Postpartum psychological distress was measured with the 20-item Self Reporting Questionnaire (SRQ-20) between six and 52 weeks after delivery, during the months of January to April, in 2010 and 2011. Results We analysed outcomes for 6275 mothers. Although the cluster mean SRQ-20 score was lower in the intervention arm (mean 5.2, standard deviation 1.8) compared to control (5.3, 1.2), the difference was not significant (β 1.44, 95% CI 0.28, 3.08). Conclusions Despite promising results in India, participatory women’s groups focused on women’s and children’s health had no significant effect on postpartum psychological distress in rural Bangladesh.
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Affiliation(s)
- Kelly Clarke
- Institute for Global Health, University College London, London, United Kingdom
- * E-mail:
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Sanjit Shaha
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasmin Nahar
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Bedowra Haq Aumon
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - James Beard
- Institute for Global Health, University College London, London, United Kingdom
| | - Anthony Costello
- Institute for Global Health, University College London, London, United Kingdom
| | - Tanja A. J. Houweling
- Institute for Global Health, University College London, London, United Kingdom
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Audrey Prost
- Institute for Global Health, University College London, London, United Kingdom
| | - Edward Fottrell
- Institute for Global Health, University College London, London, United Kingdom
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Fottrell E, Azad K, Kuddus A, Younes L, Shaha S, Nahar T, Aumon BH, Hossen M, Beard J, Hossain T, Pulkki-Brannstrom AM, Skordis-Worrall J, Prost A, Costello A, Houweling TAJ. The effect of increased coverage of participatory women's groups on neonatal mortality in Bangladesh: A cluster randomized trial. JAMA Pediatr 2013; 167:816-25. [PMID: 23689475 PMCID: PMC5082727 DOI: 10.1001/jamapediatrics.2013.2534] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Community-based interventions can reduce neonatal mortality when health systems are weak. Population coverage of target groups may be an important determinant of their effect on behavior and mortality. A women's group trial at coverage of 1 group per 1414 population in rural Bangladesh showed no effect on neonatal mortality, despite a similar intervention having a significant effect on neonatal and maternal death in comparable settings. OBJECTIVE To assess the effect of a participatory women's group intervention with higher population coverage on neonatal mortality in Bangladesh. DESIGN A cluster randomized controlled trial in 9 intervention and 9 control clusters. SETTING Rural Bangladesh. PARTICIPANTS Women permanently residing in 18 unions in 3 districts and accounting for 19 301 births during the final 24 months of the intervention. INTERVENTIONS Women's groups at a coverage of 1 per 309 population that proceed through a participatory learning and action cycle in which they prioritize issues that affected maternal and neonatal health and design and implement strategies to address these issues. MAIN OUTCOMES AND MEASURES Neonatal mortality rate. RESULTS Analysis included 19 301 births during the final 24 months of the intervention. More than one-third of newly pregnant women joined the groups. The neonatal mortality rate was significantly lower in the intervention arm (21.3 neonatal deaths per 1000 live births vs 30.1 per 1000 in control areas), a reduction in neonatal mortality of 38% (risk ratio, 0.62 [95% CI, 0.43-0.89]) when adjusted for socioeconomic factors. The cost-effectiveness was US $220 to $393 per year of life lost averted. Cause-specific mortality rates suggest reduced deaths due to infections and those associated with prematurity/low birth weight. Improvements were seen in hygienic home delivery practices, newborn thermal care, and breastfeeding practices. CONCLUSIONS AND RELEVANCE Women's group community mobilization, delivered at adequate population coverage, is a highly cost-effective approach to improve newborn survival and health behavior indicators in rural Bangladesh. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN01805825.
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Affiliation(s)
- Edward Fottrell
- Institute for Global Health, University College London, England
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Nahar T, Azad K, Aumon BH, Younes L, Shaha S, Kuddus A, Prost A, Houweling TAJ, Costello A, Fottrell E. Scaling up community mobilisation through women's groups for maternal and neonatal health: experiences from rural Bangladesh. BMC Pregnancy Childbirth 2012; 12:5. [PMID: 22273440 PMCID: PMC3298477 DOI: 10.1186/1471-2393-12-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/24/2012] [Indexed: 11/29/2022] Open
Abstract
Background Program coverage is likely to be an important determinant of the effectiveness of community interventions to reduce neonatal mortality. Rigorous examination and documentation of methods to scale-up interventions and measure coverage are scarce, however. To address this knowledge gap, this paper describes the process and measurement of scaling-up coverage of a community mobilisation intervention for maternal, child and neonatal health in rural Bangladesh and critiques this real-life experience in relation to available literature on scaling-up. Methods Scale-up activities took place in nine unions in rural Bangladesh. Recruitment and training of those who deliver the intervention, communication and engagement with the community and other stakeholders and active dissemination of intervention activities are described. Process evaluation and population survey data are presented and used to measure coverage and the success of scale-up. Results The intervention was scaled-up from 162 women's groups to 810, representing a five-fold increase in population coverage. The proportion of women of reproductive age and pregnant women who were engaged in the intervention increased from 9% and 3%, respectively, to 23% and 29%. Conclusions Examination and documentation of how scaling-up was successfully initiated, led, managed and monitored in rural Bangladesh provide a deeper knowledge base and valuable lessons. Strong operational capabilities and institutional knowledge of the implementing organisation were critical to the success of scale-up. It was possible to increase community engagement with the intervention without financial incentives and without an increase in managerial staff. Monitoring and feedback systems that allow for periodic programme corrections and continued innovation are central to successful scale-up and require programmatic and operational flexibility.
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Abstract
Aortic artery dissection is a rare but well-recognized complication of Turner's syndrome. Isolated carotid or vertebral artery dissection has not previously been reported. The authors report the clinical and magnetic resonance imaging findings in a 30-year-old woman with Turner's syndrome who developed a high cervical spinal cord infarction with a Brown-Sequard syndrome owing to bilateral vertebral artery dissection. The diagnosis and management of the case is reviewed.
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Affiliation(s)
- P Muscat
- Department of Neurology, Box 1052, Mount Sinai School of Medicine, 1 Gustav Levy Place, New York, NY 10029, USA
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Nahar T, Croft L, Shapiro R, Fruchtman S, Diamond J, Henzlova M, Machac J, Buckley S, Goldman ME. Comparison of four echocardiographic techniques for measuring left ventricular ejection fraction. Am J Cardiol 2000; 86:1358-62. [PMID: 11113413 DOI: 10.1016/s0002-9149(00)01243-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Accurate quantitative measurement of left ventricular (LV) ejection fraction (EF) by 2-dimensional echocardiography is limited by subjective visual endocardial border detection. Both harmonic and precision contrast microbubbles provide better delineation of endocardial borders than fundamental imaging. The aim of this study was to correlate 2-dimensional echocardiographic quantification of LVEF measured by 4 currently available techniques with radionuclide angiography. A total of 50 patients who underwent radionuclide (EF) measurement (47 of 50 had technically difficult echocardiograms by fundamental imaging) underwent echocardiography by 4 methods: fundamental alone, fundamental with contrast, harmonic alone, and harmonic with contrast. Three echocardiologists measured the biplane 2-dimensional echocardiographic LVEF independently and were blinded to radionuclide angiography. The correlation of echocardiographic EF with radionuclide EF improved incrementally with each method. However, contrast with harmonic imaging provided the closest correlation (r = 0.95, 0.96, and 0.95 as assessed by the 3 independent analysts.
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Affiliation(s)
- T Nahar
- Zena & Michael A. Weiner Cardiovascular Institute, Mount Sinai Medical Center, New York, New York 10029, USA
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Fayad ZA, Nahar T, Fallon JT, Goldman M, Aguinaldo JG, Badimon JJ, Shinnar M, Chesebro JH, Fuster V. In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography. Circulation 2000; 101:2503-9. [PMID: 10831525 DOI: 10.1161/01.cir.101.21.2503] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The structure and composition of aortic atherosclerotic plaques are associated with the risk of future cardiovascular events. Magnetic resonance (MR) imaging may allow accurate visualization and characterization of aortic plaques. METHODS AND RESULTS We developed a noninvasive MR method, free of motion and blood flow artifacts, for submillimeter imaging of the thoracic aortic wall. MR imaging was performed on a clinical MR system in 10 patients with aortic plaques identified by transesophageal echocardiography (TEE). Plaque composition, extent, and size were assessed from T1-, proton density-, and T2- weighted images. Comparison of 25 matched MR and TEE cross-sectional aortic plaque images showed a strong correlation for plaque composition (chi(2) = 43.5, P<0.0001; 80% overall agreement; n = 25) and mean maximum plaque thickness (r = 0.88, n = 25; 4.56+/-0.21 mm by MR and 4.62+/-0.31 mm by TEE). Overall aortic plaque extent as assessed by TEE and MR was also statistically significant (chi(2) = 61.77, P<0.0001; 80% overall agreement; n = 30 regions). CONCLUSIONS This study demonstrates that noninvasive MR evaluation of the aorta compares well with TEE imaging for the assessment of atherosclerotic plaque thickness, extent, and composition. This MR method may prove useful for the in vivo study of aortic atherosclerosis.
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Affiliation(s)
- Z A Fayad
- Zena and Michael A. Wiener Cardiovascular Institute, Department of Radiology, Mount Sinai School of Medicine, New York, USA.
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Nelson JE, Croft LB, Nahar T, Vorchheimer D. Evaluation of subclavian catheter position. J Cardiothorac Vasc Anesth 1999; 13:359-61. [PMID: 10392692 DOI: 10.1016/s1053-0770(99)90278-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J E Nelson
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
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Abstract
BACKGROUND Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double-orifice valve, with reported adequate control of mitral regurgitation. METHODS We started to use the "bow-tie" repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4). Mean follow-up was 336 days (range, 82 to 551 days) with no postoperative deaths. RESULTS Mitral regurgitation decreased from 3.6+/-0.5 to 0.8+/-0.4 (p < 0.0001), with a concomitant increase in ejection fraction from 33%+/-13% to 45%+/-11% (p = 0.0156) before hospital discharge. Mitral valve area, measured by pressure half-time, decreased from a mean of 2.5+/-0.3 to 2.1+/-0.3 cm2, with a mean transvalvular gradient of 4.5+/-2.0 mm Hg. In patients whose mitral valve was repaired using the bow-tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm2 during exercise, further supporting the concept that this technique preserves mitral valve annular function. CONCLUSIONS These observations suggest that the bow-tie repair may offer advantages over conventional techniques of mitral valve repair and should be considered as an adjunct, especially in patients with impaired left ventricular function.
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Affiliation(s)
- J P Umaña
- Division of Cardiothoracic Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
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Abstract
Thrombus formation at the pulmonary venous anastomotic site after lung transplantation may have catastrophic consequences, including allograft failure and stroke. However, treatment with systemic anticoagulation may facilitate bleeding in the early postoperative period. In the present report, we describe the clinical and transesophageal echocardiographic findings of pulmonary venous thrombosis in two patients in the immediate postoperative period after lung transplantation. Treatment with systemic anticoagulation was not feasible because of extensive postoperative thoracic bleeding in each instance. A conservative approach was taken on the basis of the small size of each thrombus and lack of accelerated flow velocity at the site of the thrombus. Each thrombus resolved spontaneously without clinical sequelae. These two cases suggest that thrombus size and flow velocity at the anastomotic site may be used to guide the clinical management of pulmonary venous thrombosis after lung transplantation.
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Affiliation(s)
- T Nahar
- Department of Medicine, College of Physicians & Surgeons of Columbia University, New York, New York 10032, USA
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Abstract
Transvenous endomyocardial biopsy is a well established procedure to diagnose rejection after heart transplantation as well as to assess for other cardiomyopathic processes. However, it is rarely used to obtain samples of unidentified cardiac masses. We report a case of a primary cardiac sarcoma in which the histologic diagnosis was provided by transesophageal echocardiography-guided transvenous biopsy. This procedure is accurate and can avoid the potential risk of a diagnostic thoracotomy.
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Affiliation(s)
- M T Savoia
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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