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Adherence to the test, treat and track malaria policy among selected health facilities in Ghana: the clients' perspective.
Get PDFBackground Malaria continues to be a major disease burden affecting all ages. The WHO in 2012 introduced the test, treat and track (T3) policy for malaria management in endemic settings. All malaria suspected conditions are to be confirmed by test and treatment initiated with recommended artemisinin-based combination therapy (ACT) and treatment outcomes monitored over the course of the illness. This study evaluated the adherence of health facilities and client's perspective of T3 policy in Ghana. Methods This cross sectional study was conducted in November 2019 involving 30 health facilities conveniently selected from six districts in the 3 malaria epidemiological zones, and clients exit interviews were performed from each facility. Factors associated with the test, treat and track defined outcomes were assessed using chi square and multivariable logistic regression models at 5% level of significance and 95% confidence interval. Data were classified according to facility and clients' perspectives. Results Overall, 590 patients and 30 health facility managers were interviewed from 30 facilities in 6 districts across the three zones. CHPS compounds formed 18 (60.0%) of facilities assessed. Twenty-nine out of 30 health facilities had Rapid Diagnostic Test (RDT) kits and antimalarials. Health facilities in the southern zone of Ghana had 2.87 increased odds of adhering to the T3 policy compared to the middle zone [aOR = 2.87 (1.7, 4.8): p < 0.001]. Males were more likely not to return to the health facility for review or more likely to miss home visit [aOR = 0.6 (0.3, 0.9): p = 0.018]. Conclusion Testing and treating for malaria were high among health facilities in the three zones. However, tracking of patients was very low across the zones. Adherence from clients' perspective was low especially for males. The study recommended among others that the National Malaria Elimination Programme (NMEP) should ensure periodic trainings of health facility staff especially those within the Northern and Middle zones of Ghana and strengthen monitoring and supervision of health facilities to enhance adherence to the T3 policy
Person-centered maternity care: adaptation and validation of a tool to measure person-centered maternity care in Sri Lanka.
Get PDFINTRODUCTION: Person-centered maternity care (PCMC) is recognized as a crucial component in improving maternal health outcomes by addressing patients' experiences. Although Sri Lanka has made progress in reducing maternal mortality, validated tools to assess PCMC are lacking, limiting the understanding of care quality from the patient's perspective. This study aimed to adapt and validate a PCMC scale specifically for Sri Lanka's context.
METHODS: The PCMC scale, originally validated in Kenya, Ghana, and India, was adapted through expert reviews and cognitive interviews, followed by psychometric testing. The tool was translated into Sinhala and Tamil. Sixteen experts evaluated the tool for content validity, and 20 postpartum women provided feedback on its contextual relevance. Psychometric analysis included exploratory factor analysis and Cronbach's alpha to establish construct validity and reliability of the scale.
RESULTS: A total of 400 postpartum women, with a mean age of 27.3 years (SD = 5.51), participated in the study. Multivariate normality checks revealed that all items except Q2, Q14, and Q22 fell within acceptable skewness and kurtosis ranges. The KMO measure of sampling adequacy ranged from 0.512 to 0.891 (overall KMO = 0.811), indicating suitability for factor analysis. Items Q11, Q17, and Q18 had borderline adequacy but were retained. Using principal axis factoring with Oblimin rotation, two factors were extracted based on the Kaiser criterion. Factor 1, named respectful and supportive care, included 14 items (Cronbach's α = 0.788). Factor 2, communication, autonomy, and privacy, included ten items (Cronbach's α = 0.708). The refined 24-item scale demonstrated good internal consistency and reliability (Cronbach's α = 0.813). The factor structure reflects the tool's construct validity, aligning with the goal of capturing the dimensions of respectful maternity care while addressing contextual and cultural factors.
CONCLUSIONS: The Sri Lanka-specific PCMC scale provides a culturally tailored measure to assess the experience of care, addressing a crucial gap in maternal health evaluations. This tool enables healthcare providers and policymakers to identify areas for quality improvement in maternity services, aligning with the WHO recommendations for respectful, person-centered care. Future research should explore the utility of this tool in diverse settings in Sri Lanka
Incorporating High-Risk Individuals Beyond Smoking History Into Lung Cancer Screening in Hong Kong: A Cost-Effectiveness Study
Get PDFIntroduction: Lung cancer (LC) accounts for 26.4% of all cancer deaths in Hong Kong (HK). Lung cancer screening (LCS) with low-dose computed tomography (LDCT) can reduce LC mortality. The cost-effectiveness of LDCT screening in high-risk individuals on the basis of smoking history has previously been investigated. However, nearly half of patients with LC in HK never smoke, indicating a different LC epidemiology compared with Western countries, where most LC cases are associated with smoking. We conducted a cost-effectiveness analysis for LCS, utilizing local data and expanding the target population to include we not only high-risk individuals identified on the basis of smoking history but also those identified through other risk factors.
Methods: A decision tree combined with a state-transition Markov model was developed to simulate identification, diagnosis, and treatments for high-risk individuals, from a health care provider perspective. The selection criteria and screening effectiveness for high-risk individuals on the basis of smoking history were obtained from the Dutch-Belgian Lung Cancer Screening Study, targeting heavy smokers aged 50 to 74 years; whereas the Taiwan Lung Cancer Screening in Never-Smoker Trial was used to model high-risk individuals on the basis of factors other than smoking history. Local LC survival and cost data were used to populate the model. The willingness-to-pay threshold used in the study was US40,202 per quality-adjusted life-year (QALY).
Results: Screening led to additional early LC detected, and LC mortality reduction, compared with no screening. Over a lifetime horizon, the incremental cost-effectiveness ratio for high-risk individuals on the basis of smoking history was US9610 per QALY.
Conclusion: LCS with LDCT can be considered cost-effective in HK for high-risk individuals on the basis of smoking history and factors other than smoking history, contributing to the health benefits of the population. Our findings support a population-based LCS for all high-risk individuals identified through criteria beyond smoking history
WHF Roadmap on Single Pill Combination Therapies.
Get PDFCardiovascular diseases (CVDs) are the leading global cause of mortality, with treatment adherence posing a major barrier to effective prevention and control. Single pill combinations (SPCs), also known as fixed-dose combinations, simplify treatment by combining multiple agents into one pill, improving adherence and reducing cardiovascular risk. This World Heart Federation Roadmap synthesizes the latest clinical evidence and identifies key barriers to SPC implementation, including limited manufacturing, affordability, regulatory complexity, and inconsistent guideline inclusion. Drawing on global expert input and health systems analysis, the Roadmap outlines practical, context-specific solutions to improve access, scale-up, and integration of SPCs into national strategies, especially in low- and middle-income countries. It serves as a tool for policymakers, clinicians, and advocates to drive progress in aligning cardiovascular prevention efforts with evidence-based, people-centred care
Learning Together for Mental Health: Rapid systematic review of reviews of school-level interventions to promote mental health and wellbeing.
Get PDFBACKGROUND: The high prevalence of mental health disorders among adolescents point to the need for interventions that prevent or minimise harms from these. Schools are the ideal setting for such interventions, given almost all children can be reached. We adapted a whole-school health intervention to target mental health. As part of this research, we aimed to provide schools with a report on mental health needs among their students and a menu of evidence-based actions that schools could take to address these needs. Given the multiple existing systematic reviews in this area, the actions to be included in the menu were informed by a rapid systematic review of reviews. AIMS: To identify effective school-level or simple interventions to address student needs across various domains of mental health in secondary schools or an equivalent phase, which have been identified in existing systematic reviews. METHODS: We undertook a rapid systematic review of reviews. In January 2022, we searched three databases [PubMed, PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Library] for systematic reviews of mental health interventions in the domains of: antisocial behaviour, anxiety, body image, depressive symptoms, digital health, eating problems, emotional issues, general well-being, lesbian, gay, bisexual, trans, questioning and other (LGBTQ+) inclusion, mental health first aid, physical activity for mental health, positive mental health, self-harm, student voice and substance use. Eligible for inclusion were systematic reviews of randomised trials or quasi-experimental studies evaluating school-based interventions among secondary school- or equivalent-aged children. We retrieved 95 reviews, of which 41 were eligible for the present review. We defined effective intervention strategies as those identified as being effective in an eligible study in any review. RESULTS: We identified a number of effective school-level or simple school interventions for addressing mental health in the above domains. Nine intervention focus areas were identified: (1) positive mental health and promotion of healthy development (five intervention strategies identified); (2) mental health literacy and awareness (six strategies); (3) LGBTQ+ mental health (two strategies); (4) mental health first aid (one strategy); (5) peer mentoring (two strategies); (6) support for transition from primary to secondary school (one strategy); (7) body image and body confidence (one strategy); (8) creative arts activities (one strategy); (9) physical activity (seven strategies) and (10) increasing access to nature (one strategy). Altogether, 27 strategies were identified. CONCLUSIONS AND LIMITATIONS: This rapid review identified 27 evidence-based school-level strategies that were used to inform the development of a menu of evidence-based whole-school actions, which were simple and inexpensive to implement in schools. This menu was piloted in a feasibility study, the results of which are reported elsewhere. Our findings were limited by a lack of quality assessment and single screening of abstracts. FUTURE WORK: If Learning Together for Mental Health is demonstrated as feasible to implement and acceptable to teachers and students, a phase III cluster randomised trial will be conducted to evaluate the effectiveness of the intervention. FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131594
Zoonotic anxieties: The cultural politics of Nepal's quest for pandemic preparedness
Get PDFAbstract
Based on fieldwork conducted in Nepal (2022–2024) and by paying attention to how local and transnational notions of epidemiological risk are deployed, this ethnography introduces the concept of “zoonotic anxieties” to make sense of the multi‐species relational ethos that contemporary global health regimes propose. Namely, at the intersection of “health security,” “pandemic preparedness,” and “One Health,” multispecies interactions are becoming subject to a resignification where cultural, racial, and geopolitical anxieties are deposited, expressed as fears over the potentially apocalyptic emergence of zoonotic disease. Nepal is produced through this lens as an epidemiologically risky terrain, receiving funds from international agencies to enhance its “disease surveillance” capacity with the underlying hope that, by identifying infectious diseases early, a foretold global disaster can be contained. These investments, however, have had little impact, producing conflicts between the country's claim to medical modernity and the shortcomings of its disease surveillance ambitions
Impact of Heat on Birth Outcomes and Child Nutrition: Study Protocol using the CIDACS Birth Cohort [version 2; peer review: 1 approved, 2 approved with reservations].
Get PDFBACKGROUND: Pregnant individuals and children are particularly vulnerable to the adverse health consequences of exposure to heat. Leveraging the robust ecosystem of Brazilian linked administrative data, we aim to advance our understanding of how high temperatures and heatwaves influence birth outcomes and child nutrition.
OBJECTIVES: Investigate the association between high ambient temperatures/ heatwaves and 1) birth outcomes (low birth weight (LBW), small for gestational age (SGA), large for gestational age (LGA), and preterm birth), 2) child nutrition (growth), and 3) breastfeeding practices and complementary feeding in children.
METHODS: We will triangulate results from complementary analytical approaches, including time-stratified case-crossover designs and time-to-event techniques. We will explore the influence of high temperatures and heatwaves at different periods (or lags) preceding the event and apply distributed lag non-linear models to account for delayed and non-linear effects. We will conduct subgroup analyses to identify the population groups most at risk.
RESULTS AND CONCLUSIONS: Our study will generate new insights into the relationship between heat, birth outcomes, and child nutrition in Brazil. By providing evidence from a middle-income country with diverse ecosystems and climate zones in a context of social inequalities, this research will contribute to advancing the current knowledge base. Additionally, by identifying critical windows of vulnerability and at-risk groups, our findings can potentially inform targeted and equitable climate adaptation policies
Impact of hip fracture on survival, disability, pain, and health-related quality of life in Zimbabwe: a prospective cohort study.
Get PDFBACKGROUND: The population in Africa is ageing, and fragility fractures increasing. We assessed 1-year health outcomes following hip fracture in older adults in Zimbabwe. METHODS: In this prospective cohort study, a cohort of adults aged 40 years or older with hip fracture, presenting to hospitals in Harare (two public and five private hospitals) between Oct 15, 2021, and Oct 14, 2022, were followed up for 12 months. The primary outcome was survival, analysed with Kaplan-Meier curves at different timepoints (30 days, 120 days, 6-8 months, and 12 months after case identification), overall and stratified by age (2 weeks]), and facility type and operative management. We also quantified health-related quality of life (HRQoL), measured with 5-level EQ-5D (EQ-5D-5L), hip pain, self-reported from 0 (none) to 5 (all the time) and measured as interference with walking and sleep (1 [no interference] to 10 [complete interference]), as per the Brief Pain Inventory, and disability, measured with the WHO Disability Assessment Schedule version 2.0 (WHODAS). FINDINGS: Of 196 patients with hip fracture (96 [49%] female, 100 [51%] male; median age 74 years [IQR 62·5-83]), 162 (83%) had had a fragility fracture (low-energy trauma). In total, 173 (88%) were managed in a public hospital, of whom 96 (55%) received operative hip fixation. In contrast, all of the 23 (12%) managed in private facilities had an operation. After 12 months, 55 (29%) had died (49 [42%] of 117 patients aged ≥70 years, and six [9%] of 70 patients aged <70 years). In public hospitals, 31 (42%) of 73 non-operated patients died, compared with 18 (19%) of 93 patients who were operated on. Overall, survival declined to 88% (95% CI 82-92) by 30 days and to 71% (64-77) by 12 months. The probability of survival was lower in patients aged 70 years or older than in those younger than 70 years (mortality hazard ratio for ≥70 years 6·10, 95% CI 2·61-14·22). The mean HRQoL utility score decreased from 0·81 (95% CI 0·80-0·83) pre-fracture to 0·29 (0·25-0·34) at 30 days post fracture. Minimal recovery was seen after 120 days (0·34, 0·29-0·39). By 12 months, 97 (97%) of 100 patients alive and able to provide data still reported pain from their hip injury. Post-fracture disability was almost universal, with only two (2%) of 100 patients being disability-free (WHODAS=0) by 12 months. INTERPRETATION: Following hip fracture, survival and quality of life decreased substantially in the study population. These findings reveal the need for the implementation of guidelines to standardise care and improve operative capacity to manage the predicted rise in fractures in this region. FUNDING: Wellcome Trust
Refining methods for attributing health impacts to climate change: a heat-mortality case study in Zürich.
Get PDFHeat-related deaths occur throughout the summer months, peak during heatwaves, and are affected by temperature and exposed populations' sensitivities to meteorological conditions. Previous studies found that climate change is increasing heat-related mortality worldwide. We build on existing epidemiological methods to shed light on the adverse effects of climate change on human health. We address limitations in existing methods and apply refined approaches to assess heat mortality attributable to human-induced climate change in Zürich, Switzerland, over 50 years (1969-2018) including a case study of summer 2018. Our methodological refinements affect how counterfactual climate scenarios are derived, and facilitate accounting for changing vulnerability, and assessing impacts during and outside heatwaves. We find nearly 1,700 heat-related deaths attributable to human-induced climate change between 1969 and 2018. Declining vulnerability to heat avoided at least 700 heat-related deaths. The approach described here could be applied elsewhere to quantify the effect of climate change on other health outcomes.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10584-025-04011-5
Recommendations for studying the association of the cancer diagnosis to treatment interval with overall survival: a modified Delphi process.
Get PDFBACKGROUND: The duration from diagnosis to primary treatment initiation (DTI) is an important interval for patients with cancer, as delayed treatment has been found to be associated with heightened recurrence rates and worsened survival. Studying the association between DTI duration and overall survival (OS) is biased and confounded by clinical triaging, heterogeneous definitions, and variation in analytic approaches.
OBJECTIVE: To develop consensus-based guidance for conducting studies investigating the association of DTI duration and OS.
METHODS: A multidisciplinary panel was recruited to participate in a three-round modified Delphi approach to develop consensus recommendations on the best methodological practices when studying the association between DTI duration and OS.
RESULTS: The Delphi panel consisted of 15 experts in the fields of epidemiology, biostatistics, health services research, oncology, and health policy. A list of 24 recommendations with accompanying elaborations was generated including variable definition and measurement, cohort creation, confounder control, pertinent biases, analytic techniques, and balanced interpretation of results.
CONCLUSION: Providing valid evidence of the DTI effect on OS requires careful approaches. This paper offers recommendations on how to improve methodological quality. This will ensure that future studies effectively contribute to evidence-informed practice decisions on appropriate waiting times for patients with cancer