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Evaluating Policy to Research Fellowship programmes
Get PDFBACKGROUND: This paper provides insights into 'Policy to Research' (P2R) Fellowships and related programmes within the 'relationship' model of academic-policy engagement, which provide structured opportunities for policy officials to interact with academic researchers.
AIMS AND OBJECTIVES: Information is provided on P2R Fellowship and similar programmes in the UK, Europe and North America. The research questions concern the aims, features and intended outcomes of P2R Fellowship programmes; what can be learned from evaluations of these programmes; and whether value for money for these programmes can be deduced. The authors then aim to provide guidance for an evaluation framework.
METHODS: Programmes were identified through a subset of data gathered on research-policy engagement initiatives in a recent mapping exercise. This was supplemented via Google search. Published data on organisational websites is presented in a table, where data was checked by email with programme managers, who were also asked to provide additional evaluation documents.
FINDINGS: Twenty-four P2R Fellowship programmes were located. Eleven programme managers confirmed information provided in Table 1. Evaluation documents were provided for five programmes. An average cost of providing a P2R Fellowship was estimated at around £5,000 for each Fellow. Five common aims for P2R Fellowship programmes were identified.
DISCUSSION AND CONCLUSION: Quantitative and qualitative evaluations available from the 24 programmes are reviewed. The comparative lack of published evaluation data is discussed, and recommendations made for an evaluation framework for P2R Fellowships, to build understanding of how to intervene successfully to support a research-for-policy system which delivers for all
A Blueprint for Building Resilience and Food Security in MENA and SSA Drylands: Diversifying Agriculture With Neglected and Underutilized Species
Get PDFABSTRACT
Drylands, encompassing 41% of global land and supporting over 2 billion people, face significant challenges, including water scarcity, extreme temperatures, and soil degradation. Dryland spans vast areas of Middle East and North Africa (MENA) and Sub‐Sahara Africa (SSA) regions and poses a threat to food security and resilience. This study examines the potential of neglected and underutilized species (NUS) to improve dryland food and nutrition security, focusing on their agronomic performance, water productivity, economic viability, and nutritional benefits. Using long‐term data from FAOSTAT, USDA Food Data Central, and peer‐reviewed literature, we analyzed trends in the cultivation, yield, and nutritional contributions of 26 NUS across 22 countries in the MENA region comparing them with major staples—rice, wheat, and maize. Between 1961 and 2022, NUS crop areas in MENA fluctuated, decreasing by 7.0% since 2018 to 21.17 Mha. Despite this, NUS demonstrated superior water productivity—up to 30% higher than major cereals. For instance, sorghum and cowpea achieved 2.5 kg/m3 compared to maize (0.83 kg/m3) and wheat (0.91 kg/m3) and exhibited strong heat tolerance, withstanding temperatures of up to 42°C and 38°C, respectively. Despite a negative trade balance, NUS significantly contributed to dietary calories, surpassing wheat. A field experiment in Merchouch, Morocco, confirmed that NUS offered a higher economic value per unit than wheat, and outperformed conventional crops across key indicators. Integrating NUS into dryland farming systems can enhance food security, sustainability, and resilience to climate change. Advancing NUS requires breeding programs, tailored good agricultural practices, value addition and market linkage, supportive policies, and farmer education. Collaborative efforts among international organizations, governments, and civil society are crucial to mainstreaming NUS in agrifood systems and contributing to the diversity, sustainability, and resilience of dryland farming systems in MENA and SSA regions
The appropriateness of self-care policy for urinary tract infections among women from racialised minorities and low-income households in the United Kingdom: A qualitative study.
Get PDFObjectivesUrinary tract infections (UTIs) can negatively impact quality of life, especially when recurring. Patients often seek medical advice to relieve painful symptoms. UTIs are also the second most common reason antibiotics are prescribed in English primary care. However, overuse and long-term use of antibiotics for suspected UTIs in women can lead to antibiotic-resistant bacteria, making future treatments less effective. The UK's 2019-24 Antimicrobial Resistance National Action Plan aims to raise public awareness about the risks of overusing antibiotics and encourages self-care for minor infections, like uncomplicated UTIs. We explored how feasible and appropriate this approach is.MethodsThe transcripts from four online focus groups and 19 one-to-one online interviews involving 25 racialised minority and/or low-income women were analysed thematically. Meetings with lay members of the public with similar socio-demographics and experiences to those we planned on recruiting for the research helped to orientate the study, refine its materials and enhance its recruitment strategies.ResultsAll participants spoke about UTI-related anxieties, which they experienced differently depending on the frequency and the course of UTI episodes, and how knowledgeable they were about the symptoms. Participants often practised self-care for UTIs before seeking professional advice. They saw consultations with health care professionals as valuable for managing the symptoms of UTIs and navigating self-care options. Those with recurrent UTIs felt they could recognise when they required antibiotics and, therefore, they felt they could take responsibility for minimising overprescribing. Barriers to self-care included high pressure working days and not being able to take time off work to recover.ConclusionsParticipants in our study were often able to self-diagnose and assess the severity of their symptoms, which makes them partners in efforts to improve antibiotic stewardship. They still valued consulting professionals for advice and support about their UTIs, irrespective of whether they received a prescription
Impact of diagnosis-related group payment on medical expenditure and treatment efficiency on people with drug-resistant tuberculosis: a quasi-experimental study design.
Get PDFBACKGROUND: The severe health challenge and financial burden of drug-resistant tuberculosis (DR-TB) continues to be an impediment in China and worldwide. This study aimed to explore the impact of Diagnosis-related group (DRG) payment on medical expenditure and treatment efficiency among DR-TB patients. METHODS: This retrospective cohort study included all DR-TB patients from the digitized Hospital Information System (HIS) of Wuhan Pulmonary Hospital and the TB Information Management System (TBIMS) with completed full course of National Tuberculosis Program (NTP) standard treatment in Wuhan from January 2016 to December 2022, excluding patients whose treatment spanned both before and after the DRG timepoint. These patients are all receiving standardized treatment specified by the NTP in designated tuberculosis hospitals. We performed the difference-in-differences (DID) model to investigate 6 primary outcomes. The cost-shifting behaviors were also examined using 4 outpatient and out-of-pocket (OOP) indicators. In the DID model, the baseline period is set from January 2016 to December 2020 before the DRG payment reform, while the treatment period is from January 2021 to December 2022. The payment reform only applied to individuals covered by Wuhan Municipal Medical Insurance, so the treatment group consists of patients insured by this plan, with other patients serving as the control group. RESULTS: In this study, 279 patients were included in the analysis, their average treatment duration was 692.79 days. We found the DRG payment implementation could effectively reduce the total medical expenditure, total inpatient expenditure, and inpatient expenditure per hospitalization by 28636.03RMB (P < 0.01), 22035.03 RMB (P < 0.01) and 2448.00 RMB (P < 0.05). We also found a reduction in inpatient frequency and inpatient length of stays per hospitalization by 1.32 and 2.63 days with significance. The spillover effects of the DRG payment on outpatient and OOP expenditure were statistically insignificant. CONCLUSIONS: The DRG payment method can effectively control the increase of DR-TB patients' medical expenditure and improve treatment efficiency with the guarantee of care quality. Furthermore, there was no evidence of spillover effects of DRG payment on outpatient and out-of-pocket expenditures
Clinical presentation and epidemiological assessment of confirmed human mpox cases in DR Congo: a surveillance-based observational study.
Get PDFBACKGROUND: Mpox, caused by the monkeypox virus, is a serious public health threat in Africa, especially in DR Congo. Previously limited to endemic areas with clade 1a, monkeypox virus has recently spread to non-endemic regions, where clade 1b has emerged. This study provides a clinical comparison of mpox cases in DR Congo regions where clade 1a and clade 1b are prevalent. METHODS: We conducted a retrospective observational study, analysing PCR-confirmed mpox cases reported from sentinel health zones in seven provinces between Oct 1, 2023, and Sept 31, 2024. Cases from the newly affected provinces (South-Kivu and Kinshasa) were described along with those from four endemic provinces (Mai-Ndombe, Tshuapa, Tshopo, South-Ubangi, and Équateur). Surveillance data, including type of exposure, demographic details, clinical presentation, complications, and outcomes were collected from national surveillance systems and local health facilities, with laboratory confirmation using quantitative PCR. All analyses were restricted to descriptive statistics. FINDINGS: Of 17 927 suspected cases identified, 10 986 were investigated, 5948 were PCR-positive, and 4895 met the inclusion criteria based on data completeness: 4436 in newly affected and 459 in endemic regions. In newly affected provinces, median age was 20 years (IQR 8-28), 2119 (47·8%) participants were female, and 2310 (52·1%) were male. In endemic provinces, median age was 15 years (7-26), 179 (39·0%) participants were female, and 277 (60·3%) were male. Direct or intimate human contact was reported by 1951 (44·0%) individuals in newly affected provinces versus 25 (5·4%) in endemic provinces, and zoonotic exposure in 11 (0·2%) and 99 (21·6%), respectively. The proportions of partcipants with systemic symptoms (3828 [86·3%] in newly affected provinces and 427 [93·0%] in endemic provinces) and respiratory symptoms (2450 [55·2%] and 219 [47·7%]), and median skin lesion counts (91 [IQR 37-200] and 163 [95-345]) were similar between newly affected and endemic regions. Complications included skin infections (2041 [46·0%] in newly affected provinces and 201 [43·8%] in endemic provinces), respiratory distress (82 [1·8%] and 29 [6·3%]), vision impairment (7 [0·2%] and 28 [6·1%]), and prostration (695 [15·7%] and 51 [11·1%]). The case-fatality rate was 0·7% (95% CI 0·4-1·3; 14 of 1924) in children and 0·6% (0·3-1·0; 14 of 2483) in adults in newly affected areas, compared with 5·9% (3·4-10·0; 14 of 236) in children and 2·7% (1·1-6·1; six of 222) in adults in endemic regions. Content note: this Article and its appendix contain graphic images of mpox lesions affecting various sites including the face and genitals. INTERPRETATION: Our study indicates concurrent mpox outbreaks in DR Congo, involving younger individuals, a higher proportion of women and girls, and distinct presentations with higher lesion counts and respiratory symptoms compared with clade 2b lineage B.1 outbreaks. The high proportion of infectious complications and case-fatality rates, especially in endemic regions, emphasise the need for timely antibiotic therapy and targeted vaccination to reduce morbidity and mortality. FUNDING: Skin NTDs and STI Research Unit, Fight Infections Foundation
Prioritizing infant mental health: a research-driven pathway for action.
Get PDFA comprehensive research agenda is needed to identify gaps and actionable steps to prioritize infant and early life mental health care globally
Perinatal health outcomes of offspring of internal migrant women according to human development index: a registry-based cohort study of over 10 million live births from Brazil.
Get PDFBACKGROUND: Migration, driven by factors like poverty, violence, and natural disasters, is a key social determinant of health. While international migrants often have worse perinatal outcomes, research on perinatal health differences between internal migrants and non-migrants remains limited. We aimed to determine whether the offspring of women who migrate within Brazil experience poorer perinatal outcomes than those of non-migrants, according to the Human Development Index (HDI) of their municipalities of origin and destination. METHODS: We used the CIDACS Birth Cohort, consisting of women applying for social programmes in the Unified Registry for Social Programmes Cadastro Único linked with live births and mortality registries. We included live births conceived from March 2010 to February 2018. Internal migrants were women who changed their state of residence from registration in CadUnico to the birth of the child. We derived risk ratios (RR) of migration's effect according to HDI of residence before and after migration using logistic regression. FINDINGS: We included 10,184,021 births in the study, with 5.7% of these births from women who were internal migrants. The offspring of women who migrated to municipalities with equal/higher HDI (80% of migrations), exhibited a decreased risk of preterm births (RR: 0.94, 95% CI: 0.93-0.95), low birth weight (RR: 0.94, 95% CI: 0.92-0.95) and small for gestational age (RR: 0.92, 95% CI: 0.91-0.93), but higher risk of congenital abnormalities (RR: 1.14, 95% CI: 1.10-1.18). The offspring of women who migrated to municipalities with lower HDI had delayed access to healthcare and worse outcomes except for a lower risk of low birth weight (RR: 0.94, 95% CI: 0.92-0.96). INTERPRETATION: Offspring of those migrating to municipalities with equal/higher HDI tend to have better perinatal outcomes, whereas migrants to lower HDIs have a similar pattern to non-migrant women. FUNDING: NIHR, Wellcome Trust, Royal Society
Impact of dhps mutations on sulfadoxine-pyrimethamine protective efficacy and implications for malaria chemoprevention.
Get PDFSulfadoxine-pyrimethamine (SP) is recommended for perennial malaria chemoprevention in young children in high burden areas across Africa. Mutations in the dihydropteroate synthase (dhps) gene (437 G/540E/581 G) associated with sulfadoxine resistance vary regionally, but their effect on SP protective efficacy is unclear. We retrospectively analyse time to microscopy and PCR-confirmed re-infection in seven efficacy trials including 1639 participants in 12 sites across Africa. We estimate the duration of SP protection against parasites with different genotypes using a Bayesian mathematical model that accounts for variation in transmission intensity and genotype frequencies. The longest duration of SP protection is >42 days against dhps sulfadoxine-susceptible parasites and 30.3 days (95%Credible Interval (CrI):17.1-45.1) against the West-African genotype dhps GKA (437G-K540-A581). A shorter duration of protection is estimated against parasites with additional mutations in the dhps gene, with 16.5 days (95%CrI:11.2-37.4) protection against parasites with the east-African genotype dhps GEA (437G-540E-A581) and 11.7 days (95%CrI:8.0-21.9) against highly resistant parasites carrying the dhps GEG (437G-540E-581G) genotype. Using these estimates and modelled genotype frequencies we map SP protection across Africa. This approach and our estimated parameters can be directly applied to any setting using local genomic surveillance data to inform decision-making on where to scale-up SP-based chemoprevention or consider alternatives
Effective coverage of childbirths in health facilities in Nepal: cross-sectional study combining Demographic and Health Survey 2022 and Health Facility Survey 2021
Get PDFBackground: Crude intervention coverage, such as percentage of facility-based childbirths, does not reflect care quality. Effective coverage provides a more accurate measure by accounting for the quality of maternal health services. This study aimed to estimate effective coverage of facility-based childbirth in enabling environments in Nepal. Methods: We used data from Nepal’s Demographic and Health Survey 2022 including 1,977 women and the Health Facility Survey 2021 with a sample of 804 facilities. We calculated the percentages of births by facility type and the percentage of facility types with enabling environments for childbirth services. We combined the results from two surveys to estimate effective coverage of births for routine childbirth, basic and comprehensive emergency obstetric and newborn care (BEmONC and CEmONC). Results: Around 80 % of all births occurred in health facilities nationwide. This reduced to 18.5% nationwide when only births in facilities equipped for routine childbirth were considered, and further to 12.9% and 12.2%, respectively for BEmONC and CEmONC. The reduction between crude and effective coverage across facility types varied from 36.8% to 13.5% in government hospitals, from 16.1% to 4.7% in private hospitals for routine childbirth. While, 20.1% of births were in health posts, no health posts had enabling environments for routine childbirth. Conclusions: Fewer than one in five births occur in health facilities with enabling environments for acceptable quality care. This emphasizes the need for policymakers to prioritize the quality of childbirth services in well-equipped and well-staffed facility environments to improve maternal and neonatal outcomes
Is Brazil Reversing the Decline in Childhood Immunization Coverage in the Post-COVID-19 Era? An Interrupted Time Series Analysis.
Get PDFBackground: The COVID-19 pandemic had significant impacts on healthcare systems, including the disruption of essential services such as childhood immunization. Containment measures, such as social distancing, contributed to reduced adherence to vaccination programs, increasing the risk of re-emerging vaccine-preventable diseases. We aim to assess the evolution of childhood vaccination coverage in Brazil from 2010 to 2024, identifying trends before, during, and after the COVID-19 pandemic. Methods: An interrupted time series (ITS) study was conducted using publicly available aggregated data on vaccination coverage for children under one year of age. Prais-Winsten regression models were applied to estimate trend changes and evaluate the impact of the pandemic on immunization levels. Results: The findings indicate a progressive decline in vaccination coverage between 2010 and 2019, which was intensified in 2020 by the pandemic. The BCG vaccine showed the greatest decline (-24.88%, p < 0.001), while pentavalent and hepatitis B vaccines decreased annually by -3.72% and -2.21%, respectively. From 2021 onwards, a gradual recovery in coverage was observed, with significant increases for BCG (+7.48% per year, p < 0.001), hepatitis B (+7.45%, p = 0.014), and MMR (+6.73%, p = 0.017) vaccines. Discussion: The results highlight a concerning decline in childhood immunization, exacerbated by the pandemic but showing recent signs of recovery. This scenario underscores structural challenges within the National Immunization Program, requiring coordinated efforts to reverse vaccination losses and ensure system resilience in the face of future crises