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Validity of a visual analogue scale to measure and value the perceived level of sanitation: evidence from Ghana and Mozambique.
Get PDFTwo billion people globally lack access to a basic toilet, and sanitation is a critical determinant of health and well-being. Evaluations of sanitation programmes typically measure disease or behaviour, and visual analogue scales (VASs) have not been used to measure users' feelings about their level of sanitation. In this study, we assess the validity of a horizontal sanitation VAS numbered 0-10, with end anchors 'best imaginable' and 'worst imaginable' sanitation. In Kumasi, Ghana, we surveyed 291 participants before and after uptake of a container-based sanitation service. In Maputo, Mozambique, we surveyed 424 participants from treatment groups of a prior trial. We assessed construct validity by testing hypothesized associations between VAS scores and toilet characteristics and by respondents valuing three hypothetical sanitation states. We assessed responsiveness by comparing VAS with/without sanitation interventions. There was evidence (P < 0.05) for 60% of hypothesized associations in Ghana and 100% in Mozambique. For responsiveness, there was a 3.4-point increase (2.1 SD) in VAS 10 weeks post-intervention in Ghana and a 2.9 point difference (1.3 SD) in Mozambique. In valuation exercises, the mean was higher (P < 0.001) for the objectively better sanitation state. The sanitation VAS could be useful in economic evaluation to identify which improvements achieve quality-of-life gains most efficiently. For future studies, we recommend a vertical sanitation VAS numbered 0-100 with emojis at end anchors but retaining a 0-10 option for those who struggle with numeracy
Initiating systemic capacity development for leadership from the bottom-up: a realist evaluation of a leadership innovation in a South African health district.
Get PDFThe need for leadership within district health systems is critical for the effective delivery of services and for inter-sectoral collaboration for health. Leadership capacity development (LCD) has not, however, been prioritized within health systems, and the systemic capacity (i.e. roles, structures and processes) that is needed to develop managers who can lead is not always in place. This paper aims to contribute to understanding how to build such capacity, considering a relevant bottom-up innovation. We observed, in the period 2013-15, the emergent implementation of this innovation (a 'Leadership Commission') in a South African health district. What started out as an effort to train individual leaders evolved into the development of systemic capacity for LCD. We adopted realist evaluation as the main methodological approach, as well as case study design, and we first developed a programme theory of the internally driven LCD initiative, through a round of interviews with senior managers. We then tested the programme theory drawing on 14 in-depth interviews and field notes of meetings and processes. Our analysis suggests that building systemic capacity for LCD requires leadership to be expressed as a strategic priority by those with positional authority and that bottom-up LCD requires institutional commitment through strengthening routine structures or creating new ones. The ability to leverage existing resources is another key element of systemic capacity. The mechanisms that enable bottom-up capacity development include tacit and experiential knowledge, sensemaking, systems thinking and trust between, and motivation of, those tasked with leading LCD. Leadership development is constrained by increased workloads for those involved as the prioritization of leadership becomes simply an additional task, and sustainability challenges are likely in the absence of additional resources for bottom-up innovation
A qualitative study of Ebola survivors' psychological experiences of evacuation, treatment and community reintegration: Lessons in holistic person-centred care from the 2022 outbreak in Uganda.
Get PDFThe Ebola Virus Disease (EVD) is associated with significant mental health and psychosocial problems among patients/survivors. Effective strategies for addressing these problems necessitate an in-depth understanding of the sociocultural, economic and political context of the outbreaks, and survivors' own experiences of the disease. Yet, such context and survivors' experiences remain inadequately understood. We explore the pre- and post-diagnosis/treatment and post-recovery experiences of survivors of the 2022 EVD outbreak in Mubende District (Uganda) and draw lessons for better management of future outbreaks. A qualitative study was undertaken in Mubende District to explore the lived experiences of various categories of persons affected by the outbreak. Participants were sampled purposively. In-depth interviews were held with 15 EVD survivors. A thematic analysis of data was done. Our findings reveal that across the entire spectrum of their encounter with EVD, patients had a range of overwhelmingly stressful experiences that, according to the participants, took a toll on their mental health. These included stigma during evacuation and on return to their communities upon discharge, perceived inhuman treatment from health workers, lack of epidemic preparedness at the EVD facilities, witnessing frequent EVD deaths due to the EVD Treatment Unit's open/unpartitioned ward, delayed removal of dead bodies from the shared ward, systemic lapses in health services and EVD-induced livelihoods challenges. In conclusion, EVD patients'/survivors' experiences across the entire spectrum of their illness - from the period before diagnosis to their treatment at the EVD Treatment Unit and, later, their re-integration into their communities - are characterised with high levels of unattended, self-reported psychological distress. We propose a holistic person-centred approach to healthcare for EVD suspects, confirmed cases and survivors. Additionally, EVD education and sensitisation programs need to target health workers, among other population groups
A results to action framework for community verification: A case study from a performance based financing program in Zimbabwe
Get PDFPerformance-based financing (PBF) is a funding strategy that pays for outcomes rather than the cost of inputs. Verification through facility records (quantity verification) and patient interviews in communities (community verification) is a known cornerstone of PBF to ensure reported results are accurate. However, the literature suggests it’s common to tie payment to quantity verification results, which measure internal record alignment but do not assess the validity of records (e.g., whether records represent delivered services). We sought to understand the extent to which reported voluntary medical male circumcisions (VMMCs) in a PBF program could be verified in facility records and with patients, and if the two sources aligned at the facility-level. We performed a mixed method verification including quantity verification and community verification to verify reported results for Population Services International’s VMMC program in Zimbabwe from 2016 – 2018. We also interviewed verifiers to help understand the findings and we assessed the correlation between quantity and community verification performance scores at the facility-level to see whether facilities that have strong record keeping tended to also have strong validation from patients and vice versa. Among the 36,877 VMMCs selected from DHIS2 for quantity verification, 94% of records were sufficiently complete. Among records selected for community verification, only 55% (2,010/3,676) of patients were interviewed. Among those interviewed, 17% (342/2,010) provided answers that did not plausibly match the record. Verifiers reported that some patients admitted providing incorrect contact information to avoid follow-up and most verifiers suspected staff had fabricated data. We found no correlation between performance scores at the facility-level. Overall, results from the quantity verification were not a good proxy for the community verification. Programs that pay based on facility records alone risk overpaying for services and misreporting performance. To increase the use of community verification findings, PBF programs should consider using and improving our proposed results to action framework
Genetic liability to psoriasis predicts severe disease outcomes.
Get PDFBACKGROUND: Psoriasis is a common inflammatory skin disease with heterogeneous presentation. Up to 30% of individuals have severe disease with a greater surface area of skin involvement, co-morbidity burden and impact on quality of life. Prognostic biomarkers of psoriasis severity could improve allocation of clinical resources and enable earlier intervention to prevent disease progression, and a genetic biomarker would be cost-effective, stable over time, and unaffected by treatment or comorbidity.
METHODS: Psoriasis severity was studied in four European population-based biobanks (Estonian Biobank, HUNT, FinnGen, UK Biobank) and classified based on level of clinical intervention received, with criteria for severe disease including hospitalisation due to psoriasis, use of systemic immunomodulating therapy or phototherapy. Common genetic variants, polygenic risk scores and traditional epidemiological risk factors were tested for association with severe psoriasis in each of the constituent biobanks and combined through meta-analysis. The distribution of psoriasis polygenic risk was also evaluated in a cohort of 4151 participants in the UK-based severe psoriasis registry, BSTOP, and a cohort of 1461 participants from Novartis clinical trials of secukinumab for psoriasis.
RESULTS: In the population-based datasets, 9738 of 44,904 individuals with psoriasis (21.7%) were classified as having severe disease. Genetic variants within the major histocompatibility complex (MHC) and the TNIP1 and IL12B psoriasis susceptibility loci were associated with severe disease at genome-wide significance (P < 5.0 × 10-8). Furthermore, a strong positive correlation was observed between psoriasis susceptibility and severity effect sizes across all psoriasis susceptibility loci. An individual's genetic liability to psoriasis as measured with a polygenic risk score (PRS) strongly associated with disease severity, with a magnitude of effect comparable to established severity risk factors such as obesity and smoking. The top 5% of psoriasis cases by genetic liability to psoriasis were 1.23-to-2.00 times as likely than the average psoriasis case to have severe disease. Psoriasis cases in our external validation datasets (BSTOP registry and Novartis clinical trials) were enriched for a PRS that exceeded the 95th percentile established among UK Biobank psoriasis cases by 3.06-fold and 2.32-fold respectively.
CONCLUSIONS: The psoriasis susceptibility PRS demonstrates utility and may be more effective than established epidemiological factors, as a stratification tool to identify those individuals that are at greatest risk of severe disease and may benefit most from early intervention
The impact of multicancer early detection tests on cancer stage shift: A 10-year microsimulation model.
Get PDFINTRODUCTION: Early detection of cancer improves survival following diagnosis. However, routine screening is limited to a few cancer types. Multicancer early detection (MCED) tests could revolutionize cancer screening by simultaneously detecting multiple cancer types. This study evaluates the potential impact of an MCED test on stage shift in the US general population.
METHODS: A microsimulation model of 14 solid tumor cancer types that account for nearly 80% of cancer incidence and mortality was developed. The model was calibrated to reproduce annual incidence rates reported in the Surveillance, Epidemiology, and End Results database. Cancer diagnosis could arise from standard-of-care procedures or annual MCED testing. MCED sensitivities were derived from a large, multicenter, prospective, case control study. Ten-year disease progression was simulated for 5 million US adults aged 50 to 84 years. The primary outcome was stage shift resulting from MCED testing.
RESULTS: Over 10 years, supplemental MCED testing led to a 10% increase in Stage I diagnoses, 20% increase in Stage II diagnoses, 34% increase in Stage III diagnoses, and 45% decrease in Stage IV diagnoses, relative to the standard of care alone. The largest absolute reductions in Stage IV diagnoses were in lung (400 vs. 765 per 100,000), colorectal (96 vs. 236), and pancreatic (89 vs. 211) cancer. The largest relative reductions were in cervical (83%), liver (74%), and colorectal (59%) cancer.
CONCLUSION: MCED testing has the potential to substantially reduce late-stage cancer diagnoses, improve outcomes across multiple cancer types, and address a critical gap in screening
Religious parents receive more alloparental aid in rural Bangladesh.
Get PDFResearchers have long speculated about the evolutionary benefits of religiosity. One explanation for the evolution of religious ritual is that rituals signal commitment to co-religionists. As a major domain of prosocial behaviour, alloparental care - or care directed at children by non-parents - is a plausible benefit of religious signalling. The religious alloparenting hypothesis posits that parents who signal religious commitment receive greater alloparental support. Prior research on religiosity, cooperation, and allocare tends to treat individuals as isolated units, despite the inherent collective nature of religious cooperation. Here, we address this limitation in a survey-based study of 710 parents in rural Bangladesh. Instead of focusing only on mothers, we consider the interplay between both mothers and fathers in eliciting allocare, and leverage variation in the covertness of religious rituals to test a key mechanistic assumption linking religious ritual with cooperation. We find that parents who practice religious rituals more frequently receive greater alloparental support from co-religionists. This effect is moderated by parent gender, as well as variation in the visibility of religious rituals. Women's private practices positively affect only those alloparents with whom they share a household, whereas men's public practices positively affect alloparents more broadly
Healthcare professionals' perceptions of barriers and facilitators to postpartum diabetes screening participation in women with gestational diabetes mellitus in China: A qualitative study.
Get PDFBACKGROUND: Women with a history of gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes (T2DM). Postpartum diabetes screening is usually recommended to identify glucose intolerance and introduce timely diabetes prevention strategies. However, the uptake of postpartum diabetes screening is suboptimal, especially in China, where GDM is prevalent. Healthcare professionals (HCPs) may offer unique insights into the challenges women face when attending screening, helping to develop interventions that improve uptake and fit in with routine clinical practice. AIM: To explore HCPs' perceptions of barriers and facilitators to postpartum diabetes screening uptake. METHODS: Online semi-structured interviews were conducted with HCPs recruited via online networks. The data were analysed using framework analysis and the socio-ecological model. RESULTS: Eighteen HCPs, including obstetricians, midwives, nurses, nurse managers, and a dietician participated. Thirteen themes were generated across four levels (individual, interpersonal, organisational and policy). Individual level themes included: women's limited understanding, adherence and motivation; low diabetes risk awareness; and competing priorities. Interpersonal challenges involved communication and relationships between HCPs and women. Organizational barriers included workforce shortages, a lack of systemic GDM follow-up and care integration, and limited screening accessibility. At the policy level, GDM follow-up was not promoted nor prioritised. CONCLUSION: HCPs have a vital role in improving patient education, postpartum follow-up and support after GDM to reduce long-term health risks. Strengthening HCP training in communication with women and improving continuity and integration of care could enhance GDM follow-up and prevent diabetes in women following GDM
The Association Between Depression, Suicidal Thoughts and Intimate Partner Violence Perpetration Among Young Men in Mwanza, Tanzania
Get PDFPurpose: Depression and suicidal thoughts are associated with intimate partner violence, a major public health problem. Yet little is known about this association among young men in sub-Saharan Africa. This study aims to investigate the relationship between depression, suicidal thoughts and intimate partner violence perpetration, among young men in Tanzania from a representative community-based sample.
Methods: We conducted a cross sectional survey among 1002 young men aged between 18 and 24 years residing in Mwanza city, Tanzania. Participants were randomly selected from 6 wards that included 3 densely and 3 sparsely populated wards from the Ilemela and Nyamagana districts that were selected using a probability-based multi-stage cluster sampling approach. We collected data on participant’s socio-demographics, depression symptoms using the PHQ9, suicidal thoughts, other psychosocial factors, and perpetration of different forms of intimate partner violence. Analysis was done using Stata version 17.0 and restricted to 828 participants who self-reported being in intimate relationships in the past twelve months. Bivariate and multivariable logistic regression models were employed to determine the association between the outcome variables with intimate partner violence perpetration and other psychosocial factors.
Results: Out of 828 young men, 333(40.2%) reported depressive symptoms and 93(11.9%) suicidal thoughts, with 725(87.6%) reporting ever perpetrating any form of intimate partner violence and 653(78.9%) reporting it in the past 12 months. After adjusting for other factors in multivariable models, depressive symptoms were significantly associated with sexual intimate partner violence perpetration (aOR = 2.19, 95%CI = 1.57, 3.04), economic intimate partner violence perpetration (aOR = 1.32 95%CI = 1.01, 1.74), emotional intimate partner violence perpetration (aOR = 1.76, 95%CI = 1.26, 2.46) and controlling behaviours (aOR = 1.46 95%CI = 1.10, 1.93).
Conclusions: Depression is a common health problem strongly associated with intimate partner violence perpetration in this study population. Effective interventions to address depression and other mental health problems may help to reduce intimate partner violence perpetration in this population.
Implications: Researchers and practitioners should develop theory-based research and intervention programmes to address mental health problems such as depression and suicidal thoughts and the perpetration of intimate partner violence. The socio-ecological framework provides an insightful model for multiple level analysis and intervention
Risk of Cardiovascular Disease in Cancer Survivors after Systemic Treatment: A Population-Based Cohort Study.
Get PDFBACKGROUND: Patients face an increased risk of cardiovascular disease shortly after a cancer diagnosis, but evidence on long-term risk among cancer survivors remains limited. OBJECTIVES: In this study the authors sought to estimate the risk of cardiovascular disease in cancer survivors previously treated with systemic cancer therapy. METHODS: Using Danish population-based registries, we identified individuals who had received systemic cancer treatment and were free of both cancer and treatment 3 years after diagnosis (index date). For each cancer survivor, 5 cancer-free individuals from the general population were randomly selected, matched by birth year, sex, and calendar year. Participants were followed from the index date for up to 5 years. HRs were estimated using Cox regression, adjusted for potential confounders. RESULTS: Compared with 457,035 matched individuals, the 91,407 cancer survivors had an increased risk of heart failure or cardiomyopathy (HR: 1.08; 95% CI: 1.02-1.15), venous thromboembolism (HR: 1.50; 95% CI: 1.41-1.61), pericarditis, endocarditis, or myocarditis (HR: 1.30; 95% CI: 1.11-1.52), and kidney failure (HR: 1.17; 95% CI: 1.10-1.25), but not of ischemic heart disease, stroke, or atrial fibrillation. Estimates varied substantially by cancer type and treatment agent. For example, venous thromboembolism risk was consistently increased across nearly all cancer types, whereas hypertension risk was elevated for none. Ischemic heart disease risk was increased only among lung cancer survivors. Stroke was associated with platinum compounds but not with other systemic treatments. CONCLUSIONS: Several cardiovascular disease risks were elevated among cancer survivors, with substantial variation by cancer type and treatment