69832 research outputs found
Sort by
Do Sports Utility Vehicles (SUVs) Cause More Severe Injuries to Pedestrians and Cyclists than Passenger Cars, in the Case of a Crash? Findings from Great Britain, 2004-2023
Get PDFWe used police-reported road crash data from Great Britain, 2004-2023, to examine whether being hit by a sports utility vehicle (SUV) is more dangerous for pedestrians and cyclists than being hit by a passenger car. In adjusted analyses, being hit by an SUV increased the odds of fatality by a modest amount in adults (odds ratio 1.14 (95% confidence interval 1.02, 1.28)). In children the odds of fatality increased considerably (odds ratio 1.77 (1.33, 2.35) in children aged 0-18 years), with particularly large effects in young children (odds ratio 3.09 (1.92, 4.97) in children aged 0-9 years). Vehicle weight and height showed strong, dose-response associations with injury severity, but vehicle length showed little association
Assessments of Anopheles arabiensis behaviour around bed nets using partial adhesive treatments.
Get PDFUnderstanding the behaviour of malaria vectors could lead to improved designs of partially treated insecticidal nets and low-cost nets with less insecticide content. The behaviour of Anopheles arabiensis around cow baited bed nets with partial adhesive treatments were assessed in experimental huts. The study was conducted in Moshi Tanzania, using a Latin Square design with five arms: no bed-net, intact untreated bed-net, roof, sides and whole adhesive treated bed-nets. The data analyses were done using generalized linear mixed effects models with proportions of mosquitoes on the bed-net panels, and induced exiting as outcomes and trial arm as the predictor. There were significant reductions in the likelihood of An. arabiensis found on the side (adjusted odds ratio, AOR: 0.50; 95% CI 0.26-0.98; p value = 0.044) and roof (AOR: 0.18; 0.07-0.43; p value < 0.001) of adhesive treated bed-nets compared to the whole adhesive treated bed-net. The likelihood of An. arabiensis exiting was significantly higher in the intact untreated net trial arm compared to the no net trial arm (AOR: 2.12; 1.19-3.79; p value = 0.010). Host seeking An. arabiensis is not persistent and untreated bed-nets induced exiting, implying reduced efficacy of partially treated insecticidal nets
Integrating eye health into a child health policy in Tanzania: global and national influences.
Get PDFGlobal consensus has shifted to focus on how children can be supported to not only 'survive' but to 'thrive'. Blindness and visual loss in early childhood undermine a child's ability to thrive, affecting psychomotor, cognitive, and social development leading to life-long consequences for educational attainment, employment, economic and social status, and wellbeing. Despite this, eye health for children under the age of 5 years has been neglected, and not politically prioritized. In Tanzania, policy makers decided in 2019 to include eye conditions in the national Integrated Management of Newborn and Childhood Illness (IMNCI) programme, despite eye health not being part of the global World Health Organization/UNICEF IMNCI strategy. We conducted a qualitative policy analysis to explore enabling factors and barriers to this policy change. The interviews were semi-structured with key actors selected purposively and by snowball sampling, including those with a role in child and eye health at national and global levels. We used an adapted Shiffman and Smith framework (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet 2007;370:1370-9) to guide the interviews and analysis, and the Consolidated Criteria for Reporting Qualitative Research for planning and reporting. This study shows how rapidly one country altered its overall child health policy to include eye health, driven by good quality collaborative research and collective action (cohesive policy community) which importantly included co-design with the decision makers (Ministry of Health actors). These developments coincided with the shift in the international agenda moving from 'survive to thrive' in child health which was leveraged to include eye care in the national strategy
Impact of a multilevel HIV prevention programme on adolescent girls and young women's empowerment for risk reduction: A mixed methods evaluation in Kenya.
Get PDFEmpowerment is key to person-centered HIV prevention. This study aims to evaluate the extent to which the Determined, Resilient, Empowered, AIDS-free, Mentored, Safe (DREAMS) Partnership promotes empowerment of adolescent girls and young women (AGYW) in Kenya. We conducted a mixed-methods study to examine DREAMS influence on empowerment precursors (resources, agency, institutional structures) and outcomes, guided by Kabeer's framework for women's empowerment. With representative cohorts of AGYW aged 13-22, followed since 2017/18, we estimated the impact of DREAMS on social support and self-efficacy by 2022. With a nested sample of cohort participants in 2022, we conducted qualitative inquiry through in-depth interviews and participatory action learning with DREAMS participants, implementers, and community members, for evidence of mechanisms, achievement and contextual influences on AGYW empowerment. We found statistical evidence of a causal impact of DREAMS on social support and self-efficacy among adolescent girls. Qualitatively, DREAMS enhanced AGYW's access to and control of resources, including coveted material assets like educational subsidies, hygiene products, and business support, which reportedly reduced transactional sex through economic autonomy and bodily integrity. DREAMS enhanced intangible resources like HIV knowledge and financial skills. Greater confidence, courage, and critical consciousness enabled some AGYW to act on health choices, assume leadership roles, and continue education. In mentor-led activities, AGYW demonstrated collective action and solidarity and group saving skills for financial autonomy. DREAMS aimed to engage the broader community including leaders, parents, and young men, but social structures, dominant gender norms, gender-based violence, and widespread poverty mitigated its empowering impact for AGYW. We found compelling evidence that DREAMS strengthened many young women's access to and control of resources and their intrinsic and collective agency. These are important precursors to empowerment but insufficient for the transformation of power relations without supportive institutional structures, including gender-equitable norms and viable livelihood strategies
Healthy competition? Market structure and the quality of clinical care given to standardised patients in Tanzania.
Get PDFThe private health care sector in many low- and middle-income countries is rapidly expanding. Private sector advocates have long argued that market competition drives private providers to become more efficient and responsive to patients but empirical studies are limited to mostly high-income settings. We examine whether the number of competing health facilities in close proximity is associated with quality and prices, in a sample of 228 private for-profit and faith-based facilities in Tanzania. Primary data collection took place in the health facilities between February and June 2018. By exploiting data on the quality of clinical care given to unannounced standardised patients, we are able to compare quality across providers without confounding due to patient characteristics. We find that more local competition is associated with poorer clinical quality. The former is driven by an increase in unnecessary care rather than a reduction in appropriate care. Policymakers in such settings should be cautious in assuming that market competition will drive up quality of care
Finding knowledge: how youth identify their candidacy and sources of information regarding sexual and reproductive health in rural KwaZulu-Natal. South Africa.
Get PDFBACKGROUND: Despite efforts by government, non-governmental organizations, local communities and families, sexual and reproductive health (SRH) behavior and outcomes among adolescents and young adults ("youth") remain of concern in South Africa. Improving outcomes requires better understanding of how youth navigate and engage with potential sources of SRH information, so interventions can align with the contextual landscape. METHODS: We conducted secondary analysis of qualitative data, including interviews and group discussions, from five studies conducted in uMkhanyakude district, KwaZulu-Natal. We adapted the existing Candidacy Framework from its original focus on service use to apply to communication. We re-coded the transcripts using a thematic coding framework. RESULTS: Youth identified their candidacy for SRH information when they could not understand what others were saying about sexual health, when they feared illness in themselves or significant others, and when experiencing a health issue. Participants expected different types of information from healthcare providers, family members and peers, and had a nuanced understanding of the strengths and weaknesses of each source. Stigma related to youths' SRH and their precarious socioeconomic circumstances limited channels for communication and the ability for shared interpersonal knowledge to impact health behavior. CONCLUSIONS: Identification of candidacy for SRH information in this setting was largely ad-hoc, but once aware of need, youth were able to identify and discriminate between multiple information sources. However, this information landscape was strongly shaped by formal provider and parent views of what youth should know and do, and peer sources limited own knowledge. Future interventions could address concerns at various points on the candidacy journey
A standard gamble study to determine health state utilities associated with seizures in glioma in the UK.
Get PDFBACKGROUND: Glioma are infiltrative primary brain tumours, which despite treatment, lead to a substantial reduction in life expectancy. Seizures are a common symptom of glioma, and have a serious impact on patient health related quality of life (HRQoL). OBJECTIVE: The study aimed to estimate health state utility values for different types of seizures related to glioma, a serious type of brain tumour. METHODS: Vignettes for the different health states were initially developed from the existing literature. The health states were then refined in collaboration with patients with previous experience of seizures and clinicians experienced in treating patients with seizures. The final vignettes represented three types of acute seizure: focal aware, focal impaired awareness and tonic clonic and several different health states which combined these acute seizures with other aspects of HRQoL. These vignettes were evaluated by a sample of the UK general public using an online survey and analysed descriptively using the mean and standard deviation. RESULTS: 302 participants, representative of the UK general population in terms of age, sex and geographical region, were included in the estimation sample. For the health states representing acute seizures, the focal aware seizure had the highest mean utility value (0.607), followed by the impaired awareness seizure (0.593) and the tonic clonic seizure (0.522). For the health states that also incorporated wider aspects of HRQoL, the health state utility values ranged from 0.504 (one focal aware seizure per year) to 0.337 (at least one focal impaired awareness seizure per week). CONCLUSIONS: Seizures may have a major impact of the HRQoL of patients with glioma. The utility values obtained in the study may be used in future economic evaluations of interventions related to glioma where seizures are either a primary clinical outcome or an adverse event
‘In It From the Beginning’: How Do Young Men and Boys Explain Their Entry Into Criminal Gangs?
Get PDFThis article reports on a qualitative study exploring the intersection of mental health, exclusion from school and entry into criminal gangs. It seeks to strengthen the young person’s perspective in the literature. It examines social and psychological mechanisms implicated in the process of joining and staying in gangs. Young people who have experienced exclusion from multiple services reported that, cash earned through illicit drug deals was a key driver to gang membership, enabling them to achieve independence and status. This appeared, at times, more central to their accounts than the search for belonging often cited as a motivator for gang membership
Understanding the socio-spatial distribution of "dark retail" in England: Development of a unique retail location dataset.
Get PDFOnline food delivery services (OFDS) are an increasingly popular way of accessing both ready-to-consume foods and groceries. Such foods are sometimes delivered from facilities not open to the public - so called 'dark retail'. However, there is a lack of data on 'dark retail', which limits understanding of their location, prevalence and growth. We identified different types of dark kitchens (i.e., "virtual brands", "ghost kitchens") and dark grocery stores (i.e., "large dark grocers", "small/independent dark grocers"). Using data on 113,370 unique online food outlets from three major food delivery platforms (Uber Eats, JustEat, and Deliveroo) in England, we created a database of dark retail locations and analysed their socio-spatial distribution. Dark retail accounted for 14 % of all online food outlets, with the majority being virtual brands. Overall, dark retail is more likely to be located in more deprived areas. The extent of dark retail observed highlights the importance of incorporating them into existing regulatory frameworks. Our database and findings provide insights into the socio-spatial distribution of dark retail, which could inform future research and policy development in this area
Essential newborn care practices at health facilities and homes in Ethiopia: a cross-sectional study.
No full textBACKGROUND: WHO recommends essential newborn care practices that every newborn needs for health and survival regardless of birthplace. Previous Ethiopian studies of these actions had long recall periods and most considered either facility or home deliveries. We aimed to assess selected practices, i.e., thermal care, cord care, initiation of breastfeeding, and first immunizations among neonates born at health facilities and homes in Ethiopia. METHODS: We used data from the Performance Monitoring for Action Ethiopia 2019-2020 survey and analyzed 2,493 live births whose mothers completed interviews at seven weeks postpartum in five regions, namely Tigray, Afar, Amhara, Oromia, Southern Nations, Nationalities and Peoples regions, and Addis Ababa. Practices were assessed using an interviewer-administered questionnaire. Essential newborn care indicators were analyzed among neonates born at health facilities and homes and expressed as proportions with a 95% confidence interval. Clustering was accounted for in all analyses. RESULTS: Practices were assessed among 1532 (61%) facility-born and 961 (39%) home-born neonates. Some of the appropriate actions had higher coverage at health facilities: skin-to-skin care 76% vs. 9%, immediate drying and wrapping with a cloth 80% vs. 79%, delayed bathing until 24 h after birth 73% vs. 39%, appropriate instrument to cut the cord 100% vs. 94%, use of new or boiled instrument 90% vs. 79%, nothing or chlorhexidine applied on cord 89% vs. 64%, first-hour initiation of breastfeeding 69% vs. 62%, and BCG and first polio immunization within the first six weeks after birth 54% vs. 20%. Thermal care, cord care, and provision of vaccines at birth were relatively more common in Addis Ababa, while first-hour breastfeeding initiation was higher in the Oromia region. CONCLUSION: Neonates born at health facilities had higher, although not optimal, coverage of thermal care, cord care, early breastfeeding initiation, and the first immunizations. Strengthening the health extension program to promote facility delivery, further enhancing the coverage and quality of essential newborn care at health facilities, and increasing the coverage of first vaccinations and other essential services after birth are crucial for improving neonatal health and survival in Ethiopia