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The key design features and effectiveness of social network interventions for HIV testing and linkage services in low- and middle-income countries: a systematic review and meta-analysis.
Get PDFINTRODUCTION: HIV remains a global health challenge with a reported 39 million people living with HIV (PLHIV) in 2022. Sub-Saharan Africa, Asia and the Pacific are home to 82% of PLHIV, where limited access to healthcare resources underscores the urgency of innovative strategies to combat the epidemic effectively. Social network interventions (SNIs) hold promise for improving HIV testing and linkage services by engaging populations at greatest risk. This review evaluates the key design features and effectiveness of SNIs for HIV testing and linkage in low- and middle-income countries (LMICs). METHODS: We searched four databases (Medline, Embase, Global Health, Web of Science) for the period from 1st January 2003 until 16th June 2023. A combination of the terms "Social Network," "HIV," "testing" and "linkage" with an LMIC filter was used. We included interventional study designs that compared an SNI for HIV testing and/or linkage to care against non-network comparator approaches. Narrative synthesis and random effects meta-analyses were conducted to synthesize the results. RESULTS: Of the 6763 records, 13 studies met the inclusion criteria; eight were randomized controlled trials, and five were non-randomized designs. Nine studies engaged key populations. The most common strategy involved recruiting and training seeds, who then delivered HIV services to network members. The use of networks varied significantly across the papers. The network approaches used were induction (n = 11), alteration (n = 1) and a combination of individual and segmentation approaches (n = 1). The pooled estimates showed that SNIs had a modest effect on the uptake of HIV testing RR 1.12 [95% CI 1.08-1.17) but the directionality of effect for the proportion newly diagnosed positive (RR 0.88 [95% CI 0.74-1.04]) and linkage to care (RR 0.98 [95% CI 0.86-1.08]) was towards the null. DISCUSSION: SNIs improved the uptake of HIV testing and exhibit important variability in their design. CONCLUSIONS: There is a need for more studies designed to capture the complex relational dynamics of network interventions and to provide strong evidence on their isolated effects. Additionally, it is necessary to expand the use of network approaches to other priority populations. PROSPERO NUMBER: CRD42023434770
Health, education and well-being for children with deafblindness: a secondary analysis of 36 Multiple Indicator Cluster Surveys.
Get PDFOBJECTIVE: To examine the health, education and social inequities experienced by children with deafblindness in low- and middle-income countries. DESIGN: Secondary analysis of 36 Multiple Indicator Cluster Surveys (2017-2020), using age-adjusted modified Poisson models to compare outcomes between children with and without deafblindness. SETTING: 36 low- and middle-income countries. PATIENTS: 446 233 children aged 2-17, including 232 children with deafblindness. MAIN OUTCOME MEASURES: Education (primary school attendance rate, secondary school attendance rate, early childhood education and the Early Childhood Development Index), health (stunting, wasting, health insurance, diarrhoeal disease and acute respiratory infection) and well-being (inadequate supervision, violent discipline, living arrangements, birth registration and poverty status) were measured. RESULTS: Children with deafblindness faced inequities in health and education indicators compared with children with other disabilities and children without disabilities. Children with deafblindness had consistently lower school attendance rates across school ages (primary: adjusted Prevalence Ratio (aPR) 0.30 (0.18 to 0.50); secondary: aPR 0.42 (0.20 to 0.87)), had worse Early Childhood Development Indices (aPR 0.35 (0.22 to 0.55)) and had 2-3 times higher prevalence of nutritional disorders (stunting: aPR 1.24 (1.03 to 1.50); wasting: aPR 2.79 (1.99 to 3.92)). However, there were non-significant differences in well-being indicators, such as poverty, inadequate supervision, birth registration and living situation. Children with deafblindness were also less likely to experience violent discipline. CONCLUSION: Children with deafblindness constitute a heterogeneous group of children with disabilities. They face persistent barriers in accessing education and have poorer health, which must be addressed through building more disability-inclusive health and education systems
Use of a synthetic population to model co-benefits to air quality and health from household fuel emission mitigation policies in Kenya
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Energy emissions mitigation policies bring co-benefits for health and opportunities to drive sustainable development for rapidly transitioning economies in sub-Saharan Africa. Developing methods of quantifying these co-benefits in differing demographic groups is an area of interest for policymakers to support resource allocation efforts. Using synthetic populations of three municipalities in Kenya, we assessed the impact of policies to promote the use of clean cooking fuels on exposure to ambient and household air pollution and associated age- and gender-specific mortality. Exposure to household PM2.5 for a range of cooking fuel types and informal and formal housing archetypes were simulated using the building physics software, EnergyPlus. A combined household and ambient PM2.5 exposure was calculated for each individual by weighting PM2.5 concentrations using national demographic-specific time-activity estimates. Exposure-response functions were applied to quantify the burden of mortality for six associated health outcomes. To compare the health impacts of energy policy implementation, a two-stage policy was tested through medium and long-term transitions towards successively cleaner cooking fuels prioritising liquid petroleum gas and ethanol. The resulting difference in mortality consecutively declined through the two-stage policy transition with the greatest impact after the first transition and an incremental but smaller impact after the second. The overall difference in mortality burden averted per 100 000 population relative to the baseline scenario was largest in Kisumu (males: 39.23; females: 18.09), with smaller decreases in Mombasa (males: 5.71; females: 3.03) and Nairobi (males: 1.82; females: 1.08). A sensitivity analysis showed reductions in PM2.5 exposure under the policy scenarios may be overestimated in the presence of fuel stacking practices, where households rely on multiple fuels and stoves. This model provides a proof-of-concept for the use of individual-level modelling methods to estimate demographic-specific health impacts from environmental exposures and quantitatively compare health co-benefits of household fuel emission mitigation policies
Conflict-attributable mortality in Tigray Region, Ethiopia: Evidence from a survey of the Tigrayan diaspora.
Get PDFBACKGROUND: The war in Tigray Region, Ethiopia (November 2020 to November 2022) ended with formal commitments to accountability, but these have yet to produce publicly available accounts of the harms caused by the conflict. METHODS: We carried out an online survey of the Tigrayan diaspora to estimate mortality amongst children, adults, and older adults during, and prior to, the war-period. We collected retrospective demographic information on respondents', and their spouses', extended family inside Tigray. To mitigate selection bias, we standardised mortality estimates by rural-urban residence and wealth index. RESULTS: Of 1011 participant-reported decedents, 810 died within Tigray, and 310 of these individuals died during the war-period. Of the 310 deaths in Tigray during the war-period, 224 (72.3%) died from intentional injuries. The standardised mortality rate for adults (15-49 years) was 21.3 per 1000 person-years (29.4 for men, 14.8 for women) during the war, and 1.0 in the preceding period (2010-2020). The mortality rate amongst older adults (≥ 60 years) was 45.1 per 1000 person-years during the war-period, compared to 22.8 in 2010-2020, and is higher than the period encompassing the Ethiopian Civil War (1974-1991) and Tigray/Wollo Famine (1984-1985). The mortality ratio (men to women) was approximately 2:1 in both adults, and older adults. The mortality rate amongst adults and older adults had been declining across the pre-war periods. Few deaths were reported amongst children. We estimate that the conflict has resulted in more than 102,000 deaths amongst those aged ≥ 15 years. CONCLUSIONS: Our study suggests a significant elevation in all-cause mortality, largely driven by intentional injuries. Although our pre-war-period data are likely under-reported, comparisons with other pre-war estimates corroborate these plausible elevations, particularly amongst adults. The mortality ratio, when compared to those from other settings, does not support assertions that the military strategy primarily involved the targeting of adult males, and instead suggests widespread killing of women and older adults who would not have posed a combat threat
Defining the public in public health after Lalonde: the view from the United Kingdom, 1970s‒1990s
No full textThis article considers the impact of the Lalonde report on ideas about the public and public health in the United Kingdom from the 1970s to the 1990s. It begins by assessing how "the public" within the context of public health has been thought of. Three key modes are identified: the public as the whole population, as groups, and as individuals. An examination of the Lalonde report, and its British equivalent, Prevention and Health, Everybody's Business, points to the presence of these three ways of thinking about the public. Nonetheless, the role of the individual in disease prevention appeared to dominate both the Lalonde report and Prevention and Health. The influence of this approach is traced through an analysis of British health education campaigns around alcohol from the 1970s to the early 1990s. The target of such efforts changed over time, away from alcoholics and heavy drinkers and towards creating "sensible drinkers". Although alcohol health education campaigns were directed at getting individuals to change their drinking behaviour, they also took into account a population-level view of alcohol consumption. The current article concludes by suggesting that a reappraisal of Lalonde and Prevention and Health points to the existence of collective, as well as individual-based, ways of thinking about publics and doing public health
Family planning interventions across the League of Arab States: a regional scoping review.
Get PDFFamily planning is crucial in improving maternal and child health, reducing fertility rates and promoting gender equity. Despite global advancements in contraceptive access, disparities persist across the League of Arab States due to sociocultural, economic and policy barriers. Understanding the effectiveness of existing family planning interventions in this region is essential for addressing unmet needs and guiding policy improvements. This scoping review aims to identify and appraise family planning interventions conducted across the League of Arab States. A comprehensive search of 14 databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines, focusing on studies published between 2010 and December 2024. The review included intervention-based studies that assessed family planning outcomes in Arabic-speaking countries. Data were extracted and tabulated. Seventeen intervention studies were identified, with the majority conducted in Jordan and Egypt. Effective interventions included pharmacist-led education, multisectoral collaborations, behavioural economics approaches and crisis-responsive strategies. While most studies reported positive effects on contraceptive uptake and knowledge, challenges such as low male engagement, provider resistance and sustainability concerns persisted. Interventions in crisis-affected settings demonstrated adaptability, but scalability remains a key issue. Future efforts should focus on culturally tailored strategies, long-term intervention sustainability and integrating family planning with broader health and economic empowerment programs
An assessment of interobserver agreement on lesion size, morphology and clinical phenotype in cutaneous leishmaniasis caused by Leishmania aethiopica in Ethiopia.
Get PDFINTRODUCTION: Cutaneous leishmaniasis (CL) remains a major public health challenge, especially in endemic regions like Ethiopia, where an estimated 40,000 new cases occur annually. Effective treatment evaluation for CL relies on consistent clinical assessments, yet variability in lesion descriptions can complicate reliable outcome measures. METHODS: We conducted an inter-reliability study of clinicians' evaluations of CL lesion morphology and size at ALERT Hospital, Addis Ababa. Twelve clinicians independently examined 12 patients with parasitologically confirmed CL, each clinician assessing lesion morphology, size, and severity. RESULTS: We found high consistency in reporting major morphological categories (e.g., plaques) but significant variability in secondary features like dyspigmentation and scale, as well as mucosal involvement. Lesion size measurements showed limited variability, suggesting its reliability as a potential measure for future clinical trials. Disparities in severity assessments highlight the need for a standardized scoring system in CL. DISCUSSION: Our findings underscore the importance of training for consistent, high-quality clinical evaluations of CL and suggests that lesion size could be a reproducible outcome measure in treatment efficacy trials
Towards attaining universal health coverage in Kazakhstan: Challenges and important next steps.
Get PDFThe Alma Ata Declaration (1978) positioned primary healthcare (PHC) as central to universal health coverage (UHC). Post-independence Kazakhstan struggles with a fragmented healthcare system marked by high mortality, underfunding, and workforce shortages. Despite initiatives like "Kazakhstan 2050" and "Salamatty Kazakhstan," challenges persist: economic instability, unregulated private healthcare, high out-of-pocket costs, and rural disparities. While Kazakhstan achieved a 76% UHC index, advancing PHC quality, expanding health financing, and prioritizing rural access remain critical to achieving equitable UHC
Community inclusion, participation and support for people with disabilities in Zambia: a qualitative study.
Get PDFBACKGROUND: Recent reports, including recommendations from the United Nations Committee on the Rights of Persons with Disabilities, have highlighted failings in disability inclusion in Zambia. A recent scoping review identified need for up-to-date evidence to inform disability-inclusive policy and practice. OBJECTIVE: To generate new evidence on community inclusion, participation and support for people with disabilities in Zambia. METHODS: In-depth interviews were held with 36 participants, including 16 adults with disabilities, 16 caregivers of a child with disabilities, and four key informants from government and civil society. Participants were recruited from three districts in Lusaka Province - Lusaka, Chongwe and Kafue. Participants were purposively sampled to maximise variation by sex, age, impairment type, district and locality (rural, urban, peri-urban). Data collection was completed in November 2022. RESULTS: Key themes from the study identified stigma and discrimination towards people with disabilities, the exclusion of people with disabilities from community life, limited available support and inadequate government action on disability inclusion. There were examples of positive action on disability support, such as the Social Cash Transfer, but implementation needed improvement. Disability-awareness campaigns are widely needed across government and communities, as is funding for organisations such as the Zambia Agency For Persons With Disabilities. CONCLUSIONS: Action is needed to improve disability inclusion and implementation of the United Nations Convention on the Rights of Persons with Disabilities in Zambia. This includes appropriate funding, capacity-development and meaningful engagement with people with disabilities and their representative organisations
Letter: Robins-E risk of bias tool.
Get PDFRisk-of-bias tools are increasingly used as part of systematic reviews, to help make a uniform evaluation of study quality across a variety of studies (NASEM 2021). Several well-known tools, including OHAT and the Navigation Guide, are used to evaluate observational epidemiologic studies (OHAT 2019, Woodruff and Sutton, 2014). A recently published tool called ROBINS-E (Higgins et al. 2024) was developed to evaluate observational studies on environmental and occupational exposures. We have concerns regarding how this tool can be appropriately used and how it relates to other approaches to evidence synthesis. We are a group of environmental and occupational epidemiologists/exposure experts, nearly all of whom took part in the early discussion and piloting of this new risk-of-bias tool and previously published our general views on risk-of-bias tools (Steenland et al. 2020)