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Global, regional, and national burden of mortality associated with cold spells during 2000-19: a three-stage modelling study.
Get PDFBACKGROUND: Exposure to cold spells is associated with mortality. However, little is known about the global mortality burden of cold spells. METHODS: A three-stage meta-analytical method was used to estimate the global mortality burden associated with cold spells by means of a time series dataset of 1960 locations across 59 countries (or regions). First, we fitted the location-specific, cold spell-related mortality associations using a quasi-Poisson regression with a distributed lag non-linear model with a lag period of up to 21 days. Second, we built a multivariate meta-regression model between location-specific associations and seven predictors. Finally, we predicted the global grid-specific cold spell-related mortality associations during 2000-19 using the fitted meta-regression model and the yearly grid-specific meta-predictors. We calculated the annual excess deaths, excess death ratio (excess deaths per 1000 deaths), and excess death rate (excess deaths per 100 000 population) due to cold spells for each grid across the world. FINDINGS: Globally, 205 932 (95% empirical CI [eCI] 162 692-250 337) excess deaths, representing 3·81 (95% eCI 2·93-4·71) excess deaths per 1000 deaths (excess death ratio), and 3·03 (2·33-3·75) excess deaths per 100 000 population (excess death rate) were associated with cold spells per year between 2000 and 2019. The annual average global excess death ratio in 2016-19 increased by 0·12 percentage points and the excess death rate in 2016-19 increased by 0·18 percentage points, compared with those in 2000-03. The mortality burden varied geographically. The excess death ratio and rate were highest in Europe, whereas these indicators were lowest in Africa. Temperate climates had higher excess death ratio and rate associated with cold spells than other climate zones. INTERPRETATION: Cold spells are associated with substantial mortality burden around the world with geographically varying patterns. Although the number of cold spells has on average been decreasing since year 2000, the public health threat of cold spells remains substantial. The findings indicate an urgency of taking local and regional measures to protect the public from the mortality burdens of cold spells. FUNDING: Australian Research Council, Australian National Health and Medical Research Council, EU's Horizon 2020 Project Exhaustion
Establishing national hospital costing systems: insights from the qualitative assessment of cost surveillance pilot in Indian hospitals.
Get PDFOBJECTIVE: The Indian Government launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the world's largest health insurance scheme, in 2018. To reform pricing and gather evidence on healthcare costs, a hospital cost-surveillance pilot was initiated among PM-JAY empanelled hospitals. We analysed the process and challenges from both healthcare providers and payer agency's perspectives and offer recommendations for implementing similar systems in lower- and middle-income countries. DESIGN: We employed an open-ended, descriptive and qualitative study design using in-depth interviews (IDI) as the data collection strategy. SETTINGS: The interviews were conducted in both virtual and face-to-face modes depending on the convenience of the participants. The IDIs for the National Health Authority (NHA) officials and all providers in Kerala were conducted virtually, while face-to-face interviews were conducted and in Haryana and Chhattisgarh. PARTICIPANTS: Staff from 21 hospitals in three states (Haryana, Chhattisgarh and Kerala), including officials from State Health Agency (n=5) and NHA (n=3) were interviewed. RESULTS: The findings highlight significant challenges in reporting cost data at the hospital level. These include a shortage of trained staff, leading to difficulties in collecting comprehensive and high-quality data. Additionally, the data collection process is resource-intensive and time-consuming, putting strain on limited capacity. Operational issues with transaction management system, such as speed, user-friendliness and frequent page expirations, also pose obstacles. Finally, current patient records data has gaps, in terms of quantity and quality, to be directly put to use for pricing. CONCLUSION: Accurate cost data is vital for health policy decisions. Capacity building across healthcare levels is needed for precise cost collection. Integration into digital infrastructure is key to avoid burdening providers and ensure quality data capture
Understanding and maximising the community impact of seasonal malaria chemoprevention in Burkina Faso (INDIE-SMC): study protocol for a cluster randomised evaluation trial.
Get PDFINTRODUCTION: Seasonal malaria chemoprevention (SMC) involves repeated administrations of sulfadoxine-pyrimethamine plus amodiaquine to children below the age of 5 years during the peak transmission season in areas of seasonal malaria transmission. While highly impactful in reducing Plasmodium falciparum malaria burden in controlled research settings, the impact of SMC on infection prevalence is moderate in real-life settings. It remains unclear what drives this efficacy decay. Recently, the WHO widened the scope for SMC to target all vulnerable populations. The Ministry of Health (MoH) in Burkina Faso is considering extending SMC to children below 10 years old. We aim to assess the impact of SMC on clinical incidence and parasite prevalence and quantify the human infectious reservoir for malaria in this population. METHODS AND ANALYSIS: We will perform a cluster randomised trial in Saponé Health District, Burkina Faso, with three study arms comprising 62 clusters of three compounds: arm 1 (control): SMC in under 5-year-old children, implemented by the MoH without directly observed treatment (DOT) for the full course of SMC; arm 2 (intervention): SMC in under 5-year-old children, with DOT for the full course of SMC; arm 3 (intervention): SMC in under 10-year-old children, with DOT for the full course of SMC. The primary endpoint is parasite prevalence at the end of the malaria transmission season. Secondary endpoints include the impact of SMC on clinical incidence. Factors affecting SMC uptake, treatment adherence, drug concentrations, parasite resistance markers and transmission of parasites will be determined. ETHICS AND DISSEMINATION: The London School of Hygiene & Tropical Medicine's Ethics Committee (29193) and the Burkina Faso National Medical Ethics Committee (Deliberation No 2023-05-104) approved this study. The findings will be presented to the community; disease occurrence data and study outcomes will also be shared with the Burkina Faso MoH. Findings will be published irrespective of their results. TRIAL REGISTRATION NUMBER: NCT05878366
Tools for screening maternal mental health conditions in primary care settings in sub-Saharan Africa: systematic review.
Get PDFINTRODUCTION: In sub-Saharan Africa, pregnant and postpartum women with mental health problems are often missed in healthcare systems. To address this, a practical and simple screening tool for maternal mental health should be available to primary healthcare workers. An important step toward having such a tool is to assess the existing tools and their effectiveness in primary care settings. METHODS: We systematically searched PubMed, LILAC, CINAHL, Google Scholar, African Index Medicus, HINARI, and African Journals Online from inception to 31 January 2023, without language restriction. Reference lists of retrieved articles were reviewed and experts in the field were contacted for studies not captured by our searches. All retrieved records were collated in Endnote, de-duplicated, and exported to Rayyan for screening. Study selection and data extraction were done by at least two reviewers using a pre-tested flow chart and data extraction form. Disagreements between reviewers were resolved through discussion. We contacted primary authors for missing or insufficient information and conducted a content analysis of the psychometric properties of the tools. RESULTS: In total, 1,181 studies were retrieved by our searches, of which 119 studies were included in this review. A total of 74 out of 119 studies (62%) were screened for depression during pregnancy and or the postpartum period. The Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were the most commonly used tools. In total, 12 studies reported specificity and sensitivity for tools for measuring depression (EPDS, PHQ-9, and Whooley) and psychological distress [Self Report Questionnaire (SRQ) and Kessler Psychological Distress Scale (KPDS)]. The average sensitivity and specificity of the EPDS reported were 75.5 and 76.5%, respectively, at a cut-off of ≥13. The EPDS appears to be the most acceptable, adaptable, user-friendly, and effective in screening for maternal mental health conditions during pregnancy and postpartum. However, the methodological approach varied for a particular tool, and documentation on the attributes was scanty. CONCLUSION: The EPDS was the most commonly used tool and considered as most acceptable, adaptable, user-friendly, and effective. Information on the performance and psychometric properties of the vast majority of screening tools was limited. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022323558, identifier CRD42022323558 (PROSPERO)
Evaluation of the implementation of a community health worker-led COVID-19 contact tracing intervention in Chiapas, Mexico, from March 2020 to December 2021.
Get PDFBACKGROUND: Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES's implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. METHODS: Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. RESULTS: From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). CONCLUSIONS: Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy
Evidence Collections for Climate and Health: Food Environment Evidence Directory (FEED)
Get PDFThe Food Environment Evidence Directory (FEED) forms part of the Evidence Collections for Climate and Health project. Food Environment Evidence Directory (FEED) provides access to 160 reviews on population-level interventions and policies aimed at influencing food consumption patterns. Relevant literature was identified through a comprehensive literature search and mapped. The result is two interactive and open access tools: the FEED Map and the FEED Visualiser. Users can begin their search for literature that may be relevant to shifting diets towards healthier and more sustainable options. Alongside the final project report, the FEED consists of an Evidence Map, an Evidence Visualiser, a methodology report (Appendix A) and a User Guide to FEED (Appendix B) with four accompanying videos
A proposal for an academy to deliver capacity building in agricultural water management with particular reference to irrigation
Get PDFAbstract
The paper proposes a capacity‐building programme (CBP) on water for food/agricultural water management in sub‐Saharan Africa contained within an academy on the water–energy–food (WEF) nexus. The paper is informed by a study funded by the International Water Management Institute and supported by the Water Research Commission of South Africa. It also reports on a stakeholder consultation workshop on 26 April 2023 in Pretoria, South Africa. It identifies key components of capacity‐building design and delivery, including six teaching and learning pathways. These are managed ad hoc self‐directed learning; continuing professional development; short‐course training; vocational college training; part‐time online postgraduate training; and full‐time in‐person postgraduate training. The accompanying budget analysis is speculative based on the size of the student cohorts per year for each of the six CBP pathways. The total budget of the academy is estimated at approximately US21,600. One question, debated at the stakeholder workshop but unresolved, was the emphasis on irrigation versus the agricultural water management continuum including rainfed agriculture
Dressing masculinities: muted colours, aesthetic citizenship and nation-building in Tashkent, Uzbekistan
Get PDFThis article explores the sartorial practices of Uzbek men across diverse urban contexts in Tashkent, Uzbekistan, highlighting the significance of muted colours as a discursive site for asserting aesthetic citizenship. Drawing on thirteen months of fieldwork, this article depicts how the dressed bodies of working-class young men are intertwined with notions of hegemonic masculinity and Uzbekness. It also analyses how nation-building narratives give rise to gendered sartorial norms and forms of self-discipline, bolstered by everyday dress regulations. I argue that working-class young men’s preference for muted colours, rooted in the Soviet aesthetic’s prioritization of practicality and simplicity, serves as a somatic means of de-beautification, which allows them both to distance themselves from ‘foreign’ fashion and consolidate masculine subjectivities. Thus, embodied sartorial practices become a gendered stance against supposedly zararli (harmful) foreign ideologies and an assertion of aesthetic citizenship against a background of an ongoing surge of gendered nationalism in Uzbekistan
Cardiovascular Disease Training Programmes: Three Schemes to Train Leaders for Future Challenges.
No full textCardiovascular disease (CVD) represents the largest burden of disease globally and despite the availability of strong evidence supporting cost-effective treatments for people with CVD, the implementation of these treatments remains low, especially in low-income settings. Shortages in workforce have led to focus on how to increase clinical capacity. However, a simplistic focus on training clinicians will not fill the gaps in research, policy and implementation, which also need to be addressed at the same time. There are multiple efforts to develop early career capacity across diverse areas at national and international level to address these gaps. To-date, there have been limited efforts to compare or evaluate such programmes, and there are no efforts to harmonise such programmes to take advantage of synergies. We now compare three international programmes on global cardiovascular research to train individuals in their early- and mid-career by aims, experience and outputs