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Child public health indicators for fragile, conflict-affected, and vulnerable settings: A scoping review.
Get PDFChildren and young people are disproportionately vulnerable to harm during crises, yet child public health expertise is limited in humanitarian settings and outcomes and impact data are lacking. This review characterises child public health indicators that are routinely collected, required by donors, and recommended for use in fragile, conflict-affected, and vulnerable (FCV) settings. We conducted database and grey literature searches and collected indicators from technical agencies, partnerships, donors, and nongovernmental organisations providing child public health services in FCV settings. Indicators were included if they were child-specific or disaggregated for ≤18 years. Indicators were coded into domains of health status, health service, social determinants, and health behaviours and analysed for trends in thematic focus and clarity. A total of 668 indicators were included. Routinely collected indicators (N = 152) focused on health status and health services. Donors required only 14 indicators. Technical bodies and academics recommended 502 indicators for routine measurement. Prioritised topics included nutrition, paediatrics, infectious diseases, mortality, and maternal-newborn care. There were notable gaps in indicators for child development and disability. Child protection indicators were not routinely collected, despite being the focus of 39% of recommended indicators. There were overlaps and duplications, varied age disaggregations, and 49% of indicators required interpretation to measure. The review demonstrates that it is feasible to routinely measure child public health outcomes in FCV settings. Recommendations from technical agencies and partnerships are characterised by numerous indicators with duplication, poor definitions, and siloed sector-specific focus. There are gaps in measurement of critical child public health topics. To improve safety and effectiveness of interventions for child public health, consensus is needed on priority topics and a shortlist of quality, standardised indicators that governmental and nongovernmental actors can be reasonably expected to measure. Indicators should be prioritised to support decision-making and include proxy indicators for periods when routine measurement is hampered
Core Concepts: Self-Controlled Designs in Pharmacoepidemiology.
Get PDFOne of the key challenges in pharmacoepidemiological studies is that of uncontrolled confounding, which occurs when confounders are poorly measured, unmeasured or unknown. Self-controlled designs can help address this issue, as their key comparison is not between people, but periods of time within the same person. This controls for all time-stable confounders (genetics) and in the absence of time-varying confounding negates the need for an external control group. However, these benefits come at the cost of strong assumptions, not all of which are verifiable. This review briefly introduces the reader to different types of self-controlled study designs, their terminology and highlights key publications through an annotated reference list. We include a practical description of how these designs can be implemented and visualised using recent examples, and finish by discussing recent developments. We hope this review will serve as a starting point for researchers looking to apply self-controlled designs in their own work
A Conversational Agent (PracticePal) to Support the Delivery of a Brief Behavioral Activation Treatment for Depression in Rural India: Development and Pilot-Testing Study.
Get PDFBACKGROUND: Brief psychosocial interventions, such as the Healthy Activity Program (HAP), which are based on behavioral activation and delivered by nonspecialist providers (NSPs), have emerged as cost-effective solutions for the treatment of depression. HAP treatment outcomes are improved by the engagement of patients in activation-focused homework assignments and their adherence to these assignments during therapy. Currently, patients are expected to complete these homework assignments using a paper workbook. OBJECTIVE: The aim of this study was to describe the user-centered development process of PracticePal, a chatbot designed to enhance patient engagement and homework adherence, and to evaluate its feasibility and acceptability as a therapy aid in India. METHODS: We used a user-centered approach to co-develop PracticePal, incorporating conversational flows and video scripts in Hindi. The chatbot was piloted with 30 participants having depression who were receiving the HAP from 15 nonspecialist counselors in primary care in rural Madhya Pradesh, India. The feasibility and acceptability of PracticePal were assessed through engagement data, in-depth interviews with a subset of 6 participants, and focus group discussions with 11 counselors. Treatment completion rates and changes in depressive symptoms were explored as secondary outcomes. RESULTS: Average patient engagement spanned 29 days (95% CI 24-34) during the 60-day treatment period. The engagement of patients with PracticePal increased as their treatment progressed, particularly after the third HAP session. Of the 30 patients, 20 (67%) accessed more than half of the multimedia content available on the chatbot. On average, there was a greater frequency of self-initiated engagement (1558 out of a total of 1835 times, 84.9%) across all sessions compared with reminder prompts (277 out of 1835 times, 15.1%). All 30 patients completed treatment and experienced a reduction in the mean Patient Health Questionnaire-9 score from 13 (95% CI 12.6-13.6; signifying moderate severity) to 4 (95% CI 2.9-4.7; signifying none/minimal severity). Patients found the chatbot's reminders for activities, mood tracking, and video messages helpful and observed that it could help others in their social network. NSPs also reported improved participation of patients in the homework tasks compared with the paper workbook. A few patients faced challenges with low internet bandwidth, and those with limited literacy suggested increasing the amount of video content for easier accessibility. CONCLUSIONS: The PracticePal chatbot is a feasible and acceptable therapy aid to complement a psychological treatment, with promising potential to enhance the effectiveness of NSP-delivered psychosocial interventions in low-resource settings. Future steps include conducting a fully powered randomized controlled trial to assess its effectiveness in improving mental health outcomes
The role of economic empowerment for mental health in the Global South.
Get PDFThere is a great potential for carefully designed economic empowerment programmes to improve mental health in recipients and their significant others. Onono and colleagues interviewed 62 caregiver-adolescent dyads on the effect of an economic empowerment intervention consisting of microcredits to purchase farming implements and a water pump to irrigate crops throughout the year combined with agricultural and financial training. Their intersectoral economic empowerment intervention decreased parental stress, parental absenteeism as well as harsh parenting and disciplining practices. This translated to better caregiver-adolescent communication and improved household dynamics, thus increasing the psychological well-being of adolescents. The research contributes to a growing evidence base on the importance of economic empowerment interventions for mental health by generating hypotheses on mechanisms of action
Etiology and Outcomes of Meningitis among Adults in Three Ugandan Referral Hospitals, 2018-2023: A Prospective Cohort Study in a High-HIV Endemic Setting.
No full textStudies describing the global burden of meningitis often exclude HIV- or tuberculosis (TB)-related etiologies, thereby presenting a limited view of meningitis etiology in low- and middle-income countries. This study provides an updated evaluation of the etiology of meningitis and treatment outcomes in Uganda given advancements in molecular and TB diagnostics. We conducted a prospective observational cohort study from December 2018 to October 2023, for which adults with suspected meningitis were recruited from three referral hospitals in Uganda. We used a comprehensive diagnostic algorithm to determine microbiological etiologies of cases. Participants were followed through hospital discharge, and mortality was summarized by meningitis etiology. We enrolled 1,577 participants with suspected meningitis, of whom 96% (n = 1,511/1,577) had HIV infection and 51% (n = 772/1,577) were antiretroviral therapy naive. The median CD4 cell count was 39 cells/µL (interquartile range: 14-97 cells/µL). Cryptococcal meningitis was the most frequently diagnosed etiology of meningitis (62%) followed by TB meningitis (21%). Inpatient mortality was highest among participants diagnosed with possible TB meningitis (32%) followed by probable TB meningitis (29%) and bacterial meningitis (24%). Among the 4% (n = 66/1,577) of HIV-seronegative participants, TB meningitis was the most frequently (38%) diagnosed cause of meningitis. Despite improvements in access to HIV therapy, cryptococcal meningitis and tuberculous meningitis persist as the most common etiologies of meningitis in Uganda. Improved access to meningitis diagnostics and treatments is critically needed to mitigate the morbidity and mortality, particularly in the resource-limited settings of HIV and TB endemic regions
Plant Growth, Yield, and Quality of Bush Tea (Athrixia phylicoides) as Affected by Deficit Hidrico and Mulching.
Get PDFNative to South Africa, Bush tea is a plant that thrives in various climates. Cultural practices such as mineral nutrition, fertigation, pruning, and harvesting have been shown to influence bush tea's quality, growth, and yield. This study set out to determine the effects of mulching and deficit irrigation on the growth, yield, and quality of bush tea. Three deficit irrigation treatments (0%, 30%, and 100% Crop evapotranspiration (ETc) on field capacity) and three mulch treatments (sawdust, black plastic mulch, and no mulch) were included in a two-factor experiment, which was set up in a randomized complete block design (RCBD) with three replications. Physiological and growth parameters were taken every two weeks. The number of branches was counted, and measurements of chlorophyll content and the proportion of radiation intercepted by the canopy were recorded. Yield and secondary metabolites such as sugar residuals, fatty acids, and phenols of bush tea were determined after harvest. Growing bush tea under various water regimes showed that a 30% water regime significantly enhanced plant growth characteristics, including the proportion of intercepted radiation, plant height, and both fresh and dry weight. Furthermore, under different water regimes, sawdust improved plant growth in bush tea grown in the field. Black plastic mulch and a 0% water regime produced more compounds beneficial to health than tea treated with half or full irrigation. The extraction of data for Proton Nuclear Magnetic Resonance (NMR) and Mass Spectrometry analyses was conducted for quality components. Our study did not show any distinct structural differences in the tea under different water regimes or mulching. Flavones, phenols, diterpenes, and gardoside were some of the most abundant compounds found in bush tea using mass spectrometry. Principal Component Analysis was performed on the NMR spectral data across 27 samples of bush tea
How populist-aligned views affect receipt of non-COVID-19-related public health interventions: a systematic review of quantitative studies.
Get PDFBACKGROUND: Globally, there is increasing evidence of resistance to government-led public health interventions in areas such as vaccination, climate change mitigation, sexual and reproductive healthcare, and the implementation of non-pharmaceutical infection control measures. One potential explanation for this could be the documented global rise in populist attitudes, characterised by distrust of scientific, government and other perceived 'elites.' While the effect of such attitudes on engagement with COVID-19-related interventions has been extensively considered and researched, their association with the receipt of other public health interventions is currently underexplored. METHODS: To understand how populist-aligned views might influence the receipt of public health interventions addressing areas other than COVID-19, we systematically reviewed quantitative research published across thirteen bibliographic databases and relevant websites between 2008 and 2024. All studies were set in member countries of the Organisation for Economic Co-operation and Development (OECD). RESULTS: Across 30 included studies, the vast majority of which were cross-sectional, we found evidence that populist-aligned attitudes have a negative impact on the receipt of public health interventions including vaccinations, sexual and reproductive health care and preventive health care. We also found preliminary evidence of the negative role of populist-aligned attitudes on the receipt of disease screening related to HIV/AIDS and adherence to non-pharmaceutical interventions during times of public health emergency, such as the 2009 H1N1 pandemic. CONCLUSIONS: Although providing limited evidence of causality, the findings from this review suggest the need for future policy in many OECD countries to focus on trust-building between the public and political, scientific, and medical establishments. They also indicate the need for mitigation strategies to overcome the potentially negative impact of populist-style hostility towards out-groups on attitudes related to pressing public health issues such as abortion and family planning, for example by drawing on empathy-centred approaches. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42024513124
Connecting environment, health and livelihoods: how community experiences inform integrated programming in Rukiga District, Uganda.
Get PDFINTRODUCTION: The climate crisis has profound effects on people's lives, particularly those reliant on subsistence agriculture and ecosystem goods for their livelihoods and health. There is growing recognition of the interconnections between human health, environmental degradation and climate change, but little research on the pathways of these interconnections that could inform programme development and little attention given to community experiences and perspectives that provide essential insights into how cross-sector programmes could better address health, livelihoods and environmental needs. METHODS: Between April and June 2021, we conducted in-depth interviews and focus group discussions with residents across eight parishes affected by climate change in Rukiga District, Uganda. We investigated peoples' perceptions and experiences concerning health, climate, environment and livelihoods, then codeveloped integrated cross-sector solutions with non-governmental partners to respond to identified challenges. We analysed data using thematic content analysis. RESULTS: Community members articulated how increasingly unpredictable seasons and rainfall patterns lead to crop failures, soil erosion and flooding exacerbated by widespread practices of tree cutting and growing non-native plants. The burning of upland and wetland vegetation caused further degradation, reducing access to clean water. These led to inadequate nutritious food and malnutrition. Respondents noted that large family size puts pressure on available land, yet they have poor family planning services and information. Men who could not provide for their families reportedly spent money on alcohol; behaviour which was associated with gender-based violence.Community experiences and viewpoints were discussed at workshops and meetings with non-governmental organisations and health partners to identify key evidence-based interventions and develop integrated messaging to address the interconnected needs articulated by community members. CONCLUSION: Listening to the experiences and views of community members is essential to designing impactful, sustainable programmes to address interconnected health, environment and livelihood needs. Researchers can broker this through formative research and cocreation workshops with local responders
A Scoping Review of School-Based Nutrition Education Interventions in the Islamic Republic of Iran.
Get PDFThis scoping review aims to identify evidence-based school nutrition interventions for implementation in Iran's dynamic economic, cultural, and socio-political environment. A review of published studies (2004-August 2024) using the PRISMA-ScR guidelines across 14 databases was conducted. The efficacy of various interventions reported significant positive changes at multiple levels: anthropometric, biological, and knowledge, attitudes, and behaviors related to healthy eating and lifestyle. Investigators carrying out research on "what works" in school-based nutrition education and general healthy lifestyle programs and services in the Islamic Republic of Iran have a host of challenges; however, much more research needs to be done. While there are few studies in this area of inquiry, outcomes on the nutrition interventions to date are impressive. The major challenges in improving school-based nutrition programs include the education of young women, establishing national standards for school food programs and education, and strategic advocacy by stakeholders to improve nutrition education in schools in Iran
Development of Carprofen analogues with activity against Mycobacterium tuberculosis.
Get PDFCarprofen, a veterinary non-steroidal anti-inflammatory drug, has demonstrated bactericidal activity against Mycobacterium tuberculosis and the closely related model organism M. bovis BCG. Herein, we present the SAR-driven optimisation of three series of carbazole-based carprofen analogues for increased antimycobacterial potency and selectivity over the human monocyte-derived THP-1 cell line. An efficient synthetic route was employed to assemble a range of carprofen analogues which were then evaluated in whole-cell phenotypic assays to establish their activity against well-studied model organisms for M. tuberculosis. The most promising compound was further profiled against M. tuberculosis H37Rv, confirming the identification of a potent antitubercular carbazole with significantly enhanced therapeutic potential