69832 research outputs found
Sort by
Users' capabilities related to the electronic RHIS for newborn and stillbirth indicators: quantitative and qualitative findings of the IMPULSE study across 151 sites in the Central African Republic, Ethiopia, Tanzania, and Uganda.
Get PDFBACKGROUND: The electronic routine health information system (eRHIS) is crucial for policy and planning. However, its effectiveness depends on end-users' capabilities in utilising it. Using a mixed-methods approach, we evaluated end-users' data in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda in one of the first standardised cross-country assessment of eRHIS users' capabilities focussed on newborn and stillbirth indicators. METHODS: We collected data in 12 regions and 3 city administrations between November 2022 and July 2024 using the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Performance of Routine Information System Management (PRISM) tools. All data but staff opinions were collected through direct observation. We analysed quantitative questions and reported them as frequencies/normalised PRISM scores, both on the overall sample and by country. We analysed qualitative data using thematic analysis. RESULTS: We included end-users of the eRHIS from 151 sites (56 data offices, 95 facilities). Their capabilities in utilising the eRHIS varied and were mainly higher in Uganda, followed by Tanzania, Ethiopia, and the CAR. End-users' capabilities also varied by type of abilities, being in general higher for track report completeness (with Tanzania, Uganda, Ethiopia, and CAR having 6/10, 5/10, 4/10, and 2/10 indicators at >80%, respectively), compared to skills in data analysis and visualisation (with only Uganda showing 2/6 indicators >80% for both domains and the other countries having no indicators at >80%). Practical skills scores were low in all countries, particularly on plotting, problem-solving, and use of information. 'Champion/good performer' emerged in each country, with staff at higher health system levels showing the highest capabilities. End-users' suggestions to improve the eRHIS (n = 127) were focussed on technical/software improvements (n = 73, 57.5%) and functionalities for data quality checks and data analysis (n = 36, 28.3%). CONCLUSIONS: Our findings suggest several common gaps in end-users' capabilities in utilising the eRHIS, particularly in the CAR, and in all countries at facility levels
Schistosomiasis amongst adolescent boys in non-lakeshore southern Malawi: Investigating local risk-factors within a nested community-based cross-sectional survey.
Get PDFBACKGROUND: Schistosomiasis is endemic to Malawi, where preventive chemotherapy by mass drug administration (MDA) has been the foundational public health strategy for over a decade. Despite ongoing control, our understanding of the contemporary epidemiology of schistosomiasis in rural Malawi is limited to infrequent school-based surveys, typically lacking evidence from community-based surveys particularly within non-lakeshore upland communities who may be perceived to be at lower risk. METHODS: Between July and August 2022, we conducted a cross-sectional parasitological survey amongst a community-representative sub-sample of boys aged 10-15 years who had been randomly selected and recruited to the DeWorm3 endline survey in Namwera, Mangochi District. A total of 306 participants from 38 communities were assessed for S. mansoni by duplicate Kato-Katz thick smears. Of these, 243 (79.4%) subsequently provided a urine sample to be assessed by filtration for S. haematobium and 238 (77.8%) responded to a risk-factor questionnaire. A parallel malacological survey of eight locally important water contact sites was conducted. RESULTS: The overall prevalence of egg-patent schistosomiasis was 50.6% (95% CI 44.2-57.1). The prevalence of S. haematobium was 47.7% (95% CI 41.3-54.2), of which 37.9% (n=44) were heavy intensity infections whereas the prevalence of S. mansoni was 6.5% (95% CI 4.0-9.9), with one moderate intensity infection (0.3%). There was strong evidence of a positive association between detected S. haematobium infection and reporting "red urine" (p<0.001) and 'bilharzia' (p=0.005). Biomphalaria spp. were found at two sites while Bulinus spp. were found at five sites. CONCLUSION: Despite multiple years of MDA at reportedly high coverage, we observed a high egg-patent prevalence with high prevalence of heavy intensity infections amongst boys aged 10-15 years. This evidences engrained and ongoing transmission requiring additional efforts to gain and sustain effective control. Our findings highlight the importance of epidemiological monitoring alongside a schistosomiasis control programme, particularly in areas historically perceived to be at lower risk
What Are High-Quality Race and Ethnicity Data and How Are They Used in Health Equity Research?
No full textThe COVID-19 pandemic changed public awareness of the importance of high-quality race and ethnicity data for identifying and redressing widely documented racial and ethnic health inequity. This article emphasizes the importance of high-quality race and ethnicity data in health equity research, as highlighted by the COVID-19 pandemic. The article defines what constitutes high-quality race and ethnicity data, discusses challenges in using these data, and provides 2 cases that illustrate the role of these data in identifying and redressing health inequity. Finally, this article advocates for the use of accurate, standardized, and granular data and highlights the need for community engagement and trust building to improve data quality and research outcomes
Barriers and enablers to childhood immunization in high zero-dose burden communities in Kano and Lagos states, Nigeria.
No full textBACKGROUND: Reducing the number of zero-dose children in Nigeria requires a context-specific understanding of the factors driving under-immunization at individual and community levels. This study identifies barriers and enablers to immunization uptake among caregivers of children under two in high-burden zero-dose communities in Kano and Lagos States, Nigeria. METHODS: We followed a qualitative methods approach, conducting 40 focus group discussions (FGDs) among caregivers in the urban communities of Ungogo and Alimosho in Kano and Lagos states, respectively, peri-urban communities of Gezawa in Kano state and rural communities of Ikorodu in Lagos state. Vignettes, gender analysis, and concept-testing of interventions were integrated into the FGD guides to minimize social desirability and explore gendered factors. FGDs were pretested, translated into local languages, audio-recorded, transcribed, and back-translated into English. Thematic analysis was performed using NVivo software. RESULTS: We identified high recognition of the importance of childhood immunization among our study communities, despite inadequate immunization uptake. The main barriers to immunization uptake found in this study were gender-skewed decision-making in childhood vaccination between caregivers, prevalent misconceptions about immunization, prioritization of unmet socio-economic needs over immunization, and past negative experiences with immunization and health services. Enablers included effective community mobilization, involvement of religious and traditional leaders, positive attitudes of well-trained health workers, reliable fixed and outreach immunization services, and material incentives for caregivers. Caregivers preferred community-based strategies, especially those engaging community and religious leaders. CONCLUSION: While similar barriers and enablers are inherent in global vaccine rejection, two-way community engagement for collective action, vaccination awareness campaigns, and engagement of cultural and traditional leaders, including fathers, offer promising strategies for improving immunization uptake in Nigeria
Data-Driven Research Needed to Ensure Timely Access to New Narcolepsy Treatments
Get PDFDr Helen Strongman shares her perspective on access to new narcolepsy treatments – as a person with narcolepsy, trustee and director at Narcolepsy UK, and health data scientis
How can we improve migrant health checks in UK primary care: 'Health Catch-UP!' a protocol for a participatory intervention development study.
Get PDFINTRODUCTION: Global migration has steadily risen, with 16% of the UK population born abroad. Migrants (defined here as foreign-born individuals) face unique health risks, including potential higher rates and delays in diagnosis of infectious and non-communicable diseases, compounded by significant barriers to healthcare. UK Public Health guidelines recommend screening at-risk migrants, but primary care often faces significant challenges in achieving this, exacerbating health disparities. The Health Catch-UP! tool was developed as a novel digital, multidisease screening and catch-up vaccination solution to support primary care to identify at-risk adult migrants and offer individualised care. The tool has been shown to be acceptable and feasible and to increase migrant health screening in previous studies, but to facilitate use in routine care requires the development of an implementation package. This protocol describes the development and optimisation of an implementation package for Health Catch-UP! following the person-based approach (PBA), a participatory intervention development methodology, and evaluates our use of this methodological approach for migrant participants. METHODS AND ANALYSIS: Through engagement with both migrants and primary healthcare professionals (approximately 80-100 participants) via participatory workshops, focus groups and think-aloud interviews, the study aims to cocreate a comprehensive Health Catch-UP! implementation package. This package will encompass healthcare professional support materials, patient resources and potential Health Catch-UP! care pathways (delivery models), developed through iterative refinement based on user feedback and behavioural theory. The study will involve three linked phases (1) planning: formation of an academic-community coalition and cocreation of guiding principles, logic model and intervention planning table, (2) intervention development: focus groups and participatory workshops to coproduce prototype implementation materials and (3) intervention optimisation: think-aloud interviews to iteratively refine the final implementation package. An embedded mixed-methods evaluation of how we used the PBA will allow shared learning from the use of this methodology within the migrant health context. ETHICS AND DISSEMINATION: Ethics approval granted by the St George's University Research Ethics Committee (REC reference: 2024.0191). A community celebration event will be held to recognise contributions and to demonstrate impact
Intersections of menstruation, gender-based violence and contraceptive use: qualitative insights from girls and young women's experiences in western Kenyan family planning clinics.
Get PDFOBJECTIVE: To examine how menstruation, contraceptive use and gender-based violence intersect to shape the sexual and reproductive health and autonomy of girls and young women in Kenya. DESIGN: Qualitative study exploring girls and young women's experiences with contraceptive use and menstrual management, using in-depth interviews and focus group discussions analysed through a reflexive thematic approach. SETTING: Four county-run family planning clinics in Uasin Gishu County, Kenya. PARTICIPANTS: 77 girls and young women aged 15-19 years (via 35 in-depth interviews and 7 focus group discussions) and 27 family planning clinic providers (via 5 focus group discussions). RESULTS: Interviewees' contributions suggest that covert contraceptive use, when discovered through menstrual monitoring, provoked intimate partner violence. Heavy menstrual bleeding, whether related to contraceptive use or not, was viewed as a sexual restriction and also fuelled intimate partner violence. Furthermore, the inability to afford sanitary pads, combined with the stigma surrounding menstruation, drove some girls and young women into exploitative sexual relationships, often resulting in unwanted or unintended pregnancies. CONCLUSIONS: Menstrual bleeding and contraceptive use, both independently and in combination, affect girls and young women's reproductive autonomy and overall health and well-being, particularly in relation to gender-based violence. Improving menstrual hygiene management, challenging the stigma and harmful norms tied to menstruation and contraception and ensuring safe contraceptive use are integral to improving sexual and reproductive health and autonomy and are requisite for preventing and eradicating gender-based violence
IOLs for cataract surgery
Get PDFIn low- and/or middle-income countries, manual small-incision cataract surgery (MSICS) using rigid polymethylmethacrylate (PMMA) monofocal intraocular lenses (IOLs) has remained the default option for decades, as MSICS can be performed in basic clinical settings, and because these are the most affordable type of lens, costing around USD 17 in Africa and as little as USD 3–4 for a locally manufactured IOL in India. However, in recent years, an increasing number of IOL types have become available worldwide (see panel). In low-resource settings, the challenge is to balance good clinical practice with patient needs, costs, and infrastructure.
In resource-limited settings, a pragmatic approach, focusing on monofocal and advanced monofocal lenses, selective use of toric lenses, and efficient inventory management, can help to ensure cost effective personalised care with the best possible refractive outcomes
The Transgenerational Link: Breeder Gut Microbiota and Broiler Progeny Development.
Get PDFThe gut microbiome of breeder hens plays a pivotal role in reproductive efficiency, egg quality, and progeny development. Its composition is shaped by host factors such as age and genetics, as well as environmental influences, including diet and management practices. Importantly, the breeder gut microbiome is not only dynamic but also responsive to targeted interventions that can enhance intestinal health, metabolic function, and laying performance. Vertical transmission of maternal microbes through the cloaca and egg components provides offspring with a foundational microbial community, with the yolk sac serving as a critical reservoir for early colonisers that influence gut maturation, immunity, and growth. Emerging evidence further demonstrates that maternal nutritional strategies can programme the gut microbiota of progeny and intestinal development, highlighting the breeder microbiome as both a determinant and mediator of transgenerational performance. These insights underscore the potential of microbiome-focused approaches to improve reproductive success and sustainability in poultry production
Four targets: an enhanced framework for guiding causal inference from observational data.
Get PDFObservational studies play an increasingly important role in estimating causal effects of a treatment or an exposure, especially with the growing availability of routinely collected real-world data. To facilitate drawing causal inference from observational data, we introduce a conceptual framework centered around "four targets"-target estimand, target population, target trial, and target validity. We illustrate the utility of our proposed "four targets" framework with the example of buprenorphine dosing for treating opioid use disorder, explaining the rationale and process for employing the framework to guide causal thinking from observational data. The "four targets" framework is beneficial for those new to epidemiologic research, enabling them to grasp fundamental concepts and acquire the skills necessary for drawing reliable causal inferences from observational data