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Use of total knee arthroplasty by type of public insurance scheme: a cross-sectional study based on claims data in Thailand.
Get PDFOBJECTIVES: Life expectancy is increasing in many middle-income countries (MIC). Total knee arthroplasty (TKA) can promote independent living among older people with osteoarthritis. In Thailand, healthcare costs for employed and retired civil servants and their parents are covered by the Civil Servant Medical Benefit Scheme (CSMBS), and the Universal Coverage Scheme (UCS) protects older people not covered by other public schemes. We investigated the extent to which use of TKA varied by insurance scheme. DESIGN: A retrospective cross-sectional study. SETTING: We used national-level inpatient claims data from CSMBS and UCS between 1 Jan 2018 and 31 Dec 2020. PARTICIPANTS: We included patients aged >50 with primary osteoarthritis who underwent TKA. PRIMARY AND SECONDARY OUTCOME MEASURES: A Poisson regression model was used to estimate procedure rates per 100 000 insured people per year by an insurance scheme. In patients who underwent TKA, we used a generalised linear model to estimate absolute differences (AD) by the insurance scheme in the use of mobile-bearing implants and simultaneous BTKA. We report estimated average TKA rates, adjusted for age, sex, calendar year and health region, if all patients would have been insured either by CSMBS or UCS. RESULTS: Of the 39 198 patients undergoing TKA, 13 814 were insured by CSMBS (35.2%) and 25 384 by UCS (64.8%). The adjusted estimated TKA rate per 100 000 insured people per year for CSMBS was 149.3 (95% CI 146.8-151.8) and for UCS 59.3 (58.5-60.0), resulting in a rate ratio of 2.52 (2.47-2.57, p<0.0001). Among patients undergoing TKA, 8.7% of CSMBS-insured patients and 8.6% of UCS-insured patients received mobile-bearing implants while 6.0% and 3.6%, respectively, received simultaneous BTKA (adjusted ADs for mobile-bearing implants 0.7% (-2.4, 3.9), p=0.6445 and for simultaneous BTKA 2.7% (-0.3, 5.8), p=0.0811). CONCLUSIONS: The substantial difference between TKA rates of the two insurance schemes clearly demands policy attention. Further investigations should clarify whether the different rates reflect appropriate use. We recommend other countries experiencing rapid population ageing to explore how well healthcare systems are responding to the changing needs of their older populations
Mortality Outcomes in People with Lung Cancer with and without Type2 Diabetes: A Cohort Study in England.
Get PDFINTRODUCTION: The impact of type 2 diabetes (T2DM) on mortality following lung cancer diagnosis remains unclear, with conflicting evidence across studies. We aimed to assess differences in all-cause and cause-specific mortality between people with lung cancer with and without T2DM within a primary care population in England. METHODS: The study population was 69,674 people with incident lung cancer within the Clinical Practice Research Datalink (CPRD) Aurum primary care database (2010-2022). The study exposure was T2DM at cancer diagnosis, and the outcomes were all-cause and cause-specific mortality (cancer, cardio-vascular, respiratory). Cox models were fitted for each outcome adjusting for age, gender, smoking status, body mass index, calendar year and socioeconomic status (Index of Multiple Deprivation). RESULTS: After adjusting for age and gender, there was no evidence for a difference in all-cause mortality in people with T2DM compared with people without T2DM (IRR 0.98 95% CI 0.96, 1.01). After fully-adjusting for measured confounders, there was a small positive effect (IRR 1.07 95% CI 1.04, 1.09). After adjusting for age and gender, people with T2DM had lower rates of cancer-specific mortality compared to people without T2DM (IRR 0.96 95% CI 0.94, 0.98). However, after adjustment for all measured confounders there was a small positive association (IRR 1.05 95% CI 1.02, 1.07). In both age and gender adjusted and fully adjusted models people with T2DM had higher cardiovascular (fully adjusted HR 1.30 95% CI 1.15, 1.47) and respiratory disease mortality (fully adjusted HR 1.30 95% CI 1.15, 1.47). CONCLUSION: There was robust evidence that people with T2DM had higher cardiovascular and respiratory disease mortality following lung cancer diagnosis. The relationships between T2DM and all-cause and cancer-specific mortality were highly sensitive to adjustment for confounding. Differences in studies on approaches to confounding and levels of missing data may contribute to the mixed findings on this association in the literature
Long COVID Syndrome, Mortality and Morbidity in Patients Hospitalized with COVID-19 From 16 Countries: The World Heart Federation Global COVID-19 Study.
Get PDFBACKGROUND: Long-term adverse consequences of the COVID-19 infection affect many organ systems, which requires comprehensive understanding of the disease burden and determinants of persistent long COVID-19 symptoms in diverse population. However, data on long COVID complications are sparse, particularly from low- and middle-income countries (LMICs). The World Heart Federation (WHF) global study assessed the incidence of vascular complications, persistent long COVID symptoms and factors associated with mortality and major adverse cardiovascular events (MACE) among patients with COVID-19 up to one year after hospitalization. METHODS: We recruited a total of 2535 patients hospitalized with COVID-19 and followed up to one-year post-hospital discharge. We collected data on long COVID symptoms, quality of life, and clinical outcomes, including new onset diseases, MACE, and mortality at 1-, 3-, 6-, and 9-12 months post-discharge. Descriptive and generalized estimating equation (GEE) regression analysis was performed to assess the factors associated with mortality and MACE. FINDINGS: The majority of participants were recruited from LMICs (64%) and male (56%) with a mean (SD) age of 59.5 (20.0) years. Among those tested for COVID-19 strain (52%), Omicron strain was the most prevalent (98%). The follow-up rate at one year was 90%. Over half of the participants (56%) reported experiencing at least one major long COVID symptom (fatigue, breathlessness, anxiety, chest pain, and palpitations) at 1-month, and one-quarter participants reported persistent long COVID symptoms at 9-12 months. On the EQ-5D scale, 49% reported difficulties in usual activities, 33% reported anxiety/depression, and 23% reported problems in mobility within the first 6 months. The most frequent new-onset illnesses were pulmonary embolism (8%), kidney disease (4%), and hypertension (3%). The cumulative all-cause mortality rate was 15% (n = 382) at one-year post-discharge. Long COVID symptoms were more common among females, individuals with pre-existing comorbidities, and those with more severe acute illness. Age, obesity, ICU admission, and underlying cardiovascular or pulmonary disease were associated with increased risk of mortality and MACE. CONCLUSION: The study showed a substantial burden of mortality and morbidity, and a quarter of patients reported at least one persistent long COVID symptom after one year. Our findings underscore the need for early identification and management of long COVID symptoms in LMICs
Addressing the challenges of estimating the target population in calculation of routine infant immunization coverage in Kenya.
Get PDFTarget population estimation for immunization coverage calculations from census data is often inaccurate. This study aimed to evaluate the accuracy of the traditional census extrapolation method in comparison with three alternative approaches: the Cohort-Component Population Projections Method (CCPPM), using the Expanded Program on Immunisation (EPI) numerators - BCG and DTP1 doses as denominators, and estimates derived from first antenatal care clinic (ANC1) visits. We obtained target population estimates in Kenya from 1999 - 2023 using all 4 methods with data for ANC1 available only for 2020-2023. We assessed the accuracy of the estimates for 2003-2018 by computing the Mean Absolute Error (MAE), Mean Absolute Percentage Error (MAPE) and the Pearson Correlation Coefficient (r), excluding outliers. A sub-analysis for the period 2020-2023 included ANC1 data. The CCPPM method had the largest population estimates while the census-based method had pronounced discontinuities at the census years. The CCPPM method compared to the DTP1 doses was associated with the greatest error magnitude (MAE = 212917.19 and MAPE = 18.18) while the DTP1 doses and census-based methods showed the smallest error (MAE = 44317.16 and MAPE = 3.77). Sub-analysis of target populations for the period 2020-2023 showed similar upward trends except for the census-based method which exhibited a significantly divergent trajectory. Comparison between the ANC1 and DTP1 doses showed the strongest linear correlation (r = 1.00). Although sub-national analysis was not done and there was the significant challenge of missing data, the results nevertheless reveal significant inaccuracies in the current target population estimation methods which may have serious implications on immunisation coverage assessments. Immunisation programs should utilise diverse sources of data and triangulate results as a more pragmatic approach for approximating the target populations for vaccination in the absence of well-established civil registration systems. Additionally, more research is warranted to address this gap
Availability and readiness of health facilities in Burkina Faso to provide antenatal care: trend analysis from 2012 to 2020.
Get PDFBACKGROUND: Antenatal care (ANC) is a critical maternal health service that, if well done, helps to reduce morbidity and mortality that could occur amongst pregnant women and their babies. This study analyses the trend in availability of and health facility readiness to provide high-quality ANC in Burkina Faso between 2012 and 2020, a period spanning the introduction of user-fee exemption policy and conflict in several regions. METHODS: We conducted a trend analysis of repeated cross-sectional health facility data using the nationally representative Service Availability and Readiness Assessment (SARA) surveys conducted in 2012, 2014, 2016 and 2018 and the census-based 2020 Health Harmonized Facilities Assessment (HHFA). We used tracer indicators defined by both surveys to characterize availability of services and health facility readiness. Availability and readiness indices were calculated using the equal-weighted approach, and the domain-weighted approach was used for readiness only. Trends were assessed using weighted multivariate linear regression. RESULTS: The number of health facilities surveyed was 686 in 2012, 766 in 2014, 677 in 2016, 794 in 2018 and 2,728 in 2020. ANC availability decreased from 72.2% in 2012 to 70.9% by 2020 in a statistically significant decreasing trend ([Formula: see text]. For health facilities in rural locations, there was a statistically significant improvement in the ANC availability ([Formula: see text] while for those in urban settings, there was an overall statistically significant decreasing trend ([Formula: see text]. For ANC service readiness, there was also a statistically significant decline after adjustments for health facility characteristics ([Formula: see text]). Adjusted readiness score for staff and guidelines significantly decreased during the study period ([Formula: see text], while the adjusted score of other domains (equipment ([Formula: see text], diagnosis ([Formula: see text], and medicines ([Formula: see text] significantly increased. For both outcomes, there were regional disparities with Est showing statistically significant incremental changes and Centre Sud showing statistically significant declining trends. CONCLUSION: This study shows decreases in ANC service availability and readiness between 2012 and 2020 in Burkina Faso. In the context of the implementation of global recommendations regarding ANC services and ongoing conflict in the country disrupting the health system, there is an urgent need to pay attention to ANC service strengthening, particularly the availability of trained health personnel and guidelines at all levels of the healthcare system, especially public health facilities in urban settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12978-025-02072-4
Guidance for conducting and evaluating serological surveys to assess interruption of yaws transmission in the context of an eradication target.
Get PDFThis document provides a summary of guidance developed for national programmes on conducting serosurveys to assess yaws transmission status, with the objective of confirming yaws seroprevalence below 1% at each of three serosurveys over a period of 3-10 years after reporting the last case of active yaws in a region. It proposes active testing of children aged 1-5 years through population-based surveys and includes recommendations on survey design, sample size determination, sampling of primary sampling units (PSUs) within an evaluation unit, sampling of households within PSUs, integration with existing public health surveys, and follow-up protocols for positive results. Geospatial analysis and sustained surveillance are recommended for accurate assessment of whether transmission interruption has been achieved
The National Cancer Audit Collaborating Centre (NATCAN): improving the quality of National Health Service cancer care in England and Wales.
Get PDFThe National Cancer Audit Collaborating Centre (NATCAN) was launched on Oct 1, 2022, and is delivering ten national cancer audits to assess and assure the quality of National Health Service (NHS) cancer care in England and Wales. These audits are a collaboration between clinical leaders, methodological experts, professional organisations, civil society, and policy makers to develop and implement performance measures across all NHS cancer care and inform quality improvement of the care pathway. The aims of NATCAN are to provide transparent and timely feedback to hospitals about their practices and outcomes of cancer care, identify opportunities for improvement of cancer care, and support hospitals to conduct quality-improvement initiatives. The key methods used to achieve these aims were use of routinely collected data that did not necessitate bespoke collection by health-care staff specifically for the audit; public reporting of outcomes of care at hospital and regional levels; assessment of determinants of variation in cancer care to target quality improvement; and a central governance structure to ensure that unsafe care or outlying performance were managed effectively and promptly. This Personal View provides comparisons between NATCAN and other international audit programmes, including how other countries could consider and incorporate components of NATCAN, alongside scope for future development
Process Evaluation of Pragmatic Cluster-Randomized Trials of Digital Adherence Technologies for Tuberculosis Treatment Support: A Mixed-Method Study in Five Countries.
Get PDFDigital adherence technologies (DATs) could improve the person-centeredness of tuberculosis (TB) treatment. DATs are found to be acceptable, though evidence of their effectiveness is varied. Our objective was to understand the fidelity of DAT interventions within five cluster-randomized trials. Two DATs (smart pillbox, medication labels) were assessed, with real-time adherence data available to healthcare providers (HCPs) on a digital platform in Ethiopia, the Philippines, South Africa, Tanzania, and Ukraine. A framework assessed four components of implementation: inputs (training, support, mobile access), processes (SMS, home visits, platform usage), outputs (DAT engagement, manual dosing), and outcomes (people with TB (PwTB)-HCP relationship). Fidelity was evaluated by quantitative indicators, and content analysis of qualitative sub-studies supplemented some indicators. Engagement with DATs was high among PwTB. Pillbox users showed high levels of sustained engagement (box opening), with digitally recorded doses ranging from 82% to 91%. Differences were observed in login frequency by HCPs to the adherence platform. In Ethiopia, Tanzania, and Ukraine, there was at least one login to the platform on 71% of weekdays per facility compared with the Philippines and South Africa at 42% and 52%, respectively. Intervention fidelity varied among countries, suggesting a need for future work on optimizing implementation
Inter-cluster contamination: a semivariance analysis of community effect ranges of malaria vector control interventions in a four-armed malaria trial in Muleba, Tanzania.
Get PDFBACKGROUND: The presence of a community effect in cluster randomized trials of malaria vector control interventions has led to the implementation of "buffer zones" around clusters to limit the potential for contamination between interventions. No consensus has been reached on how large these buffers need to be to encapsulate the effect. METHODS: Nested within a phase-III cluster randomized malaria vector control trial in Northwest Tanzania, this study aims to determine the presence and spatial range of community effects from long-lasting insecticidal net (LLIN) and indoor residual spraying (IRS) interventions on household-level malaria infection in trial clusters four months post-intervention. Effective spatial range estimates of intervention community effects were compared to the 300m buffer distance implemented to limit intervention spillover between clusters in the trial. Geographically-weighted adjusted odds of malaria infection in children aged 0.5-14 years were determined four months post community-level intervention with a randomized allocation comprising one of two LLIN products (OlysetTM LN: 1000mg/m2 permethrin or OlysetTM Plus LN: 400 + permethrin 800mg/m2) with either IRS (Actellic®300CS: 1000mg/m2 micro-encapsulated pirimiphos-methyl) or no IRS. Robust semivariances were calculated for each of 48 intervention clusters and fit to semivariogram models by Weighted Least Squares. RESULTS: 6440 children from 2785 households were included in the geographically-weighted logistic regression. Prevalence of Plasmodium falciparum infection was 45.9% in the study population. Twenty (20) clusters had significant residual effect ranges, 13 of which were fit to Sine Hole Effect models, indicating periodicity in the study area. Effective range estimates for the study area had a median value of 1210 m (IQR: 958-1691). Clusters with IRS had a higher median range value: 1535 m (IQR: 976-3398) than those without IRS: 1168m (IQR: 829-1504). CONCLUSIONS: Significant semivariogram model range estimates extended beyond the trial buffer sizes by a median average of 868 m in LLIN intervention clusters and 1235 m for IRS clusters. This presents a contamination, or spillover, potential for all trialed intervention types that may reduce the statistical power to detect difference between trial arms. Future studies should consider the ranges of intervention effects and contamination potential between trial arms when designing buffer areas
Pf8: an open dataset of Plasmodium falciparum genome variation in 33,325 worldwide samples.
Get PDFWe describe the Pf8 data resource, the latest MalariaGEN release of curated genome variation data on over 33,000 Plasmodium falciparum samples from 99 partner studies and 122 locations over more than 50 years. This release provides open access to raw sequencing data and genotypes at over 12 million genomic positions. For the first time, it includes copy-number variation (CNV) calls in the drug-resistance associated genes gch1 and crt. As in Pf7, CNV calls are provided for mdr1 and plasmepsin2/3, along with calls for deletion in hrp2 and hrp3, genes associated with rapid diagnostic test failures. This data resource additionally features derived datasets, interactive web applications for exploring patterns of drug resistance and variation in over 5,000 genes, an updated Python package providing methods for accessing and analysing the data, and open access analysis notebooks that can be used as starting points for further analyses. In addition, informative example analyses show contrasting profiles of the decline of chloroquine resistance-associated mutations in Africa, and variation in copy number variation across 10 distinct sub-populations. To the best of our knowledge, Pf8 is the largest open data set of genome variation in any eukaryotic species, making it an invaluable foundational resource for understanding evolution, including that of pathogens