scholarly journals Strengthening Health Systems to Support Children with Neurodevelopmental Disabilities in Fiji—A Commentary

2020 ◽  
Vol 17 (3) ◽  
pp. 972 ◽  
Author(s):  
Sue Woolfenden ◽  
Kate Milner ◽  
Kali Tora ◽  
Kelera Naulumatua ◽  
Reapi Mataika ◽  
...  
Keyword(s):  
Evidence Base ◽  
Pacific Island ◽  
Model Of Care ◽  
High Quality ◽  
International Leadership ◽  
Middle Income ◽  
Local Leadership ◽  
Research Engagement ◽  
Neurodevelopmental Disabilities ◽  
Local Evidence

Supporting children with neurodevelopmental disabilities (NDDs) is recognized as an increasing priority in Fiji, a middle-income Pacific Island country. Our objective was to describe our approach to developing a model of care and strengthening local leadership in developmental paediatrics in Fiji to ensure high-quality identification, assessment and management of children with NDDs. Paediatric staff at Colonial War Memorial (CWM) Hospital in Suva have worked in partnership with Australian paediatricians to develop the model of care. The platform of continuing medical education during biannual 3 to 4 days of clinic-based teaching with visiting developmental paediatricians from Australia has been used. Since 2010, there have been 15 local and regional paediatric trainees trained. Since 2015, our two local lead paediatric trainees have run a weekly local developmental clinic. In total, 370 children aged 0 to 18 with NDDs have been comprehensively assessed with a detailed history and standardised tools. The model is extending to two divisional hospitals. Research engagement with the team is resulting in the development of a local evidence base. Local, regional and international leadership and collaboration has resulted in increased capacity in the Fijian health system to support children with NDDs.

scholarly journals Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool

2018 ◽  
pp. 1-9
Author(s):  
Chika R. Nwachukwu ◽  
Omobola Mudasiru ◽  
Lynn Million ◽  
Shruti Sheth ◽  
Hope Qamoos ◽  
...  
Keyword(s):  
Palliative Care ◽  
Needs Assessment ◽  
Cancer Care ◽  
Assessment Tool ◽  
Hospital Staff ◽  
Teaching Hospitals ◽  
High Quality ◽  
Middle Income ◽  
Quality Cancer Care ◽  
Oncology Care

Purpose Despite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation. Methods Using a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable. Results Data from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals. Conclusion This study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.

scholarly journals Management of chyle leaks following esophageal resection: a systematic review

2021 ◽  
Author(s):  
Robert Power ◽  
Philip Smyth ◽  
Noel E Donlon ◽  
Timothy Nugent ◽  
Claire L Donohoe ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Prospective Studies ◽  
Case Series ◽  
Esophageal Resection ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Optimal Management ◽  
Retrospective Case ◽  
High Quality ◽  
Chyle Leakage

Summary Background Chyle leakage is an uncommon but potentially life-threatening complication following esophageal resections. The optimal management strategy is not clear, with a limited evidence base. Methods Searches were conducted up to 31 December 2020 on MEDLINE, Embase, and Web of Science for randomized trials or retrospective studies that evaluated the management of chyle leakage following esophageal resection. Two authors independently screened studies, extracted data, and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Results A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including two low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leak/fistula was 3.2%. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, 5 by pleurodesis, and 6 described percutaneous lymphangiography with thoracic duct embolization or disruption. Conclusions The evidence base for optimal management of chyle leakage postesophagectomy is lacking, which may be related to its low incidence. There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity but lower efficacy compared with surgery. Further high-quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.

scholarly journals Scoping review assessing the evidence used to support the adoption of mobile health (mHealth) technologies for the education and training of community health workers (CHWs) in low-income and middle-income countries

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e019827 ◽  
Author(s):  
Niall Winters ◽  
Laurenz Langer ◽  
Anne Geniets
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Low Income ◽  
Health Workers ◽  
Education And Training ◽  
Evidence Base ◽  
Mobile Technologies ◽  
Middle Income ◽  
And Training ◽  
Formal Theories

ObjectivesUndertake a systematic scoping review to determine how a research evidence base, in the form of existing systematic reviews in the field of mobile health (mHealth), constitutes education and training for community health workers (CHWs) who use mobile technologies in everyday work. The review was informed by the following research questions: does educational theory inform the design of the education and training component of mHealth interventions? How is education and training with mobile technology by CHWs in low-income and middle-income countries categorised by existing systematic reviews? What is the basis for this categorisation?SettingThe review explored the literature from 2000 to 2017 to investigate how mHealth interventions have been positioned within the available evidence base in relation to their use of formal theories of learning.ResultsThe scoping review found 24 primary studies that were categorised by 16 systematic reviews as supporting CHWs’ education and training using mobile technologies. However, when formal theories of learning from educational research were used to recategorise these 24 primary studies, only four could be coded as such. This identifies a problem with how CHWs’ education and training using mobile technologies is understood and categorised within the existing evidence base. This is because there is no agreed on, theoretically informed understanding of what counts as learning.ConclusionThe claims made by mHealth researchers and practitioners regarding the learning benefits of mobile technology are not based on research results that are underpinned by formal theories of learning. mHealth suffers from a reductionist view of learning that underestimates the complexities of the relationship between pedagogy and technology. This has resulted in miscategorisations of what constitutes CHWs’ education and training within the existing evidence base. This can be overcome by informed collaboration between the health and education communities.

scholarly journals The burgeoning role of global health diplomacy to alleviate suffering of cancer patients in low- and middle-income countries

2020 ◽  
Vol 12 (3) ◽  
pp. 231-233
Author(s):  
Melissa Adomako ◽  
Alaei Kamiar ◽  
Abdulla Alshaikh ◽  
Lyndsay S Baines ◽  
Desiree Benson ◽  
...  
Keyword(s):  
Global Health ◽  
Evidence Base ◽  
International Affairs ◽  
Global Health Diplomacy ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Diplomacy ◽  
Health Practitioners ◽  
And Control ◽  
Low And Middle Income

Abstract The science of global health diplomacy (GHD) consists of cross-disciplinary, multistakeholder credentials comprised of national security, public health, international affairs, management, law, economics and trade policy. GHD is well placed to bring about better and improved multilateral stakeholder leverage and outcomes in the prevention and control of cancer. It is important to create an evidence base that provides clear and specific guidance for health practitioners in low- and middle-income countries (LMICs) through involvement of all stakeholders. GHD can assist LMICs to negotiate across multilateral stakeholders to integrate prevention, treatment and palliative care of cancer into their commercial and trade policies.

scholarly journals Much research, but little learned to date: A scoping review on mental health of health workers in low- and lower-middle income countries and roadmap for future research

2021 ◽  
Author(s):  
Julia Lohmann ◽  
Denny John ◽  
Aso Dzay
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Health Workers ◽  
Tertiary Care ◽  
Psychological Wellbeing ◽  
Future Research ◽  
Measurement Tool ◽  
High Quality ◽  
Middle Income ◽  
Middle Income Countries

Abstract BackgroundSARS-CoV-2 has resulted in unprecedented research efforts on health workers’ work realities and their potential mental health impacts. To understand the latter, high-quality evidence on the baseline situation is paramount. With the aim of providing a comprehensive overview of existing evidence and to inform future research, we undertook a scoping review of the quantitative literature on mental health and psychological wellbeing of clinical skilled healthcare personnel working in all settings of care in low- and lower-middle income countries (LLMIC).MethodsWe performed a systematic search of the literature up to the end of 2019, in English or French language, in MEDLINE, EMBASE, PsychINFO, Global Health, and CAIRN. We included both studies estimating levels of mental health and studies investigating associations with other factors. We extracted data on study characteristics and methodology, and assessed the methodological quality of the included studies along nine criteria.ResultsWe found 143 relevant studies, 135 including data on mental health levels and 126 including data on associations with other factors. The studies covered 26 of the world’s 78 LLMICs, with most studies conducted in India, Nigeria, Pakistan, or Egypt, in urban secondary- and tertiary-care settings. 67% of studies assessed burnout, 25% general psychological wellbeing, and 20% other mental health outcomes. Only 19% of studies were of high quality due to shortcomings particularly in regards to sample representativeness, context-specific measurement tool validity, and reporting of methodological detail. We found much heterogeneity in investigated associated factors. Studies focused almost exclusively on potential determinants of mental health, while none linked mental health to objectively measured performance outcomes.ConclusionWe conclude that despite its impressive size, we can learn comparatively little from the current body of literature. Based on our findings, we outline areas for expansion, methodological improvement, and standardization of reporting in future research on mental health of health workers.Systematic review registrationPROSPERO no. CRD42019140036

Childhood Sexual Violence in Indonesia: A Systematic Review

2018 ◽  
Vol 21 (2) ◽  
pp. 284-299 ◽  
Author(s):  
Lauren Rumble ◽  
Ryan Fajar Febrianto ◽  
Melania Niken Larasati ◽  
Carolyn Hamilton ◽  
Ben Mathews ◽  
...  
Keyword(s):  
Protective Factors ◽  
Sexual Violence ◽  
Survey Methods ◽  
Significant Risk ◽  
Evidence Base ◽  
Limited Information ◽  
Childhood Experiences ◽  
Middle Income ◽  
Prevalence Studies ◽  
Nationally Representative

There has been relatively little research into the prevalence of childhood sexual violence (CSV) as well as the risk and protective factors for CSV in low- and middle-income countries including Indonesia. Systematic searches conducted in English and Bahasa Indonesia in this review identified 594 records published between 2006 and 2016 in peer-reviewed journals and other literature including 299 Indonesian records. Fifteen studies, including nine prevalence studies, met the quality appraisal criteria developed for this review. The review found that CSV research is scarce: Only one study included nationally representative prevalence estimates. Varying definitions for CSV, survey methods, and sample characteristics limited the generalizability of the data. The available evidence points to significant risk of sexual violence affecting both girls and boys across many geographical and institutional settings. Married adolescent girls are vulnerable to sexual violence by partners in their homes. Children in schools are vulnerable to CSV by peers and adults. Victims seldom disclose incidents and rarely seek support. In addition, early childhood experiences of trauma were strongly associated with later perpetration of sexual violence and revictimization. Limited information is available about protective factors. This review synthesizes evidence about what is currently known about CSV in Indonesia and identifies the strengths and weaknesses of the existing research. A more robust evidence base regarding CSV is required to better inform policy and justify investment into prevention programs.

The Impact of Cash Transfers: A Review of the Evidence from Low- and Middle-income Countries

2018 ◽  
Vol 48 (03) ◽  
pp. 569-594 ◽  
Author(s):  
FRANCESCA BASTAGLI ◽  
JESSICA HAGEN-ZANKER ◽  
LUKE HARMAN ◽  
VALENTINA BARCA ◽  
GEORGINA STURGE ◽  
...  
Keyword(s):  
Evidence Base ◽  
Cash Transfers ◽  
Cash Transfer ◽  
Future Research ◽  
Unintended Effects ◽  
Screening Process ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Impact ◽  
Low And Middle Income

AbstractThis article presents the findings of a review of the impact of non-contributory cash transfers on individuals and households in low- and middle-income countries, covering the literature of 15 years, from 2000 to 2015. Based on evidence extracted from 165 studies, retrieved through a systematic search and screening process, this article discusses the impact of cash transfers on 35 indicators covering six outcome areas: monetary poverty; education; health and nutrition; savings, investment and production; work; and empowerment. For most of the studies, cash transfers contributed to progress in the selected indicators in the direction intended by policymakers. Despite variations in the size and strength of the underlying evidence base by outcome and indicator, this finding is consistent across all outcome areas. The article also investigates unintended effects of cash transfer receipt, such as potential reductions in adult work effort and increased fertility, finding limited evidence for such unintended effects. Finally, the article highlights gaps in the evidence base and areas which would benefit from additional future research.

scholarly journals What role should randomized control trials play in providing the evidence base for conservation?

Oryx ◽  
2019 ◽  
pp. 1-10 ◽  
Author(s):  
Edwin L. Pynegar ◽  
James M. Gibbons ◽  
Nigel M. Asquith ◽  
Julia P. G. Jones
Keyword(s):  
Large Scale ◽  
Relevant Literature ◽  
Evidence Base ◽  
Randomized Control Trials ◽  
High Quality ◽  
Bolivian Andes ◽  
Behavioural Effects ◽  
Randomized Control ◽  
The Impact ◽  
Conservation Interventions

AbstractThe effectiveness of many widely used conservation interventions is poorly understood because of a lack of high-quality impact evaluations. Randomized control trials (RCTs), in which experimental units are randomly allocated to treatment or control groups, offer an intuitive way to calculate the impact of an intervention by establishing a reliable counterfactual scenario. As many conservation interventions depend on changing people's behaviour, conservation impact evaluation can learn a great deal from RCTs in fields such as development economics, where RCTs have become widely used but are controversial. We build on relevant literature from other fields to discuss how RCTs, despite their potential, are just one of a number of ways to evaluate impact, are not feasible in all circumstances, and how factors such as spillover between units and behavioural effects must be considered in their design. We offer guidance and a set of criteria for deciding when RCTs may be an appropriate approach for evaluating conservation interventions, and factors to consider to ensure an RCT is of high quality. We illustrate this with examples from one of the few concluded RCTs of a large-scale conservation intervention: an incentive-based conservation programme in the Bolivian Andes. We argue that conservation should aim to avoid a rerun of the polarized debate surrounding the use of RCTs in other fields. Randomized control trials will not be feasible or appropriate in many circumstances, but if used carefully they can be useful and could become a more widely used tool for the evaluation of conservation impact.

Economic evaluation and health systems strengthening: a review of the literature

2020 ◽  
Author(s):  
Susan Cleary
Keyword(s):  
Quality Of Care ◽  
Economic Evaluation ◽  
Health Systems ◽  
Evidence Base ◽  
Health Systems Strengthening ◽  
Value For Money ◽  
Middle Income ◽  
Disease Specific ◽  
Low And Middle Income

Abstract Health systems strengthening (HSS) is firmly on the global health and development agenda. While a growing evidence base seeks to understand the effectiveness of HSS, there is limited evidence regarding cost and cost-effectiveness. Without such evidence, it is hard to argue that HSS represents value for money and the level of investment needed cannot be quantified. This paper seeks to review the literature regarding the economic evaluation of HSS from low- and middle-income country (LMIC) settings, and to contribute towards the development of methods for the economic evaluation of HSS. A systematic search for literature was conducted in PubMed, Scopus and the Health Systems Evidence database. MeSH terms related to economic evaluation were combined with key words related to the concept of HSS. Of the 204 records retrieved, 52 were retained for full text review and 33 were included. Of these, 67% were published between January 2015 and June 2019. While many HSS interventions have system wide impacts, most studies (71%) investigated these impacts using a disease-specific lens (e.g. the impact of quality of care improvements on uptake of facility deliveries). HSS investments were categorized, with the majority being investments in platform efficiency (e.g. quality of care), followed by simultaneous investment in platform efficiency and platform capacity (e.g. quality of care and task shifting). This review identified a growing body of work seeking to undertake and/or conceptualize the economic evaluation of HSS in low- and middle-income countries. The majority assess HSS interventions using a disease-specific or programmatic lens, treating HSS in a similar manner to the economic evaluation of medicines and diagnostics. While this approach misses potential economies of scope from HSS investments, it allows for a preliminary understanding of relative value for money. Future research is needed to complement the emerging evidence base.

Sign in / Sign up

Export Citation Format

Share Document