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1. Diagnostic and Therapeutic Costs of Patients With a Diagnosis of or Suspected Coronavirus Disease in Iran

Author

Seyed Javad Hoseini, Marjan Vejdani, Amin Adel, Shapour Badiee Aval, Zahra Ebnehoseini, Hosein Ebrahimipour, Hassan Haghparast-Bidgoli, and Sara Jamili

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Cost, media_common.quotation_subject, Economics, Econometrics and Finance (miscellaneous), Disease, Iran, Humans, Medicine, Social determinants of health, Pharmacology, Toxicology and Pharmaceutics (miscellaneous), Retrospective Studies, media_common, Government, Data collection, SARS-CoV-2, business.industry, Health Policy, COVID-19, Retrospective cohort study, Health Care Costs, Payment, Family medicine, Resource use, Economic Evaluation, business
Abstract

Objectives To understand the social and individual effects of the disease and make decisions on the allocation of health resources, it is necessary to understand the economic burden of coronavirus disease (COVID-19); however, there are limited data in this field. This study aimed to estimate diagnostic and therapeutic costs of patients with a diagnosis of or suspected of COVID-19 disease admitted to hospitals in northeast Iran. Methods This descriptive and analytical research was conducted as a retrospective study using the data collected from 2980 patients admitted to 30 hospitals from February to April 2020 in Iran. For data collection, an appropriate data capture tool was designed to record detailed resource use. A multivariate regression analysis was performed to examine the association between the treatment costs and sociodemographic, disease severity, and underlying diseases. Data were analyzed using Excel 2017 (Microsoft, Redmond, WA) and SPSS version 21 software (SPSS Inc., Chicago, IL). Results The inpatient costs per patient were Int$416, of which 74% were paid by social health insurance systems, 19% by the government, and 7% by the patients. The largest cost components were hoteling (37%) and medicine (36%). The 4 subscales of age, sex, underlying disease, and severity predicted 48.6% of the cost variance. Conclusion Understanding the economic consequences of diseases can help policymakers to make plans to reduce out-of-pocket payments and make plans for funding. Since COVID-19 is a newly emerging disease and there is no definitive cure for the disease, the discovery of an effective medicine may alter medical costs and reduce the hospital length of stay, therefore significantly reducing treatment costs.

Published
2022
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2. Effect of nutrition-sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutritional outcomes in rural Odisha, India (UPAVAN trial): a four-arm, observer-blind, cluster-randomised controlled trial

Author

Avinash Upadhyay, Manoj Parida, Philip James, Satyanarayan Mohanty, Peggy Koniz-Booher, Prasanta Tripathy, Helen Harris-Fry, Jolene Skordis, Ronali Pradhan, Shibanand Rath, Meghan O’Hearn, Hassan Haghparast-Bidgoli, Shibanath Padhan, Sneha Krishnan, Diana Elbourne, Abhinav Kumar, Emma Beaumont, Heather Danton, Naba Kishor Mishra, Audrey Prost, Nirmala Nair, Emily Fivian, Elizabeth Allen, Joanna Sturgess, Suneetha Kadiyala, and Suchitra Rath

Subjects
Health (social science), Nutrition sensitive agriculture, Population, Psychological intervention, India, Medicine (miscellaneous), 010501 environmental sciences, Standard score, 01 natural sciences, Food group, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Women, GE1-350, 030212 general & internal medicine, Cluster randomised controlled trial, Child, education, Wasting, 0105 earth and related environmental sciences, education.field_of_study, business.industry, Health Policy, Public Health, Environmental and Occupational Health, Agriculture, Articles, Group Processes, Environmental sciences, Cross-Sectional Studies, Relative risk, Female, medicine.symptom, business, Demography
Abstract

Summary: Background: Almost a quarter of the world's undernourished people live in India. We tested the effects of three nutrition-sensitive agriculture (NSA) interventions on maternal and child nutrition in India. Methods: We did a parallel, four-arm, observer-blind, cluster-randomised trial in Keonjhar district, Odisha, India. A cluster was one or more villages with a combined minimum population of 800 residents. The clusters were allocated 1:1:1:1 to a control group or an intervention group of fortnightly women's groups meetings and household visits over 32 months using: NSA videos (AGRI group); NSA and nutrition-specific videos (AGRI-NUT group); or NSA videos and a nutrition-specific participatory learning and action (PLA) cycle meetings and videos (AGRI-NUT+PLA group). Primary outcomes were the proportion of children aged 6–23 months consuming at least four of seven food groups the previous day and mean maternal body-mass index (BMI). Secondary outcomes were proportion of mothers consuming at least five of ten food groups and child wasting (proportion of children with weight-for-height Z score SD

Published
2021
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3. The contributions of public health policies and healthcare quality to gender gap and country differences in life expectancy in the UK

Author

Ali Kiadaliri, Kasim Allel, Hassan Haghparast-Bidgoli, Franceso Salustri, Kasim, Allel, Salustri, Francesco, Hassan, Haghparast-Bidgoli, and Ali, Kiadaliri

Subjects
Male, medicine.medical_specialty, Epidemiology, Life expectancy, media_common.quotation_subject, Computer applications to medicine. Medical informatics, R858-859.7, Affect (psychology), Sex Factors, Avoidable death, Cause of Death, Health care, Medicine, Humans, Quality (business), Gender gap, UK, Mortality, media_common, Decomposition, business.industry, Public health, Health Policy, Research, Public Health, Environmental and Occupational Health, Health services research, Avoidable deaths, United Kingdom, Female, Public aspects of medicine, RA1-1270, business, Demography
Abstract

Background In many high-income countries, life expectancy (LE) has increased, with women outliving men. This gender gap in LE (GGLE) has been explained with biological factors, healthy behaviours, health status, and sociodemographic characteristics, but little attention has been paid to the role of public health policies that include/affect these factors. This study aimed to assess the contributions of avoidable causes of death, as a measure of public health policies and healthcare quality impacts, to the GGLE and its temporal changes in the UK. We also estimated the contributions of avoidable causes of death into the gap in LE between countries in the UK. Methods We obtained annual data on underlying causes of death by age and sex from the World Health Organization mortality database for the periods 2001–2003 and 2014–2016. We calculated LE at birth using abridged life tables. We applied Arriaga’s decomposition method to compute the age- and cause-specific contributions into the GGLE in each period and its changes between two periods as well as the cross-country gap in LE in the 2014–2016 period. Results Avoidable causes had greater contributions than non-avoidable causes to the GGLE in both periods (62% in 2001–2003 and 54% in 2014–2016) in the UK. Among avoidable causes, ischaemic heart disease (IHD) followed by injuries had the greatest contributions to the GGLE in both periods. On average, the GGLE across the UK narrowed by about 1.0 year between 2001–2003 and 2014–2016 and three avoidable causes of IHD, lung cancer, and injuries accounted for about 0.8 years of this reduction. England & Wales had the greatest LE for both sexes in 2014–2016. Among avoidable causes, injuries in men and lung cancer in women had the largest contributions to the LE advantage in England & Wales compared to Northern Ireland, while drug-related deaths compared to Scotland in both sexes. Conclusion With avoidable causes, particularly preventable deaths, substantially contributing to the gender and cross-country gaps in LE, our results suggest the need for behavioural changes by implementing targeted public health programmes, particularly targeting younger men from Scotland and Northern Ireland.

Published
2021

4. Economic evaluation of nutrition-sensitive agricultural interventions to increase maternal and child dietary diversity and nutritional status in rural Odisha, India

Author

Hassan Haghparast-Bidgoli, Helen Harris-Fry, Abhinav Kumar, Ronali Pradhan, Naba Kishore Mishra, Shibananth Padhan, Amit Kumar Ojha, Sailendra Narayan Mishra, Emily Fivian, Philip James, Sarah Ferguson, Sneha Krishnan, Meghan O’Hearn, Tom Palmer, Peggy Koniz-Booher, Heather Danton, Sandee Minovi, Satyanarayan Mohanty, Shibanand Rath, Suchitra Rath, Nirmala Nair, Prasanta Tripathy, Audrey Prost, Elizabeth Allen, Jolene Skordis, and Suneetha Kadiyala

Subjects
Nutrition and Dietetics, Pregnancy, Cost-Benefit Analysis, Polyesters, Medicine (miscellaneous), Humans, India, Nutritional Status, Agriculture, Female, Child, Diet
Abstract

Economic evaluations of nutrition-sensitive agriculture (NSA) interventions are scarce, limiting assessment of their potential affordability and scalability.We conducted cost-consequence analyses of 3 participatory video-based interventions of fortnightly women's group meetings using the following platforms: 1) NSA videos; 2) NSA and nutrition-specific videos; or 3) NSA videos with a nutrition-specific participatory learning and action (PLA) cycle.Interventions were tested in a 32-mo, 4-arm cluster-randomized controlled trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) in the Keonjhar district, Odisha, India. Impacts were evaluated in children aged 0-23 mo and their mothers. We estimated program costs using data collected prospectively from expenditure records of implementing and technical partners and societal costs using expenditure assessment data collected from households with a child aged 0-23 mo and key informant interviews. Costs were adjusted for inflation, discounted, and converted to 2019 US$.Total program costs of each intervention ranged from US$272,121 to US$386,907. Program costs per pregnant woman or mother of a child aged 0-23 mo were US$62 for NSA videos, US$84 for NSA and nutrition-specific videos, and US$78 for NSA videos with PLA (societal costs: US$125, US$143, and US$122, respectively). Substantial shares of total costs were attributable to development and delivery of the videos and PLA (52-69%) and quality assurance (25-41%). Relative to control, minimum dietary diversity was higher in the children who underwent the interventions incorporating nutrition-specific videos and PLA (adjusted RRs: 1.19 and 1.27; 95% CIs: 1.03-1.37 and 1.11, 1.46, respectively). Relative to control, minimum dietary diversity in mothers was higher in those who underwent NSA video (1.21 [1.01, 1.45]) and NSA with PLA (1.30 [1.10, 1.53]) interventions.NSA videos with PLA can increase both maternal and child dietary diversity and have the lowest cost per unit increase in diet diversity. Building on investments made in developing UPAVAN, cost-efficiency at scale could be increased with less intensive monitoring, reduced startup costs, and integration within existing government programs. This trial was registered at clinicaltrials.gov as ISRCTN65922679.

Published
2022

5. Equity impact of participatory learning and action community mobilisation and mHealth interventions to prevent and control type 2 diabetes and intermediate hyperglycaemia in rural Bangladesh : analysis of a cluster randomised controlled trial

Author

Malini Pires, Sanjit Shaha, Carina King, Joanna Morrison, Tasmin Nahar, Naveed Ahmed, Hannah Maria Jennings, Kohenour Akter, Hassan Haghparast-Bidgoli, A K Azad Khan, Anthony Costello, Abdul Kuddus, Kishwar Azad, and Edward Fottrell

Subjects
Adult, Blood Glucose, Bangladesh, Diabetes Mellitus, Type 2, Epidemiology, Hyperglycemia, Polyesters, Public Health, Environmental and Occupational Health, Humans, Female, Telemedicine
Abstract

BackgroundA cluster randomised trial of mHealth and participatory learning and action (PLA) community mobilisation interventions showed that PLA significantly reduced the prevalence of intermediate hyperglycaemia and type 2 diabetes mellitus (T2DM) and the incidence of T2DM among adults in rural Bangladesh; mHealth improved knowledge but showed no effect on glycaemic outcomes. We explore the equity of intervention reach and impact.MethodsIntervention reach and primary outcomes of intermediate hyperglycaemia and T2DM were assessed through interview surveys and blood fasting glucose and 2-hour oral glucose tolerance tests among population-based samples of adults aged ≥30 years. Age-stratified, gender-stratified and wealth-stratified intervention effects were estimated using random effects logistic regression.ResultsPLA participants were similar to non-participants, though female participants were younger and more likely to be married than female non-participants. Differences including age, education, wealth and marital status were observed between individuals exposed and those not exposed to the mHealth intervention.PLA reduced the prevalence of T2DM and intermediate hyperglycaemia in all age, gender and wealth strata. Reductions in 2-year incidence of T2DM of at least 51% (0.49, 95% CI 0.26 to 0.92) were observed in all strata except among the oldest and least poor groups. mHealth impact on glycaemic outcomes was observed only among the youngest group, where a 47% reduction in the 2-year incidence of T2DM was observed (0.53, 95% CI 0.28 to 1.00).ConclusionLarge impacts of PLA across all strata indicate a highly effective and equitable intervention. mHealth may be more suitable for targeting higher risk, younger populations.Trial registration numberISRCTN41083256.

Published
2022

6. Effectiveness of conditional cash transfers (Afya credits incentive) to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya: a cluster-randomised trial

Author

Fedra Vanhuyse, Oliver Stirrup, Aloyce Odhiambo, Tom Palmer, Sarah Dickin, Jolene Skordis, Neha Batura, Hassan Haghparast-Bidgoli, Alex Mwaki, and Andrew Copas

Subjects
Motivation, maternal medicine, public health, Parturition, General Medicine, Continuity of Patient Care, Global Health, Ambulatory Care Facilities, Kenya, Pregnancy, Medicine, Humans, Female, Child, community child health
Abstract

ObjectivesGiven high maternal and child mortality rates, we assessed the impact of conditional cash transfers (CCTs) to retain women in the continuum of care (antenatal care (ANC), delivery at facility, postnatal care (PNC) and child immunisation).DesignWe conducted an unblinded 1:1 cluster-randomised controlled trial.Setting48 health facilities in Siaya County, Kenya were randomised. The trial ran from May 2017 to December 2019.Participants2922 women were recruited to the control and 2522 to the intervention arm.InterventionsAn electronic system recorded attendance and triggered payments to the participant’s mobile for the intervention arm (US$4.5), and phone credit for the control arm (US$0.5). Eligibility criteria were resident in the catchment area and access to a mobile phone.Primary outcomesPrimary outcomes were any ANC, delivery, any PNC between 4 and 12 months after delivery, childhood immunisation and referral attendance to other facilities for ANC or PNC. Given problems with the electronic system, primary outcomes were obtained from maternal clinic books if participants brought them to data extraction meetings (1257 (50%) of intervention and 1053 (36%) control arm participants). Attendance at referrals to other facilities is not reported because of limited data.ResultsWe found a significantly higher proportion of appointments attended for ANC (67% vs 60%, adjusted OR (aOR) 1.90; 95% CI 1.36 to 2.66) and child immunisation (88% vs 85%; aOR 1.74; 95% CI 1.10 to 2.77) in intervention than control arm. No intervention effect was seen considering delivery at the facility (90% vs 92%; aOR 0.58; 95% CI 0.25 to 1.33) and any PNC attendance (82% vs 81%; aOR 1.25; 95% CI 0.74 to 2.10) separately. The pooled OR across all attendance types was 1.64 (1.28 to 2.10).ConclusionsDemand-side financing incentives, such as CCTs, can improve attendance for appointments. However, attention needs to be paid to the technology, the barriers that remain for delivery at facility and PNC visits and encouraging women to attend ANC visits within the recommended WHO timeframe.Trial registrationNCT03021070.

Published
2022

7. Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries : protocol for a longitudinal mixed-methods study

Author

Anusha Ramani-Chander, Rohina Joshi, Josefien van Olmen, Edwin Wouters, Peter Delobelle, Rajesh Vedanthan, J Jaime Miranda, Brian Oldenburg, Stephen Sherwood, Lal B Rawal, Robert James Mash, Vilma Edith Irazola, Monika Martens, Maria Lazo-Porras, Hueiming Liu, Gina Agarwal, Gade Waqa, Milena Soriano Marcolino, Maria Eugenia Esandi, Antonio Luiz Pinho Ribeiro, Ari Probandari, Francisco González-Salazar, Abha Shrestha, Sujarwoto Sujarwoto, Naomi Levitt, Myriam Paredes, Tomohiko Sugishita, Malek Batal, Yuan Li, Hassan Haghparast-Bidgoli, Violet Naanyu, Feng J He, Puhong Zhang, Sayoki Godfrey Mfinanga, Jan-Walter De Neve, Meena Daivadanam, Kamran Siddiqi, Pascal Geldsetzer, Kerstin Klipstein-Grobusch, Mark D Huffman, Jacqui Webster, Dike Ojji, Andrea Beratarrechea, Maoyi Tian, Maarten Postma, Mayowa O Owolabi, Josephine Birungi, Laura Antonietti, Zulma Ortiz, Anushka Patel, David Peiris, Darcelle Schouw, Jaap Koot, Keiko Nakamura, Gindo Tampubolon, Amanda G Thrift, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Microbes in Health and Disease (MHD), Mental Health and Wellbeing research group, and Public Health Sciences

Subjects
Enablers, hypertension, Systems Analysis, protocols & guidelines, health services administration & management, 111799 Public Health and Health Services not elsewhere classified, longitudinal mixed-methods study, FOS: Health sciences, Diabetes Mellitus/therapy, low-income countries, Noncommunicable Diseases/therapy, Internal Medicine, Diabetes Mellitus, Humans, Noncommunicable Diseases, Developing Countries, Medicine(all), diabetes, public health, Public Health, Environmental and Occupational Health, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, middle-income countries, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Nephrology, Technologie and Innovatie, Hypertension/diagnosis, Hypertension, Knowledge Technology and Innovation, Kennis, Human medicine, Kennis, Technologie and Innovatie
Abstract

IntroductionThere is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions.Methods and analysisWe will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TPand conduct multistakeholder qualitative interviews to gather data at T0and T1.We will undertake descriptive statistical analysis of TPdata and analyse T0and T1data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks.Ethics and disseminationThe current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.

Published
2022

8. Implementation of the Afya conditional cash transfer intervention to retain women in the continuum of care : a mixed-methods process evaluation

Author

Sarah Dickin, Fedra Vanhuyse, Oliver Stirrup, Carla Liera, Andrew Copas, Aloyce Odhiambo, Tom Palmer, Hassan Haghparast-Bidgoli, Neha Batura, Alex Mwaki, and Jolene Skordis

Subjects
Pregnancy, Omvårdnad, Humans, Female, Prenatal Care, Health Facilities, General Medicine, Nursing, Continuity of Patient Care, Kenya
Abstract

ObjectivesWe report the results of a mixed-methods process evaluation that aimed to provide insight on the Afya conditional cash transfer (CCT) intervention fidelity and acceptability.Intervention, setting and participantsThe Afya CCT intervention aimed to retain women in the continuum of maternal healthcare including antenatal care (ANC), delivery at facility and postnatal care (PNC) in Siaya County, Kenya. The cash transfers were delivered using an electronic card reader system at health facilities. It was evaluated in a trial that randomised 48 health facilities to intervention or control, and which found modest increases in attendance for ANC and immunisation appointments, but little effect on delivery at facility and PNC visits.DesignA mixed-methods process evaluation was conducted. We used the Afya electronic portal with recorded visits and payments, and reports on use of the electronic card reader system from each healthcare facility to assess fidelity. Focus group interviews with participants (N=5) and one-on-one interviews with participants (N=10) and healthcare staff (N=15) were conducted to assess the acceptability of the intervention. Data analyses were conducted using descriptive statistics and qualitative content analysis, as appropriate.ResultsDelivery of the Afya CCT intervention was negatively affected by problems with the electronic card reader system and a decrease in adherence to its use over the intervention period by healthcare staff, resulting in low implementation fidelity. Acceptability of cash transfers in the form of mobile transfers was high for participants. Initially, the intervention was acceptable to healthcare staff, especially with respect to improvements in attaining facility targets for ANC visits. However, acceptability was negatively affected by significant delays linked to the card reader system.ConclusionsThe findings highlight operational challenges in delivering the Afya CCT intervention using the Afya electronic card reader system, and the need for greater technology readiness before further scale-up.Trial registration numberNCT03021070.

Published
2022

9. Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Author

Priya Rathi, Ritesh G. Menezes, Edris Hasanpoor, Sanni Yaya, Mohsen Bayati, Maciej Banach, Raffaele Palladino, Mikhail Sergeevich Zastrozhin, Siamak Sabour, Theo Vos, Tuomo J. Meretoja, Dimas Ria Angga Pribadi, Shahin Soltani, Simona Cătălina Ștefan, Behzad Karami Matin, Cyrus Alinia, Tudorel Andrei, Mehdi Bohluli, Nikita Otstavnov, Yanfang Su, Mohammad Ali Mansournia, Simon I. Hay, Mansour Ghafourifard, Songhomitra Panda-Jonas, Pushpendra Singh, Salman Rawaf, Morteza Arab-Zozani, Robert Ancuceanu, Samer Hamidi, Maarten J. Postma, Vijay Kumar Chattu, Ted R. Miller, Stanislav S. Otstavnov, Gbenga A. Kayode, Chhabi Lal Ranabhat, João Vasco Santos, Savita Lasrado, Jonathan F. Mosser, Chaw Yin Myint, Mihajlo Jakovljevic, Masoud Moghadaszadeh, Tanvir M. Huda, Fakher Rahim, Seyedeh Zahra Masoumi, Yingxi Zhao, Aziz Sheikh, Subramanian Senthilkumaran, Sheikh Mohammed Shariful Islam, Fariborz Mansour-Ghanaei, Andrew T Olagunju, Atif Amin Baig, Ali H. Mokdad, Anders Larsson, Atte Meretoja, Bach Xuan Tran, Lal B. Rawal, Brandon Cunningham, Vahid Alipour, Sowmya J. Rao, Anamika Pandey, Vahid Yazdi-Feyzabadi, Salime Goharinezhad, Angela E Micah, Leticia Avila-Burgos, Hayley N Stutzman, Farshad Farzadfar, M. Mofizul Islam, Sharareh Eskandarieh, Saqib Ali, Srikanta Banerjee, Zhi-Jiang Zhang, Anirudh Kotlo, Ravensara S. Travillian, Aziz Rezapour, Huong Lan Thi Nguyen, Sergio I. Prada, Biagio Simonetti, Maitreyi Sahu, Sadaf G. Sepanlou, Carlos A Castañeda-Orjuela, Hoa Thi Do, Farahnaz Joukar, Aso Mohammad Darwesh, Syed Mohamed Aljunid, Modhurima Moitra, In-Hwan Oh, Ayman Grada, Kenji Shibuya, Sojib Bin Zaman, Steven D Bachmeier, Hilda L Harb, Edson Serván-Mori, Bahram Mohajer, Van C. Lansingh, Ali Almasi, German Martinez, Till Bärnighausen, Reza Malekzadeh, Adam E. Berman, Matthew T. Schneider, Michael K. Hole, Reza Rawassizadeh, Bing-Fang Hwang, Bianca S. Zlavog, Mohammad Rabiee, Moses K. Muriithi, Anton C Harle, Mokhtar Mahdavi, Yohannes Kinfu, Olatunde Aremu, Cristiana Abbafati, Nelson Alvis-Guzman, Joseph L Dieleman, Lucero Cahuana-Hurtado, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Zeleke Hailemariam Abebo, Muge Cevik, Hassan Abolhassani, Farnam Mohebi, Job F M van Boven, Nataliya Foigt, Neda Milevska Kostova, Abdallah M. Samy, Roman Topor-Madry, Golsum Tsakalos, Benjamin B. Massenburg, Spencer L. James, Erkin M. Mirrakhimov, Miloje Savic, Mehdi Hosseinzadeh, Sawyer W Crosby, Ayesha Humayun, Hamidreza Setayesh, G Anil Kumar, Juan Sanabria, Jalal Arabloo, Milena M Santric Milicevic, Ai Koyanagi, Shokofeh Maleki, Junjie Wu, Nathaniel J Henry, Efat Mohamadi, Francesco Saverio Violante, Samad Azari, Delia Hendrie, Ahad Bakhtiari, Olayinka Stephen Ilesanmi, Pankaj Bhardwaj, Ahamarshan Jayaraman Nagarajan, Adnan Kisa, Masood Ali Shaikh, Shafiu Mohammed, Justice Nonvignon, Firooz Esmaeilzadeh, Eduardo A. Undurraga, Khurshid Alam, Muktar Beshir Ahmed, Mohamed M. Gad, Mikk Jürisson, Usman Iqbal, Chuanhua Yu, Luis Camera, Mohammad Ali Jahani, Abigail Chapin, Pascual R. Valdez, Reinhard Busse, Tomislav Mestrovic, Paul S. F. Yip, Christopher J L Murray, Jacob Olusegun Olusanya, Salah Eddin Karimi, Mustafa Z. Younis, Michael R.M. Abrigo, Rahul R. Zende, Mina Anjomshoa, Shane D. Morrison, Marcel Ausloos, Bruno Piassi Sao Jose, Zohre Javaheri, Saravanan Muthupandian, Valentin Yurievich Skryabin, Endalkachew Worku Mengesha, Lalit Dandona, Jacek Jerzy Jozwiak, Omar Mukhtar Salman, Rakhi Dandona, Mojtaba Bagherzadeh, Mostafa Dianatinasab, Reza Mohammadpourhodki, Seyed Sina Naghibi Irvani, Nancy Fullman, Claudiu Herteliu, Andreea Mirica, Jasvinder A. Singh, Amin Soheili, Lee Ling Lim, Charles D.A. Wolfe, Catalina Liliana Andrei, Ali Kazemi Karyani, Bolajoko O. Olusanya, Carl Abelardo T. Antonio, Tommi Vasankari, Jean Jacques Noubiap, Mehdi Naderi, Jagadish Rao Padubidri, Bernhard T. Baune, Navid Rabiee, Mark G. Shrime, Mayowa O. Owolabi, Lorenzo G. Mantovani, Desta Debalkie Atnafu, Vasily Vlassov, Kyle E. Simpson, Sorin Hostiuc, Shaun Wen Huey Lee, Cuong Tat Nguyen, Ian E Cogswell, Tesleem Kayode Babalola, Sanjay Basu, Hassan Haghparast Bidgoli, Leila Doshmangir, Marcos Roberto Tovani-Palone, Maha El Tantawi, Obinna Onwujekwe, Mohammad Ali Sahraian, Ahmed Omar Bali, Joshua A. Salomon, Hamidreza Komaki, David Laith Rawaf, Zoubida Zaidi, Hassan Magdy Abd El Razek, Reshmi Bhageerathy, Emilie R Maddison, Naohiro Yonemoto, Ahmad Ghashghaee, Asadollah Gholamian, Ferrán Catalá-López, Stefan Kohler, Rafael Tabarés-Seisdedos, Anwar Faraj, Rafael Lozano, Rufus Akinyemi, Florian Fischer, Jost B. Jonas, Dian Kusuma, Martin Amogre Ayanore, Rohollah Kalhor, Falk Schwendicke, Seyyed Meysam Mousavi, Micah, A. E., Su, Y., Bachmeier, S. D., Chapin, A., Cogswell, I. E., Crosby, S. W., Cunningham, B., Harle, A. C., Maddison, E. R., Moitra, M., Sahu, M., Schneider, M. T., Simpson, K. E., Stutzman, H. N., Tsakalos, G., Zende, R. R., Zlavog, B. S., Abbafati, C., Abebo, Z. H., Abolhassani, H., Abrigo, M. R. M., Ahmed, M. B., Akinyemi, R. O., Alam, K., Ali, S., Alinia, C., Alipour, V., Aljunid, S. M., Almasi, A., Alvis-Guzman, N., Ancuceanu, R., Andrei, T., Andrei, C. L., Anjomshoa, M., Antonio, C. A. T., Arabloo, J., Arab-Zozani, M., Aremu, O., Atnafu, D. D., Ausloos, M., Avila-Burgos, L., Ayanore, M. A., Azari, S., Babalola, T. K., Bagherzadeh, M., Baig, A. A., Bakhtiari, A., Banach, M., Banerjee, S. K., Barnighausen, T. W., Basu, S., Baune, B. T., Bayati, M., Berman, A. E., Bhageerathy, R., Bhardwaj, P., Bohluli, M., Busse, R., Cahuana-Hurtado, L., Camera, L. L. A., Castaneda-Orjuela, C. A., Catala-Lopez, F., Cevik, M., Chattu, V. K., Dandona, L., Dandona, R., Dianatinasab, M., Do, H. T., Doshmangir, L., El Tantawi, M., Eskandarieh, S., Esmaeilzadeh, F., Faraj, A., Farzadfar, F., Fischer, F., Foigt, N. A., Fullman, N., Gad, M. M., Ghafourifard, M., Ghashghaee, A., Gholamian, A., Goharinezhad, S., Grada, A., Haghparast Bidgoli, H., Hamidi, S., Harb, H. L., Hasanpoor, E., Hay, S. I., Hendrie, D., Henry, N. J., Herteliu, C., Hole, M. K., Hosseinzadeh, M., Hostiuc, S., Huda, T. M., Humayun, A., Hwang, B. -F., Ilesanmi, O. S., Iqbal, U., Irvani, S. S. N., Islam, S. M. S., Islam, M. M., Jahani, M. A., Jakovljevic, M., James, S. L., Javaheri, Z., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kalhor, R., Karami Matin, B., Karimi, S. E., Kayode, G. A., Kazemi Karyani, A., Kinfu, Y., Kisa, A., Kohler, S., Komaki, H., Kosen, S., Kotlo, A., Koyanagi, A., Kumar, G. A., Kusuma, D., Lansingh, V. C., Larsson, A. O., Lasrado, S., Lee, S. W. H., Lim, L. -L., Lozano, R., Magdy Abd El Razek, H., Mahdavi, M. M., Maleki, S., Malekzadeh, R., Mansour-Ghanaei, F., Mansournia, M. A., Mantovani, L. G., Martinez, G., Masoumi, S. Z., Massenburg, B. B., Menezes, R. G., Mengesha, E. W., Meretoja, T. J., Meretoja, A., Mestrovic, T., Milevska Kostova, N., Miller, T. R., Mirica, A., Mirrakhimov, E. M., Moghadaszadeh, M., Mohajer, B., Mohamadi, E., Mohammad Darwesh, A., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mohebi, F., Mokdad, A. H., Morrison, S. D., Mosser, J. F., Mousavi, S. M., Muriithi, M. K., Muthupandian, S., Myint, C. -Y., Naderi, M., Nagarajan, A. J., Nguyen, C. T., Nguyen, H. L. T., Nonvignon, J., Noubiap, J. J., Oh, I. -H., Olagunju, A. T., Olusanya, J. O., Olusanya, B. O., Omar Bali, A., Onwujekwe, O. E., Otstavnov, S. S., Otstavnov, N., Owolabi, M. O., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Pandey, A., Postma, M. J., Prada, S. I., Pribadi, D. R. A., Rabiee, M., Rabiee, N., Rahim, F., Ranabhat, C. L., Rao, S. J., Rathi, P., Rawaf, S., Rawaf, D. L., Rawal, L., Rawassizadeh, R., Rezapour, A., Sabour, S., Sahraian, M. A., Salman, O. M., Salomon, J. A., Samy, A. M., Sanabria, J., Santos, J. V., Santric Milicevic, M. M., Sao Jose, B. P., Savic, M., Schwendicke, F., Senthilkumaran, S., Sepanlou, S. G., Servan-Mori, E., Setayesh, H., Shaikh, M. A., Sheikh, A., Shibuya, K., Shrime, M. G., Simonetti, B., Singh, J. A., Singh, P., Skryabin, V. Y., Soheili, A., Soltani, S., Stefan, S. C., Tabares-Seisdedos, R., Topor-Madry, R., Tovani-Palone, M. R., Tran, B. X., Travillian, R., Undurraga, E. A., Valdez, P. R., van Boven, J. F. M., Vasankari, T. J., Violante, F. S., Vlassov, V., Vos, T., Wolfe, C. D. A., Wu, J., Yaya, S., Yazdi-Feyzabadi, V., Yip, P., Yonemoto, N., Younis, M. Z., Yu, C., Zaidi, Z., Zaman, S. B., Zastrozhin, M. S., Zhang, Z. -J., Zhao, Y., Murray, C. J. L., Dieleman, J. L., Global Burden of Disease Health Financing Collaborator Network, Violante FS, Micah, A, Su, Y, Bachmeier, S, Chapin, A, Cogswell, I, Crosby, S, Cunningham, B, Harle, A, Maddison, E, Moitra, M, Sahu, M, Schneider, M, Simpson, K, Stutzman, H, Tsakalos, G, Zende, R, Zlavog, B, Abbafati, C, Abebo, Z, Abolhassani, H, Abrigo, M, Ahmed, M, Akinyemi, R, Alam, K, Ali, S, Alinia, C, Alipour, V, Aljunid, S, Almasi, A, Alvis-Guzman, N, Ancuceanu, R, Andrei, T, Andrei, C, Anjomshoa, M, Antonio, C, Arabloo, J, Arab-Zozani, M, Aremu, O, Atnafu, D, Ausloos, M, Avila-Burgos, L, Ayanore, M, Azari, S, Babalola, T, Bagherzadeh, M, Baig, A, Bakhtiari, A, Banach, M, Banerjee, S, Barnighausen, T, Basu, S, Baune, B, Bayati, M, Berman, A, Bhageerathy, R, Bhardwaj, P, Bohluli, M, Busse, R, Cahuana-Hurtado, L, Camera, L, Castaneda-Orjuela, C, Catala-Lopez, F, Cevik, M, Chattu, V, Dandona, L, Dandona, R, Dianatinasab, M, Do, H, Doshmangir, L, El Tantawi, M, Eskandarieh, S, Esmaeilzadeh, F, Faraj, A, Farzadfar, F, Fischer, F, Foigt, N, Fullman, N, Gad, M, Ghafourifard, M, Ghashghaee, A, Gholamian, A, Goharinezhad, S, Grada, A, Haghparast Bidgoli, H, Hamidi, S, Harb, H, Hasanpoor, E, Hay, S, Hendrie, D, Henry, N, Herteliu, C, Hole, M, Hosseinzadeh, M, Hostiuc, S, Huda, T, Humayun, A, Hwang, B, Ilesanmi, O, Iqbal, U, Irvani, S, Islam, S, Islam, M, Jahani, M, Jakovljevic, M, James, S, Javaheri, Z, Jonas, J, Joukar, F, Jozwiak, J, Jurisson, M, Kalhor, R, Karami Matin, B, Karimi, S, Kayode, G, Kazemi Karyani, A, Kinfu, Y, Kisa, A, Kohler, S, Komaki, H, Kosen, S, Kotlo, A, Koyanagi, A, Kumar, G, Kusuma, D, Lansingh, V, Larsson, A, Lasrado, S, Lee, S, Lim, L, Lozano, R, Magdy Abd El Razek, H, Mahdavi, M, Maleki, S, Malekzadeh, R, Mansour-Ghanaei, F, Mansournia, M, Mantovani, L, Martinez, G, Masoumi, S, Massenburg, B, Menezes, R, Mengesha, E, Meretoja, T, Meretoja, A, Mestrovic, T, Milevska Kostova, N, Miller, T, Mirica, A, Mirrakhimov, E, Moghadaszadeh, M, Mohajer, B, Mohamadi, E, Mohammad Darwesh, A, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, S, Mohebi, F, Mokdad, A, Morrison, S, Mosser, J, Mousavi, S, Muriithi, M, Muthupandian, S, Myint, C, Naderi, M, Nagarajan, A, Nguyen, C, Nguyen, H, Nonvignon, J, Noubiap, J, Oh, I, Olagunju, A, Olusanya, J, Olusanya, B, Omar Bali, A, Onwujekwe, O, Otstavnov, S, Otstavnov, N, Owolabi, M, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Postma, M, Prada, S, Pribadi, D, Rabiee, M, Rabiee, N, Rahim, F, Ranabhat, C, Rao, S, Rathi, P, Rawaf, S, Rawaf, D, Rawal, L, Rawassizadeh, R, Rezapour, A, Sabour, S, Sahraian, M, Salman, O, Salomon, J, Samy, A, Sanabria, J, Santos, J, Santric Milicevic, M, Sao Jose, B, Savic, M, Schwendicke, F, Senthilkumaran, S, Sepanlou, S, Servan-Mori, E, Setayesh, H, Shaikh, M, Sheikh, A, Shibuya, K, Shrime, M, Simonetti, B, Singh, J, Singh, P, Skryabin, V, Soheili, A, Soltani, S, Stefan, S, Tabares-Seisdedos, R, Topor-Madry, R, Tovani-Palone, M, Tran, B, Travillian, R, Undurraga, E, Valdez, P, van Boven, J, Vasankari, T, Violante, F, Vlassov, V, Vos, T, Wolfe, C, Wu, J, Yaya, S, Yazdi-Feyzabadi, V, Yip, P, Yonemoto, N, Younis, M, Yu, C, Zaidi, Z, Zaman, S, Zastrozhin, M, Zhang, Z, Zhao, Y, Murray, C, Dieleman, J, University of Helsinki, Clinicum, HUS Comprehensive Cancer Center, HUS Neurocenter, Helsinki University Hospital Area, University of St Andrews. School of Medicine, University of St Andrews. Infection and Global Health Division, Groningen Research Institute for Asthma and COPD (GRIAC), Value, Affordability and Sustainability (VALUE), and Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET)

Subjects
Economic growth, Financing, Government, Psychological intervention, HIV Infections, burden of disease, 030204 cardiovascular system & hematology, DISEASE, ALLOCATION, 0302 clinical medicine, RA0421, RA0421 Public health. Hygiene. Preventive Medicine, Sustainable development, Global health, health economics, Healthcare Financing, HIV Infection, 030212 general & internal medicine, 10. No inequality, 11 Medical and Health Sciences, DALY, Healthy lives, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, 3rd-DAS, General Medicine, Sustainable Development, 3. Good health, tuberculosis, IMPOVERISHMENT, TERRITORIES, Financing, Human, Financing, Personal, Resource (biology), Tuberculosi, 195 COUNTRIES, Developing Countrie, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Acquired immunodeficiency syndrome (AIDS), General & Internal Medicine, SYSTEMATIC ANALYSIS, medicine, Humans, Burden, HIV/AIDS, tubercolosis, malaria, Human resources, Developing Countries, Government, Acquired Immunodeficiency Syndrome, Health economics, business.industry, DISABILITY, CATASTROPHE, Global Burden of Disease Health Financing Collaborator Network, GLOBAL BURDEN, medicine.disease, Malaria, SDG, health sector spending, development assistant for health, Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, 3121 General medicine, internal medicine and other clinical medicine, NA, Health Expenditures, business, EXPENDITURE
Abstract

BACKGROUND: Sustainable Development Goal (SDG) 3 aims to "ensure healthy lives and promote well-being for all at all ages". While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. METHODS: We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. FINDINGS: Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching $7·9 trillion (95% uncertainty interval 7·8-8·0) in 2017 and is expected to increase to $11·0 trillion (10·7-11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was $20·2 billion (17·0-25·0) and on tuberculosis it was $10·9 billion (10·3-11·8), and in malaria-endemic countries spending on malaria was $5·1 billion (4·9-5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019, $374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6-81·7) in 2015 to 83·1% (82·8-83·3) in 2030. INTERPRETATION: Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. For complete list of authors see http://dx.doi.org/10.1016/S0140-6736(20)30608-5

Published
2020
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10. Effectiveness of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial

Author

Hemanta Pradhan, Amit Ojha, Andrew Copas, Rajkumar Gope, Audrey Prost, Shibanand Rath, Suchitra Rath, Manir Ahmed, Parabita Basu, Vasudha Chakravarthy, Akay Minz, Riza Mahanta, Hassan Haghparast-Bidgoli, Amit Kumar, Vikash Nath, Prasanta Tripathy, Nirmala Nair, Tanja A. J. Houweling, Pradeep Baskey, and Public Health

Subjects
Rural Population, medicine.medical_specialty, Medicine (General), Population, India, Infectious and parasitic diseases, RC109-216, Disease cluster, maternal health, law.invention, R5-920, SDG 3 - Good Health and Well-being, Randomized controlled trial, law, Intervention (counseling), Infant Mortality, medicine, Humans, Women, education, Original Research, education.field_of_study, Government, business.industry, Health Policy, Public health, Public Health, Environmental and Occupational Health, Infant, Newborn, Eastern india, Scale (social sciences), child health, Female, Public Health, business, Demography
Abstract

IntroductionThe WHO recommends community mobilisation with women’s groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with government frontline workers.MethodsWe did a pragmatic cluster non-randomised controlled trial of women’s groups practising PLA scaled up by government front-line workers in Jharkhand, eastern India. Groups prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies and evaluated progress. Intervention coverage and quality were tracked state-wide. Births and deaths to women of reproductive age were monitored in six of Jharkhand’s 24 districts: three purposively allocated to an early intervention start (2017) and three to a delayed start (2019). We monitored vital events prospectively in 100 purposively selected units of 10 000 population each, during baseline (1 March 2017–31 August 2017) and evaluation periods (1 September 2017–31 August 2019). The primary outcome was neonatal mortality.ResultsWe identified 51 949 deliveries and conducted interviews for 48 589 (93.5%). At baseline, neonatal mortality rates (NMR) were 36.9 per 1000 livebirths in the early arm and 39.2 in the delayed arm. Over 24 months of intervention, the NMR was 29.1 in the early arm and 39.2 in the delayed arm, corresponding to a 24% reduction in neonatal mortality (adjusted OR (AOR) 0.76, 95% CI 0.59 to 0.98), including 26% among the most deprived (AOR 0.74, 95% CI 0.57 to 0.95). Twenty of Jharkhand’s 24 districts achieved adequate meeting coverage and quality. In these 20 districts, the intervention saved an estimated 11 803 newborn lives (min: 1026–max: 20 527) over 42 months, and cost 41 international dollars per life year saved.ConclusionParticipatory women’s groups scaled up by the Indian public health system reduced neonatal mortality equitably in a largely rural state and were highly cost-effective, warranting scale-up in other high-mortality rural settings.Trial registrationISRCTN99422435.

Published
2021

11. Protocol for the cost-consequence and equity impact analyses of a cluster randomised controlled trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child dietary diversity and nutritional status in rural Odisha, India (UPAVAN trial)

Author

Jolene Skordis, Shibanand Rath, Shibananth Pradhan, Abhinav Kumar, Sarah Cunningham, Helen Harris-Fry, Sneha Krishnan, Avinash Upadhyay, Naba Kishore Mishra, Hassan Haghparast-Bidgoli, Suneetha Kadiyala, Amit Ojha, Tom Palmer, Ronali Pradhan, Peggy Koniz-Booher, and Meghan O’Hearn

Subjects
Adult, Rural Population, Adolescent, Nutrition-sensitive agriculture, Cost-Benefit Analysis, Psychological intervention, India, Nutritional Status, Medicine (miscellaneous), Women’s groups, Young Adult, Study Protocol, 03 medical and health sciences, Indirect costs, 0302 clinical medicine, Environmental health, Outcome Assessment, Health Care, Health care, medicine, Cluster Analysis, Humans, Pharmacology (medical), 030212 general & internal medicine, Cluster randomised controlled trial, Agricultural extension, Randomized Controlled Trials as Topic, lcsh:R5-920, Equity (economics), Dietary diversity, Maternal and child nutrition, business.industry, Malnutrition, Agriculture, Middle Aged, medicine.disease, Cost-consequence analysis, Diet, Economic evaluation, Participatory learning and action, Public Health, business, lcsh:Medicine (General), 030217 neurology & neurosurgery
Abstract

Background Undernutrition causes around 3.1 million child deaths annually, around 45% of all child deaths. India has one of the highest proportions of maternal and child undernutrition globally. To accelerate reductions in undernutrition, nutrition-specific interventions need to be coupled with nutrition-sensitive programmes that tackle the underlying causes of undernutrition. This paper describes the planned economic evaluation of the UPAVAN trial, a four-arm, cluster randomised controlled trial that tests the nutritional and agricultural impacts of an innovative agriculture extension platform of women’s groups viewing videos on nutrition-sensitive agriculture practices, coupled with a nutrition-specific behaviour-change intervention of videos on nutrition, and a participatory learning and action approach. Methods The economic evaluation of the UPAVAN interventions will be conducted from a societal perspective, taking into account all costs incurred by the implementing agency (programme costs), community and health care providers, and participants and their households, and all measurable outcomes associated with the interventions. All direct and indirect costs, including time costs and donated goods, will be estimated. The economic evaluation will take the form of a cost-consequence analysis, comparing incremental costs and incremental changes in the outcomes of the interventions, compared with the status quo. Robustness of the results will be assessed through a series of sensitivity analyses. In addition, an analysis of the equity impact of the interventions will be conducted. Discussion Evidence on the cost and cost-effectiveness of nutrition-sensitive agriculture interventions is scarce. This limits understanding of the costs of rolling out or scaling up programs. The findings of this economic evaluation will provide useful information for different multisectoral stakeholders involved in the planning and implementation of nutrition-sensitive agriculture programmes. Trial registration ISRCTN65922679. Registered on 21 December 2016 Electronic supplementary material The online version of this article (10.1186/s13063-019-3388-2) contains supplementary material, which is available to authorized users.

Published
2019
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12. Economic burden of road traffic injuries in sub-Saharan Africa: a systematic review of existing literature

Author

Justine Davies, Dennis H Marke, Giulia Rinaldi, Marie Hasselberg, Marco Necchi, Marcella Farrelle Dorothea Ryan-Coker, and Hassan Haghparast-Bidgoli

Subjects
Health economics, business.industry, Cost-Benefit Analysis, public health, MEDLINE, General Medicine, Checklist, EconLit, orthopaedic & trauma surgery, Indirect costs, Systematic review, Health Economics, Cost of Illness, Environmental health, Economic evaluation, Medicine, Humans, Mass Screening, business, Activity-based costing, Africa South of the Sahara
Abstract

ObjectiveThis systematic review aims to explore and synthesise existing literature on the direct and indirect costs from road traffic injuries (RTIs) in sub-Saharan Africa (SSA), the quality of existing evidence, methods used to estimate and report these costs, and the factors that drive the costs.MethodologyMEDLINE, SCOPUS, ProQuest Central, Web of Science, Global Index Medicus, Embase, World Bank Group e-Library, Econlit, Google Scholar and WHO webpages were searched for relevant literature. References of selected papers were also examined for related articles. Screening was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were included in this review if they were published by March 2019, written in English, conducted in SSA and reported original findings on the cost of illness or economic burden of RTIs. The results were systematically examined, and the quality assessed by two reviewers using a modified Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsEleven studies met the inclusion criteria. RTIs can cost between INT$119 and 178 634 per injury and INT$486 and 12 845 per hospitalisation. Findings show variability in costing methods and inadequacies in the quality of existing evidence. Prolonged hospital stays, surgical sundries and severity of injury were the most common factors associated with cost.ConclusionWhile available data are limited, evidence shows that the economic burden of RTIs in SSA is high. Poor quality of existing evidence and heterogeneity in costing methods limit the generalisability of costs reported.

Published
2021

13. Factors associated with women's healthcare decision-making during and after pregnancy in urban slums in Mumbai, India: a cross-sectional analysis

Author

Neha Batura, Stavros Poupakis, Sushmita Das, Ujwala Bapat, Glyn Alcock, Jolene Skordis, Hassan Haghparast-Bidgoli, Shanti Pantvaidya, and David Osrin

Subjects
Male, Cross-Sectional Studies, Socioeconomic Factors, Pregnancy, Poverty Areas, Decision Making, Public Health, Environmental and Occupational Health, Humans, Female, Delivery of Health Care
Abstract

Background Understanding factors associated with women's healthcare decision-making during and after pregnancy is important. While there is considerable evidence related to general determinants of women’s decision-making abilities or agency, there is little evidence on factors associated with women's decision-making abilities or agency with regards to health care (henceforth, health agency), especially for antenatal and postnatal care. We assessed women’s health agency during and after pregnancy in slums in Mumbai, India, and examined factors associated with increased participation in healthcare decisions. Methods Cross-sectional data were collected from 2,630 women who gave birth and lived in 48 slums in Mumbai. A health agency module was developed to assess participation in healthcare decision-making during and after pregnancy. Linear regression analysis was used to examine factors associated with increased health agency. Results Around two-thirds of women made decisions about perinatal care by themselves or jointly with their husband, leaving about one-third outside the decision-making process. Participation increased with age, secondary and higher education, and paid employment, but decreased with age at marriage and household size. The strongest associations were with age and household size, each accounting for about a 0.2 standard deviation difference in health agency score for each one standard deviation change (although in different directions). Similar differences were observed for those in paid employment compared to those who were not, and for those with higher education compared to those with no schooling. Conclusion Exclusion of women from maternal healthcare decision-making threatens the effectiveness of health interventions. Factors such as age, employment, education, and household size need to be considered when designing health interventions targeting new mothers living in challenging conditions, such as urban slums in low- and middle-income countries.

Published
2021

14. National tuberculosis spending efficiency and its associated factors in 121 low-income and middle-income countries, 2010-19: a data envelopment and stochastic frontier analysis

Author

Gerard Joseph Abou Jaoude, Ines Garcia Baena, Peter Nguhiu, Andrew Siroka, Tom Palmer, Lara Goscé, Kasim Allel, Edina Sinanovic, Jolene Skordis, and Hassan Haghparast-Bidgoli

Subjects
Universal Health Insurance, Gross Domestic Product, Humans, Tuberculosis, General Medicine, Health Expenditures, Global Health, Developing Countries
Abstract

BACKGROUND: Maximising the efficiency of national tuberculosis programmes is key to improving service coverage, outcomes, and progress towards End TB targets. We aimed to determine the overall efficiency of tuberculosis spending and investigate associated factors in 121 low-income and middle-income countries between 2010 and 2019. METHODS: In this data envelopment and stochastic frontier analysis, we used data from the WHO Global TB report series on tuberculosis spending as the input and treatment coverage as the output to estimate tuberculosis spending efficiency. We investigated associations between 25 independent variables and overall efficiency. FINDINGS: We estimated global tuberculosis spending efficiency to be between 73·8% (95% CI 71·2-76·3) and 87·7% (84·9-90·6) in 2019, depending on the analytical method used. This estimate suggests that existing global tuberculosis treatment coverage could be increased by between 12·3% (95% CI 9·4-15·1) and 26·2% (23·7-28·8) for the same amount of spending. Efficiency has improved over the study period, mainly since 2015, but a substantial difference of 70·7-72·1 percentage points between the most and least efficient countries still exists. We found a consistent significant association between efficiency and current health expenditure as a share of gross domestic product, out-of-pocket spending on health, and some Sustainable Development Goal (SDG) indicators such as universal health coverage. INTERPRETATION: To improve efficiency, treatment coverage will need to be increased, particularly in the least efficient contexts where this might require additional spending. However, progress towards global End TB targets is slow even in the most efficient countries. Variables associated with TB spending efficiency suggest efficiency is complimented by commitments to improving health-care access that is free at the point of use and wider progress towards the SDGs. These findings support calls for additional investment in tuberculosis care. FUNDING: None.

Published
2021

15. Care-seeking and managing diabetes in rural Bangladesh : a mixed methods study

Author

Kishwar Azad, Hassan Haghparast-Bidgoli, Hannah Jennings, Joanna Morrison, Carina King, Tasmin Nahar, Edward Fottrell, Naveed Ahmed, Abdul Kuddus, Sanjit Shaha, and Kohenour Akter

Subjects
Adult, Rural Population, medicine.medical_specialty, Type 2 diabetes, Trust, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Medical advice, Diabetes management, Health care, medicine, Humans, 030212 general & internal medicine, Care seeking, Qualitative Research, Bangladesh, business.industry, 030503 health policy & services, Public health, Research, Public Health, Environmental and Occupational Health, Type 2 Diabetes Mellitus, Patient Acceptance of Health Care, medicine.disease, Focus group, Diabetes Mellitus, Type 2, Family medicine, Female, Biostatistics, Public aspects of medicine, RA1-1270, 0305 other medical science, business
Abstract

Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

Published
2021

16. Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women's groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal

Author

Naomi M. Saville, Chandani Kharel, Joanna Morrison, Helen Harris-Fry, Philip James, Andrew Copas, Santosh Giri, Abriti Arjyal, B. James Beard, Hassan Haghparast-Bidgoli, Jolene Skordis, Adam Richter, Sushil Baral, and Sara Hillman

Subjects
Adult, Counseling, Adolescent, Iron, Medicine (miscellaneous), Anemia, Middle Aged, Hemoglobins, Young Adult, Nepal, Pregnancy, Dietary Supplements, Humans, Pharmacology (medical), Female, Pregnant Women, Iron, Dietary, Randomized Controlled Trials as Topic
Abstract

Background Anaemia in pregnancy remains prevalent in Nepal and causes severe adverse health outcomes. Methods This non-blinded cluster-randomised controlled trial in the plains of Nepal has two study arms: (1) Control: routine antenatal care (ANC); (2) Home visiting, iron supplementation, Participatory Learning and Action (PLA) groups, plus routine ANC. Participants, including women in 54 non-contiguous clusters (mean 2582; range 1299–4865 population) in Southern Kapilbastu district, are eligible if they consent to menstrual monitoring, are resident, married, aged 13–49 years and able to respond to questions. After 1–2 missed menses and a positive pregnancy test, consenting women Outcomes are captured at 30 ± 2 weeks gestation. Primary outcome is haemoglobin concentration (g/dL). Secondary outcomes are as follows: anaemia prevalence (%), mid-upper arm circumference (cm), mean probability of micronutrient adequacy (MPA) and number of ANC visits at a health facility. Indicators to assess pathways to impact include number of IFA tablets consumed during pregnancy, intake of energy (kcal/day) and dietary iron (mg/day), a score of bioavailability-enhancing behaviours and recall of one nutrition knowledge indicator. Costs and cost-effectiveness of the intervention will be estimated from a provider perspective. Using constrained randomisation, we allocated clusters to study arms, ensuring similarity with respect to cluster size, ethnicity, religion and distance to a health facility. Analysis is by intention-to-treat at the individual level, using mixed-effects regression. Discussion Findings will inform Nepal government policy on approaches to increase adherence to IFA, improve diets and reduce anaemia in pregnancy. Trial registration ISRCTN 12272130.

Published
2021

17. Learning from a diabetes mHealth intervention in rural Bangladesh: what worked, what did not and what next?

Author

Anthony Costello, Kohenour Akter, Naveed Ahmed, Hannah Jennings, A.K.Azad Khan, Edward Fottrell, Abdul Kuddus, Carina King, Joanna Morrison, Kishwar Azad, Sanjit Kumer Shaha, Hassan Haghparast-Bidgoli, and Tasmin Nahar

Subjects
Rural Population, Population, Internet privacy, Psychological intervention, 03 medical and health sciences, 0302 clinical medicine, Participatory design, Intervention (counseling), Humans, Relevance (information retrieval), 030212 general & internal medicine, Cluster randomised controlled trial, education, mHealth, education.field_of_study, Bangladesh, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, Telemedicine, Diabetes Mellitus, Type 2, Mobile phone, 0305 other medical science, Psychology, business, Cell Phone
Abstract

There is an urgent need for population-based interventions to slow the growth of the diabetes epidemic in low-and middle-income countries. We tested the effectiveness of a population-based mHealth voice messaging intervention for T2DM prevention and control in rural Bangladesh through a cluster randomised controlled trial. mHealth improved knowledge and awareness about T2DM but there was no detectable effect on T2DM occurrence. We conducted mixed-methods research to understand this result. Exposure to messages was limited by technological faults, high frequency of mobile phone number changes, message fatigue and (mis)perceptions that messages were only for those who had T2DM. Persistent social norms, habits and desires made behaviour change challenging, and participants felt they would be more motivated by group discussions than mHealth messaging alone. Engagement with mHealth messages for T2DM prevention and control can be increased by (1) sending identifiable messages from a trusted source (2) using participatory design of mHealth messages to inform modelling of behaviours and increase relevance to the general population (3) enabling interactive messaging. mHealth messaging is likely to be most successful if implemented as part of a multi-sectoral, multi-component approach to address T2DM and non-communicable disease risk factors.

Published
2021

18. Protocol for an intervention development and pilot implementation evaluation study of an e-health solution to improve newborn care quality and survival in two low-resource settings, Malawi and Zimbabwe: Neotree

Author

Emma Wilson, Hannah Gannon, Gwendoline Chimhini, Felicity Fitzgerald, Nushrat Khan, Fabiana Lorencatto, Erin Kesler, Deliwe Nkhoma, Tarisai Chiyaka, Hassan Haghparast-Bidgoli, Monica Lakhanpaul, Mario Cortina Borja, Alexander G. Stevenson, Caroline Crehan, Yali Sassoon, Tim Hull-Bailey, Kristina Curtis, Msandeni Chiume, Simbarashe Chimhuya, and Michelle Heys

Subjects
Postnatal Care, Zimbabwe, Malawi, Infant, Newborn, 1103 Clinical Sciences, Pilot Projects, General Medicine, Decision Support Systems, Clinical, neonatology, Mobile Applications, Quality Improvement, Telemedicine, quality in health care, 1117 Public Health and Health Services, Health Resources, Humans, Infant Health, Program Development, health informatics, Poverty, Algorithms, 1199 Other Medical and Health Sciences, Quality of Health Care
Abstract

IntroductionEvery year 2.4 million deaths occur worldwide in babies younger than 28 days. Approximately 70% of these deaths occur in low-resource settings because of failure to implement evidence-based interventions. Digital health technologies may offer an implementation solution. Since 2014, we have worked in Bangladesh, Malawi, Zimbabwe and the UK to develop and pilot Neotree: an android app with accompanying data visualisation, linkage and export. Its low-cost hardware and state-of-the-art software are used to improve bedside postnatal care and to provide insights into population health trends, to impact wider policy and practice.Methods and analysisThis is a mixed methods (1) intervention codevelopment and optimisation and (2) pilot implementation evaluation (including economic evaluation) study. Neotree will be implemented in two hospitals in Zimbabwe, and one in Malawi. Over the 2-year study period clinical and demographic newborn data will be collected via Neotree, in addition to behavioural science informed qualitative and quantitative implementation evaluation and measures of cost, newborn care quality and usability. Neotree clinical decision support algorithms will be optimised according to best available evidence and clinical validation studies.Ethics and disseminationThis is a Wellcome Trust funded project (215742_Z_19_Z). Research ethics approvals have been obtained: Malawi College of Medicine Research and Ethics Committee (P.01/20/2909; P.02/19/2613); UCL (17123/001, 6681/001, 5019/004); Medical Research Council Zimbabwe (MRCZ/A/2570), BRTI and JREC institutional review boards (AP155/2020; JREC/327/19), Sally Mugabe Hospital Ethics Committee (071119/64; 250418/48). Results will be disseminated via academic publications and public and policy engagement activities. In this study, the care for an estimated 15 000 babies across three sites will be impacted.Trial registration numberNCT0512707; Pre-results

Published
2022
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19. Community participatory learning and action cycle groups to reduce type 2 diabetes in Bangladesh (D:Clare trial): study protocol for a stepped-wedge cluster randomised controlled trial

Author

Abdul Kuddus, A.K.Azad Khan, Edward Fottrell, Kishwar Azad, Kohenour Akter, Sanjit Kumer Shaha, Hassan Haghparast-Bidgoli, Malini Pires, Joanna Morrison, Carina King, Naveed Ahmed, Andrew Copas, and Tasmin Nahar

Subjects
Rural Population, Population, Psychological intervention, Medicine (miscellaneous), T2DM, 030209 endocrinology & metabolism, Stepped-wedge trial, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, Intervention (counseling), Environmental health, Medicine, Cluster Analysis, Humans, Pharmacology (medical), 030212 general & internal medicine, Cluster randomised controlled trial, Non-communicable diseases, education, Baseline (configuration management), Randomized Controlled Trials as Topic, Protocol (science), Estimation, education.field_of_study, lcsh:R5-920, Bangladesh, business.industry, Diabetes, Community Participation, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Scale (social sciences), Participatory learning and action, business, lcsh:Medicine (General)
Abstract

Background An estimated 463 million people globally have diabetes, with the prevalence growing in low-and middle-income settings, such as Bangladesh. Given the need for context-appropriate interventions to prevent type 2 diabetes mellitus (T2DM), the ‘Diabetes: Community-led Awareness, Response and Evaluation’ (D:Clare) trial will rigorously evaluate the replication and scale-up of a participatory learning and action (PLA) cycle intervention in Bangladesh, to inform policy on population-level T2DM prevention and control. Methods This is a stepped-wedge cluster randomised controlled trial, with integrated process and economic evaluations, conducted from March 2020 to September 2022. The trial will evaluate a community-based four-phase PLA cycle intervention focused on prevention and control of T2DM implemented over 18 months, against a control of usual care. Twelve clusters will be randomly allocated (1:1) to implement the intervention at project month 1 or 12. The intervention will be evaluated through three cross-sectional surveys at months 1, 12 and 24. The trial will be conducted in Alfadanga Upazila, Faridpur district, with an estimated population of 120,000. Clusters are defined as administrative geographical areas, with approximately equal populations. Each of the six unions in Alfadanga will be divided into two clusters, forming 12 clusters in total. Given the risk of inter-cluster contamination, evaluation surveys will exclude villages in border areas. Participants will be randomly sampled, independently for each survey, from a population census conducted in January 2020. The primary outcome is the combined prevalence of intermediate hyperglycaemia and T2DM, measured through fasting and 2-h post-glucose load blood tests. A total of 4680 participants provide 84% power to detect a 30% reduction in the primary outcome, assuming a baseline of 30% and an ICC of 0.07. The analysis will be by intention-to-treat, comparing intervention and control periods across all clusters, adjusting for geographical clustering. Discussion This study will provide further evidence of effectiveness for community-based PLA to prevent T2DM at scale in a rural Bangladesh setting. However, we encountered several challenges in applying the stepped-wedge design to our research context, with particular consideration given to balancing seasonality, timing and number of steps and estimation of partial versus full effect. Trial registration ISRCTN: ISRCTN42219712. Registered on 31 October 2019

Published
2021

20. Participatory learning and action cycles with women s groups to prevent neonatal death in low-resource settings : A multi-country comparison of cost-effectiveness and affordability

Author

Lumbani Banda, Neha Batura, Edward Fottrell, Amit Ojha, Charles Makwenda, Mikey Rosato, Jolene Skordis, Sung Wook Kim, Florida Banda, Kishwar Azad, Hassan Haghparast-Bidgoli, Anthony Costello, Anni-Maria Pulkki-Brännström, Tim Colbourn, Josephine Borghi, Audrey Prost, Rajesh Sinha, and Sanjit Shaha

Subjects
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, Malawi, Cost effectiveness, Cost-Benefit Analysis, Perinatal Death, Psychological intervention, India, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Nepal, law, Environmental health, community mobilization, Humans, AcademicSubjects/MED00860, Women, 030212 general & internal medicine, Activity-based costing, Average cost, health care economics and organizations, Cost database, Randomized Controlled Trials as Topic, Bangladesh, 030503 health policy & services, Health Policy, Infant, Newborn, cost-effectiveness analysis, Public Health, Global Health, Social Medicine and Epidemiology, Cost-effectiveness analysis, Original Articles, Health Care Service and Management, Health Policy and Services and Health Economy, maternal and child health, Costs, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Scale (social sciences), randomized controlled trial, Female, Business, Erratum, 0305 other medical science
Abstract

WHO recommends participatory learning and action cycles with women’s groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effectiveness ratios, and model the cost of scale-up. Primary cost data were collated, and costing methods harmonized. Effectiveness was extracted from a meta-analysis and converted to neonatal life-years saved. Cost-effectiveness ratios were calculated from the provider perspective compared with current practice. Associations between unit costs and cost-effectiveness ratios with coverage, scale and intensity were explored. Scale-up costs and outcomes were modelled using local unit costs and the meta-analysis effect estimate for neonatal mortality. Results were expressed in 2016 international dollars. The average cost was $203 (range: $61–$537) per live birth. Start-up costs were large, and spending on staff was the main cost component. The cost per neonatal life-year saved ranged from $135 to $1627. The intervention was highly cost-effective when using income-based thresholds. Variation in cost-effectiveness across trials was strongly correlated with costs. Removing discounting of costs and life-years substantially reduced all cost-effectiveness ratios. The cost of rolling out the intervention to rural populations ranges from 1.2% to 6.3% of government health expenditure in the four countries. Our analyses demonstrate the challenges faced by economic evaluations of community-based interventions evaluated using a cluster randomized controlled trial design. Our results confirm that women’s groups are a cost-effective and potentially affordable strategy for improving birth outcomes among rural populations.

Published
2021

21. Assessing the efficiency of countries in making progress towards universal health coverage: a data envelopment analysis of 172 countries

Author

Emma Jordi, Gerard Joseph Abou Jaoude, Hassan Haghparast-Bidgoli, Matthew Jowett, Caitlin Pley, Abou Jaoude, Gerard Joseph [0000-0001-6022-3036], and Apollo - University of Cambridge Repository

Subjects
Best practice, Declaration, other study design, Simar, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, Universal Health Insurance, Data envelopment analysis, health economics, Humans, lcsh:RC109-216, 030212 general & internal medicine, Baseline (configuration management), Original Research, Sustainable development, lcsh:R5-920, Health economics, Public economics, 030503 health policy & services, Health Policy, Corporate governance, Financial risk, Public Health, Environmental and Occupational Health, Environmental economics, Business, 0305 other medical science, lcsh:Medicine (General), health systems, health systems evaluation
Abstract

IntroductionMaximising efficiency of resources is critical to progressing towards universal health coverage (UHC) and the sustainable development goal (SDG) for health. This study estimates the technical efficiency of national health spending in progressing towards UHC, and the environmental factors associated with efficient UHC service provision.MethodsA two-stage efficiency analysis using Simar and Wilson’s double bootstrap data envelopment analysis investigates how efficiently countries convert health spending into UHC outputs (measured by service coverage and financial risk protection) for 172 countries. We use World Bank and WHO data from 2015. Thereafter, the environmental factors associated with efficient progress towards UHC goals are identified.ResultsThe mean bias-corrected technical efficiency score across 172 countries is 85.7% (68.9% for low-income and 95.5% for high-income countries). High-achieving middle-income and low-income countries such as El Salvador, Colombia, Rwanda and Malawi demonstrate that peer-relative efficiency can be attained at all incomes. Governance capacity, income and education are significantly associated with efficiency. Sensitivity analysis suggests that results are robust to changes.ConclusionWe provide a 2015 baseline for cross-country UHC technical efficiency scores. If countries wish to improve their UHC outputs within existing budgets, they should identify their current efficiency and try to emulate more efficient peers. Policy-makers should focus on strengthening institutions and implementing known best practices to replicate efficient systems. Using resources more efficiently is likely to positively impact UHC coverage goals and health outcomes, and without addressing gaps in efficiency progress towards achieving the SDGs will be impeded.

Published
2020

22. Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Author

Giulio Castelpietra, Feng Sha, Khalid A Altirkawi, Seyedeh Zahra Masoumi, Gebreamlak Gebremedhn Gebremeskel, Ahmad Daryani, Ibrahim Abdollahpour, Simon I. Hay, Deborah Carvalho Malta, Erin B Hamilton, Kate E. LeGrand, Nikolay Ivanovich Briko, Ana-Laura Manda, Aziz Eftekhari, Irfan Ullah, Seth Christopher Yaw Appiah, Zichen Liu, Maida Umar, Shaimaa I. El-Jaafary, Marina Pinheiro, Farhad Ghamari, Milad Mohammadoo-Khorasani, Rajaram Yadav, Syed Mohamed Aljunid, Ramesh Holla, Farzad Jalilian, Jacek Jerzy Jozwiak, Omar Mukhtar Salman, Bayew Kelkay, Tanuj Kanchan, Irina Filip, Michael R. Phillips, Hamid Reza Tohidinik, Demelash Abewa Elemineh, Reza Malekzadeh, Tomasz Miazgowski, Diana Silva, Samath D Dharmaratne, Eleonora Dubljanin, Fatemeh Zare, Jasvinder A. Singh, Hagazi Gebremedhin Kassaye, Nathaniel J Henry, Venkatesh Maled, Girikumar Kumaresh, Alireza Rafiei, Zhi-Jiang Zhang, Arielle Wilder Eagan, Merhawi Gebremedhin Tekle, Gholamreza Roshandel, Jeevan Pereira, Tinuke O Olagunju, Olatunde Aremu, Mohammad Zamani, Mu'awiyyah Babale Sufiyan, Lidia Morawska, Bayisa Abdissa Baye, Eduarda Fernandes, Feleke Mekonnen Demeke, Beriwan Abdulqadir Ali, Ibrahim A Khalil, Hafte Kahsay Kebede, Songhomitra Panda-Jonas, Yuichiro Yano, Haileab Fekadu Wolde, Antonio Maria Borzì, Delia Hendrie, Azeem Majeed, Vahid Rashedi, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Derrick A Bennett, Roba Khundkar, Mohammed Madadin, Biniyam Sahiledengle Geberemariyam, Parul Puri, Lidia Sanchez Riera, Yetunde O. John-Akinola, Jennifer Rickard, Saeed Shahabi, Tiffany K. Gill, Jemal Abdu Mohammed, Alessandra C. Goulart, Mohiuddin Ahsanul Kabir Chowdhury, Roya Safari-Faramani, Pawan Faris, Farhad Moradpour, Guilherme Borges, Sadia Bibi, Bartosz Miazgowski, Wubalem Fekadu, Rakhi Dandona, Ali Reza Soltanian, Alaa Badawi, Amir Hasanzadeh, Hassan Haghparast Bidgoli, Carlos A Castañeda-Orjuela, Morteza Arab-Zozani, Vinay Nangia, Gaurav Gupta, Farkhonde Salehi, Isabela M. Benseñor, Rekha Thapar, Yasser S. Amer, Naohiro Yonemoto, Ahmad Ghashghaee, Amanda J. Mason-Jones, Marcela Agudelo-Botero, Ashraf Nabhan, Saeed Safari, Lorainne Tudor Car, Ayman Grada, Stanislav S. Otstavnov, Keyvan Pakshir, Nefsu Awoke, Ahamarshan Jayaraman Nagarajan, Adnan Kisa, Ghasem Azarian, Yogesh Sabde, Soufiane Boufous, Fatemeh Khosravi Shadmani, Ketema Bizuwork Gebremedhin, Heather Orpana, Narayan Bahadur Mahotra, Tripti Khanna, Peter Nyasulu, Tommi Vasankari, Reza Mohammadpourhodki, Peter Njenga Keiyoro, Andrea Werdecker, Sanghamitra Pati, Rajan Nikbakhsh, Sorin Hostiuc, Prateek Rastogi, Xuefeng Liu, Manasi Kumar, Josip Car, Chuanhua Yu, Aziz Rezapour, Narayana Manjunatha, Ritesh G. Menezes, Michael K. Hole, Asadollah Gholamian, Pascual R. Valdez, Lorenzo Monasta, Amit Arora, Marek Majdan, Abraham Getachew Kelbore, Irini Chatziralli, Rafael Alves Guimarães, Mohammad Hassan Emamian, Filippo Ariani, Jeadran N. Malagón-Rojas, Jae Il Shin, Aziz Sheikh, Garumma Tolu Feyissa, Ahmed Abdelalim, Babak Moazen, Smita Pakhale, Bija Soleymani, Mehdi Hosseinzadeh, Young Eun Kim, Yunquan Zhang, Guoqing Hu, Yousef Khader, Suzanne Barker-Collo, Rizwan Suliankatchi Abdulkader, Mahdi Safdarian, Arash Sarveazad, Maria Magdalena Constantin, Dhirendra N Sinha, Alireza Ansari-Moghaddam, Khezar Hayat, Ferrán Catalá-López, Shaun Wen Huey Lee, Susan M Sawyer, Soosanna Kumary Chattu, Salman Rawaf, Seyed Sina Naghibi Irvani, Eun-Kee Park, Nauman Khalid, Marwa Rashad Salem, Duduzile Ndwandwe, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Borhan Mansouri, Faramarz Shaahmadi, Rovshan Khalilov, Milena M Santric Milicevic, Pankaj Singh, Ashish Badiye, Ai Koyanagi, Priya Rathi, Sanni Yaya, Ali Bijani, Shanshan Li, Onome Bright Oghenetega, Manoochehr Karami, Huong Lan Thi Nguyen, Soheil Hassanipour, Chukwudi A Nnaji, Obinna Onwujekwe, Swayam Prakash, Animut Tagele Tamiru, Ted R. Miller, Rebecca Ivers, Paulo A. Lotufo, Tomislav Mestrovic, Bhaskaran Unnikrishnan, Morteza Shamsizadeh, Abdollah Mohammadian-Hafshejani, Savita Lasrado, Amir Almasi-Hashiani, Burcu Kucuk Bicer, Samad Azari, Degena Bahrey Tadesse, Ziad El-Khatib, Ashish Pathak, Kebreab Paulos, Krittika Bhattacharyya, Animut Alebel, Rupak Desai, Rafael Tabarés-Seisdedos, Melkamu Merid Mengesha, Ayenew Kassie Tesema, Amir Radfar, Shane D. Morrison, Inga Dora Sigfusdottir, Hamid Yimam Hassen, Miloud Taki Eddine Aichour, Getnet Gedefaw, Hamed Zandian, Chi Linh Hoang, Seyedmojtaba Seyedmousavi, Desalegn Getnet Demsie, Fares Alahdab, Vafa Rahimi-Movaghar, Atalay Goshu Muluneh, Leeberk Raja Inbaraj, Muluken Bekele Sorrie, Olayinka Stephen Ilesanmi, Om P Kurmi, Subramanian Senthilkumaran, Ahmed Omar Bali, Wagaye Fentahun Chanie, Abadi Kahsu Gebre, Neha Chaudhary, Endang Indriasih, Neeraj Bedi, Ghobad Moradi, Pankaj Bhardwaj, Erkin M. Mirrakhimov, Daniel Y. Cho, Karen M. Tabb, Elham Ehsani-Chimeh, Kamarul Imran Musa, Mustafa Z. Younis, Meresa Berwo Mengesha, Veincent Christian Filipino Pepito, Jalal Arabloo, Mukhammad David Naimzada, Ingan Ukur Tarigan, Eleni Bagli, Prasanna Mithra, Masood Ali Shaikh, Siamak Sabour, Theo Vos, Van C. Lansingh, Cuong Tat Nguyen, Dennis Odai Laryea, Tuomo J. Meretoja, Ireneous N. Soyiri, Mariam Molokhia, Biruk Wogayehu Taddele, Robert C. Reiner, Till Bärnighausen, Walter Mendoza, Maciej Banach, Justin J. Lang, Maysaa El Sayed Zaki, Martha Híjar, Farahnaz Joukar, João Mauricio Castaldelli-Maia, R V Polibin, Sudha Jayaraman, S. Mohammad Sajadi, Cyrus Alinia, Nicholas L S Roberts, Aso Mohammad Darwesh, Akine Eshete Abosetugn, Mostafa Dianati Nasab, Samar Al-Hajj, Jagadish Rao Padubidri, Gebretsadkan Hintsa Tekulu, Kidanemaryam Berhe, Mehdi Mirzaei-Alavijeh, Hasan Yusefzadeh, Felix Akpojene Ogbo, Mahesh P A, Amir Manafi, Berhe Gebremichael, Carlos Miguel Rios González, Rahman Shiri, Girmay Teklay Weldesamuel, Pallab K. Maulik, Suresh Jungari, Ali Yadollahpour, Ali H. Mokdad, Alan D. Lopez, Masoud Behzadifar, Naho Morisaki, Nithin Kumar, Corina Benjet, Seyed-Mohammad Fereshtehnejad, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, Serge Resnikoff, Inbal Salz, Muhammed Magdy Abd El Razek, Taweewat Wiangkham, Vinod C. Nayak, Niguse Meles Alema, G Anil Kumar, Mohammed Ibrahim Mohialdeen Gubari, Yoshan Moodley, Amir Kasaeian, Nitin Joseph, Mihajlo Jakovljevic, Farnam Mohebi, Navid Rabiee, Ali Kabir, Hossein Poustchi, Gebrekiros Gebremichael Meles, Asres Bedaso Tilahune, Yonatal Mesfin Tefera, Abdur Razzaque Sarker, Zoubida Zaidi, Hung Chak Ho, Andre M. N. Renzaho, Vahid Alipour, Sowmya J. Rao, Francesco Saverio Violante, Monika Sawhney, Daniel N. Kiirithio, Josephine W. Ngunjiri, Muhammad Aziz Rahman, Amin Soheili, Félix Carvalho, Hafiz Ansar Rasul Suleria, Saleh Salehi Zahabi, Benjamin B. Massenburg, Yun Jin Kim, Tomas Y Ferede, Saqib Ali, Yousef Mohammad, Getinet Ayano, Zabihollah Yousefi, Neeti Kapoor, Lope H Barrero, Hosni Salem, Sharareh Eskandarieh, Hai Quang Pham, Zahra Sadat Dibaji Forooshani, Erika Ota, Srikanta Banerjee, Babak Asghari, Arash Tehrani-Banihashemi, Dina Nur Anggraini Ningrum, Tauseef Ahmad, Giovanni Damiani, Hamidreza Komaki, Catalina Liliana Andrei, Karzan Abdulmuhsin Mohammad, Rosario Cárdenas, Richard C. Franklin, Naznin Hossain, Miriam Levi, Hayimro Edemealem Merie, Kavitha Ranganathan, Anwar Rafay, Srinivas Murthy, Engida Yisma, Mehdi Sayyah, Bruno Ramos Nascimento, Lalit Dandona, Ahmad Zarei, Kwaku Oppong Asante, Masoud Moradi, Luca Ronfani, Berhe Etsay Tesfay, Prabhat Lamichhane, Juan Sanabria, Brijesh Sathian, Daniel Kim, Yoosik Youm, Kewal Krishan, Maryam Zamanian, Christian Lycke Ellingsen, Dawit Habte Woldeyes, Josep Maria Haro, Gebre Teklemariam Demoz, Zahiruddin Quazi Syed, Hamid Sharifi, Dinh-Toi Chu, Vasily Vlassov, Emmanuel Wandera Okunga, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Mark A. Stokes, Faris Lami, Yousef Fatahi, Moritz U. G. Kraemer, Anusha Ganapati Bhat, Naser Mohammad Gholi Mezerji, Samantha M. Colquhoun, Louisa Degenhardt, Ivo Rakovac, Saeed Amini, Sadaf G. Sepanlou, Claudio Alberto Dávila-Cervantes, Asmamaw Demis, Samer Hamidi, Teshome Abegaz Kamil, Muhammad Shahdaat Bin Sayeed, In-Hwan Oh, Afshin Derakhshani, Sojib Bin Zaman, Peter Memiah, Andreea Mirica, Dawit Zewdu Wondafrash, Sheikh Mohammed Shariful Islam, Oluwatosin Kuti, Shivakumar K.M. Kondlahalli, Soraya Seedat, Mohammad Ali Jahani, Bereket Duko Adema, Paul S. F. Yip, Gurudatta Naik, Ali Rajabpour-Sanati, Farid Najafi, Kebede Deribe, Ionut Negoi, Malke Asaad, Mehedi Hasan, Tim Driscoll, Reza Rawassizadeh, Vishnu Renjith, Taras Kavetskyy, Masoud Foroutan, Akbar Barzegar, Mohsen Bayati, Mohammad Ali Mansournia, Zohreh Arefi, Saif Ullah, Fatemeh Heydarpour, Joemer C. Maravilla, Masoud Moghadaszadeh, Rasmus Havmoeller, Pietro Ferrara, Vijay Kumar Chattu, Rohollah Kalhor, Amrit Banstola, Payman Salamati, Genet Melak Alamene, George C Patton, André Faro, Rushdia Ahmed, Era Upadhyay, Vivek Kumar, Mahmood Moosazadeh, Temesgen Gebeyehu Wondmeneh, Vladimir Andreevich Korshunov, Soraya Siabani, Shyam Sundar Budhathoki, Alexander C. Tsai, Suliman Alghnam, Irena Ilic, Tsegaye Lolaso Lenjebo, Andrew T Olagunju, Mohan Bairwa, Amy E. Peden, Catalin-Gabriel Smarandache, Ejaz Ahmad Khan, Spencer L. James, Ronan A Lyons, Seok Jun Yoon, Siavash Rahimi, Kathryn H. Jacobsen, Morenike Oluwatoyin Folayan, Zachary V Dingels, Florian Fischer, Joht Singh Chandan, Amir Abdoli, Takeshi Fukumoto, Tariku Tesfaye Bekuma, Efat Mohamadi, David C. Schwebel, Milena Ilic, Daniel Adane Endalew, Mahdi Sharif-Alhoseini, Jost B. Jonas, Mahtab Alikhani, Fariborz Mansour-Ghanaei, Bach Xuan Tran, Lal B. 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E., Mestrovic, T., Miazgowski, B., Miazgowski, T., Miller, T. R., Mini, G. K., Mirica, A., Mirrakhimov, E. M., Mirzaei-Alavijeh, M., Mithra, P., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Mohammad, K. A., Darwesh, A. M., Mezerji, N. M. G., Mohammadian-Hafshejani, A., Mohammadoo-Khorasani, M., Mohammadpourhodki, R., Mohammed, S., Mohammed, J. A., Mohebi, F., Molokhia, M., Monasta, L., Moodley, Y., Moosazadeh, M., Moradi, M., Moradi, G., Moradi-Lakeh, M., Moradpour, F., Morawska, L., Velasquez, I. M., Morisaki, N., Morrison, S. D., Mossie, T. B., Muluneh, A. G., Murthy, S., Musa, K. I., Mustafa, G., Nabhan, A. F., Nagarajan, A. J., Naik, G., Naimzada, M. D., Najafi, F., Nangia, V., Nascimento, B. R., Naserbakht, M., Nayak, V., Ndwandwe, D. E., Negoi, I., Ngunjiri, J. W., Nguyen, C. T., Nguyen, H. L. T., Nikbakhsh, R., Ningrum, D. N. A., Nnaji, C. A., Nyasulu, P. S., Ogbo, F. A., Oghenetega, O. B., Oh, I. -H., Okunga, E. W., Olagunju, A. T., Olagunju, T. O., Bali, A. O., Onwujekwe, O. E., Asante, K. O., Orpana, H. M., Ota, E., Otstavnov, N., Otstavnov, S. S., Mahesh, P. A., Padubidri, J. R., Pakhale, S., Pakshir, K., Panda-Jonas, S., Park, E. -K., Patel, S. K., Pathak, A., Pati, S., Patton, G. C., Paulos, K., Peden, A. E., Pepito, V. C. F., Pereira, J., Pham, H. Q., Phillips, M. R., Pinheiro, M., Polibin, R. V., Polinder, S., Poustchi, H., Prakash, S., Pribadi, D. R. A., Puri, P., Syed, Z. Q., Rabiee, M., Rabiee, N., Radfar, A., Rafay, A., Rafiee, A., Rafiei, A., Rahim, F., Rahimi, S., Rahimi-Movaghar, V., Rahman, M. A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Ranganathan, K., Rao, S. J., Rashedi, V., Rastogi, P., Rathi, P., Rawaf, S., Rawal, L., Rawassizadeh, R., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Rezapour, A., Ribeiro, A. I., Rickard, J., Gonzalez, C. M. R., Ronfani, L., Roshandel, G., Saad, A. M., Sabde, Y. D., Sabour, S., Saddik, B., Safari, S., Safari-Faramani, R., Safarpour, H., Safdarian, M., Mohammad Sajadi, S., Salamati, P., Salehi, F., Zahabi, S. S., Rashad Salem, M. R., Salem, H., Salman, O., Salz, I., Samy, A. M., Sanabria, J., Riera, L. S., Santric Milicevic, M. M., Sarker, A. R., Sarveazad, A., Sathian, B., Sawhney, M., Sawyer, S. M., Saxena, S., Sayyah, M., Schwebel, D. C., Seedat, S., Senthilkumaran, S., Sepanlou, S. G., Seyedmousavi, S., Sha, F., Shaahmadi, F., Shahabi, S., Shaikh, M. A., Shams-Beyranvand, M., Shamsizadeh, M., Sharif-Alhoseini, M., Sharifi, H., Sheikh, A., Shigematsu, M., Shin, J. I., Shiri, R., Siabani, S., Sigfusdottir, I. D., Singh, P. K., Singh, J. A., Sinha, D. N., Smarandache, C. -G., Smith, E. U. R., Soheili, A., Soleymani, B., Soltanian, A. R., Soriano, J. B., Sorrie, M. B., Soyiri, I. N., Stein, D. J., Stokes, M. A., Mu'Awiyyah, B. S., Suleria, H. A. R., Sykes, B. L., Tabares-Seisdedos, R., Tabb, K. M., Taddele, B. W., Tadesse, D. B., Tamiru, A. T., Tarigan, I. U., Tefera, Y. M., Tehrani-Banihashemi, A., Tekle, M. G., Tekulu, G. H., Tesema, A. K., Tesfay, B. E., Thapar, R., Tilahune, A. B., Tlaye, K. G., Tohidinik, H. R., Topor-Madry, R., Tran, B. X., Tran, K. B., Tripathy, J. P., Tsai, A. C., Car, L. T., Ullah, S., Ullah, I., Umar, M., Unnikrishnan, B., Upadhyay, E., Uthman, O. A., Valdez, P. R., Vasankari, T. J., Venketasubramanian, N., Violante, F. S., Vlassov, V., Waheed, Y., Weldesamuel, G. T., Werdecker, A., Wiangkham, T., Wolde, H. F., Woldeyes, D. H., Wondafrash, D. Z., Wondmeneh, T. G., Wondmieneh, A. B., Wu, A. -M., Yadav, R., Yadollahpour, A., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Yip, P., Yisma, E., Yonemoto, N., Yoon, S. -J., Youm, Y., Younis, M. Z., Yousefi, Z., Yu, Y., Yu, C., Yusefzadeh, H., Moghadam, T. Z., Zaidi, Z., Zaman, S. B., Zamani, M., Zamanian, M., Zandian, H., Zarei, A., Zare, F., Zhang, Z. -J., Zhang, Y., Zodpey, S., Dandona, L., Dandona, R., Degenhardt, L., Dharmaratne, S. D., Hay, S. I., Mokdad, A. H., Reiner, R. C., Sartorius, B., Vos, T., James, Spencer L, Castle, Chris D, Dingels, Zachary V, Fox, Jack T, Adema, Bereket Duko, Yisma, Engida, and Vos, Theo

Subjects
Dánarmein, Fötlun, Dánartíðni, Lífslíkur, Life expectancy, 1106 Human Movement and Sports Sciences, burden of disease, Global Health, Global Burden of Disease, 0302 clinical medicine, Quality-Adjusted Life Year, Global health, Medicine, LIFE EXPECTANCY, 030212 general & internal medicine, POPULATION, Cause of death, Original Research, RISK, education.field_of_study, Global disease burdens, Injuries, Sjúkdómar, Incidence (epidemiology), Incidence, Population health, Burden of disease, Global, global, 3142 Public health care science, environmental and occupational health, 3. Good health, Descriptive epidemiology, Lýðheilsa, Quality-Adjusted Life Years, Public Health, TERRITORIES, descriptive epidemiology, Human, Population, 195 COUNTRIES, Humans, Life Expectancy, Morbidity, Wounds and Injuries, 1117 Public Health and Health Services, 03 medical and health sciences, AGE, SYSTEMATIC ANALYSIS, Mortality, education, Disability, SEX-SPECIFIC MORTALITY, business.industry, Faraldsfræði, DISABILITY, Public Health, Environmental and Occupational Health, Quality-adjusted life year, Years of potential life lost, Áverkar, 1701 Psychology, Human medicine, business, 030217 neurology & neurosurgery, Demography
Abstract

Publisher's version (útgefin grein), Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care., Bill and Melinda Gates Foundation OPP1152504, "Peer Reviewed"

Published
2020
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23. Community groups or mobile phone messaging to prevent and control type 2 diabetes and intermediate hyperglycaemia in Bangladesh (DMagic): a cluster-randomised controlled trial

Author

Sanjit Kumer Shaha, A.K.Azad Khan, Kishwar Azad, Hannah Jennings, Abdul Kuddus, Edward Fottrell, Joanna Morrison, Anthony Costello, Hassan Haghparast-Bidgoli, Naveed Ahmed, Carina King, Kohenour Akter, and Tasmin Nahar

Subjects
Male, Rural Population, Cross-sectional study, Endocrinology, Diabetes and Metabolism, Health Behavior, Type 2 diabetes, Community Networks, 0302 clinical medicine, Endocrinology, Surveys and Questionnaires, Cumulative incidence, 030212 general & internal medicine, Aged, 80 and over, education.field_of_study, Bangladesh, Incidence, Incidence (epidemiology), 1. No poverty, Middle Aged, Prognosis, Telemedicine, 3. Good health, Research Design, Cohort, Female, Adult, Community-Based Participatory Research, medicine.medical_specialty, Diabetes risk, Population, 030209 endocrinology & metabolism, Article, 03 medical and health sciences, Internal medicine, Internal Medicine, medicine, Humans, education, Life Style, Aged, Text Messaging, business.industry, Odds ratio, medicine.disease, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Case-Control Studies, Hyperglycemia, business, Risk Reduction Behavior, Cell Phone, Follow-Up Studies
Abstract

Summary Background Strategies are needed to prevent and control type 2 diabetes and intermediate hyperglycaemia, which together affect roughly a third of adults in Bangladesh. We aimed to assess the effects of mHealth and community mobilisation on the prevalence of intermediate hyperglycaemia and diabetes among the general adult population in rural Bangladesh, and to assess the effect of these interventions on the incidence of type 2 diabetes among people with intermediate hyperglycaemia within the study population. Methods DMagic was a three-arm, cluster-randomised trial of participatory community mobilisation, mHealth mobile phone messaging, and usual care (control) in 96 villages (population roughly 125 000) in Bangladesh. Community mobilisation involved 18 monthly group meetings, led by lay facilitators, applying a participatory learning and action (PLA) cycle focused on diabetes prevention and control. mHealth involved twice-weekly voice messages over 14 months promoting behaviour change to reduce diabetes risk. The primary outcomes were the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the overall population at the end of the intervention implementation period, and 2-year cumulative incidence of type 2 diabetes in a cohort with intermediate hyperglycaemia at baseline. Primary outcomes were assessed through fasting blood glucose concentrations and 2-h oral glucose tolerance tests among a cross-section of adults aged 30 years and older and a cohort of individuals identified with intermediate hyperglycaemia. Prevalence findings are based on a cross-sectional survey at the end of the study; incidence findings are based on 2-year follow-up survey of a cohort of individuals identified with intermediate hyperglycaemia through a cross-sectional survey at baseline. We also assessed the cost-effectiveness of the interventions. This trial is registered with the ISRCTN registry, number ISRCTN41083256, and is completed. Findings The study took place between June 27, 2015, and June 28, 2018, with the PLA intervention running in 32 villages from June, 2016, to December, 2017, and the mHealth intervention running in 32 villages from Oct 21, 2016, to Dec 24, 2017. End-of study prevalence was assessed in 11 454 individuals and incidence in 2100 individuals. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group at the end of the study (adjusted [for stratification, clustering, and wealth] odds ratio [aOR] 0·36 [0·27–0·48]), with an absolute reduction of 20·7% (95% CI 14·6–26·7). Among 2470 adults with intermediate hyperglycaemia at baseline, 2100 (85%) were followed-up at 2 years. The 2-year cumulative incidence of diabetes in this cohort was significantly lower in the PLA group compared with control (aOR 0·39, 0·24–0·65), representing an absolute incidence reduction of 8·7% (3·5–14·0). There was no evidence of effect of mHealth on combined prevalence of intermediate hyperglycaemia and diabetes (aOR 0·93, 0·74–1·16) or the incidence of diabetes (1·02, 0·73–1·43). The incremental cost-effectiveness ratios for PLA were INT$316 per case of intermediate hyperglycaemia or type 2 diabetes prevented and $6518 per case of type 2 diabetes prevented among individuals with intermediate hyperglycaemia. Interpretation Our data provide strong evidence to support the use of community mobilisation based on PLA to prevent type 2 diabetes in this rural Bangladeshi population. Despite raising knowledge and awareness of diabetes, the mHealth intervention did not change disease outcomes in our population. Replication studies in other populations should be a priority. Funding UK Medical Research Council.

Published
2019

24. The global Optima HIV allocative efficiency model: targeting resources in efforts to end AIDS

Author

Janne Estill, Kelsey L. Grantham, Sherrie L Kelly, S Azfar Hussain, Jolene Skordis-Worrall, Iyanoosh Reporter, Robyn M. Stuart, Nicole Fraser, David Wilson, David J. Kedziora, Richard Gray, Cliff C. Kerr, Rowan Martin-Hughes, Marelize Gorgens, Zofia Baranczuk, David P Wilson, Laura Grobicki, Janka Petravic, Olivia Keiser, Hassan Haghparast-Bidgoli, Andrew J. Shattock, Xiao F Yap, and Clemens Benedikt

Subjects
0301 basic medicine, Resource (biology), Epidemiology, Service delivery framework, Cost-Benefit Analysis, Immunology, 610 Medicine & health, Resource Allocation, Health care rationing, 03 medical and health sciences, Pre-exposure prophylaxis, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Risk Factors, 360 Social problems & social services, Virology, medicine, Humans, 030212 general & internal medicine, 11 Medical and Health Sciences, health care economics and organizations, ddc:613, Acquired Immunodeficiency Syndrome, Health Care Rationing, Cost–benefit analysis, Public economics, business.industry, virus diseases, public health, HIV interventions, Models, Theoretical, medicine.disease, 030104 developmental biology, Infectious Diseases, Resource allocation, Pre-Exposure Prophylaxis, Allocative efficiency, business, Algorithms
Abstract

Summary Background To move towards ending AIDS by 2030, HIV resources should be allocated cost-effectively. We used the Optima HIV model to estimate how global HIV resources could be retargeted for greatest epidemiological effect and how many additional new infections could be averted by 2030. Methods We collated standard data used in country modelling exercises (including demographic, epidemiological, behavioural, programmatic, and expenditure data) from Jan 1, 2000, to Dec 31, 2015 for 44 countries, capturing 80% of people living with HIV worldwide. These data were used to parameterise separate subnational and national models within the Optima HIV framework. To estimate optimal resource allocation at subnational, national, regional, and global levels, we used an adaptive stochastic descent optimisation algorithm in combination with the epidemic models and cost functions for each programme in each country. Optimal allocation analyses were done with international HIV funds remaining the same to each country and by redistributing these funds between countries. Findings Without additional funding, if countries were to optimally allocate their HIV resources from 2016 to 2030, we estimate that an additional 7·4 million (uncertainty range 3·9 million–14·0 million) new infections could be averted, representing a 26% (uncertainty range 13–50%) incidence reduction. Redistribution of international funds between countries could avert a further 1·9 million infections, which represents a 33% (uncertainty range 20–58%) incidence reduction overall. To reduce HIV incidence by 90% relative to 2010, we estimate that more than a three-fold increase of current annual funds will be necessary until 2030. The most common priorities for optimal resource reallocation are to scale up treatment and prevention programmes targeting key populations at greatest risk in each setting. Prioritisation of other HIV programmes depends on the epidemiology and cost-effectiveness of service delivery in each setting as well as resource availability. Interpretation Further reductions in global HIV incidence are possible through improved targeting of international and national HIV resources. Funding World Bank and Australian NHMRC.

Published
2018
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25. Health Financing Consequences of Implementing Health Transformation Plan in Iran: Achievements and Challenges

Author

Mohammad Bazyar, Behzad Najafi, Leila Doshmangir, and Hassan Haghparast-Bidgoli

Subjects
health financing, Health (social science), Leadership and Management, Healthcare financing, MEDLINE, Health Promotion, Plan (drawing), Management, Monitoring, Policy and Law, Letter to Editor, Health Services Accessibility, Transformation (music), 03 medical and health sciences, 0302 clinical medicine, Health Information Management, Healthcare Financing, Humans, 030212 general & internal medicine, iran, health transformation plan, Finance, business.industry, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, Health Plan Implementation, lcsh:RA1-1270, Health Care Reform, Business, 0305 other medical science
Published
2019
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26. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Kyu, Hh, Abate, D, Abate, Kh, Abay, Sm, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, Rs, Abebe, M, Abebe, Z, Abil, Oz, Aboyans, V, Abrham, Ar, Abu-Raddad, Lj, Abu-Rmeileh, Nme, Accrombessi, Mmk, Acharya, D, Acharya, P, Ackerman, In, Adamu, Aa, Adebayo, Om, Adekanmbi, V, Ademi, Z, Adetokunboh, Oo, Adib, Mg, Adsuar, Jc, Afanvi, Ka, Afarideh, M, Afshin, A, Agarwal, G, Agesa, Km, Aggarwal, R, Aghayan, Sa, Agrawal, A, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, Mb, Ahmed, S, Aichour, An, Aichour, I, Aichour, Mte, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, Hm, Al-Raddadi, Rm, Alahdab, F, Alam, K, Alam, T, Alashi, A, Alavian, Sm, Alene, Ka, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, Sm, Alkerwi, A, Alla, F, Allebeck, P, Alonso, J, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Aminde, Ln, Amini, E, Amiresmaili, M, Ammar, W, Amoako, Ya, Anber, Nh, Andrei, Cl, Androudi, S, Animut, Md, Anjomshoa, M, Ansha, Mg, Antonio, Cat, Anwari, P, Arabloo, J, Aremu, O, Ärnlöv, J, Arora, A, Arora, M, Artaman, A, Aryal, Kk, Asayesh, H, Ataro, Z, Ausloos, M, Avila-Burgos, L, Avokpaho, Efga, Awasthi, A, Ayala, Quintanilla, Ayer, R, Azzopardi, Ps, Babazadeh, A, Badali, H, Balakrishnan, K, Bali, Ag, Banach, M, Banoub, Jam, Barac, A, Barboza, Ma, Barker-Collo, Sl, Bärnighausen, Tw, Barquera, S, Barrero, Lh, Bazargan-Hejazi, S, Bedi, N, Beghi, E, Behzadifar, M, Bekele, Bb, Bekru, Et, Belachew, Ab, Belay, Ya, Bell, Ml, Bello, Ak, Bennett, Da, Bensenor, Im, Berhane, A, Bernabe, E, Bernstein, Rs, Beuran, M, Beyranvand, T, Bhala, N, Bhatt, S, Bhaumik, S, Bhutta, Za, Biadgo, B, Biehl, Mh, Bijani, A, Bikbov, B, Bilano, V, Bililign, N, Bin, Sayeed, Bisanzio, D, Bjørge, T, Bleyer, A, Bobasa, Em, Bou-Orm, Ir, Boufous, S, Bourne, R, Brady, Oj, Brant, Lc, Brayne, C, Brazinova, A, Breitborde, Njk, Brenner, H, Briant, Ps, Briko, An, Britton, G, Brugha, T, Buchbinder, R, Busse, R, Butt, Za, Cahuana-Hurtado, L, Campuzano, Rincon, Cano, J, Cárdenas, R, Carrero, Jj, Carter, A, Carvalho, F, Castañeda-Orjuela, Ca, Castillo, Rivas, J, Castro, F, Catalá-López, F, Cercy, Km, Cerin, E, Chaiah, Y, Chang, Jc, Charlson, Fj, Chattu, Vk, Chiang, Pp, Chitheer, A, Choi, Jj, Christensen, H, Christopher, Dj, Chung, Sc, Cicuttini, Fm, Cirillo, Massimo, Collado-Mateo, D, Cooper, C, Cortesi, Pa, Cortinovis, M, Cousin, E, Criqui, Mh, Cromwell, Ea, Cross, M, Crump, Ja, Daba, Ak, Dachew, Ba, Dadi, Af, Dandona, L, Dandona, R, Dargan, Pi, Daryani, A, Das, Gupta, Das, R, Neves, J, Dasa, Tt, Davitoiu, Dv, De, La, Hoz, Fp, Leo, De, D, De, Neve, Jw, Steur, De, H, Degefa, Mg, Degenhardt, L, Deiparine, S, Demoz, Gt, Denova-Gutiérrez, E, Deribe, K, Dervenis, N, Des, Jarlais, Dey, S, Dharmaratne, Sd, Dhimal, M, Dinberu, Mt, Dirac, Ma, Djalalinia, S, Doan, L, Dokova, K, Doku, Dt, Dorsey, Er, Doyle, Ke, Driscoll, Tr, Dubey, M, Dubljanin, E, Duken, Ee, Duncan, Bb, Duraes, Ar, Ebrahimi, H, Ebrahimpour, S, Echko, Mm, Edessa, D, Edvardsson, D, Effiong, A, Eggen, Ae, Ehrlich, Jr, Bcheraoui, El, C, El-Khatib, Z, Elyazar, Irf, Enayati, A, Endalifer, Ml, Endries, Ay, Er, B, Erskine, He, Eskandarieh, S, Esteghamati, A, Esteghamati, S, Fakhim, H, Faramarzi, M, Fareed, M, Farhadi, F, Farid, Ta, Farinha, Cses, Farioli, A, Faro, A, Farzadfar, F, Fazaeli, Aa, Feigin, Vl, Fentahun, N, Fereshtehnejad, Sm, Fernandes, E, Fernandes, Jc, Ferrari, Aj, Ferreira, Ml, Filip, I, Fischer, F, Fitzmaurice, C, Foigt, Na, Foreman, Kj, Frank, Td, Fukumoto, T, Fullman, N, Fürst, T, Furtado, Jm, Gakidou, E, Gall, S, Gallus, S, Ganji, M, Garcia-Basteiro, Al, Gardner, Wm, Gebre, Ak, Gebremedhin, At, Gebremichael, Tg, Gelano, Tf, Geleijnse, Jm, Genova-Maleras, R, Geramo, Ycd, Gething, Pw, Gezae, Ke, Ghadami, Mr, Ghadiri, K, Ghasemi-Kasman, M, Ghimire, M, Ghoshal, Ag, Gill, Ps, Gill, Tk, Ginawi, Ia, Giussani, G, Gnedovskaya, Ev, Goldberg, Em, Goli, S, Gómez-Dantés, H, Gona, Pn, Gopalani, Sv, Gorman, Tm, Goulart, Ac, Goulart, Bng, Grada, A, Grosso, G, Gugnani, Hc, Guillemin, F, Guo, Y, Gupta, Pc, Gupta, R, Gupta, T, Gutiérrez, Ra, Gyawali, B, Haagsma, Ja, Hachinski, V, Hafezi-Nejad, N, Haghparast, Bidgoli, Hagos, Tb, Hailegiyorgis, Tt, Haj-Mirzaian, A, Hamadeh, Rr, Hamidi, S, Handal, Aj, Hankey, Gj, Hao, Y, Harb, Hl, Harikrishnan, S, Haririan, H, Haro, Jm, Hassankhani, H, Hassen, Hy, Havmoeller, R, Hay, Rj, Hay, Si, Hedayatizadeh-Omran, A, Heibati, B, Hendrie, D, Henok, A, Heredia-Pi, I, Herteliu, C, Heydarpour, F, Heydarpour, P, Hibstu, Dt, Hoek, Hw, Hoffman, Hj, Hole, Mk, Homaie, Rad, E, Hoogar, P, Hosgood, Hd, Hosseini, Sm, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Hotez, Pj, Hoy, Dg, Hsairi, M, Htet, As, Huang, Jj, Iburg, Km, Ikeda, Ct, Ilesanmi, Os, Irvani, Ssn, Irvine, Cms, Islam, Sms, Islami, F, Jacobsen, Kh, Jahangiry, L, Jahanmehr, N, Jain, Sk, Jakovljevic, M, James, Sl, Jayatilleke, Au, Jeemon, P, Jha, Rp, Jha, V, Js, Ji, Johnson, Co, Jonas, Jb, Jonnagaddala, J, Jorjoran, Shushtari, Z, Joshi, A, Jozwiak, Jj, Jungari, Sb, Jürisson, M, Kabir, Z, Kadel, R, Kahsay, A, Kalani, R, Kanchan, T, Kar, C, Karami, M, Karami, Matin, B, Karch, A, Karema, C, Karimi, N, Karimi, Sm, Kasaeian, A, Kassa, Dh, Kassa, Gm, Kassa, Td, Kassebaum, Nj, Katikireddi, Sv, Kaul, A, Kawakami, N, Kazemi, Z, Karyani, Ak, Keighobadi, Mm, Keiyoro, Pn, Kemmer, L, Kemp, Gr, Kengne, Ap, Keren, A, Khader, Ys, Khafaei, B, Khafaie, Ma, Khajavi, A, Khalid, N, Khalil, Ia, Khan, Ea, Khan, Ms, Khan, Ma, Khang, Yh, Khater, Mm, Khazaei, M, Khoja, At, Khosravi, A, Khosravi, Mh, Kiadaliri, Aa, Kidanemariam, Zt, Kiirithio, Dn, Kim, Ci, Kim, D, Kim, Ye, Kim, Yj, Kimokoti, Rw, Kinfu, Y, Kisa, A, Kissimova-Skarbek, K, Knudsen, Aks, Kocarnik, Jm, Kochhar, S, Kokubo, Y, Kolola, T, Kopec, Ja, Kosen, S, Kotsakis, Ga, Koul, Pa, Koyanagi, A, Krishan, K, Krishnaswami, S, Krohn, Kj, Kuate, Defo, Kucuk, B, Bicer, B, Kumar, Ga, Kumar, M, Kuzin, I, Lad, Dp, Lad, Sd, Lafranconi, A, Lalloo, R, Lallukka, T, Lami, Fh, Lang, Jj, Langan, Sm, Lansingh, Vc, Latifi, A, Lau, 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Subjects
Male, Health Status, health statu, HALE, mortality rate, communicable disease, DALYs, Global Burden of Disease, Risk Factors, Prevalence, Medicine and Health Sciences, Singapore, OUTCOMES, disability-adjusted life year, international cooperation, Medicine (all), 11 Medical And Health Sciences, Central African Republic, newborn disease, IRON-DEFICIENCY, AIDS, priority journal, Bahrain, disease severity, Female, Quality-Adjusted Life Years, cerebrovascular accident, Ukraine, Life Sciences & Biomedicine, INTERVENTIONS, Slovakia, DISORDERS, Burundi, WEIGHTS, GBD 2017 DALYs and HALE Collaborators, Communicable Diseases, Article, STYLE, Medicine, General & Internal, Life Expectancy, General & Internal Medicine, Humans, Disabled Persons, human, Healthy Lifestyle, HALE, DALYs, global burden of disease, Mortality, Aged, Science & Technology, Mortality, Premature, HIV, ischemic heart disease, major clinical study, PREVENTION, non communicable disease, GBD, disability-adjusted life-years, age, sex factor, Socioeconomic Factors, Algeria, Federation of Bosnia and Herzegovina, lower respiratory tract infection, Wounds and Injuries, GENDER, Human medicine, trend study, chronic obstructive lung disease
Abstract

Background How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7.4 years (95% uncertainty interval 74-7.8), from 65.6 years (65.3-65- 8) in 1990 to 73.0 years (72.7-73.3) in 2017. The increase in years of life varied from 5.1 years (5.0-5.3) in high SDI countries to 12.0 years (11.3-12.8) in low SDI countries. Of the additional years of life expected at birth, 26.3% (20.1-33.1) were expected to be spent in poor health in high SDI countries compared with 11.7% (8.8-15.1) in low-middle SDI countries. HALE at birth increased by 6.3 years (5.9-6.7), from 57.0 years (54.6-59.1) in 1990 to 63.3 years (60.5-65.7) in 2017. The increase varied from 3.8 years (3.4-4.1) in high SDI countries to 10.5 years (9.8-11.2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1.0 year (0.4-1.7) in Saint Vincent and the Grenadines (62.4 years [59.9-64.7] in 1990 to 63.5 years [60.9-65.8] in 2017) to 23.7 years (21.9-25.6) in Eritrea (30.7 years [28.9-32.2] in 1990 to 54.4 years [51.5-57.1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1.4 years (0.6-2.3) in Algeria to 11.9 years (10.9-12.9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75.8 years [72.4-78.7]) and males (72.6 years [69 " 8-75.0]) and the lowest estimates were in Central African Republic (47.0 years [43.7-50.2] for females and 42.8 years [40.1-45.6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41.3% (38.8-43.5) for communicable diseases and by 49"8% (47.9-51.6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40.1% (36.8-43.0), although age-standardised DALY rates decreased by 18.1% (16.0-20.2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low S DI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.

Published
2018

27. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050

Author

Angela Y. Chang, Krycia Cowling, Angela E. Micah, Abigail Chapin, Catherine S. Chen, Gloria Ikilezi, Nafis Sadat, Golsum Tsakalos, Junjie Wu, Theodore Younker, Yingxi Zhao, Bianca S. Zlavog, Cristiana Abbafati, Anwar E Ahmed, Khurshid Alam, Vahid Alipour, Syed Mohamed Aljunid, Mohammed J. Almalki, Nelson Alvis-Guzman, Walid Ammar, Catalina Liliana Andrei, Mina Anjomshoa, Carl Abelardo T. Antonio, Jalal Arabloo, Olatunde Aremu, Marcel Ausloos, Leticia Avila-Burgos, Ashish Awasthi, Martin Amogre Ayanore, Samad Azari, Natasha Azzopardi-Muscat, Mojtaba Bagherzadeh, Till Winfried Bärnighausen, Bernhard T Baune, Mohsen Bayati, Yared Belete Belay, Yihalem Abebe Belay, Habte Belete, Dessalegn Ajema Berbada, Adam E. Berman, Mircea Beuran, Ali Bijani, Reinhard Busse, Lucero Cahuana-Hurtado, Luis Alberto Cámera, Ferrán Catalá-López, Bal Govind Chauhan, Maria-Magdalena Constantin, Christopher Stephen Crowe, Alexandra Cucu, Koustuv Dalal, Jan-Walter De Neve, Selina Deiparine, Feleke Mekonnen Demeke, Huyen Phuc Do, Manisha Dubey, Maha El Tantawi, Sharareh Eskandarieh, Reza Esmaeili, Mahdi Fakhar, Ali Akbar Fazaeli, Florian Fischer, Nataliya A. Foigt, Takeshi Fukumoto, Nancy Fullman, Adriana Galan, Amiran Gamkrelidze, Kebede Embaye Gezae, Alireza Ghajar, Ahmad Ghashghaee, Ketevan Goginashvili, Annie Haakenstad, Hassan Haghparast Bidgoli, Samer Hamidi, Hilda L. Harb, Edris Hasanpoor, Hamid Yimam Hassen, Simon I. Hay, Delia Hendrie, Andualem Henok, Ileana Heredia-Pi, Claudiu Herteliu, Chi Linh Hoang, Michael K. Hole, Enayatollah Homaie Rad, Naznin Hossain, Mehdi Hosseinzadeh, Sorin Hostiuc, Olayinka Stephen Ilesanmi, Seyed Sina Naghibi Irvani, Mihajlo Jakovljevic, Amir Jalali, Spencer L. James, Jost B. Jonas, Mikk Jürisson, Rajendra Kadel, Behzad Karami Matin, Amir Kasaeian, Habtamu Kebebe Kasaye, Mesfin Wudu Kassaw, Ali Kazemi Karyani, Roghayeh Khabiri, Junaid Khan, Md Nuruzzaman Khan, Young-Ho Khang, Adnan Kisa, Katarzyna Kissimova-Skarbek, Stefan Kohler, Ai Koyanagi, Kristopher J. Krohn, Ricky Leung, Lee-Ling Lim, Stefan Lorkowski, Azeem Majeed, Reza Malekzadeh, Morteza Mansourian, Lorenzo Giovanni Mantovani, Benjamin Ballard Massenburg, Martin McKee, Varshil Mehta, Atte Meretoja, Tuomo J Meretoja, Neda Milevska Kostova, Ted R Miller, Erkin M Mirrakhimov, Bahram Mohajer, Aso Mohammad Darwesh, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Shane Douglas Morrison, Seyyed Meysam Mousavi, Saravanan Muthupandian, Ahamarshan Jayaraman Nagarajan, Vinay Nangia, Ionut Negoi, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Son Hoang Nguyen, Shirin Nosratnejad, Olanrewaju Oladimeji, Stefano Olgiati, Jacob Olusegun Olusanya, Obinna E Onwujekwe, Stanislav S Otstavnov, Adrian Pana, David M. Pereira, Bakhtiar Piroozi, Sergio I Prada, Mostafa Qorbani, Mohammad Rabiee, Navid Rabiee, Alireza Rafiei, Fakher Rahim, Vafa Rahimi-Movaghar, Usha Ram, Chhabi Lal Ranabhat, Anna Ranta, David Laith Rawaf, Salman Rawaf, Satar Rezaei, Elias Merdassa Roro, Ali Rostami, Salvatore Rubino, Mohamadreza Salahshoor, Abdallah M. Samy, Juan Sanabria, João Vasco Santos, Milena M Santric Milicevic, Bruno Piassi Sao Jose, Miloje Savic, Falk Schwendicke, Sadaf G. Sepanlou, Masood Sepehrimanesh, Aziz Sheikh, Mark G Shrime, Solomon Sisay, Shahin Soltani, Moslem Soofi, Vinay Srinivasan, Rafael Tabarés-Seisdedos, Anna Torre, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Khanh Bao Tran, Eduardo A. Undurraga, Pascual R Valdez, Job F M van Boven, Veronica Vargas, Yousef Veisani, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Sebastian Vollmer, Giang Thu Vu, Charles D A Wolfe, Naohiro Yonemoto, Mustafa Z. Younis, Mahmoud Yousefifard, Sojib Bin Zaman, Alireza Zangeneh, Elias Asfaw Zegeye, Arash Ziapour, Adrienne Chew, Christopher J L Murray, Joseph L Dieleman, Chang A.Y., Cowling K., Micah A.E., Chapin A., Chen C.S., Ikilezi G., Sadat N., Tsakalos G., Wu J., Younker T., Zhao Y., Zlavog B.S., Abbafati C., Ahmed A.E., Alam K., Alipour V., Aljunid S.M., Almalki M.J., Alvis-Guzman N., Ammar W., Andrei C.L., Anjomshoa M., Antonio C.A.T., Arabloo J., Aremu O., Ausloos M., Avila-Burgos L., Awasthi A., Ayanore M.A., Azari S., Azzopardi-Muscat N., Bagherzadeh M., Barnighausen T.W., Baune B.T., Bayati M., Belay Y.B., Belay Y.A., Belete H., Berbada D.A., Berman A.E., Beuran M., Bijani A., Busse R., Cahuana-Hurtado L., Camera L.A., Catala-Lopez F., Chauhan B.G., Constantin M.-M., Crowe C.S., Cucu A., Dalal K., De Neve J.-W., Deiparine S., Demeke F.M., Do H.P., Dubey M., El Tantawi M., Eskandarieh S., Esmaeili R., Fakhar M., Fazaeli A.A., Fischer F., Foigt N.A., Fukumoto T., Fullman N., Galan A., Gamkrelidze A., Gezae K.E., Ghajar A., Ghashghaee A., Goginashvili K., Haakenstad A., Haghparast Bidgoli H., Hamidi S., Harb H.L., Hasanpoor E., Hassen H.Y., Hay S.I., Hendrie D., Henok A., Heredia-Pi I., Herteliu C., Hoang C.L., Hole M.K., Homaie Rad E., Hossain N., Hosseinzadeh M., Hostiuc S., Ilesanmi O.S., Irvani S.S.N., Jakovljevic M., Jalali A., James S.L., Jonas J.B., Jurisson M., Kadel R., Karami Matin B., Kasaeian A., Kasaye H.K., Kassaw M.W., Kazemi Karyani A., Khabiri R., Khan J., Khan M.N., Khang Y.-H., Kisa A., Kissimova-Skarbek K., Kohler S., Koyanagi A., Krohn K.J., Leung R., Lim L.-L., Lorkowski S., Majeed A., Malekzadeh R., Mansourian M., Mantovani L.G., Massenburg B.B., McKee M., Mehta V., Meretoja A., Meretoja T.J., Milevska Kostova N., Miller T.R., Mirrakhimov E.M., Mohajer B., Mohammad Darwesh A., Mohammed S., Mohebi F., Mokdad A.H., Morrison S.D., Mousavi S.M., Muthupandian S., Nagarajan A.J., Nangia V., Negoi I., Nguyen C.T., Nguyen H.L.T., Nguyen S.H., Nosratnejad S., Oladimeji O., Olgiati S., Olusanya J.O., Onwujekwe O.E., Otstavnov S.S., Pana A., Pereira D.M., Piroozi B., Prada S.I., Qorbani M., Rabiee M., Rabiee N., Rafiei A., Rahim F., Rahimi-Movaghar V., Ram U., Ranabhat C.L., Ranta A., Rawaf D.L., Rawaf S., Rezaei S., Roro E.M., Rostami A., Rubino S., Salahshoor M., Samy A.M., Sanabria J., Santos J.V., Santric Milicevic M.M., Sao Jose B.P., Savic M., Schwendicke F., Sepanlou S.G., Sepehrimanesh M., Sheikh A., Shrime M.G., Sisay S., Soltani S., Soofi M., Srinivasan V., Tabares-Seisdedos R., Torre A., Tovani-Palone M.R., Tran B.X., Tran K.B., Undurraga E.A., Valdez P.R., van Boven J.F.M., Vargas V., Veisani Y., Violante F.S., Vladimirov S.K., Vlassov V., Vollmer S., Vu G.T., Wolfe C.D.A., Yonemoto N., Younis M.Z., Yousefifard M., Zaman S.B., Zangeneh A., Zegeye E.A., Ziapour A., Chew A., Murray C.J.L., Dieleman J.L., Global Burden Dis Hlth Financing C, Bill & Melinda Gates Foundation, Chang, A, Cowling, K, Micah, A, Chapin, A, Chen, C, Ikilezi, G, Sadat, N, Tsakalos, G, Wu, J, Younker, T, Zhao, Y, Zlavog, B, Abbafati, C, Ahmed, A, Alam, K, Alipour, V, Aljunid, S, Almalki, M, Alvis-Guzman, N, Ammar, W, Andrei, C, Anjomshoa, M, Antonio, C, Arabloo, J, Aremu, O, Ausloos, M, Avila-Burgos, L, Awasthi, A, Ayanore, M, Azari, S, Azzopardi-Muscat, N, Bagherzadeh, M, Barnighausen, T, Baune, B, Bayati, M, Belay, Y, Belete, H, Berbada, D, Berman, A, Beuran, M, Bijani, A, Busse, R, Cahuana-Hurtado, L, Camera, L, Catala-Lopez, F, Chauhan, B, Constantin, M, Crowe, C, Cucu, A, Dalal, K, De Neve, J, Deiparine, S, Demeke, F, Do, H, Dubey, M, Tantawi, M, Eskandarieh, S, Esmaeili, R, Fakhar, M, Fazaeli, A, Fischer, F, Foigt, N, Fukumoto, T, Fullman, N, Galan, A, Gamkrelidze, A, Gezae, K, Ghajar, A, Ghashghaee, A, Goginashvili, K, Haakenstad, A, Bidgoli, H, Hamidi, S, Harb, H, Hasanpoor, E, Hassen, H, Hay, S, Hendrie, D, Henok, A, Heredia-Pi, I, Herteliu, C, Hoang, C, Hole, M, Rad, E, Hossain, N, Hosseinzadeh, M, Hostiuc, S, Ilesanmi, O, Irvani, S, Jakovljevic, M, Jalali, A, James, S, Jonas, J, Jurisson, M, Kadel, R, Matin, B, Kasaeian, A, Kasaye, H, Kassaw, M, Karyani, A, Khabiri, R, Khan, J, Khan, M, Khang, Y, Kisa, A, Kissimova-Skarbek, K, Kohler, S, Koyanagi, A, Krohn, K, Leung, R, Lim, L, Lorkowski, S, Majeed, A, Malekzadeh, R, Mansourian, M, Mantovani, L, Massenburg, B, Mckee, M, Mehta, V, Meretoja, A, Meretoja, T, Kostova, N, Miller, T, Mirrakhimov, E, Mohajer, B, Darwesh, A, Mohammed, S, Mohebi, F, Mokdad, A, Morrison, S, Mousavi, S, Muthupandian, S, Nagarajan, A, Nangia, V, Negoi, I, Nguyen, C, Nguyen, H, Nguyen, S, Nosratnejad, S, Oladimeji, O, Olgiati, S, Olusanya, J, Onwujekwe, O, Otstavnov, S, Pana, A, Pereira, D, Piroozi, B, Prada, S, Qorbani, M, Rabiee, M, Rabiee, N, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Ram, U, Ranabhat, C, Ranta, A, Rawaf, D, Rawaf, S, Rezaei, S, Roro, E, Rostami, A, Rubino, S, Salahshoor, M, Samy, A, Sanabria, J, Santos, J, Milicevic, M, Jose, B, Savic, M, Schwendicke, F, Sepanlou, S, Sepehrimanesh, M, Sheikh, A, Shrime, M, Sisay, S, Soltani, S, Soofi, M, Srinivasan, V, Tabares-Seisdedos, R, Torre, A, Tovani-Palone, M, Tran, B, Tran, K, Undurraga, E, Valdez, P, Van Boven, J, Vargas, V, Veisani, Y, Violante, F, Vladimirov, S, Vlassov, V, Vollmer, S, Vu, G, Wolfe, C, Yonemoto, N, Younis, M, Yousefifard, M, Zaman, S, Zangeneh, A, Zegeye, E, Ziapour, A, Chew, A, Murray, C, and Dieleman, J

Subjects
health financing, coverage, 030204 cardiovascular system & hematology, systematic analysis, Global Health, Gross domestic product, DISEASE, burden, project, 0302 clinical medicine, Per capita, Global health, Healthcare Financing, 030212 general & internal medicine, our of pocket, 11 Medical and Health Sciences, Government spending, government, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Public Assistance, COVERAGE, Models, Economic, 8. Economic growth, health financing, project, government, our of pocket, BURDEN, Life Sciences & Biomedicine, Human, Gross Domestic Product, Department of Error, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, SYSTEMATIC ANALYSIS, Revenue, Humans, medicine (all), Health policy, Finance, sex-specific mortality, Government, disease, Science & Technology, SEX-SPECIFIC MORTALITY, business.industry, Prepaid Health Plan, International health, Global Burden of Disease Health Financing Collaborator Network, Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Human medicine, Health Expenditures, business, Prepaid Health Plans
Abstract

Published Erratum. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet. 2021 Sep 11;398(10304):956. doi: 10.1016/S0140-6736(21)01806-7. PMID: 34509230. BACKGROUND: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS: Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION: Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING: Bill & Melinda Gates Foundation. Bill & Melinda Gates Foundation Sí

Published
2019
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28. Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child nutritional outcomes in rural Odisha, India: study protocol for a cluster randomised controlled trial

Author

Kadiyala, Suneetha, Prost, Audrey, Harris-Fry, Helen, O’Hearn, Meghan, Pradhan, Ronali, Pradhan, Shibananth, Mishra, Naba Kishore, Rath, Suchitra, Nair, Nirmala, Rath, Shibanand, Tripathy, Prasantha, Krishnan, Sneha, Koniz-Booher, Peggy, Danton, Heather, Elbourne, Diana, Sturgess, Joanna, Beaumont, Emma, Haghparast-Bidgoli, Hassan, Skordis-Worrall, Jolene, Mohanty, Satyanarayan, Upadhay, Avinash, and Allen, Elizabeth

Subjects
Adult, Crops, Agricultural, Male, Adolescent, Video Recording, India, Nutritional Status, Rural Health, Recommended Dietary Allowances, Women’s groups, Participatory Learning and Action, Trial, Peer Group, Videos, Body Mass Index, Food Supply, Agricultural extension, Study Protocol, Young Adult, Pregnancy, Digital technology, Humans, Multicenter Studies as Topic, Maternal nutrition, Infant Nutritional Physiological Phenomena, Randomized Controlled Trials as Topic, Child nutrition, lcsh:R5-920, Dietary diversity, Malnutrition, Infant, Newborn, Portion Size, Infant, Agriculture, Maternal Nutritional Physiological Phenomena, Middle Aged, Infant Nutrition Disorders, House Calls, Female, Rural Health Services, Diet, Healthy, lcsh:Medicine (General), Nutritive Value
Abstract

Background Maternal and child undernutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality, and they are associated with low educational attainment, economic productivity as an adult, and human wellbeing. ‘Nutrition-sensitive’ agriculture programs could tackle the underlying causes of undernutrition. Methods/design This study is a four-arm cluster randomised controlled trial in Odisha, India. Interventions are as follows: (1) an agricultural extension platform of women’s groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; (2) women’s groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and (3) women’s groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions, are (1) percentage of children aged 6–23 months consuming ≥ 4 out of 7 food groups per day and (2) mean body mass index (BMI) (kg/m2) of non-pregnant, non-postpartum (gave birth > 42 days ago) mothers or female primary caregivers of children aged 0–23 months. Secondary outcomes are percentage of mothers consuming ≥ 5 out of 10 food groups per day and percentage of children’s weight-for-height z-score 70%) proportion of Scheduled Tribe or Scheduled Caste (disadvantaged) households. A process evaluation will assess the quality of implementation and mechanisms behind the intervention effects. A cost-consequence analysis will compare incremental costs and outcomes of the interventions. Discussion This trial will contribute evidence on the impacts of NSA extension through participatory, low-cost, video-based approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts. Trial registration ISRCTN , ISRCTN65922679. Registered on 21 December 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2521-y) contains supplementary material, which is available to authorized users.

Published
2018
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29. Global Mortality From Firearms, 1990-2016

Author

Leticia Avila-Burgos, Mahdi Safdarian, Devina Nand, Tim Driscoll, David C. Schwebel, Andrew T Olagunju, Saeid Safiri, Vasily Vlassov, Dina Nur Anggraini Ningrum, Jost B. Jonas, Reyna A Gutiérrez, Delia Hendrie, Fentaw Tadese, Jagdish Khubchandani, Gessessew Bugssa Hailu, Bach Xuan Tran, Mekonnen Sisay, Amanda J. Mason-Jones, Mu'awiyyah Babale Sufiyan, Tommi Vasankari, Kyle J Foreman, Kristopher J. Krohn, Haftay Berhane Mezgebe, Christian Kieling, Nadia Akseer, Maheswar Satpathy, Reza Assadi, Christopher J L Murray, Tsegaye Tewelde Gebrehiwot, Ali Rowhani-Rahbar, Rakhi Dandona, Sudha Jayaraman, Rintaro Mori, Mustafa Z. Younis, Tesfay Mehari Atey, Ashish Awasthi, Amit Arora, Rodrigo Sarmiento-Suarez, Kingsley N. Ukwaja, Alan D. Lopez, Masoud Behzadifar, Ibrahim A Khalil, G Anil Kumar, George C Patton, Nancy Fullman, Nigussie Tadesse Sharew, André Faro, Guoqing Hu, Yousef Khader, Benn Sartorius, Suzanne Barker-Collo, Young-Ho Khang, Rajesh Sagar, Martha Híjar, Florian Fischer, Suliman Alghnam, Michael Kutz, Valery L. Feigin, Raimundas Lunevicius, Suzanne Polinder, Bryan L. Sykes, Van C. Lansingh, Adauto Martins Soares Filho, Mamta Swaroop, Jasvinder A. Singh, Mohsen Asadi-Lari, Afarin Rahimi-Movaghar, Spencer L. James, Alireza Esteghamati, Theo Vos, Tuomo J. Meretoja, Soewarta Kosen, Kerrie E. Doyle, Michael R. Phillips, Amaha Kahsay, Miloud Taki Eddine Aichour, Samath D Dharmaratne, James R. Bennett, Rohan Borschmann, Muhammed Magdy Abd El Razek, Rafael Tabarés-Seisdedos, Joseph S Salama, Salman Rawaf, Hamid Yimam Hassen, Heidi J. Larson, Ted R. Miller, Caitlin Hawley, Beatriz Paulina Ayala Quintanilla, Katya Anne Shackelford, Lalit Dandona, Vafa Rahimi-Movaghar, Aman Yesuf Endries, Guilherme Borges, Carlos A Castañeda-Orjuela, Shahrzad Bazargan-Hejazi, Soraya Seedat, Paul S. F. Yip, Juan Sanabria, Maziar Moradi-Lakeh, Farshad Pourmalek, Olayinka Stephen Ilesanmi, Masood Ali Shaikh, Mahfuzar Rahman, Richard Matzopoulos, Richard C. Franklin, Huyen Phuc Do, Mostafa Qorbani, Eric L. Ding, Mark A. Stokes, Rajaa Al-Raddadi, Stephen S Lim, Tung Thanh Tran, Dan J. Stein, Naohiro Yonemoto, Mohsen Naghavi, Vegard Skirbekk, Chhabi Lal Ranabhat, Walter Mendoza, Arebu Issa Bilal, Pengpeng Ye, Shai Linn, Ali H. Mokdad, Alexandra Brazinova, Nima Hafezi-Nejad, Julio Cesar Campuzano Rincon, Ashish Bhalla, Simon I. Hay, Deborah Carvalho Malta, David Teye Doku, Ivy Shiue, Farshad Farzadfar, Shafiu Mohammed, Aliasghar Ahmad Kiadaliri, Molly K. Miller-Petrie, Khurshid Alam, Milena M Santric Milicevic, Dumessa Edessa, Quyen Nguyen, Rajesh Kumar Rai, Paul I. Dargan, Reza Malekzadeh, Olatunde Aremu, David Laith Rawaf, Zoubida Zaidi, Hassan Magdy Abd El Razek, Carl Abelardo T. Antonio, Meysam Behzadifar, Josep Maria Haro, Ziad El-Khatib, Cuong Tat Nguyen, Laurie B. Marczak, Peter Njenga Keiyoro, Andrea Werdecker, Megha Arora, Neal D. Futran, Maysaa El Sayed Zaki, Diego De Leo, Faris Lami, Hassan Haghparast Bidgoli, Amir Kasaeian, Peter Memiah, Zulfiqar A Bhutta, Till Bärnighausen, Sadaf G. Sepanlou, Felix Akpojene Ogbo, Mihajlo Jakovljevic, Félix Carvalho, Yun Jin Kim, Global Burden Dis 2016 Injury Col, Universitat de Barcelona, and Public Health

Subjects
Male, Global Health, 01 natural sciences, 0302 clinical medicine, Firearm injury, Armas de Fuego, Homicide, Global health, Medicine, 030212 general & internal medicine, Young adult, Child, Aged, 80 and over, Mortality rate, Armes de foc, 11 Medical And Health Sciences, General Medicine, Middle Aged, 16. Peace & justice, Firearm suicide, Suicide, Gun ownership, Child, Preschool, Violencia, Female, Adult, Firearms, Adolescent, Uncertainty interval, Violence, Young Adult, 03 medical and health sciences, Age Distribution, General & Internal Medicine, Mortalitat, Humans, Vital registration, Suicidio, Sex Distribution, 0101 mathematics, Mortality, Aged, business.industry, 010102 general mathematics, Infant, Newborn, Infant, Heridas por Arma de Fuego, Homicidio, Mortalidad, Wounds, Gunshot, Human medicine, business, Demography
Abstract

IMPORTANCE: Understanding global variation in firearm mortality rates could guide prevention policies and interventions. OBJECTIVE: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. DESIGN, SETTING, AND PARTICIPANTS: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. EXPOSURES: Firearm ownership and access. MAIN OUTCOMES AND MEASURES: Cause-specific deaths by age, sex, location, and year. RESULTS: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P

Published
2018

30. The REFANI-S study protocol: a non-randomised cluster controlled trial to assess the role of an unconditional cash transfer, a non-food item kit, and free piped water in reducing the risk of acute malnutrition among children aged 6–59 months living in camps for internally displaced persons in the Afgooye corridor, Somalia

Author

Jelle, Mohamed, Grijalva-Eternod, Carlos S, Haghparast-Bidgoli, Hassan, King, Sarah, Cox, Cassy L, Skordis-Worrall, Jolene, Morrison, Joanna, Colbourn, Timothy, Fottrell, Edward, and Seal, Andrew J

Subjects
Male, Somalia, Child Nutrition Disorders, Food Supply, Population Groups, Risk Factors, Water Supply, Surveys and Questionnaires, Study protocol, Prevalence, Humans, Acute malnutrition, Internally displaced persons, Children, Family Characteristics, Refugees, lcsh:Public aspects of medicine, Malnutrition, Infant, lcsh:RA1-1270, Public Assistance, Food security, Focus Groups, Diet, Wasting, Research Design, Child, Preschool, Female, Food Assistance, Emergencies, Cash transfer
Abstract

Background The prevalence of acute malnutrition is often high in emergency-affected populations and is associated with elevated mortality risk and long-term health consequences. Increasingly, cash transfer programmes (CTP) are used instead of direct food aid as a nutritional intervention, but there is sparse evidence on their nutritional impact. We aim to understand whether CTP reduces acute malnutrition and its known risk factors. Methods/design A non-randomised, cluster-controlled trial will assess the impact of an unconditional cash transfer of US$84 per month for 5 months, a single non-food items kit, and free piped water on the risk of acute malnutrition in children, aged 6–59 months. The study will take place in camps for internally displaced persons (IDP) in peri-urban Mogadishu, Somalia. A cluster will consist of one IDP camp and 10 camps will be allocated to receive the intervention based on vulnerability targeting criteria. The control camps will then be selected from the same geographical area. Needs assessment data indicates small differences in vulnerability between camps. In each trial arm, 120 households will be randomly sampled and two detailed household surveys will be implemented at baseline and 3 months after the initiation of the cash transfer. The survey questionnaire will cover risk factors for malnutrition including household expenditure, assets, food security, diet diversity, coping strategies, morbidity, WASH, and access to health care. A community surveillance system will collect monthly mid-upper arm circumference measurements from all children aged 6–59 months in the study clusters to assess the incidence of acute malnutrition over the duration of the intervention. Process evaluation data will be compiled from routine quantitative programme data and primary qualitative data collected using key informant interviews and focus group discussions. The UK Department for International Development will provide funding for this study. The European Civil Protection and Humanitarian Aid Operations will fund the intervention. Concern Worldwide will implement the intervention as part of their humanitarian programming. Discussion This non-randomised cluster controlled trial will provide needed evidence on the role of unconditional CTP in reducing the risk of acute malnutrition among IDP in this context. Trial registration ISRCTN29521514 . Registered 19 January 2016.

Published
2017
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31. Participatory learning and action to address type 2 diabetes in rural Bangladesh: a qualitative process evaluation

Author

Kohenour Akter, Edward Fottrell, Tasmin Nahar, Kishwar Azad, Sanjit Kumer Shaha, Hassan Haghparast-Bidgoli, Abdul Kuddus, Naveed Ahmed, Anthony Costello, Joanna Morrison, A.K.Azad Khan, Carina King, and Hannah Jennings

Subjects
Male, Rural Population, Health Knowledge, Attitudes, Practice, Endocrinology, Diabetes and Metabolism, Health Behavior, Psychological intervention, lcsh:Diseases of the endocrine glands. Clinical endocrinology, 0302 clinical medicine, Photovoice, Medicine, 030212 general & internal medicine, Cluster randomised controlled trial, 10. No inequality, Qualitative Research, Randomised controlled trial, Bangladesh, Diabetes, 1. No poverty, Behaviour change, General Medicine, Non-communicable disease, Prognosis, 3. Good health, Research Design, Female, 0305 other medical science, Qualitative, Research Article, Community-Based Participatory Research, Health literacy, Context (language use), Theory of change, Process evaluation, 03 medical and health sciences, Social support, Nursing, Patient Education as Topic, Humans, Exercise, Aged, Retrospective Studies, lcsh:RC648-665, 030505 public health, business.industry, Focus group, Self Care, Diabetes Mellitus, Type 2, business, Follow-Up Studies
Abstract

Background Diabetes is 7th largest cause of death worldwide, and prevalence is increasing rapidly in low-and middle-income countries. There is an urgent need to develop and test interventions to prevent and control diabetes and develop the theory about how such interventions can be effective. We conducted a participatory learning and action (PLA) intervention with community groups in rural Bangladesh which was evaluated through a cluster randomised controlled trial. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group. We present findings from qualitative process evaluation research to explore how this intervention was effective. Methods We conducted group interviews and focus group discussions using photovoice with purposively sampled group attenders and non-attenders, and intervention implementers. Data were collected before the trial analysis. We used inductive content analysis to generate theory from the data. Results The intervention increased the health literacy of individuals and communities - developing their knowledge, capacity and self-confidence to enact healthy behaviours. Community, household and individual capacity increased through social support and social networks, which then created an enabling community context, further strengthening agency and enabling community action. This increased opportunities for healthy behaviour. Community actions addressed lack of awareness about diabetes, gendered barriers to physical activity and lack of access to blood glucose testing. The interaction between the individual, household, and community contexts amplified change, and yet there was limited engagement with macro level, or ‘state’, barriers to healthy behaviour. Conclusions The participatory approach enabled groups to analyse how context affected their ability to have healthy behaviours and participants engaged with issues as a community in the ways that they felt comfortable. We suggest measuring health literacy and social networks in future interventions and recommend specific capacity strengthening to develop public accountability mechanisms and health systems strengthening to complement community-based interventions. Trial registration Registered at ISRCTN on 30th March 2016 (Retrospectively Registered) Registration number: ISRCTN41083256.

Published
2019

32. Gendered perceptions of physical activity and diabetes in rural Bangladesh: a qualitative study to inform mHealth and community mobilization interventions

Author

Sanjit Kumer Shaha, Jenevieve Mannell, Hannah Jennings, Kohenour Akter, Kishwar Azad, Abdul Kuddus, Joanna Morrison, Anthony Costello, Tasmin Nahar, Edward Fottrell, Hassan Haghparast-Bidgoli, A.K.Azad Khan, and Naveed Ahmed

Subjects
Gerontology, Adult, Male, Rural Population, Health Knowledge, Attitudes, Practice, media_common.quotation_subject, Control (management), Culture, Health Behavior, Psychological intervention, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Perception, Humans, 030212 general & internal medicine, mHealth, Exercise, Qualitative Research, media_common, Bangladesh, Motivation, 030503 health policy & services, Citizen journalism, Focus Groups, Middle Aged, Focus group, Telemedicine, Community mobilization, Diabetes Mellitus, Type 2, Female, 0305 other medical science, Psychology, Qualitative research
Abstract

Background Diabetes prevalence is increasing rapidly in Bangladesh, and there is an urgent need to promote preventive behaviours for type 2 diabetes, such as maintaining a healthy body weight, eating healthily, avoiding tobacco and being active for 150 minutes per week. Methods We used a qualitative methodology informed by the capability, opportunity, motivation theory of behaviour change to explore the factors affecting physical activity among men and women in rural Bangladesh. We conducted semi-structured interviews and focus group discussions with 64 purposively sampled participants with and without diabetes, and five health workers. From the results of descriptive content analysis, we identified key capabilities, opportunities and motivations to engage with in our mHealth and community mobilization interventions. Results Men and women without diabetes lacked awareness about the need to remain physically active to prevent diabetes, and most felt that their activity levels were sufficient. Housework was not commonly perceived as physical activity among all respondents. These knowledge and capability gaps could be addressed through mHealth messaging and community mobilization providing information on sufficiency and types of physical activity to prevent and control diabetes. Men were physically active while working outside the home, whereas women felt unsafe and conspicuous, and were constrained by family commitments and social expectations of appropriate behaviour. Women engaged in strategies to protect their own and their family’s reputations. These opportunity factors affecting physical activity indicated the need for strategies developed through participatory processes to challenge unhealthy gender norms and increase women’s safety. Conclusion Formative research data can enable the development of contextually relevant interventions. Data show that mHealth interventions should consider gendered barriers to physical activity, tailoring information to meet men’s and women’s needs, and that community mobilization interventions should enable unhealthy, gendered community norms to be challenged. Participatory interventions can enable communities to push the boundaries of socially acceptable behaviours to increase physical activity, helping to prevent and control diabetes.

Published
2019

33. Process evaluation in the field: global learnings from seven implementation research hypertension projects in low-and middle-income countries

Author

Limbani, Felix, Goudge, Jane, Joshi, Rohina, Maar, Marion A., Miranda, J. Jaime, Oldenburg, Brian, Parker, Gary, Pesantes, Maria Amalia, Riddell, Michaela A., Salam, Abdul, Trieu, Kathy, Thrift, Amanda G., van Olmen, Josefien, Vedanthan, Rajesh, Webster, Ruth, Yeates, Karen, Webster, Jacqui, Pozas, Alfonso Fernandez, Patel, Anushka, Pillay, Arti, Cotrez, Briana, Salinas, Carlos Aguilar, Nowson, Caryl, Johnson, Claire, Villalpando, Clicerio Gonzalez, Garcia-Ulloa, Cristina, Litzelman, Debra, Praveen, Devarsetty, Hua, Diane, Kakoulis, Dimitrios, Fottrell, Ed, Vucovich, Elsa Cornejo, Salazar, Francisco Gonzalez, Musa, Hadi, Chemusto, Harriet, Haghparast-Bidgoli, Hassan, Mutabazi, Jean Claude, Schultz, Jimaima, Odenkirchen, Joanne, Zavala-Loayza, Jose, Gyamfi, Joyce, Bobrow, Kirsty, Neira, Leticia, Maple-Brown, Louise, Lazo, Maria, Daivadanam, Meena, Wijemanne, Nilmini, Almeda-Valdes, Paloma, Camacho-Lopez, Paul, Delobelle, Peter, Zhang, Puhong, Saulson, Raelle, Guggilla, Rama, Kirkham, Renae, Angeles, Ricardo, Mohan, Sailesh, Tobe, Sheldon, Jha, Sujeet, Lei, Sun, Irazola, Vilma, Ma, Yuan, Shenderovich, Yulia, Public Health Sciences, and The Global Alliance for Chronic Diseases, Process Evaluation Working Group

Subjects
Male, Process management, purl.org/pe-repo/ocde/ford#3.03.05 [https], COMPLEX INTERVENTIONS, PROCESS EVALUATION, Psychological intervention, MIXED-METHODS, Process Assessment (Health Care)/methods, 0302 clinical medicine, IMPLEMENTATION SCIENCE, middle aged, Medicine, 030212 general & internal medicine, media_common, Process Assessment (Health Care), Clinical Trials as Topic, lcsh:Public aspects of medicine, Process Assessment, Health Care, Capacity building, Public Health, Global Health, Social Medicine and Epidemiology, clinical trial (topic), Middle Aged, 3. Good health, female, health care quality, Hypertension, Implementation science, purl.org/becyt/ford/3 [https], Female, Research Article, Adult, Canada, Process (engineering), media_common.quotation_subject, Best practice, Fidelity, 030209 endocrinology & metabolism, Process evaluation, Indigenous, 03 medical and health sciences, purl.org/becyt/ford/3.3 [https], Complex interventions, LOW AND MIDDLE-INCOME COUNTRIES, Intervention (counseling), Humans, human, procedures, Developing Countries, Mixed-methods, HYPERTENSION, business.industry, Public Health, Environmental and Occupational Health, developing country, lcsh:RA1-1270, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Low and middle-income countries, Human medicine, Implementation research, business
Abstract

Background: Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD). Methods: Preliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified. Results: The case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effective communication between researchers responsible for trial implementation, process evaluation and outcome evaluation. Conclusion: This research demonstrates the important role of process evaluation in understanding implementation process of complex interventions. This can help to highlight a broad range of system requirements such as new policies and capacity building to support implementation. Process evaluation is crucial in understanding contextual factors that may impact intervention implementation which is important in considering whether or not the intervention can be translated to other contexts. Fil: Limbani, Felix. University of the Witwatersrand; Sudáfrica Fil: Goudge, Jane. University of the Witwatersrand; Sudáfrica Fil: Joshi, Rohina. University Of Technology Sydney.; Australia Fil: Maar, Marion A.. University of New South Wales; Australia Fil: Miranda, J. Jaime. Universidad Peruana Cayetano Heredia; Perú Fil: Oldenburg, Brian. University of Melbourne; Australia Fil: Parker, Gary. University College London; Estados Unidos Fil: Pesantes, Maria Amalia. Universidad Peruana Cayetano Heredia; Perú Fil: Riddell, Michaela A.. School Of Clinical Sciences At Monash Health; Australia Fil: Salam, Abdul. University of New South Wales; Australia Fil: Trieu, Kathy. University Of Technology Sydney.; Australia Fil: Thrift, Amanda G.. School Of Clinical Sciences At Monash Health; Australia Fil: Van Olmen, Josefien. Bernhard Nocht Institute For Tropical Medicine.; Alemania Fil: Vedanthan, Rajesh. University of New York; Estados Unidos Fil: Webster, Ruth. The George Institute For Global Health; Australia Fil: Yeates, Karen. Queens University; Canadá Fil: Webster, Jacqui. University Of Technology Sydney.; Australia Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina

Published
2019

34. A method for measuring spatial effects on socioeconomic inequalities using the concentration index

Author

Neha Batura, Sung Wook Kim, Jolene Skordis-Worrall, Hassan Haghparast-Bidgoli, and Stavros Petrou

Subjects
Male, Malawi, Inequality, Service delivery framework, media_common.quotation_subject, Probit, HIV Infections, Concentration index, 03 medical and health sciences, 0302 clinical medicine, Probit model, Econometrics, Humans, Mass Screening, 030212 general & internal medicine, Healthcare Disparities, Spatial analysis, Socioeconomic status, Health policy, media_common, Spatial Analysis, 030505 public health, Equity (economics), Health Policy, lcsh:Public aspects of medicine, Research, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, HIV testing, Geography, Socioeconomic Factors, Female, 0305 other medical science
Abstract

Background Although spatial effects contribute to inequalities in health care service utilisation and other health outcomes in low and middle income countries, there have been no attempts to incorporate the impact of neighbourhood effects into equity analyses based on concentration indices. This study aimed to decompose and estimate the contribution of spatial effects on inequalities in uptake of HIV tests in Malawi. Methods We developed a new method of reflecting spatial effects within the concentration index using a spatial weight matrix. Spatial autocorrelation is presented using a spatial lag model. We use data from the Malawi Demographic Health Survey (n = 24,562) to illustrate the new methodology. Need variables such as ‘Any STI last 12 month’, ‘Genital sore/ulcer’, ‘Genital discharge’ and non need variables such as Education, Literacy, Wealth, Marriage, and education were used in the concentration index. Using our modified concentration index that incorporates spatial effects, we estimate inequalities in uptake of HIV testing amongst both women and men living in Malawi in 2015–2016, controlling for need and non-need variables. Results For women, inequalities due to need variables were estimated at − 0.001 and − 0.0009 (pro-poor) using the probit and new spatial probit estimators, respectively, whereas inequalities due to non-need variables were estimated at 0.01 and 0.0068 (pro-rich) using the probit and new spatial probit estimators. The results suggest that spatial effects increase estimated inequalities in HIV uptake amongst women. Horizontal inequity was almost identical (0.0103 vs 0.0102) after applying the spatial lag model. For men, inequalities due to need variables were estimated at − 0.0002 using both the probit and new spatial probit estimators; however, inequalities due to non-need variables were estimated at − 0.006 and − 0.0074 for the probit and new spatial probit models. Horizontal inequity was the same for both models (− 0.0057). Conclusion Our findings suggest that men from lower socioeconomic groups are more likely to receive an HIV test after adjustment for spatial effects. This study develops a novel methodological approach that incorporates estimation of spatial effects into a common approach to equity analysis. We find that a significant component of inequalities in HIV uptake in Malawi driven by non-need factors can be explained by spatial effects. When the spatial model was applied, the inequality due to non need in Lilongwe for men and horizontal inequity in Salima for women changed the sign. This approach can be used to explore inequalities in other contexts and settings to better understand the impact of spatial effects on health service use or other health outcomes, impacting on recommendations for service delivery.

Published
2019

35. Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: a protocol for a systematic review

Author

Rinaldi, Giulia, Hijazi, Alexa, and Haghparast-Bidgoli, Hassan

Subjects
Diabetes and Endocrinology, Diabetes Mellitus, Type 2, Research Design, general diabetes, Cost-Benefit Analysis, Protocol, health economics, Humans, telemedicine, Systematic Reviews as Topic
Abstract

Introduction Type 2 diabetes mellitus (T2DM) remains one of the most common chronic diseases of adulthood which creates high degrees of morbidity and mortality worldwide. The incidence of T2DM continues to rise and recently, mHealth interventions have been increasingly used in the prevention, monitoring and management of T2DM. The aim of this study is to systematically review the published evidence on cost and cost-effectiveness of mHealth interventions for T2DM, as well as assess the quality of reporting of the evidence. Methods and analysis A comprehensive review of PubMed, EMBASE, Science Direct and Web of Science of articles published until January 2019 will be conducted. Included studies will be partial or full economic evaluations which provide cost or cost-effectiveness results for mHealth interventions targeting individuals diagnosed with, or at risk of, T2DM. The quality of reporting evidence will be assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results will be presented using a flowchart following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Graphical and tabulated representations of the results will be created for both descriptive and numerical results. The cost and cost-effectiveness values will be presented as reported by the original studies as well as converted into international dollars to allow comparability. As we are predicting heterogenous results, we will conduct a narrative and interpretive analysis of the data. Ethics and dissemination No formal approval or review of ethics is required for this systematic review as it will involve the collection and analysis of secondary data. This protocol follows the current PRISMA-P guidelines. The review will provide information on the cost and cost-effectiveness of mHealth interventions targeting T2DM. These results will be disseminated through publication and submission to conferences for presentations and posters. PROSPERO registration number CRD42019123476

Published
2019

36. Optima TB: A tool to help optimally allocate tuberculosis spending

Author

Henadz Hurevich, Jolene Skordis, David Wilson, Lara Goscé, Anna Roberts, Jasmina Panovska-Griffiths, Azfar Hussain, Sherrie L Kelly, Nicole Fraser-Hurt, Robyn M. Stuart, Tom Palmer, Marelize Gorgens, Hassan Haghparast-Bidgoli, Romesh G. Abeysuriya, Gerard Joseph Abou Jaoude, Rowan Martin-Hughes, Ibrahim Abubakar, Cliff C. Kerr, Sarah Jarvis, David J. Kedziora, Clemens Benedikt, Dzmitry Klimuk, Feng Zhao, Nejma Cheikh, and Alena Skrahina

Subjects
Bacterial Diseases, Male, Republic of Belarus, Epidemiology, Economics, Service delivery framework, Extensively Drug-Resistant Tuberculosis, Cost-Benefit Analysis, Psychological intervention, Social Sciences, Geographical Locations, Medical Conditions, Medicine and Health Sciences, Prevalence, Prospective Studies, Biology (General), Child, Aged, 80 and over, education.field_of_study, Ecology, Pharmaceutics, Multi-Drug-Resistant Tuberculosis, Belarus, Health Care Costs, Middle Aged, Europe, Infectious Diseases, Models, Economic, Computational Theory and Mathematics, Child, Preschool, Modeling and Simulation, General partnership, Physical Sciences, Female, 01 Mathematical Sciences, 06 Biological Sciences, 08 Information and Computing Sciences, Algorithms, Research Article, Optimization, Adult, medicine.medical_specialty, Tuberculosis, Adolescent, QH301-705.5, Bioinformatics, Population, Models, Biological, Resource Allocation, Young Adult, Cellular and Molecular Neuroscience, Drug Therapy, Environmental health, Genetics, medicine, Income country, Humans, education, Molecular Biology, Ecology, Evolution, Behavior and Systematics, Mass screening, Aged, Infant, Newborn, Computational Biology, Infant, Tropical Diseases, medicine.disease, People and Places, Business, Mathematics, Finance, Software
Abstract

Approximately 85% of tuberculosis (TB) related deaths occur in low- and middle-income countries where health resources are scarce. Effective priority setting is required to maximise the impact of limited budgets. The Optima TB tool has been developed to support analytical capacity and inform evidence-based priority setting processes for TB health benefits package design. This paper outlines the Optima TB framework and how it was applied in Belarus, an upper-middle income country in Eastern Europe with a relatively high burden of TB. Optima TB is a population-based disease transmission model, with programmatic cost functions and an optimisation algorithm. Modelled populations include age-differentiated general populations and higher-risk populations such as people living with HIV. Populations and prospective interventions are defined in consultation with local stakeholders. In partnership with the latter, demographic, epidemiological, programmatic, as well as cost and spending data for these populations and interventions are then collated. An optimisation analysis of TB spending was conducted in Belarus, using program objectives and constraints defined in collaboration with local stakeholders, which included experts, decision makers, funders and organisations involved in service delivery, support and technical assistance. These analyses show that it is possible to improve health impact by redistributing current TB spending in Belarus. Specifically, shifting funding from inpatient- to outpatient-focused care models, and from mass screening to active case finding strategies, could reduce TB prevalence and mortality by up to 45% and 50%, respectively, by 2035. In addition, an optimised allocation of TB spending could lead to a reduction in drug-resistant TB infections by 40% over this period. This would support progress towards national TB targets without additional financial resources. The case study in Belarus demonstrates how reallocations of spending across existing and new interventions could have a substantial impact on TB outcomes. This highlights the potential for Optima TB and similar modelling tools to support evidence-based priority setting., Author summary Tuberculosis (TB) remains a leading global cause of death and morbidity, and 85% of deaths occur in countries where resources for TB care and control are limited. Many countries cannot finance all TB interventions or technologies, which means difficult decisions on what to prioritise and publically finance. Modelling tools can help decision-makers set priorities based on evidence, in a systematic and transparent way. This study presents Optima TB, a tool that estimates which allocations of spending across interventions will most likely maximise specified objectives—such as minimising TB deaths, prevalence and incidence. In partnership with local decision-makers and stakeholders, Optima TB was applied in Belarus. Recommendations from the model findings include focussing investment on outpatient rather than inpatient care and actively finding people with TB (e.g. through contact tracing) rather than mass testing of the population. The recommended reallocations of spending could reduce TB prevalence and deaths by up to 45% and 50%, respectively, by 2035 for the same amount of spending. Key stakeholders were engaged throughout the analysis and findings and uncertainty around the results were clearly communicated with decision-makers. The timeliness of the results helped inform national dialogue on TB care reform, among other key policy discussions.

Published
2021
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37. Exploring the Associations between Early Childhood Development Outcomes and Ecological Country-Level Factors across Low- and Middle-Income Countries

Author

Jolene Skordis, Stavros Poupakis, Kasim Allel, Hassan Haghparast-Bidgoli, Gerard Joseph Abou Jaoude, and Neha Batura

Subjects
Early childhood education, Health, Toxicology and Mutagenesis, Sustainable Development Goals, Psychological intervention, lcsh:Medicine, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, Child Development, 0302 clinical medicine, inequalities, Humans, Medicine, low- and middle-income countries, 030212 general & internal medicine, Early childhood, Child, Developing Countries, Poverty, Socioeconomic status, Multiple Indicator Cluster Surveys, business.industry, Ecology, Mortality rate, lcsh:R, Public Health, Environmental and Occupational Health, Attendance, Health indicator, early childhood development, Maternal Mortality, Child, Preschool, Income, child health, business
Abstract

A poor start in life shapes children’s development over the life-course. Children from low- and middle-income countries (LMICs) are exposed to low levels of early stimulation, greater socioeconomic deprivation and persistent environmental and health challenges. Nevertheless, little is known about country-specific factors affecting early childhood development (ECD) in LMICs. Using data from 68 LMICs collected as part of the Multiple Indicator Cluster Surveys between 2010 and 2018, along with other publicly available data sources, we employed a multivariate linear regression analysis at a national level to assess the association between the average Early Childhood Development Index (ECDI) in children aged 3–5 and country-level ecological characteristics: early learning and nurturing care and socioeconomic and health indicators. Our results show that upper-middle-income country status, attendance at early childhood education (ECE) programs and the availability of books at home are positively associated with a higher ECDI. Conversely, the prevalence of low birthweight and high under-5 and maternal mortality are negatively associated with ECDI nationally. On average, LMICs with inadequate stimulation at home, higher mortality rates and without mandatory ECE programs are at greater risks of poorer ECDI. Investment in early-year interventions to improve nurturing care and ECD outcomes is essential for achieving Sustainable Development Goals.

Published
2021
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38. Applying the 'no-one worse off' criterion to design Pareto efficient HIV responses in Sudan and Togo

Author

Rowan Martin-Hughes, David J. Kedziora, David Wilson, Cliff C. Kerr, Jolene Skordis, Hassan Haghparast-Bidgoli, Sherrie L Kelly, Robyn M. Stuart, Jasmina Panovska-Griffiths, and Laura Grobicki

Subjects
0301 basic medicine, Adult, Budgets, Male, Adolescent, media_common.quotation_subject, Immunology, Population, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Resource Allocation, Sudan, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Age Distribution, Virology, medicine, Economics, Immunology and Allergy, Humans, 030212 general & internal medicine, Sex Distribution, education, Child, media_common, Aged, Aged, 80 and over, education.field_of_study, Actuarial science, Pareto principle, Infant, Newborn, Infant, Pareto efficiency, Maximization, Middle Aged, 030104 developmental biology, Infectious Diseases, Child, Preschool, Togo, Resource allocation, Health Resources, 06 Biological Sciences, 11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences, Female, Welfare, Health funding
Abstract

INTRODUCTION: Globally, there is increased focus on getting the greatest impact from available health funding. However, the pursuit of overall welfare maximization may mean some are left worse off than before. Pareto efficiency takes welfare shifts into account by ruling out funding reallocations that worsen outcomes for any person or group. METHODS: Using the Optima HIV model, studies of HIV response efficiency were conducted in Sudan in 2014 and Togo in 2015. In this article, we estimate the welfare maximizing and Pareto efficient allocations for these two national HIV budgets, using data from the original studies. RESULTS: We estimate that, if the 2013 HIV budget for Sudan was annually available to 2020 but with funds reallocated according to the welfare maximizing allocation, a 36% reduction in cumulative new infections could be achieved between 2014 and 2020. We also find that this is Pareto efficient. In Togo, however, we find that it is possible to reduce overall new infections but applying the Pareto efficiency criterion means that shifts in emphases cannot occur in the HIV response without additional resources. DISCUSSION: Protecting service coverage for key population groups is not necessarily equivalent to protecting health outcomes. In some cases, requiring Pareto efficiency may reduce the potential for population-wide welfare gains, but this is not always the case. CONCLUSION: Pareto efficiency may be an appropriate addition to the quantitative toolset for evaluating HIV responses.

Published
2019
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39. Developing a theory-driven contextually relevant mHealth intervention

Author

Edward Fottrell, Kishwar Azad, Sanjit Kumer Shaha, A.K.Azad Khan, Tasmin Nahar, Hassan Haghparast-Bidgoli, Abdul Kuddus, Joanna Morrison, Hannah Jennings, Kohenour Akter, and Naveed Ahmed

Subjects
Adult, Male, Rural Population, Process (engineering), Applied psychology, Population, Psychological intervention, Health Promotion, behaviour change, Formative assessment, 03 medical and health sciences, 0302 clinical medicine, Behavior Therapy, Intervention (counseling), message development, Humans, 030212 general & internal medicine, education, mHealth, Qualitative Research, Motivation, education.field_of_study, Bangladesh, diabetes, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Focus Groups, Middle Aged, Patient Acceptance of Health Care, Focus group, Telemedicine, Female, Original Article, 0305 other medical science, Psychology, Attitude to Health, Qualitative research
Abstract

Background: mHealth interventions have huge potential to reach large numbers of people in resource poor settings but have been criticised for lacking theory-driven design and rigorous evaluation. This paper shares the process we developed when developing an awareness raising and behaviour change focused mHealth intervention, through applying behavioural theory to in-depth qualitative research. It addresses an important gap in research regarding the use of theory and formative research to develop an mHealth intervention. Objectives: To develop a theory-driven contextually relevant mHealth intervention aimed at preventing and managing diabetes among the general population in rural Bangladesh. Methods: In-depth formative qualitative research (interviews and focus group discussions) were conducted in rural Faridpur. The data were analysed thematically and enablers and barriers to behaviour change related to lifestyle and the prevention of and management of diabetes were identified. In addition to the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change we selected the Transtheoretical Domains Framework (TDF) to be applied to the formative research in order to guide the development of the intervention. Results: A six step-process was developed to outline the content of voice messages drawing on in-depth qualitative research and COM-B and TDF models. A table to inform voice messages was developed and acted as a guide to scriptwriters in the production of the messages. Conclusions: In order to respond to the local needs of a community in Bangladesh, a process of formative research, drawing on behavioural theory helped in the development of awareness-raising and behaviour change mHealth messages through helping us to conceptualise and understand behaviour (for example by categorising behaviour into specific domains) and subsequently identify specific behavioural strategies to target the behaviour.

Published
2019

40. Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: A systematic review

Author

Alexa Hijazi, Hassan Haghparast-Bidgoli, and Giulia Rinaldi

Subjects
Telemedicine, business.industry, Cost effectiveness, Cost-Benefit Analysis, Endocrinology, Diabetes and Metabolism, Control (management), Psychological intervention, Type 2 Diabetes Mellitus, 030209 endocrinology & metabolism, General Medicine, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Diabetes Mellitus, Type 2, Environmental health, Economic evaluation, Internal Medicine, Per capita, Humans, Medicine, 030212 general & internal medicine, business, mHealth, health care economics and organizations
Abstract

The prevalence of type 2 diabetes mellitus continues to rise and simultaneously technology has contributed to the growth of MHealth interventions for its prevention, monitoring and management. This systematic review aimed to summarize and evaluate the quality of the published evidence on cost and cost-effectiveness of mHealth interventions for T2DM. A systematic literature search of PubMed, EMBASE, and Web of Science was conducted for papers up to end of April 2019. We included all partial or full economic evaluations providing cost or cost-effectiveness results for mHealth interventions targeting individuals diagnosed with, or at risk of, type 2 diabetes mellitus. Twenty-three studies met the inclusion criteria. Intervention cost varied substantially based on the type and numbers or combination of technologies used, ranging from 1.8 INT $ to 10101.1 INT $ per patient per year. The studies which presented cost effectiveness results demonstrated highly cost-effective interventions, with cost per QALY gained ranging from 0.4 to 62.5 percent of GDP per capita of the country. The quality of partial economic evaluations was on average lower than that of full economic evaluations. Cost of mHealth interventions varied substantially based on type and combination of technology used, however, where cost-effectiveness results were reported, the intervention was cost-effective. PROSPERO registration number: CRD42019123476; Registered: 27/01/2019.

Published
2020
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41. Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis

Author

Geordan Shannon, Nicole Minckas, Jenevieve Mannell, Hassan Haghparast-Bidgoli, Des Tan, and Neha Batura

Subjects
Public Administration, media_common.quotation_subject, Wage, Feminist economics, 03 medical and health sciences, Wage gap, 0302 clinical medicine, Professional Role, Wage conditions, Political science, Health care, Global health, Gender analysis, Humans, Women, 030212 general & internal medicine, Health Workforce, Health policy, health care economics and organizations, media_common, lcsh:R5-920, business.industry, Salaries and Fringe Benefits, 030503 health policy & services, lcsh:Public aspects of medicine, Research, Public Health, Environmental and Occupational Health, Gender, Correction, lcsh:RA1-1270, Interrupted Time Series Analysis, Allied health professions, Health Occupations, Workforce, Workforce planning, Demographic economics, Female, Inequalities, 0305 other medical science, business, lcsh:Medicine (General)
Abstract

Background The feminisation of the global health workforce presents a unique challenge for human resource policy and health sector reform which requires an explicit gender focus. Relatively little is known about changes in the gender composition of the health workforce and its impact on drivers of global health workforce dynamics such as wage conditions. In this article, we use a gender analysis to explore if the feminisation of the global health workforce leads to a deterioration of wage conditions in health. Methods We performed an exploratory, time series analysis of gender disaggregated WageIndicator data. We explored global gender trends, wage gaps and wage conditions over time in selected health occupations. We analysed a sample of 25 countries over 9 years between 2006 and 2014, containing data from 970,894 individuals, with 79,633 participants working in health occupations (48,282 of which reported wage data). We reported by year, country income level and health occupation grouping. Results The health workforce is feminising, particularly in lower- and upper-middle-income countries. This was associated with a wage gap for women of 26 to 36% less than men, which increased over time. In lower- and upper-middle-income countries, an increasing proportion of women in the health workforce was associated with an increasing gender wage gap and decreasing wage conditions. The gender wage gap was pronounced in both clinical and allied health professions and over lower-middle-, upper-middle- and high-income countries, although the largest gender wage gaps were seen in allied healthcare occupations in lower-middle-income countries. Conclusion These results, if a true reflection of the global health workforce, have significant implications for health policy and planning and highlight tensions between current, purely economic, framing of health workforce dynamics and the need for more extensive gender analysis. They also highlight the value of a more nuanced approach to health workforce planning that is gender sensitive, specific to countries’ levels of development, and considers specific health occupations.

Published
2018

42. A cash-based intervention and the risk of acute malnutrition in children aged 6-59 months living in internally displaced persons camps in Mogadishu, Somalia: A non-randomised cluster trial

Author

Grijalva-Eternod, Carlos S., Jelle, Mohamed, Haghparast-Bidgoli, Hassan, Colbourn, Tim, Golden, Kate, King, Sarah, Cox, Cassy L., Morrison, Joanna, Skordis-Worrall, Jolene, Fottrell, Edward, and Seal, Andrew J.

Subjects
Adult, Male, Drug Research and Development, Physiology, Somalia, Pathology and Laboratory Medicine, Research and Analysis Methods, Pediatrics, Geographical Locations, Families, Signs and Symptoms, Diagnostic Medicine, Risk Factors, Adaptation, Psychological, Medicine and Health Sciences, Edema, Financial Support, Humans, Public and Occupational Health, Clinical Trials, Children, Nutrition, Pharmacology, Family Characteristics, Motivation, Refugees, Refugee Camps, Incidence, Malnutrition, Food Consumption, Child Health, Biology and Life Sciences, Infant, Diet, Intention to Treat Analysis, Age Groups, Food, Child, Preschool, People and Places, Africa, Acute Disease, Cluster Trials, Medicine, Population Groupings, Female, Clinical Medicine, Physiological Processes, Research Article
Abstract

Background Somalia has been affected by conflict since 1991, with children aged, Carlos S Grijalva-Eternod and colleagues present results for acute malnutrition, dietary diversity, and other nutrition-related outcomes from their non-randomised trial of a CBI for displaced families with young children., Author summary Why was this study done? Interventions that include the provision of cash have become ubiquitous within most humanitarian responses to crisis. The transfer of cash often aims to prevent children becoming acutely malnourished, but it is still unknown whether it works as a preventive intervention in different settings. Somalia has been affected by conflict since 1991, periodically forcing large-scale displacement and increasing mortality. Somalia has one of the highest levels of acute malnutrition observed in children aged less than 5 years. Evidence is needed to understand whether, in Somalia, a humanitarian intervention involving cash transfers would reduce the risk of children becoming malnourished and/or improve conditions that are often associated with malnutrition. What did the researchers do and find? We studied the changes in the risk of children aged 6–59 months becoming undernourished and the changes in the children’s dietary diversity following a cash-based humanitarian intervention in a population of internally displaced persons living in camps in peri-urban Mogadishu, Somalia. We compared the occurrence of acute malnutrition in all children aged 6–59 months living in the 10 camps that received the intervention with 10 camps that did not receive the intervention. We also compared the children’s dietary diversity in a sample of 240 households. Diet diversity appeared to improve in children from households receiving the cash-based humanitarian intervention. An apparent improvement in diet and food security was also observed in their mothers or primary carers and in their households. However, despite this apparent improvement in food security and diet diversity, we did not observe an associated reduction in the risk of children becoming acutely malnourished in camps receiving the cash-based humanitarian intervention. What do these findings mean? Humanitarian interventions involving cash transfers have consistently been shown to improve beneficiaries’ food security and diet. However, malnutrition has many causes, and this study provides evidence that these interventions are not always effective in preventing children becoming acutely malnourished. The study limitations include the fact that the intervention was allocated to camps based on vulnerability. This renders the negative finding for reducing malnutrition more difficult to interpret. In addition, we could not collect more information on undernutrition to better understand other potential changes, and the overall occurrence of acute malnutrition in the children was lower than we anticipated. It is unclear why this humanitarian intervention did not appear to reduce the risk of malnutrition in children. Future work is necessary to understand whether modifications to this intervention, such as adding specific nutritious foods or social and behaviour change communication, could positively affect its ability to prevent children from becoming acutely malnourished.

Published
2018

43. Protocol of economic evaluation and equity impact analysis of mHealth and community groups for prevention and control of diabetes in rural Bangladesh in a three-arm cluster randomised controlled trial

Author

Haghparast-Bidgoli, Hassan, Shaha, Sanjit Kumar, Kuddus, Abdul, Chowdhury, Md Alimul Reza, Jennings, Hannah, Ahmed, Naveed, Morrison, Joanna, Akter, Kohenour, Nahar, Badrun, Nahar, Tasmin, King, Carina, Skordis-Worrall, Jolene, Batura, Neha, Khan, Jahangir A, Mansaray, Anthony, Hunter, Rachael, Khan, A K Azad, Costello, Anthony, Azad, Kishwar, and Fottrell, Edward

Subjects
Adult, Male, Rural Population, wa_30, Bangladesh, wk_810, Cost-Benefit Analysis, wa_395, health policy, Health Care Costs, 41b6e438, Telemedicine, Health Economics, Diabetes Mellitus, Type 2, Research Design, Risk Factors, Protocol, Humans, Female, Community Health Services, 7c0bbdab, f0e481db, Program Evaluation
Abstract

Introduction: Type 2 Diabetes mellitus (T2DM) is one of the leading causes of death and disability worldwide, generating substantial economic burden for people with diabetes and their families, and to health systems and national economies. Bangladesh has one of the largest numbers of adults with diabetes in the South Asian region. This paper describes the planned economic evaluation and equity impact analysis of a three-arm cluster randomised control trial of mHealth and community mobilisation interventions to prevent and control T2DM and non-communicable diseases’ (NCDs) risk factors in rural Bangladesh (D-Magic trial).\ud \ud Methods and Analysis: The economic evaluation will be conducted as a within-trial analysis to evaluate the incremental costs and health outcomes of mHealth and community mobilisation interventions compared to the status quo. The analyses will be conducted from a societal perspective, assessing the economic impact for all parties affected by the interventions, including implementing agencies (program costs), health care providers, and participants and their households. Incremental cost-effectiveness ratios (ICERs) will be calculated in terms of cost per case of intermediate hyperglycaemia and T2DM prevented and cost per case of diabetes prevented among individuals with intermediate hyperglycaemia at baseline, and cost- per mm Hg reduction in systolic blood pressure. In addition to ICERs, the economic evaluation will be presented as a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Robustness of the results will be assessed through sensitivity analyses. In addition to cost-effectiveness analysis, an analysis of equity impact of the interventions among the target population will be conducted.\ud \ud Ethics and dissemination: The approval to conduct the study was obtained by the University College London Research Ethics Committee (4766/002) and by the Ethical Review Committee of the Diabetic Association of Bangladesh (BADAS-ERC/EC/t5100246). The findings of this study will be disseminated through different means within academia and the wider policy sphere.

Published
2018

44. The 'ComPAS Trial' combined treatment model for acute malnutrition: study protocol for the economic evaluation

Author

Natasha Lelijveld, Amy Mayberry, Dieynaba S. N’Diaye, Chloe Puett, Jeanette Bailey, Hassan Haghparast-Bidgoli, and Lani Trenouth

Subjects
Moderate acute malnutrition, Male, Time Factors, Cost effectiveness, Cost-Benefit Analysis, Child Health Services, Medicine (miscellaneous), Weight Gain, Sudan, Study Protocol, 0302 clinical medicine, Child Development, Economic cost, Community management of acute malnutrition, Urban Health Services, Medicine, Multicenter Studies as Topic, Pharmacology (medical), 030212 general & internal medicine, Wasting, lcsh:R5-920, 030503 health policy & services, Age Factors, Health Care Costs, Cost-consequence analysis, Infant Nutrition Disorders, Treatment Outcome, Severe acute malnutrition, Child, Preschool, Acute Disease, Food, Fortified, Female, Nutrition Therapy, medicine.symptom, lcsh:Medicine (General), 0305 other medical science, Child Nutritional Physiological Phenomena, medicine.medical_specialty, Severe Acute Malnutrition, Nutritional Status, Equivalence Trials as Topic, Child Nutrition Disorders, 03 medical and health sciences, Humans, Intensive care medicine, Protocol (science), Food, Formulated, business.industry, Malnutrition, Infant, medicine.disease, Kenya, Therapeutic food, Economic evaluation, Cost-effectiveness, Rural Health Services, business
Abstract

Background Acute malnutrition is currently divided into severe (SAM) and moderate (MAM) based on level of wasting. SAM and MAM currently have separate treatment protocols and products, managed by separate international agencies. For SAM, the dose of treatment is allocated by the child’s weight. A combined and simplified protocol for SAM and MAM, with a standardised dose of ready-to-use therapeutic food (RUTF), is being trialled for non-inferior recovery rates and may be more cost-effective than the current standard protocols for treating SAM and MAM. Method This is the protocol for the economic evaluation of the ComPAS trial, a cluster-randomised controlled, non-inferiority trial that compares a novel combined protocol for treating uncomplicated acute malnutrition compared to the current standard protocol in South Sudan and Kenya. We will calculate the total economic costs of both protocols from a societal perspective, using accounting data, interviews and survey questionnaires. The incremental cost of implementing the combined protocol will be estimated, and all costs and outcomes will be presented as a cost-consequence analysis. Incremental cost-effectiveness ratio will be calculated for primary and secondary outcome, if statistically significant. Discussion We hypothesise that implementing the combined protocol will be cost-effective due to streamlined logistics at clinic level, reduced length of treatment, especially for MAM, and reduced dosages of RUTF. The findings of this economic evaluation will be important for policymakers, especially given the hypothesised non-inferiority of the main health outcomes. The publication of this protocol aims to improve rigour of conduct and transparency of data collection and analysis. It is also intended to promote inclusion of economic evaluation in other nutrition intervention studies, especially for MAM, and improve comparability with other studies. Trial Registration ISRCTN 30393230, date: 16/03/2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2594-7) contains supplementary material, which is available to authorized users.

Published
2018

45. How Should HIV Resources be Allocated? Lessons Learnt from Applying Optima HIV in 23 Countries

Author

Elizabeth Mziray, Jolene Skordis, Cliff C. Kerr, David J. Kedziora, Janka Petravic, Rowan Martin-Hughes, Iyanoosh Reporter, Hassan Haghparast-Bidgoli, David Wilson, Zara Shubber, Jasmina Panovska-Griffiths, Olivia Keiser, Xiao F Yap, Nicole Fraser-Hurt, Clemens Benedikt, Andrew J. Shattock, Janne Estill, Sherrie L Kelly, Robyn M. Stuart, Richard Gray, Laura Grobicki, Marelize Gorgens, Emiko Masaki, Zofia Baranczuk, Kelsey L. Grantham, S Azfar Hussain, and Nejma Cheikh

Subjects
Cost effectiveness, Psychological intervention, resource allocation, Distribution (economics), 610 Medicine & health, allocative efficiency, HIV Infections, Context (language use), Review Article, Allocative efficiency, 1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences, Global Health, Optimal HIV investment, 03 medical and health sciences, 510 Mathematics, 0302 clinical medicine, 360 Social problems & social services, Cost-effectiveness, HIV modeling, Resource allocation, Resource needs, Global health, Humans, Medicine, 030212 general & internal medicine, Review Articles, resource needs, ddc:613, Strategic planning, Public economics, optimal HIV investment, business.industry, Incidence, 030503 health policy & services, HIV MODELLING, Public Health, Environmental and Occupational Health, 1. No poverty, cost‐effectiveness, 3. Good health, Infectious Diseases, Health Resources, 0305 other medical science, business
Abstract

Introduction With limited funds available, meeting global health targets requires countries to both mobilize and prioritize their health spending. Within this context, countries have recognized the importance of allocating funds for HIV as efficiently as possible to maximize impact. Over the past six years, the governments of 23 countries in Africa, Asia, Eastern Europe and Latin America have used the Optima HIV tool to estimate the optimal allocation of HIV resources. Methods Each study commenced with a request by the national government for technical assistance in conducting an HIV allocative efficiency study using Optima HIV. Each study team validated the required data, calibrated the Optima HIV epidemic model to produce HIV epidemic projections, agreed on cost functions for interventions, and used the model to calculate the optimal allocation of available funds to best address national strategic plan targets. From a review and analysis of these 23 country studies, we extract common themes around the optimal allocation of HIV funding in different epidemiological contexts. Results and discussion The optimal distribution of HIV resources depends on the amount of funding available and the characteristics of each country's epidemic, response and targets. Universally, the modelling results indicated that scaling up treatment coverage is an efficient use of resources. There is scope for efficiency gains by targeting the HIV response towards the populations and geographical regions where HIV incidence is highest. Across a range of countries, the model results indicate that a more efficient allocation of HIV resources could reduce cumulative new HIV infections by an average of 18% over the years to 2020 and 25% over the years to 2030, along with an approximately 25% reduction in deaths for both timelines. However, in most countries this would still not be sufficient to meet the targets of the national strategic plan, with modelling results indicating that budget increases of up to 185% would be required. Conclusions Greater epidemiological impact would be possible through better targeting of existing resources, but additional resources would still be required to meet targets. Allocative efficiency models have proven valuable in improving the HIV planning and budgeting process.

Published
2018
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46. The global burden of tuberculosis: results from the Global Burden of Disease Study 2015'

Author

Murray, Christopher J. L., Kyu, Hmwe H., Maddison, Emilie R., Henry, Nathaniel J., Mumford, John Everett, Barber, Ryan, Shields, Chloe, Brown, Jonathan C., Nguyen, Grant, Carter, Austin, Wolock, Timothy M., Wang, Haidong, Liu, Patrick Y., Reitsma, Marissa, Ross, Jennifer M., Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbas, Kaja, Abera, Mubarek, Abera, Semaw Ferede, Hareri, Habtamu Abera, Ahmed, Muktar, Alene, Kefyalew Addis, Alvis-Guzman, Nelson, Amo-Adjei, Joshua, Andrews, Jason, Ansari, Hossein, Antonio, Carl Abelardo, Anwari, Palwasha, Asayesh, Hamid, Atey, Tesfay Mehari, Atre, Sachin, Barac, Aleksandra, Beardsley, Justin, Bedi, Neeraj, Bensenor, Isabela, Beyene, Addisu Shunu, Butt, Zahid Ahmad, Cardona, Pere-Joan, Christopher, Devasahayam, Dandona, Lalit, Dandona, Rakhi, Deribe, Kebede, Deribew, Amare, Ehrenkranz, Rebecca, Zaki, Maysaa El Sayed, Endries, Aman, Feyissa, Tesfaye R., Fischer, Florian, Gai, Ruoyan, Garcia-Basteiro, Alberto L., Gebrehiwot, Tsegaye Tewelde, Gesesew, Hailay, Getahun, Belete, Gona, Philimon, Goodridge, Amador, Gugnani, Harish, Haghparast-Bidgoli, Hassan, Hailu, Gessessew Bugssa, Hassen, Hamid Yimam, Hilawe, Esayas, Horita, Nobuyuki, Jacobsen, Kathryn H., Jonas, Jost B., Kasaeian, Amir, Kedir, Muktar Sano, Kemmer, Laura, Khader, Yousef, Khan, Ejaz, Khang, Young-Ho, Khoja, Abdullah T., Kim, Yun Jin, Koul, Parvaiz, Koyanagi, Ai, Krohn, Kristopher J., Kumar, G. Anil, Kutz, Michael, Lodha, Rakesh, Magdy, Hassan, El Razek, Abd, Majdzadeh, Reza, Manyazewal, Tsegahun, Memish, Ziad, Mendoza, Walter, Mezgebe, Haftay Berhane, Mohammed, Shafiu, Ogbo, Felix Akpojene, Oh, In-Hwan, Oren, Eyal, Osgood-Zimmerman, Aaron, Pereira, David, Plass, Dietrich, Pourmalek, Farshad, Qorbani, Mostafa, Rafay, Anwar, Rahman, Mahfuzar, Rai, Rajesh Kumar, Rao, Puja C., Ray, Sarah E., Reiner, Robert, Reinig, Nickolas, Safiri, Saeid, Salomon, Joshua A., Sandar, Logan, Sartorius, Benn, Shamsizadeh, Morteza, Shey, Muki, Shifti, Desalegn Markos, Shore, Hirbo, Singh, Jasvinder, Sreeramareddy, Chandrashekhar T., Swaminathan, Soumya, Swartz, Scott J., Tadese, Fentaw, Tedla, Bemnet Amare, Tegegne, Balewgizie Sileshi, Tessema, Belay, Topor-Madry, Roman, Ukwaja, Kingsley Nnanna, Uthman, Olalekan A., Vlassov, Vasiliy, Vollset, Stein Emil, Wakayo, Tolassa, Weldegebreal, Solomon, Westerman, Ronny, Workicho, Abdulhalik, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Naghavi, Mohsen, Hay, Simon I., and Vos, Theo

Subjects
Alcohol Drinking, Incidence, Smoking, HIV Infections, Smoking Prevention, Global Health, Article, Global Burden of Disease, Risk Factors, Diabetes Mellitus, Prevalence, Humans, Tuberculosis, Investments
Abstract

Background An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. Methods We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. Findings Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10.2 million (95% uncertainty interval 9.2 million to 11.5 million), the number of prevalent cases was 10.1 million (9.2 million to 11.1 million), and the number of deaths was 1.3 million (1.1 million to 1.6 million). Among individuals who were HIV negative, the number of incident cases was 8.8 million (8.0 million to 9.9 million), the number of prevalent cases was 8.9 million (8.1 million to 9.7 million), and the number of deaths was 1.1 million (0.9 million to 1.4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (-4.1% [-5.0 to -3.4]) than in incidence (-1.6% [-1.9 to -1.2]) and prevalence (-0.7% [-1.0 to -0.5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11.4% (9.3-13.0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10.6% (6.8-14.8), and smoking accounted for 7.8% (3.8-12.0). Interpretation Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis. Copyright (c) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.

Published
2018

47. Effect of participatory women's groups and counselling through home visits on children's linear growth in rural eastern India (CARING trial): a cluster-randomised controlled trial

Author

Nair, Nirmala, Tripathy, Prasanta, Sachdev, H S, Pradhan, Hemanta, Bhattacharyya, Sanghita, Gope, Rajkumar, Gagrai, Sumitra, Rath, Shibanand, Rath, Suchitra, Sinha, Rajesh, Roy, Swati Sarbani, Shewale, Suhas, Singh, Vijay, Srivastava, Aradhana, Costello, Anthony, Copas, Andrew, Skordis-Worrall, Jolene, Haghparast-Bidgoli, Hassan, Saville, Naomi, and Prost, Audrey

Subjects
Counseling, Male, Rural Population, Child Health, Infant, Newborn, India, Infant, Article, House Calls, Child Development, Pregnancy, Infant Mortality, Women's Health, Cluster Analysis, Humans, Female, Child Care, Child, Infant Nutritional Physiological Phenomena, Follow-Up Studies
Abstract

Summary Background Around 30% of the world's stunted children live in India. The Government of India has proposed a new cadre of community-based workers to improve nutrition in 200 districts. We aimed to find out the effect of such a worker carrying out home visits and participatory group meetings on children's linear growth. Methods We did a cluster-randomised controlled trial in two adjoining districts of Jharkhand and Odisha, India. 120 clusters (around 1000 people each) were randomly allocated to intervention or control using a lottery. Randomisation took place in July, 2013, and was stratified by district and number of hamlets per cluster (0, 1–2, or ≥3), resulting in six strata. In each intervention cluster, a worker carried out one home visit in the third trimester of pregnancy, monthly visits to children younger than 2 years to support feeding, hygiene, care, and stimulation, as well as monthly women's group meetings to promote individual and community action for nutrition. Participants were pregnant women identified and recruited in the study clusters and their children. We excluded stillbirths and neonatal deaths, infants whose mothers died, those with congenital abnormalities, multiple births, and mother and infant pairs who migrated out of the study area permanently during the trial period. Data collectors visited each woman in pregnancy, within 72 h of her baby's birth, and at 3, 6, 9, 12, and 18 months after birth. The primary outcome was children's length-for-age Z score at 18 months of age. Analyses were by intention to treat. Due to the nature of the intervention, participants and the intervention team were not masked to allocation. Data collectors and the data manager were masked to allocation. The trial is registered as ISCRTN (51505201) and with the Clinical Trials Registry of India (number 2014/06/004664). Results Between Oct 1, 2013, and Dec 31, 2015, we recruited 5781 pregnant women. 3001 infants were born to pregnant women recruited between Oct 1, 2013, and Feb 10, 2015, and were therefore eligible for follow-up (1460 assigned to intervention; 1541 assigned to control). Three groups of children could not be included in the final analysis: 147 migrated out of the study area (67 in intervention clusters; 80 in control clusters), 77 died after the neonatal period and before 18 months (31 in intervention clusters; 46 in control clusters), and seven had implausible length-for-age Z scores (

Published
2017

48. Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya

Author

Neha Batura, Andrew Copas, Jolene Skordis, Sarah Dickin, Hassan Haghparast-Bidgoli, Caroline Ochieng, Fedra Vanhuyse, Alex Mwaki, Alie Eleveld, Tom Palmer, and Aloyce Odiambo

Subjects
Postnatal Care, Rural Population, Cash transfers, economic evaluation, Cost effectiveness, Cost-Benefit Analysis, child immunization, 03 medical and health sciences, Health Economics, 0302 clinical medicine, antenatal care, Pregnancy, Environmental health, Protocol, Humans, Medicine, conditional cash transfers, 030212 general & internal medicine, business.industry, cost effectiveness analysis, Fiscal space, Equity (finance), Prenatal Care, General Medicine, Cost-effectiveness analysis, maternal and child health, Continuity of Patient Care, priority setting, Delivery, Obstetric, Kenya, Child mortality, Evaluation Studies as Topic, Research Design, Economic evaluation, Female, facility delivery, business, 030217 neurology & neurosurgery
Abstract

IntroductionA wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial.Methods and analysisThe economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted.Ethics and disseminationThe study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.Trial registration numberNCT03021070

Published
2019
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49. Measuring financial risk protection in health benefits packages: scoping review protocol to inform allocative efficiency studies

Author

Jolene Skordis-Worrall, Hassan Haghparast-Bidgoli, and Gerard Joseph Abou Jaoude

Subjects
Risk, Scopus, universal health coverage, Resource Allocation, 03 medical and health sciences, Health Economics, 0302 clinical medicine, Universal Health Insurance, Protocol, Humans, Medicine, 030212 general & internal medicine, allocative efficiency modelling, Protocol (science), Descriptive statistics, business.industry, 030503 health policy & services, Financial risk, General Medicine, Grey literature, priority setting, Risk Sharing, Financial, scoping review protocol, Review Literature as Topic, Data extraction, Risk analysis (engineering), Research Design, financial risk protection, Allocative efficiency, Thematic analysis, 0305 other medical science, business, Delivery of Health Care
Abstract

IntroductionTo progress towards Universal Health Coverage (UHC), countries will need to define a health benefits package of services free at the point of use. Financial risk protection is a core component of UHC and should therefore be considered a key dimension of health benefits packages. Allocative efficiency modelling tools can support national analytical capacity to inform an evidence-based selection of services, but none are currently able to estimate financial risk protection. A review of existing methods used to measure financial risk protection can facilitate their inclusion in modelling tools so that the latter can become more relevant to national decision making in light of UHC.Methods and analysisThis protocol proposes to conduct a scoping review of existing methods used to measure financial risk protection and assess their potential to inform the selection of services in a health benefits package. The proposed review will follow the methodological framework developed by Arksey and O’Malley and the subsequent recommendations made by Levacet al. Several databases will be systematically searched including: (1) PubMed; (2) Scopus; (3) Web of Science and (4) Google Scholar. Grey literature will also be scanned, and the bibliography of all selected studies will be hand searched. Following the selection of studies according to defined inclusion and exclusion criteria, key characteristics will be collected from the studies using a data extraction tool. Key characteristics will include the type of method used, geographical region of focus and application to specific services or packages. The extracted data will then be charted, collated, reported and summarised using descriptive statistics, a thematic analysis and graphical presentations.Ethics and disseminationThe scoping review proposed in this protocol does not require ethical approval. The final results will be disseminated via publication in a peer-reviewed journal, conference presentations and shared with key stakeholders.

Published
2019
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50. Getting it right when budgets are tight: Using optimal expansion pathways to prioritize responses to concentrated and mixed HIV epidemics

Author

S Azfar Hussain, Iyanoosh Reporter, David Wilson, Nejma Cheikh, Zofia Baranczuk, Hassan Haghparast-Bidgoli, Vilma Montañez, Cliff C. Kerr, Krittayawan Boonto, Fernando Lavadenz, Olivia Keiser, Jolene Skordis-Worrall, Clemens Benedikt, Richard Gray, Rowan Martin-Hughes, Janne Estill, Laura Grobicki, Sutayut Osornprasop, Sherrie L Kelly, Robyn M. Stuart, Lorena Prieto, and David J. Kedziora

Subjects
RNA viruses, Budgets, Financial Management, Epidemiology, Economics, Cost-Benefit Analysis, Psychological intervention, Distribution (economics), lcsh:Medicine, Social Sciences, HIV Infections, Myanmar, Pathology and Laboratory Medicine, Geographical Locations, 0302 clinical medicine, Immunodeficiency Viruses, Peru, Per capita, 030212 general & internal medicine, lcsh:Science, 610 Medicine & health, health care economics and organizations, Multidisciplinary, Public economics, Cost–benefit analysis, 030503 health policy & services, Belarus, Cost-effectiveness analysis, Investment (macroeconomics), Europe, Core (game theory), HIV epidemiology, Medical Microbiology, Viral Pathogens, Togo, Viruses, Pathogens, 0305 other medical science, 360 Social problems & social services, Research Article, Asia, General Science & Technology, Cost-Effectiveness Analysis, Microbiology, 03 medical and health sciences, 510 Mathematics, Retroviruses, Humans, Microbial Pathogens, ddc:613, Medicine and health sciences, business.industry, Health Priorities, lcsh:R, Lentivirus, Organisms, Biology and Life Sciences, HIV, South America, Virology, Economic Analysis, Intervention (law), People and Places, Africa, lcsh:Q, Business, Finance
Abstract

BACKGROUND Prioritizing investments across health interventions is complicated by the nonlinear relationship between intervention coverage and epidemiological outcomes. It can be difficult for countries to know which interventions to prioritize for greatest epidemiological impact, particularly when budgets are uncertain. METHODS We examined four case studies of HIV epidemics in diverse settings, each with different characteristics. These case studies were based on public data available for Belarus, Peru, Togo, and Myanmar. The Optima HIV model and software package was used to estimate the optimal distribution of resources across interventions associated with a range of budget envelopes. We constructed "investment staircases", a useful tool for understanding investment priorities. These were used to estimate the best attainable cost-effectiveness of the response at each investment level. FINDINGS We find that when budgets are very limited, the optimal HIV response consists of a smaller number of 'core' interventions. As budgets increase, those core interventions should first be scaled up, and then new interventions introduced. We estimate that the cost-effectiveness of HIV programming decreases as investment levels increase, but that the overall cost-effectiveness remains below GDP per capita. SIGNIFICANCE It is important for HIV programming to respond effectively to the overall level of funding availability. The analytic tools presented here can help to guide program planners understand the most cost-effective HIV responses and plan for an uncertain future.

Published
2017
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