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Technologies are often viewed as the route to better, safer and more efficient care, but technology projects rarely deliver all the benefits expected of them. Based on a literature review and empirical case studies, we developed a framework (NASSS) for studying the non-adoption, abandonment and challenges to scale-up, spread and sustainability of technology-supported change efforts in health and social care. Such projects meet problems usually because they are too complex – and because the complexity is sub-optimally handled. NASSS consists of six domains – the illness or condition, the technology, the value proposition, the individuals intended to adopt the technology, the organisation(s) and the wider system – along with a seventh domain that considers how all these evolve over time. The NASSS framework incorporates a number of other theories and analytic approaches described elsewhere in this book. It is not intended to offer a predictive or formulaic solution to technology adoption. Rather, NASSS should be used to generate a rich and situated narrative of the multiple influences on a complex project; to identify parts of the project where complexity might be reduced; and to consider how individuals and organisations might be supported to handle the remaining complexities better. [ABSTRACT FROM AUTHOR]

While food insecurity is a well-known cause of under-nutrition and stunting, in recent decades it has also been linked with obesity. Understanding and thus minimising the risk factors for obesity in low- and middle-income country contexts, which often lack the health system capacity to treat the consequent obesity-related illnesses, is crucial. This study adopted realist review methodology because it enabled us to analyse and organise the evidence from low- and middle-income countries into a coherent scheme. By comparing this evidence to existing theory on food security and nutrition, we aimed to provide a richer understanding of the nuances and the socio-demographic nature of the food insecurity–obesity relationship. The review generated 13 peer-reviewed articles which studied the relationship between food insecurity and overweight/obesity in low- and middle-income countries. Affordability of high-energy, processed foods was identified as a main mechanism, which determined whether or not food insecurity leads to obesity in low- and middle-income countries. Other mechanisms identified were: quantity and diversity of food consumed; spatial-temporal access to nutritious food; inter-personal food choice and distribution; and non-dietary behaviours. Despite the limited empirical evidence available, our review presents meaningful and policy-relevant insights into the food insecurity–obesity relationship in from low- and middle-income countries. Interventions to address the food insecurity–obesity link need to address diet quality, and demand a broad understanding across a variety of experiences. [ABSTRACT FROM AUTHOR]

Background: Policy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria's decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives.Methods: Having engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach.Results: Contrary to national government's assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of "Office Establishment" and Legislation" respectively, no state was fully compliant to "Human Resource Management" and "Funding" requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives.Conclusions: Our study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes. [ABSTRACT FROM AUTHOR]

International scholarships for higher education are a large component of foreign aid in many high-income countries, including Australia. The aims for Australian scholarships awarded to African students are to achieve development in Africa and advance the influence of Australia. However, well-articulated theories of change that define how scholarships are linked to these and other outcomes are not available in the literature. In order to address this gap, the authors explore the perspectives of Australian-funded Master's-level alumni from Kenya, Uganda and Mozambique on the implementation process before, during and after their scholarship award, and the outcomes of the scholarships. The authors found that Australian scholarships to Africans have the potential to spread Australian influence, and that returnee scholars, by virtue of their study in Australia, gain the capacity to become agents for development in their country. The process of choosing scholarship awardees, the local circumstances in each country on return, and support and mentoring networks after return can influence the achievement of these outcomes. Investments in international scholarships should be directed to develop additional skills and facilitate networks in order to further prepare the returnee scholars to influence development in their country and perpetuate Australian influence. [ABSTRACT FROM AUTHOR]

Background: It is necessary to select a range of consistently identified prognostic factors from exploratory studies to include in multivariate models of confirmatory studies. We illustrate a systematic approach to selecting consistently identified prognostic factors using the example of predictors of remission in newly diagnosed epilepsy. Methods: Medline and Embase were searched for reports of cohort studies enrolling at least 100 people with epilepsy within 1 year of diagnosis, and followed up for at least 1 year. We included studies that identified predictors of remission after adjusting for confounders using multivariate regression analysis. To identify consistent predictors a chart was designed to list the variables considered for inclusion in each model and those retained in more than one model from different cohorts were deemed to be consistent. Results: Remission off medication was less likely if there was more than one seizure between 6 and 12 months on medication and if there was comorbid intellectual disability in childhood onset epilepsy. The likelihood of remission on or off medication reduces with mixed seizure types at onset, intellectual disability, symptomatic aetiology, and also with increasing number of seizures before diagnosis or in the first 6 months after diagnosis. Conclusion: A greater number of seizures before diagnosis and early in treatment, intellectual disability, and symptomatic aetiology are consistent predictors of less likelihood of remission. This suggests that early identification, diagnosis of epilepsy, and seizure control should be the primary aim of medical intervention, and that these predictors should be included in future confirmatory studies of prognostic factors of remission in newly diagnosed epilepsy. [ABSTRACT FROM AUTHOR]

The article discusses the need of the needs of biomedical science training in Africa. To conduct the survey of the region, a total of 107 young scientists were recruited through existing international networks and interviewed via a web-based program, on the current status of biomedical research in their different institutions. Information on the obstacles for biomedical science research which include the lack of infrastructure and financial support from government is presented.

Understanding how health systems respond to shocks has become a pressing need to strengthen response efforts. With already fragmented and disrupted health services, fragile and conflict affected [FCA] countries are more vulnerable to shocks. Previous studies have focused more on conceptualizing health system resilience rather than how health systems [especially in FCA countries] respond to or are resilient to acute shocks. To understand how health systems in FCA countries respond to the shocks and what influence their responses, we conducted a review of the literature published between January 2011 and September 2021 on health system responses to acute shocks in FCA countries. We searched Medline, Embase, Scopus, Jester and Google Scholar – 60 empirical studies in FCA countries on response to sudden, extreme, and unanticipated shocks were included in the review. We found that health systems in FCA countries responded to acute shock using absorptive, adaptive, or transformative capacities. These capacities were mediated by four dimensions of context; knowledge, uncertainties, interdependence, and legitimacy. In addition, we identified the cross-cutting role of community involvement [and its self-evolving nature], frontline workers, and leadership capacity. To our knowledge, this is among the first reviews that focus on FCA country health systems responses to acute shock. By highlighting enabling and constraining factors to each type of capacity, this study provides important lessons and practical strategies from FCA countries on how to absorb, adapt and transform in response to acute shocks – thus promoting health system resilience globally. [ABSTRACT FROM AUTHOR]

The benefits of an interconnected world for health care remain untapped. As a result of the politics of inequality between rich and poor countries, one or a few health systems are set up as models. Every country, irrespective of political or economic status, should be open to learning from others to build relevant and cost-effective systems. To combat the current global challenge of chronic noncommunicable diseases, poor countries have the advantage of flexible health systems that are veritable laboratories of health systems research. Not only can research conducted in these health systems help harness the potential of mobile communication technologies and informal health providers, it can also help rich country health systems adapt to meet the chronic disease challenge. [ABSTRACT FROM AUTHOR]