392 results on '"Obinna Onwujekwe"'
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152. Additional file 1 of Patients with positive malaria tests not given artemisinin-based combination therapies: a research synthesis describing under-prescription of antimalarial medicines in Africa
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Shennae O’Boyle, Bruxvoort, Katia, Ansah, Evelyn, Burchett, Helen, Chandler, Clare, Siân Clarke, Goodman, Catherine, Mbacham, Wilfred, Mbonye, Anthony, Obinna Onwujekwe, Staedke, Sarah, Wiseman, Virginia, Whitty, Christopher, and Hopkins, Heidi
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mental disorders - Abstract
Additional file 1: Table S1. Number (%) of mRDT-positive patients i) not prescribed ACT and ii) prescribed other medications. Table S2. Risk factors associated with non-prescription of ACT in mRDT-positive patients not prescribed ACT. Table S3. Risk factors associated with prescription of medications in mRDT-positive patients not prescribed ACT.
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- 2020
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153. Additional file 1 of What makes advocacy work? Stakeholders’ voices and insights from prioritisation of maternal and child health programme in Nigeria
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Uzochukwu, Benjamin, Chioma Onyedinma, Chinyere Okeke, Obinna Onwujekwe, Manzano, Ana, Bassey Ebenso, Enyi Etiaba, Nkoli Ezuma, and Tolib Mirzoev
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Data_FILES - Abstract
Additional file 1.
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- 2020
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154. Mapping disparities in education across low- and middle-income countries
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Lauren E. Schaeffer, Belay Tessema, Reza Malekzadeh, Olatunde Aremu, Mehdi Hosseinzadeh, Milena M Santric Milicevic, Seyyed Meysam Mousavi, Azeem Majeed, Badr Hasan Sobaih, Jalal Arabloo, Philimon Gona, Aliasghar Ahmad Kiadaliri, Mostafa Qorbani, Fatemeh Rajati, Ipsita Sutradhar, Giuseppe Remuzzi, Babak Eshrati, Olufemi Ajumobi, Lauren Woyczynski, Parul Puri, Vinay Nangia, Guoqing Hu, Yousef Khader, Suzanne Barker-Collo, Hamideh Salimzadeh, Félix Carvalho, Yun Jin Kim, Moslem Soofi, Ali Bijani, Shanshan Li, Catalina Liliana Andrei, Ali Kazemi Karyani, Mehran Asadi-Aliabadi, Andrea Sylvia Winkler, Arya Haj-Mirzaian, Maziar Moradi-Lakeh, Farnam Mohebi, Mohamad-Hani Temsah, Kala M. Mehta, Simon I. Hay, Benjamin B. Massenburg, Sanjay Zodpey, Tuomo J. Meretoja, Ireneous N. Soyiri, Bach Xuan Tran, George C Patton, Kavumpurathu Raman Thankappan, Engida Yisma, Vasily Vlassov, Samer Hamidi, Ghulam Mustafa, André Faro, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Rajat Gupta, Shirin Djalalinia, Dina Nur Anggraini Ningrum, Sheikh Mohammed Shariful Islam, Juan Sanabria, Leonardo Roever, Dayane Gabriele Alves Silveira, Samad Azari, Vahid Alipour, Gabrielle B. Britton, Luca Ronfani, Rosario Cárdenas, Maarten J. Postma, Hamid Yimam Hassen, Pn Sylaja, Brijesh Sathian, Paul S. F. Yip, Vegard Skirbekk, Chhabi Lal Ranabhat, Paramjit Gill, Walter Mendoza, Lorenzo Monasta, Dara K. Mohammad, Naznin Hossain, Dhirendra N Sinha, Ali H. Mokdad, Aziz Rezapour, Megan F. Schipp, Ziyad Al-Aly, Takeshi Fukumoto, Kebede Deribe, Paula Moraga, Mohammad Ebrahimi Kalan, Ai Koyanagi, Andre M. N. Renzaho, Cyrus Cooper, Ghobad Moradi, Ruth W Kimokoti, Swayam Prakash, Rafael Tabarés-Seisdedos, Zahra Jorjoran Shushtari, Zemenu Tadesse Tessema, Amir Radfar, Jean Jacques Noubiap, Emmanuela Gakidou, Mahdi Afshari, Suleman Atique, Reza Majdzadeh, Kiomars Sharafi, Seyed-Mohammad Fereshtehnejad, Foad Abd-Allah, Zahid A Butt, Beruk Berhanu Desalegn, Ruxandra Irina Negoi, Marek Majdan, Yoshan Moodley, Jianrong Zhang, Farid Najafi, Aso Mohammad Darwesh, Benn Sartorius, Amber Sligar, Nicole Davis Weaver, Naohiro Yonemoto, Jacob Olusegun Olusanya, Olayinka Stephen Ilesanmi, Neeraj Bedi, Suraj Bhattarai, Sadaf G. Sepanlou, Francisco Rogerlandio Martins-Melo, Malihe Nourollahpour Shiadeh, Bernardo Hernández Prado, Masood Ali Shaikh, Khalid A Altirkawi, Carlos Rios-Gonzalez, Claudiu Herteliu, Jason B. Hall, Irina Filip, Abdullah Sulieman Terkawi, Sojib Bin Zaman, Nathaniel J Henry, Eleonora Dubljanin, Jasvinder A. Singh, Pushpendra Kumar, Akram Pourshams, Jung-Chen Chang, Irfan Ullah, Lorainne Tudor Car, Franz Castro, George A. Mensah, Delia Hendrie, Mehran Shams-Beyranvand, Zulfiqar A Bhutta, Jaifred Christian F. Lopez, Laura Dwyer-Lindgren, Lee Ling Lim, Charles D.A. Wolfe, Adnan Kisa, Seyed Sina Naghibi Irvani, Alaa Badawi, Bolajoko O. Olusanya, Tomohide Yamada, Gholamreza Roshandel, Jonathan F. Mosser, Jose A. Garcia, Andre Rodrigues Duraes, Mohammadreza Amiresmaili, Krittika Bhattacharyya, Yuan-Pang Wang, Sebastian Vollmer, Felix Akpojene Ogbo, Birkneh Tilahun Tadesse, Mihajlo Jakovljevic, Songhomitra Panda-Jonas, Paul H. Lee, Michael Collison, Sanghamitra Pati, Aziz Sheikh, Kalkidan Hassen Abate, Anthony Barnett, Ejaz Ahmad Khan, Michael A. Cork, Meghnath Dhimal, Norberto Perico, Francesco Saverio Violante, Daniel N. Kiirithio, Ted R. Miller, Arundhati R. Sawant, Olalekan A. Uthman, Kewal Krishan, Ashish Awasthi, Anthony Masaka, Katherine F. Wilson, Padukudru Anand Mahesh, Roy Burstein, Amir Kasaeian, Yuming Guo, Peter Nyasulu, Chuanhua Yu, Pascual R. Valdez, Josephine W. Ngunjiri, Vipin Gupta, Tomislav Mestrovic, Long Hoang Nguyen, Neda Izadi, Faris Lami, Marcos Roberto Tovani-Palone, Azin Nahvijou, Jun She, Christopher J L Murray, Krishna K. Aryal, Payman Salamati, Mona M. Khater, Rajeev Gupta, Robert Reiner, Mustafa Z. Younis, Ali Rostami, Duduzile Ndwandwe, Obinna Onwujekwe, Manasi Kumar, Nafis Sadat, Nahla Anber, Joan B. Soriano, Victor Adekanmbi, John C. Wilkinson, Babak Moazen, Andrew T Olagunju, Nicholas Graetz, Andualem Henok, Mina Anjomshoa, Boris Bikbov, Melaku Desta, Yahya Safari, Jan-Walter De Neve, Carlos A Castañeda-Orjuela, Mohammad Fareed, Ayman Grada, Eduardo Ortiz-Panozo, Rajesh Sharma, Beatriz Paulina Ayala Quintanilla, Enrico Rubagotti, John S. Ji, Mika Shigematsu, Fakher Rahim, Randah R. Hamadeh, G. K. Mini, Yasir Waheed, Meghdad Pirsaheb, Yousef Veisani, Daniel Diaz, Adrian Pana, Salman Rawaf, Ehsan Sadeghi, Yahya Salimi, Joseph Adel Mattar Banoub, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, David M. Pigott, Fares Alahdab, Vafa Rahimi-Movaghar, Anbissa Muleta Senbeta, Tomi Akinyemiju, Damaris K. Kinyoki, Morteza Shamsizadeh, Ziad El-Khatib, Abdallah M. Samy, Roman Topor-Madry, Farah Daoud, Cuong Tat Nguyen, Aubrey J. Levine, Sameer Vali Gopalani, Ravi Prakash Jha, Mesfin Tadese Dinberu, Shafiu Mohammed, Simon Øverland, David Laith Rawaf, Arvin Haj-Mirzaian, Satar Rezaei, Oladimeji Adebayo, Nasir Salam, Mohammad Ali Mansournia, Rajesh Sagar, Alex Yeshaneh, Michael K. Hole, Agus Sudaryanto, Yunquan Zhang, Mahbobeh Faramarzi, Natalia V. Bhattacharjee, Aniruddha Deshpande, Soewarta Kosen, Mahmoud Yousefifard, Jacek Jerzy Jozwiak, Mehedi Hasan, Shane D. Morrison, Erkin M. Mirrakhimov, Marcel Ausloos, Ionut Negoi, Jacqueline Elizabeth Alcalde Rabanal, Barthelemy Kuate Defo, Giang Thu Vu, Lucas Earl, Doris D. V. Ortega-Altamirano, Yu Liao, Peter Njenga Keiyoro, Tanuj Kanchan, Chandrasekharan Nair Kesavachandran, Mu'awiyyah Babale Sufiyan, Mohammad Hifz Ur Rahman, Lidia Morawska, Tiffany K. Gill, Manisha Dubey, David C. Schwebel, Jost B. Jonas, Ester Cerin, Mehran Alijanzadeh, Florian Fischer, Stefan Listl, Benjamin K. Mayala, Mahmood Moosazadeh, Soraya Siabani, Derrick A Bennett, Collaborators, Local Burden of Disease Educational Attainment, Institute for Molecular Medicine Finland, HUS Comprehensive Cancer Center, Clinicum, Helsinki University Hospital Area, University of Helsinki, Local Burden Dis Educ Attainment C, Graetz N., Woyczynski L., Wilson K.F., Hall J.B., Abate K.H., Abd-Allah F., Adebayo O.M., Adekanmbi V., Afshari M., Ajumobi O., Akinyemiju T., Alahdab F., Al-Aly Z., Rabanal J.E.A., Alijanzadeh M., Alipour V., Altirkawi K., Amiresmaili M., Anber N.H., Andrei C.L., Anjomshoa M., Antonio C.A.T., Arabloo J., Aremu O., Aryal K.K., Asadi-Aliabadi M., Atique S., Ausloos M., Awasthi A., Quintanilla B.P.A., Azari S., Badawi A., Banoub J.A.M., Barker-Collo S.L., Barnett A., Bedi N., Bennett D.A., Bhattacharjee N.V., Bhattacharyya K., Bhattarai S., Bhutta Z.A., Bijani A., Bikbov B., Britton G., Burstein R., Butt Z.A., Cardenas R., Carvalho F., Castaneda-Orjuela C.A., Castro F., Cerin E., Chang J.-C., Collison M.L., Cooper C., Cork M.A., Daoud F., Das Gupta R., Weaver N.D., De Neve J.-W., Deribe K., Desalegn B.B., Deshpande A., Desta M., Dhimal M., Diaz D., Dinberu M.T., Djalalinia S., Dubey M., Dubljanin E., Duraes A.R., Dwyer-Lindgren L., Earl L., Kalan M.E., El-Khatib Z., Eshrati B., Faramarzi M., Fareed M., Faro A., Fereshtehnejad S.-M., Fernandes E., Filip I., Fischer F., Fukumoto T., Garcia J.A., Gill P.S., Gill T.K., Gona P.N., Gopalani S.V., Grada A., Guo Y., Gupta R., Gupta V., Haj-Mirzaian A., Hamadeh R.R., Hamidi S., Hasan M., Hassen H.Y., Hendrie D., Henok A., Henry N.J., Prado B.H., Herteliu C., Hole M.K., Hossain N., Hosseinzadeh M., Hu G., Ilesanmi O.S., Irvani S.S.N., Islam S.M.S., Izadi N., Jakovljevic M., Jha R.P., Ji J.S., Jonas J.B., Shushtari Z.J., Jozwiak J.J., Kanchan T., Kasaeian A., Karyani A.K., Keiyoro P.N., Kesavachandran C.N., Khader Y.S., Khafaie M.A., Khan E.A., Khater M.M., Kiadaliri A.A., Kiirithio D.N., Kim Y.J., Kimokoti R.W., Kinyoki D.K., Kisa A., Kosen S., Koyanagi A., Krishan K., Defo B.K., Kumar M., Kumar P., Lami F.H., Lee P.H., Levine A.J., Li S., Liao Y., Lim L.-L., Listl S., Lopez J.C.F., Majdan M., Majdzadeh R., Majeed A., Malekzadeh R., Mansournia M.A., Martins-Melo F.R., Masaka A., Massenburg B.B., Mayala B.K., Mehta K.M., Mendoza W., Mensah G.A., Meretoja T.J., Mestrovic T., Miller T.R., Mini G.K., Mirrakhimov E.M., Moazen B., Mohammad D.K., Darwesh A.M., Mohammed S., Mohebi F., Mokdad A.H., Monasta L., Moodley Y., Moosazadeh M., Moradi G., Moradi-Lakeh M., Moraga P., Morawska L., Morrison S.D., Mosser J.F., Mousavi S.M., Murray C.J.L., Mustafa G., Nahvijou A., Najafi F., Nangia V., Ndwandwe D.E., Negoi I., Negoi R.I., Ngunjiri J.W., Nguyen C.T., Nguyen L.H., Ningrum D.N.A., Noubiap J.J., Shiadeh M.N., Nyasulu P.S., Ogbo F.A., Olagunju A.T., Olusanya B.O., Olusanya J.O., Onwujekwe O.E., Ortega-Altamirano D.D.V., Ortiz-Panozo E., Overland S., Mahesh P.A., Pana A., Panda-Jonas S., Pati S., Patton G.C., Perico N., Pigott D.M., Pirsaheb M., Postma M.J., Pourshams A., Prakash S., Puri P., Qorbani M., Radfar A., Rahim F., Rahimi-Movaghar V., Rahman M.H.U., Rajati F., Ranabhat C.L., Rawaf D.L., Rawaf S., Reiner R.C., Remuzzi G., Renzaho A.M.N., Rezaei S., Rezapour A., Rios-Gonzalez C., Roever L., Ronfani L., Roshandel G., Rostami A., Rubagotti E., Sadat N., Sadeghi E., Safari Y., Sagar R., Salam N., Salamati P., Salimi Y., Salimzadeh H., Samy A.M., Sanabria J., Santric Milicevic M.M., Sartorius B., Sathian B., Sawant A.R., Schaeffer L.E., Schipp M.F., Schwebel D.C., Senbeta A.M., Sepanlou S.G., Shaikh M.A., Shams-Beyranvand M., Shamsizadeh M., Sharafi K., Sharma R., She J., Sheikh A., Shigematsu M., Siabani S., Silveira D.G.A., Singh J.A., Sinha D.N., Skirbekk V., Sligar A., Sobaih B.H., Soofi M., Soriano J.B., Soyiri I.N., Sreeramareddy C.T., Sudaryanto A., Babale Sufiyan M., Sutradhar I., Sylaja P., Tabares-Seisdedos R., Tadesse B.T., Temsah M.-H., Terkawi A.S., Tessema B., Tessema Z.T., Thankappan K.R., Topor-Madry R., Tovani-Palone M.R., Tran B.X., Car L.T., Ullah I., Uthman O.A., Valdez P.R., Veisani Y., Violante F.S., Vlassov V., Vollmer S., Thu Vu G., Waheed Y., Wang Y.-P., Wilkinson J.C., Winkler A.S., Wolfe C.D.A., Yamada T., Yeshaneh A., Yip P., Yisma E., Yonemoto N., Younis M.Z., Yousefifard M., Yu C., Bin Zaman S., Zhang J., Zhang Y., Zodpey S., Gakidou E., Hay S.I., Graetz, Nicholas, Woyczynski, Lauren, Wilson, Katherine F, Hall, Jason B, Yisma, Engida, Hay, Simon I, Local Burden of Disease Educational Attainment Collaborators, Microbes in Health and Disease (MHD), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), and Value, Affordability and Sustainability (VALUE)
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Male ,ATTAINMENT ,Health Status ,Disease ,education ,low- and middle-income countries ,0302 clinical medicine ,WORLD ,gender ,Global health ,risk factors ,030212 general & internal medicine ,Aetiology ,10. No inequality ,media_common ,Developing world ,Pediatric ,Multidisciplinary ,1. No poverty ,Multidisciplinary Sciences ,Geography ,Science & Technology - Other Topics ,Female ,HEALTH ,developing world ,social and economic factors ,Engineering sciences. Technology ,disparitie ,AFRICA ,medicine.medical_specialty ,Inequality ,General Science & Technology ,media_common.quotation_subject ,MODELS ,Developing country ,Local Burden of Disease Educational Attainment Collaborators ,Article ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,Education ,03 medical and health sciences ,2.3 Psychological ,medicine ,Humans ,Society ,Social determinants of health ,Developing Countries ,Science & Technology ,Equity (economics) ,MORTALITY ,Public health ,Bayes Theorem ,Educational attainment ,3141 Health care science ,society ,Good Health and Well Being ,Risk factors ,Socioeconomic Factors ,Demographic economics ,030217 neurology & neurosurgery - Abstract
Educational attainment is an important social determinant of maternal, newborn, and child health1–3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4–6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9–11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries12–14. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations., Analyses of the proportions of individuals who have completed key levels of schooling across all low- and middle-income countries from 2000 to 2017 reveal inequalities across countries as well as within populations.
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- 2020
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155. Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17
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Ninuk Hariyani, Benjamin Uzochukwu, Anas M. Saad, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Behzad Karami Matin, Abdallah M. Samy, Roman Topor-Madry, Nelson G.M. Gomes, Afsaneh Arzani, Simin Liu, Maryam Khayamzadeh, Ejaz Ahmad Khan, Asmamaw Bizuneh Demis, Anelisa Jaca, Amir Kasaeian, Fereshteh Ansari, Abdur Razzaque Sarker, Ali Kabir, Jorge Cano, Marcos Roberto Tovani-Palone, Tufa Kolola, Josephine W. Ngunjiri, Roghiyeh Faridnia, Kedir Hussein Abegaz, Hosni Salem, Sharareh Eskandarieh, Norberto Perico, Sergio I. Prada, Fisaha Haile Tesfay, Jai K Das, Ana Isabel Ribeiro, Sameer Vali Gopalani, Dessalegn Haile, Shivakumar Km Marulasiddaiah M. KMShivakumar, Narayan Prasad, Pranab Chatterjee, Shafiu Mohammed, Ravi Prakash Jha, Xiu Ju George Zhao, Farshad Farzadfar, Ahmad Daryani, Pramesh Raj Ghimire, Abbas Mosapour, Ebrahim Babaee, Rajat Das Gupta, Jean Jacques Noubiap, Daniel Bekele Ketema, Teshome Bekele Elema I, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Muktar Beshir Ahmed, Wondimeneh Shibabaw Shiferaw, Mehran Asadi-Aliabadi, Mohamed M. Gad, Eugenio Traini, Milena Santric-Milicevic, Bakhtiar Piroozi, Mohsen Afarideh, Duduzile Ndwandwe, Ibrahim Abdollahpour, Aisha Elsharkawy, Bárbara Niegia Garcia de Goulart, Soufiane Boufous, Obinna Onwujekwe, Seyyed Meysam Mousavi, Azeem Majeed, Meghnath Dhimal, Bruno F. Sunguya, Daniel Adane Endalew, Hosein Shabaninejad, Siddhesh Zadey, Takahiro Tabuchi, Gebrekiros Gebremichael Meles, Davide Guido, Trang Huyen Nguyen, Yonatal Mesfin Tefera, Hala Elhabashy, Devasahayam J. Christopher, Malede Mequanent Sisay, Davide Rasella, Hedayat Abbastabar, Maziar Moradi-Lakeh, Anthony Masaka, Wagaye Fentahun Chanie, B. Suresh Kumar Shetty, Matiwos Soboka Daba, Tesfaye Yitna Yitna Chichiabellu, Arianna Maever L. Amit, Tomohide Yamada, Alireza Rafiei, Reinhard Busse, Abdullah Al Mamun, Genet Melak Alamene, George C Patton, Andem Effiong, Rushdia Ahmed, Jagadish Rao Padubidri, Mohamad-Hani Temsah, Nizal Sarrafzadegan I, Francesco Saverio Violante, Monika Sawhney, Eyal Oren, Kimberly B. Johnson, Benn Sartorius, Shirin Djalalinia, Mohsen Bayati, Merhawi Gebremedhin Tekle, Navid Rabiee, Javad Nazari, Krishna K. Aryal, Kavumpurathu Raman Thankappan, Yoshan Moodley, Anh Kim Dang, Mohammad Khazaei, Parvaiz A Koul, Edson Serván-Mori, Foad Abd-Allah, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, Sonia Saxena, Bayu Begashaw Bekele, Hagos Degefa de Hidru I, Enayatollah Homaie Rad, Richard C. Franklin, Dara K. Mohammad, Naznin Hossain, Oliver J. Brady, Natalie Maria Cormier, Ghulam Mustafa, Samiah Alam, Guoqing Hu, Yousef Khader, Mohsen Mazidi, Hamed Kalani, Hamideh Salimzadeh, Mayowa O. Owolabi, Ali Bijani, Getu Debalkie Demissie, Tsegaye Lolaso Lenjebo, German Martinez, Elias Merdassa Roro, Hamidreza Komaki, Giovanni Damiani, Nelson Alvis-Guzman, Reza Shirkoohi, Aditya Prasad Dash, Benny Antony, Cheru Tesema Leshargie, Josip Car, Turki Alanzi, Amir Jalali, Shahin Soltani, Arvin Haj-Mirzaian, John S. Ji, Nima Hafezi-Nejad, S. Mohammad Sajadi, Khalid A Altirkawi, Shanshan Li, Hunduma Amensisa Amensisa Bojia I, Estifanos Baye, Hany Aref, Kebreab Paulos, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Felix Lam, Themba G.G. Ginindza, Behnam Heidari, Chukwudi A Nnaji, Kebadnew Mulatu Mihretie, Mostafa Leili, Sohail Ahmad, Babak Moazen, Samad Azari, Feleke Gebremeskel W, Jacqueline Elizabeth Alcalde-Rabanal, Khanh Bao Tran, Okechukwu S Ogah, Bruno Ramos Nascimento, Tefera Chane Mekonnen, Irina Filip, Bogdan Oancea, Lalit Dandona, Desalegn Markos Shifti, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Mohammad Ebrahimi Kalan, Sheetal D. Lad, Michael R.M. Abrigo, Ken Lee Chin, Masoud Moradi, Temesgen Yihunie Akalu, Behzad Heibati, Ole Frithjof Norheim, Man Mohan Mehndiratta, Mahya Beheshti, Ali Yadollahpour, Gelin Xu, Siamak Sabour, Neda Izadi, Carlos Culquichicón, Tuomo J. Meretoja, Ireneous N. Soyiri, Jacob Olusegun Olusanya, Félix Carvalho, Hamid Yimam Hassen, Dereje Bayissa Demissie, Yun Jin Kim, Rajesh Sagar, Fakher Rahim, Catrin E. Moore, Thomas R. Hird, Amjad Mohamadi-Bolbanabad, Naser Mohammad Gholi Mezerji, Ahamarshan Jayaraman Nagarajan, Anton Sokhan, Faris Lami, Masoud Behzadifar, Ritesh G. Menezes, Amira Hamed Darwish, Mohammad Zamani, Tesleem Kayode Babalola, Navid Manafi, Charles Shey Wiysonge, Diego Augusto Santos Silva, Daniel Diaz, Eleonora Dubljanin, Soraya Nouraei Motlagh, Suraj Bhattarai, Getasew Taddesse Worku, Noore Alam, Jasvinder A. Singh, Catalina Liliana Andrei, Ali Kazemi Karyani, Robert C. Reiner, Mohammedaman Mama Hussen, Fatemeh Heydarpour, Nuruzzaman Khan I, Bach Xuan Tran, Lal B. Rawal, Bereket Duko, Joemer C. Maravilla, Rakhi Dandona, Sandra B. Munro, Jae Il Shin, Julia Moreira Pescarini, Claudiu Herteliu, Ahmed Abdelalim, Manasi Kumar, Pushpendra Kumar, Saleem Muhammad Rana, Hedley Quintana, Akram Pourshams, Franz Castro, Muhammad Aziz Rahman, Beyene Meressa Adhena, Aberash Abay Tasew, Linda Morales, Dawit Zewdu Wondafrash, Wasiq Faraz Rawasia, David Laith Rawaf, Zoubida Zaidi, Tomislav Mestrovic, Rajeev Gupta, Seyyede Masoume Athari, Peter Njenga Keiyoro, Andrea Werdecker, Santi Martini, Fatemeh Rajati, Andre Pascal Kengne, Victor Adekanmbi, Seid Tiku Mereta, Yared Asmare Aynalem, Kewal Krishan, Marzieh Nojomi, Yves Miel H Zuniga, Mohammad Reza Sobhiyeh, Frank B. Osei, Nefsu Awoke, Randah R. Hamadeh, G. K. Mini, Edris Hasanpoor, Ayele Geleto Bali, Moslem Soofi, Prabhat Lamichhane, Peter Azzopardi, Amir Khater, G Anil Kumar, Catherine A. Welgan, Abraham Getachew Kelbore, Jaifred Christian F. Lopez, Senthilkumar Balakrishnan, Mohammad Ali Sahraian, Ahmed I. Hasaballah, Virendra Singh, Arash Ziapour, Zahid A Butt, Hebat Allah Salah A. Yousof, Tewodros Eshete Wonde, Sanjay Zodpey, Amaha Kahsay, Achala Upendra Jayatilleke, Segun Emmanuel Ibitoye, Beriwan Abdulqadir Ali, Simin Mouodi, Salman Rawaf, Iqbal R. F. Elyazar, Ai-Min Wu, Seyed Sina Naghibi Irvani, Yasir Waheed, Delia Hendrie, Hadi Pourjafar, Farnam Mohebi, Naohiro Yonemoto, Ahmad Ghashghaee, Veincent Christian Filipino Pepito, Paulina A. Lindstedt, Nauman Khalid, Sezer Kisa, Chi Linh Hoang, Niranjan Kissoon, Kindie Fentahun Muchie, Valery L. Feigin, Mathew M. Baumann, Alemayehu Toma, Andre Rodrigues Duraes, Benjamin B. Massenburg, Santosh Varughese, Yuan-Pang Wang, Ingan Ukur Tarigan, Ali Kiadaliri, Hamed Zandian, Demelash Woldeyohannes Handiso, Hassan Magdy Abd El Razek, Ketema Bizuwork Gebremedhin, Hafiz Ansar Rasul Suleria, Oluchi Ezekannagha, Getinet Ayano, Bolajoko O. Olusanya, Manu Raj Mathur, Manfred Accrombessi, Christopher J L Murray, Moritz U. G. Kraemer, Saeed Amini, Ziad A. Memish, Yousef Mohammad, Luis Camera, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Negar Rezaei, Ted R. Miller, Aziz Eftekhari, Nevine El Nahas, Sebastian Vollmer, Sanjay Basu, Hesham M. Al-Mekhlafi, D. R. Mahadeshwara Prasad, Rufus A. Adedoyin, Miliva Mozaffor I, Mihiretu Kebede, Preeti Dhillon, Dilaram Acharya, Iman El Sayed, Narendar Manohar, Paul S. F. Yip, Ben Lacey, Felix Akpojene Ogbo, Adrian Davis, Dinh-Toi Chu, Ranjani Somayaji, Raaj Kishore Biswas, Taddese Alemu Zerfu, Claudio Alberto Dávila-Cervantes, Sharath Burugina Nagaraja, Getachew Mullu Kassa, Mohan Bairwa, Gurudatta Naik, André Karch, Gudlavalleti V S Murthy, Avula Laxmaiah, Farid Najafi, Birhanu Geta Meharie, Lorenzo Monasta, Amit Arora, Christopher S Yilgwan, Samer Hamidi, Keivan Ahmadi, Kebede Deribe, Ehimario U. Igumbor, Engida Yisma, Henok Biresaw Netsere, Mihajlo Jakovljevic, Ali S. Shalash, Thirunavukkarasu Sathish, Sachin R Atre, Mohamed I Hegazy, Mehedi Hasan, Hamidreza Haririan, Lucas Guimarães Abreu, Nejimu Biza Zepro, Surendra Karki, Krittika Bhattacharyya, Hiroshi Yatsuya, Gbenga A. Kayode, Osayomwanbo Osarenotor, Paul H. Lee, Deepak Paudel, Hagos Tasew Atalay, Hatem S Shehata, Mohammad Fareed, Adnan Kisa, Hisham Atan Edinur, Mehran Alijanzadeh, Shafiur Rahman, Mohammad Hossein Khosravi, Anusha Ganapati Bhat, Bahram Mohajer, Narinder Pal Singh, Shai Linn, Savita Lasrado, Joseph Adel Mattar Banoub, Amir Almasi-Hashiani, Mohd Anisul Karim, Praveen Hoogar, Kerrie E. Doyle, Bedilu Girma Weji, Juan Sanabria, Olatunji O. Adetokunboh, Mohamed Hsairi, Alireza Esteghamati, Seok Jun Yoon, Paramjit Gill, Dabere Nigatu, Tariq Jamal Siddiqi, Muhammad Usman, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Florian Fischer, Peter Memiah, Rakesh Lodha, Nihal Thomas, Karzan Abdulmuhsin Mohammad, Mohammad Sadegh Rezai, Tanuj Kanchan, Vinay Nangia, Ashraf Nabhan, Gebre Teklemariam Demoz, Eirini Skiadaresi, Aleksandra Barac, Simon I. Hay, Sadaf G. Sepanlou, Michellr L. Bell, Nicola Luigi Bragazzi, Aklilu Endalamaw, Vishnu Renjith, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Ayenew Negesse Abejie, Smita Pakhale, Doris V.V. Ortega-Altamirano, Noushin Mohammadifard, Deborah Carvalho Malta, Vo Dinh Bay, Kirsten E. Wiens, Hamidreza Karimi-Sari, Mustafa Z. Younis, Shaimaa I. El-Jaafary, Morenike Oluwatoyin Folayan, Phetole Walter Mahasha, Mu'awiyyah Babale Sufiyan, Harish Chander Gugnani, Mohammad Hifz Ur Rahman, Sheikh Mohammed Shariful Islam, Maarten J. Postma, Usman Iqbal, Abdu A. Adamu, Marwa R.Rashad Salem I, Fares Alahdab, Vafa Rahimi-Movaghar, Zulfiqar A. Bhutta, Masoud Foroutan, Muhammad Shahzeb Khan, In-Hwan Oh, Yahya Salimi, Takeshi Fukumoto, Chhabi Lal Ranabhat, Tiffany K. Gill, Angel Paternina-Caicedo, Walter Mendoza, Sojib Bin Zaman, Olayinka Stephen Ilesanmi, Brigette F. Blacker, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Ambrish Singh, Mehdi Fazlzadeh, Mahesh P A, Carlo La Vecchia, Alex Yeshaneh, Benjamin K. Mayala, Aniruddha Deshpande, Agus Sudaryanto, Neeraj Bedi, Morteza Shamsizadeh, Jemal Abdu Mohammed, Vahid Alipour, Haileab Fekadu Wolde, Boris Bikbov, Ahmed Abualhasan, Ali H. Mokdad, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Jacek Jerzy Jozwiak, Alessandra C. Goulart, Mahmoud Yousefifard, Masood Ali Shaikh, Roya Safari-Faramani, MohammadBagher Shamsi, Aso Mohammad Darwesh, Amir Anoushiravani, Kebede Embaye Gezae, Degena Bahrey Tadesse, Paula Moraga, Maha El Tantawi, Rosario Cárdenas, Assefa Desalew, Vivek Kumar, Mina Anjomshoa, Junaid Khan, Jagdish Khubchandani, Marcel Ausloos, Soraya Siabani, Anwar E. Ahmed, Mohammed Ibrahim Mohialdeen Gubari, Andre M. N. Renzaho, Vuong Minh Nong, Kaushik Sarkar, Bruno Piassi Sao Jose, Yafeng Wang, Mitchell T. Wallin, Edgar Denova-Gutiérrez, Mohammad Hasan Imani-Nasab, Melese Abate Reta, Kala M. Mehta, Yahya Safari, Marufa Sultana, David C. Schwebel, Roghayeh Mohammadibakhsh, Samath D Dharmaratne, Maysaa El Sayed Zaki, Shiwei Liu, Gail Davey, Milena Ilic, Yunquan Zhang, Bahram Armoon, Seyed-Mohammad Fereshtehnejad, Jost B. Jonas, Dian Kusuma, Yawukal chane Kasahun, Beatriz Paulina Ayala Quintanilla, Mohammad Moradi-Joo, Gebrehiwot G. Kassa, Maria Jesus Rios-Blancas, Serge Resnikoff, Seifadin Ahmed Shallo, Bartosz Miazgowski, Huda Basaleem, Jobert Richie Nansseu, Enrico Rubagotti, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Meysam Behzadifar, Maryam Adabi, Saravanan Muthupandian, Soumyadeep Bhaumik, hawariat, Carlos A Castañeda-Orjuela, Bhaskaran Unnikrishnan, Martin Amogre Ayanore, Dragos Virgil Davitoiu, Hossein Poustchi, Moses K. Muriithi, Dharmesh Kumar Lal, Ayman Grada, Rafael Tabarés-Seisdedos, Seyyed Shamsadin Athari, Ashish Pathak, Salvatore Rubino, Kenji Shibuya, Ana Laura Manda, Muluken Bekele Sorrie, Vivekanand Jha, Habtamu Kebebe Kasaye, Mohammad Hoseini, Sonali Kochhar, Van C. Lansingh, Ali Almasi, Amir Radfar, Till Bärnighausen, Marcia R. Weaver, Mowafa Househ, Arya Haj-Mirzaian, Gebremicheal Gebreslassie Kasahun, Arash Etemadi, Getahun Fentaw Mulaw, Zubair Kabir, Cuong Tat Nguyen, Chabila C Mapoma, Aubrey J. Levine, Solomon Gedlu Nigatu, Aslam Pervaiz, Muhammed Magdy Abd El Razek, Nataliya A. Foigt, Andrey Nikolaevich Briko, Sadaf Esteghamati, Chuanhua Yu, Pascual R. Valdez, Jennifer Rickard, Jennifer M. Ross, Ionut Negoi, Hailay Abrha Gesesew, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Sangram Kishor Patel, Vera Marisa Costa, Mostafa Hosseini, Hajer Elkout, Mika Shigematsu, Bryan L. Sykes, Afarin Rahimi-Movaghar, Nuworza Kugbey, Vijay Kumar Chattu, Payman Salamati, Mona M. Khater, Reta Tsegaye Gayesa, Ehsan Sadeghi, Andrew T Olagunju, Govinda Prasad Dhungana, Dina Nur Anggraini Ningrum, Yaschilal Muche Belayneh, Leonardo Roever, Luca Ronfani, Nathaniel J. Henry, Brijesh Sathian, Hamid Sharifi, Liliana Preotescu, Joshua Longbottom, Somayeh Bohlouli, Huong Lan Thi Nguyen, Khaled Khatab, Ziyad Al-Aly, Ghobad Moradi, Ruth W Kimokoti, Jalal Arabloo, Mariam Molokhia, Maciej Banach, Hasan Yusefzadeh, Rahman Shiri, Girmay Teklay Weldesamuel, Mekdes Tigistu Yilma, Taweewat Wiangkham, Soewarta Kosen, Kovin Naidoo, Fernando de la Hoz, Mohammed Shannawaz, Berhe Etsay Tesfay I, Yogesh Sabde, Syed Mohamed Aljunid, Belay Tessema, Reza Malekzadeh, Tinuke O Olagunju, Olatunde Aremu, Mohammad Reza Salahshoor, Derrick A Bennett, Oladimeji M. Adebayo, Teshome Gebre, Narayan Bahadur Mahotra, Nelson J. Alvis-Zakzuk, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Mehdi Hosseinzadeh, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Rovshan Khalilov, Ai Koyanagi, Salman Khazaei, Ismael R. Campos-Nonato, Alaa Badawi, Amir Hasanzadeh, Gebreamlak Gebremedhn Gebremeskel, Gessessew Bugssa Hailu, Dessalegn Ajema Berbada, Kate E. LeGrand, Azadeh Shafieesabet, Nikolay Ivanovich Briko, Robert S. Bernstein, Irfan Ullah, Isaac Oluwafemi Dipeolu, Hadi Hassankhani, Keyghobad Ghadiri, Local Burden of Disease Diarrhoea Collaborator, Violante FS, Wiens, KE, Lindstedt, PA, Blacker, BF, Johnson, KB, Yisma, E, Ahmed, Muktar Beshir, Reiner, Robert C, Duko, Bereket, Local Burden of Disease Diarrhoea Collaborators, Microbes in Health and Disease (MHD), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Local Burden Dis Diarrhoea, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, GeoHealth, HUS Comprehensive Cancer Center, Clinicum, Institute for Molecular Medicine Finland, Department of Oncology, University of Helsinki, and Instituto de Saúde Pública da Universidade do Porto
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RJ101 ,medicine.medical_treatment ,CHILDREN ,ZINC ,0302 clinical medicine ,030212 general & internal medicine ,media_common ,Geography ,lcsh:Public aspects of medicine ,1. No poverty ,Low income and middle income countries ,General Medicine ,3142 Public health care science, environmental and occupational health ,3. Good health ,Child, Preschool ,A990 Medicine and Dentistry not elsewhere classified ,Geographical inequalities ,0605 Microbiology ,Diarrhea ,AFRICA ,Inequality ,DEATHS ,media_common.quotation_subject ,030231 tropical medicine ,Developing country ,Article ,RS ,1117 Public Health and Health Services ,03 medical and health sciences ,MORBIDITY ,Environmental health ,DIARRHEAL DISEASE ,medicine ,Humans ,Oral rehydration therapy ,Healthcare Disparities ,Developing Countries ,Models, Statistical ,CHOLERA ,MORTALITY ,Infant, Newborn ,Infant ,lcsh:RA1-1270 ,Bayes Theorem ,Middle income ,GLOBAL BURDEN ,Child mortality ,0605 Microbiology, 1117 Public Health and Health Services ,Health Care Surveys ,ITC-ISI-JOURNAL-ARTICLE ,Fluid Therapy ,NA ,Human medicine ,ITC-GOLD - Abstract
Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. This work was primarily supported by a grant from the Bill & Melinda Gates Foundation (OPP1132415). L G Abreu has received support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001), Conselho Nacional de Desenvolvimento Científico e Tecnológico and Fundação de Amparo à Pesquisa do Estado de Minas Gerais. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. H T Atalay acknowledges Aksum University. M Ausloos and C Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. P S Azzopardi was supported by an Australian National Health and Medical Research Council (NHMRC) early career fellowship. A Badawi is supported by the Public Health Agency of Canada. T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research; the EU; the Wellcome Trust; and from National Institute of Child Health and Human Development of National Institutes of Health (NIH; R01-HD084233), National Institute on Aging of NIH (P01-AG041710), National Institute of Allergy and Infectious Diseases of NIH (R01-AI124389 and R01-AI112339), as well as Fogarty International Center of NIH (D43-TW009775). G B Britton is supported by Sistema Nacional de Investigación (SNI) de la Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) of Panamá. A Barac is funded by the Project of Ministry of Education, Science and Technology of the Republic of Serbia (number III45005). D A Bennett was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/Ministério da Ciência, Tecnologia e Ensino Superior through national funds. K Deribe is supported by a Wellcome Trust grant (number 201900/Z/16/Z) as part of his International Intermediate Fellowship. C Herteliu is partially supported by a grant co-funded by European Fund for Regional Development through the Operational Program for Competitiveness (project ID P_40_382). P Hoogar thanks Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education, Manipal and Centre for Holistic Development and Research, Kalaghatgi-Karnataka. S M S Islam is funded by a Fellowship from National Heart Foundation of Australia and Deakin University. M Jakovljevic and the Serbian part of this GBD contribution was co-funded through grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. A P Kengne is supported by the South African Medical Research Council. Y J Kim's work was supported by the Research Management Centre, Xiamen University Malaysia, grants number XMUMRF/2018-C2/ITCM/0001. K Krishan is supported by a DST PURSE grant and UGC Center of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar acknowledges K43 TW010716-03. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the British Heart Foundation Centre of Research Excellence, Oxford. P T N Memiah acknowledges the Council for the Development of Social Science Research in Africa. M Molokhia is supported by the NIHR Biomedical Research Center at Guy's and St Thomas' National Health Service Foundation Trust and King's College London. I Moreno Velásquez is supported by the Sistema Nacional de Investigación (SENACYT, Panamá). G C Patton is funded by an NHMRC Fellowship. A M Samy received a fellowship from the Egyptian Fulbright Mission programme. M M Santric-Milicevic acknowledges the support of the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). A Sheikh acknowledges the support of Health Data Research UK. M R Sobhiyeh acknowledges the Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences for their wise advice. R Tabarés-Seisdedos was supported in part by grant PI17/00719 from Instituto de Salud Carlos III–FEDER. B Unnikrishnan acknowledges Manipal Academy of Higher Education, Manipal. M R Weaver was supported by the Bill & Melinda Gates Foundation grant OPP1127433. C S Wiysonge was supported by the South African Medical Research Council.
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- 2020
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156. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
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L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL
- Subjects
Male ,Life expectancy ,Disability-Adjusted Life Year ,Diseases ,Disease ,communicable disease ,systematic analysis ,Global Burden of Disease ,0302 clinical medicine ,80 and over ,Medicine ,10. No inequality ,Child ,11 Medical and Health Sciences ,injuries ,Aged, 80 and over ,education.field_of_study ,Sjúkdómar ,DEMENTIA ,FALLS ,General Medicine ,Forvarnir ,3. Good health ,Child, Preschool ,Human ,GBD ,Population health ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,Humans ,Global Burden of Disease Study ,education ,Aged ,Spatial Analysis ,Global burden ,Disability ,Prevention ,DISABILITY ,Infant ,Spatial Analysi ,Mortality rate ,Global Burden of Disease, Diseases, Injuries, Systematic analysis ,PREVENTION ,Years of potential life lost ,Risk factors ,Disease study ,ITC-ISI-JOURNAL-ARTICLE ,RISK-FACTORS ,Clinical Medicine ,RA ,Demography ,Fötlun ,Dánartíðni ,Áhættuþættir ,030204 cardiovascular system & hematology ,Risk Factors ,Cause of Death ,Global health ,030212 general & internal medicine ,1. No poverty ,Disability-Adjusted Life Years ,Public Health, Global Health, Social Medicine and Epidemiology ,Middle Aged ,3142 Public health care science, environmental and occupational health ,Adolescent ,Adult ,Age Distribution ,Female ,Infant, Newborn ,Young Adult ,Lýðheilsa ,CLINICAL-TRIALS ,Population ,Settore MED/01 - Statistica Medica ,diseases ,ITC-HYBRID ,Heilbrigðisvísindi ,General & Internal Medicine ,Mortality ,Preschool ,Disease burden ,business.industry ,Risk Factor ,Klinisk medicin ,Newborn ,purl.org/pe-repo/ocde/ford#3.02.00 [https] ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Áverkar ,Systematic analysis ,NA ,business - Abstract
Publisher's version (útgefin grein), Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"
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157. Additional file 1 of Impact of capacity building interventions on individual and organizational competency for HPSR in endemic disease control in Nigeria: a qualitative study
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Obinna Onwujekwe, Chinyere Mbachu, Enyi Etiaba, Nkoli Ezumah, Uchenna Ezenwaka, Ifeyinwa Arize, Chinyere Okeke, Chikezie Nwankwor, and Uzochukwu, Benjamin
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Additional file 1. In-depth interview guides for producers and users of evidence.
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158. Morbidity and mortality from road injuries : results from the Global Burden of Disease Study 2017
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Andualem Henok, Mohammad Reza Sobhiyeh, Arash Tehrani-Banihashemi, Sanjay Zodpey, Hayimro Edemealem Merie, Parvaiz A Koul, Dillon O Sylte, Nicholas L S Roberts, Carlo La Vecchia, Oladimeji Adebayo, Molly R Nixon, Catherine Bisignano, Simon I. Hay, Zeinab Sharafi, Spencer L. James, Naser Mohammad Gholi Mezerji, Boikhutso Tlou, Yun Jin Kim, Suliman Alghnam, Erin B Hamilton, Zichen Liu, David M. Pigott, Farkhonde Salehi, Eyasu Tamru Bekru, Teamur Aghamolaei, Rajan Nikbakhsh, Belayneh K Gelaw, Yoshan Moodley, Mustafa Z. Younis, Aso Mohammad Darwesh, Taweewat Wiangkham, Manoochehr Karami, Hagos de Hidru, Ali H. Mokdad, Ted R. Miller, Rafael Tabarés-Seisdedos, Melkamu Merid Mengesha, Robert C. Reiner, Guoqing Hu, Obinna Onwujekwe, Nitin Joseph, Derrick A Bennett, Peter Memiah, Jack T Fox, Mohammad Ali Jahani, Bereket Duko Adema, Ahmed Omar Bali, Alaa Badawi, Kebede Deribe, Sharvari Rahul Shukla, Jens R. Chapman, Eskezyiaw Agedew Getahun, Maziar Moradi-Lakeh, Reza Pourmirza Kalhori, Kamarul Imran Musa, Saeed Shahabi, Yousef Fatahi, Roman Topor-Madry, Meysam Behzadifar, Peter Nyasulu, Delia Hendrie, Morteza Shamsizadeh, Mehdi Yaseri, Mehdi Mirzaei-Alavijeh, Farzad Jalilian, Alan D. Lopez, Masoud Behzadifar, Nuruzzaman Khan, Roghayeh Mohammadibakhsh, Reza Majdzadeh, Bryan L. Sykes, Seifadin Ahmed Shallo, Degena Bahrey Tadesse, Abraham Getachew Kelbore, Arash Ziapour, Mehdi Hosseinzadeh, Zachary V Dingels, Syed Mohamed Aljunid, Mihajlo Jakovljevic, Bruno Ramos Nascimento, Man Mohan Mehndiratta, Sanni Yaya, Muluken Azage Yenesew, Amir Almasi-Hashiani, Shai Linn, Sanghamitra Pati, Lydia R. Lucchesi, Yonatal Mesfin Tefera, Darrah McCracken, Chris D Castle, Joan B. Soriano, James, Spencer L, Lucchesi, Lydia R, Bisignano, Catherine, Castle, Chris D, Adema, Bereket Duko, and Mokdad, Ali H
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medicine.medical_specialty ,Asia ,Population ,Poison control ,burden of disease ,pedestrian injuries ,Global Health ,road injuries, pedestrian injuries ,Global Burden of Disease ,03 medical and health sciences ,0302 clinical medicine ,Injury prevention ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Mortality ,education ,Original Research ,education.field_of_study ,business.industry ,road traffic accident ,Mortality rate ,Incidence (epidemiology) ,traumatic brain injury ,motorcycle ,Public Health, Environmental and Occupational Health ,Accidents, Traffic ,Miscellaneous ,Epidemiological transition ,Years of potential life lost ,Wounds and Injuries ,road injuries ,Quality-Adjusted Life Years ,Morbidity ,business ,descriptive epidemiology ,030217 neurology & neurosurgery ,Demography - Abstract
BackgroundThe global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years.MethodsWe used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury.ResultsGlobally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change.ConclusionsWhile road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented.
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159. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
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William M. Gardner, Rawlance Ndejjo, Govinda Prasad Dhungana, Fereshteh Ansari, Kathleen Pillsbury Hopf, João Pedro Silva, M. Mofizul Islam, Cong Zhu, Abdul Hafiz, Irmina Maria Michalek, Syed Mohamed Aljunid, Leonardo Roever, Mustefa Glagn, Davood Anvari, Tessa M. Pilz, Sameer Vali Gopalani, Joel M. Francis, Man Mohan Mehndiratta, Rakhi Dandona, Abbas Sheikhtaheri, Mansour Ghafourifard, Simon Øverland, David Laith Rawaf, Jaykaran Charan, Akram Pourshams, Mostafa Dianatinasab, Morteza Mahmoudi, Alton Lu, Alyssa N. Sbarra, Lorainne Tudor Car, Franz Castro, Hafiz Ansar Rasul Suleria, Luca Ronfani, Marina Pinheiro, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Hoa Thi Do, Whitney L. Teagle, Sofia Androudi, Carl Abelardo T. Antonio, Myron Anthony Godinho, Bhaskaran Unnikrishnan, Oluchi Ezekannagha, Getinet Ayano, Seyyed Shamsadin Athari, Dimas Ria Angga Pribadi, Kyle E. Simpson, Muluken Bekele Sorrie, Vivekanand Jha, Chukwuma David Umeokonkwo, Akshaya Srikanth Bhagavathula, Cuong Tat Nguyen, Amr Hassan, Akine Eshete Abosetugn, Hailay Abrha Gesesew, Anna V. Korotkova, Brijesh Sathian, Marcello Tonelli, Olatunde Aremu, Mohammad Reza Salahshoor, Juan Jesus Carrero, Cameron J. Kneib, Ravi Prakash Jha, David H. Shaw, Hossein Samadi Kafil, Tanuj Kanchan, Khezar Hayat, Hamid Sharifi, Morteza Shamsizadeh, Muktar Omer Omer, Fatemeh Amiri, Hamidreza Pazoki Toroudi, David Edvardsson, Xiu Ju George Zhao, Hannah Han, Leticia Avila-Burgos, Adam E. Berman, Jemal Abdu Mohammed, Thomas Pilgrim, Leila Doshmangir, Mu'awiyyah Babale Sufiyan, David M. Pigott, Hadi Hassankhani, Beatriz Paulina Ayala Quintanilla, Teklemariam Gultie, Arash Ziapour, Seyed Sina Naghibi Irvani, Ilse N. Dippenaar, Jean Jacques Noubiap, Emmanuela Gakidou, Abiyu Mekonnen Gebrehiwot, Maha El Tantawi, Xuefeng Liu, Zulfiqar A. Bhutta, Keyghobad Ghadiri, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Yunquan Zhang, Vera Marisa Costa, Iyad Sultan, Mostafa Hosseini, Abdulaziz Khalid Abu Haimed, Haidong Wang, Kaleab Alemayehu Zewdie, Celine M. Barthelemy, Hosna Janjani, Bartosz Miazgowski, Jobert Richie Nansseu, Arianna Maever L. Amit, John S. Ji, Ata Rafiee, Maria Inês Schmidt, Alireza Rafiei, Somayeh Bohlouli, Joana Morgado-da-Costa, Huong Lan Thi Nguyen, Pradyumna Agasthi, Tiffany K. Gill, Martin McKee, Khaled Khatab, Jae Il Shin, Animut Tagele Tamiru, Giancarlo Logroscino, Hassan Abolhassani, Syed Saoud Zaidi, Sivan Yegnanarayana Iyer Saraswathy, Garumma Tolu Feyissa, Ahmad Daryani, Ziyad Al-Aly, Gebreamlak Gebremedhn Gebremeskel, Michael T. Chung, Amirhossein Sahebkar, Mehedi Hasan, Saeed Shahabi, Diep Ngoc Nguyen, Yohannes Kinfu, Nicholas L S Roberts, Jagadish Rao Padubidri, Mika Shigematsu, Lucero Cahuana-Hurtado, Deepa Jahagirdar, Islam Y. Elgendy, Erkin M. Mirrakhimov, Tanvir M. Huda, Fakher Rahim, Dara K. Mohammad, Yingxi Zhao, Ruxandra Irina Negoi, Vinod C. Nayak, Reinhard Busse, Andrew T. Leever, Muhammad Aziz Rahman, Kathryn Mei Ming Lau, Stefania Mondello, Vivian Chia-Rong Hsieh, Kris J. Krohn, Reza Rawassizadeh, Vishnu Renjith, Jianing Ma, Moses K. Muriithi, Mark G. Shrime, Mayowa O. Owolabi, Nobuyuki Horita, Seyed Hossein Yahyazadeh Jabbari, Daniel Y. Cho, Miloje Savic, Moslem Soofi, Iqbal R. F. Elyazar, Freweini Gebrearegay G. Tela, Jonathan F. Mosser, Palash Chandra Banik, Andre Rodrigues Duraes, Yuan-Pang Wang, Natalie C. Galles, Rashid Abdi Guled, Abdallah M. Samy, Hadi Pourjafar, Roman Topor-Madry, Ayesha Humayun, Leila Zaki, Nuworza Kugbey, Maryam Khayamzadeh, Naznin Hossain, Jiregna Darega Gela, Jordi Alonso, Ruth W Kimokoti, A. A. Fomenkov, Jalal Arabloo, Aletta E. Schutte, Biruk Wogayehu Taddele, Teklehaimanot Gereziher Haile, Diego Augusto Santos Silva, Seyed Mohammad Kazem Aghamir, Maciej Banach, Deanna Anderlini, Moses J. Bockarie, Saleem Muhammad Rana, Randah R. Hamadeh, Farhad Islami, Olalekan A. Uthman, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Kairat Davletov, Soraya Seedat, Alan D. Lopez, Masoud Behzadifar, Benjamin B. Massenburg, Santosh Varughese, Ingan Ukur Tarigan, Amin Soheili, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Caleb Mackay Salpeter Irvine, Mojgan Gitimoghaddam, G Anil Kumar, Rasmus J. Havmoeller, Hiroyasu Iso, Atte Meretoja, Yasir Waheed, João M. Furtado, Christian Razo, Neeti Kapoor, Mowafa Househ, Rajaa Al-Raddadi, Mohammad Khammarnia, Santi Martini, Feng Sha, Marco Vacante, Jacek A. Kopec, Hunduma Amensisa Bojia, Jacob Olusegun Olusanya, Kate E. LeGrand, Nikolay Ivanovich Briko, Robert S. Bernstein, Arun Balachandran, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Leake G. Gebremeskel, Smita Pakhale, Ejaz Ahmad Khan, Daniel Cury Ribeiro, Yousef Mohammad, Bernhard T. Baune, Azeem Majeed, Luis Camera, Mohammad Ali Jahani, Hasan Yusefzadeh, Rahman Shiri, Massimo Cirillo, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, Paolo Lauriola, Irfan Ullah, Aruna M Kamath, Maryam Mirzaei, Zabihollah Yousefi, Iman El Sayed, Mohammad Farahmand, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Felix Akpojene Ogbo, Megan Knight, Nelson J. Alvis-Zakzuk, Teferi Mekonnen, Iván Landires, Robert G. Weintraub, Chukwudi A Nnaji, Lauren E. Schaeffer, Paulo A. Lotufo, Mehdi Naderi, Tomislav Mestrovic, André Faro, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Vladimir Andreevich Korshunov, Birhanu Geta Meharie, Mihajlo Jakovljevic, Abdiwahab Hashi, Olatunji O. Adetokunboh, Dejana Braithwaite, Sergio I. Prada, Bárbara Niegia Garcia de Goulart, Reza Pourmirza Kalhori, Jee-Young Jasmine Choi, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Paul S. F. Yip, Mehdi Mirzaei-Alavijeh, Gebremariam Woldu, Rashmi Gupta, Onome Bright Oghenetega, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Mehdi Hosseinzadeh, Marcos Roberto Tovani-Palone, K M Shivakumar, Alireza Ansari-Moghaddam, Archith Boloor, Aidin Abedi, Binyam Minuye Birihane, Mohammad Ali Mansournia, Nihad A. Almasri, Simachew Animen Bante, Carlo Eduardo Medina-Solís, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Antonio Biondi, Valentin Yurievich Skryabin, Srinivasa Vittal Katikireddi, Sarika Chaturvedi, Francesco Saverio Violante, Abhay Gaidhane, George A. Mensah, Naohiro Yonemoto, Ahmad Ghashghaee, Ebrahim Babaee, Saman Esmaeilnejad, Sharath Burugina Nagaraja, Avina Vongpradith, Javad Nazari, Amir Khater, Michael K. Hole, Ben Lacey, Razique Anwer, Łukasz Szumowski, Ai Koyanagi, Rajesh Sagar, Ali Rajabpour-Sanati, Seyed M Karimi, Yordanos Gizachew Yeshitila, Mona Pathak, Nithin Kumar, Masoud Foroutan, Mehdi Fazlzadeh, Anusha Ganapati Bhat, Abbas Mosapour, Kebede Deribe, Nermin Ghith, Vaman Kulkarni, Sanjay Zodpey, Asadollah Gholamian, Mohammed Shannawaz, Nancy Fullman, Benn Sartorius, Giulio Castelpietra, Ghulam Mustafa, Silvia Schiavolin, Nelson Alvis-Guzman, Jeffrey D. Stanaway, Rafael Lozano, Christopher J L Murray, Guoqing Hu, Andrew M. Briggs, Ashish Badiye, Yousef Khader, Masoud Moghadaszadeh, Rahmatollah Moradzadeh, Valery L. Feigin, Claudia I. Mastrogiacomo, Emma Smith, Yasser Vasseghian, Saeed Amini, Asif Hanif, Achala Upendra Jayatilleke, Maryam Adabi, Sarah Wulf Hanson, Bhaskar Thakur, Ravi Mehrotra, Virginia Núñez-Samudio, Lalit Dandona, Segun Emmanuel Ibitoye, Simon I. Hay, Kiirithio N. 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University, Health Sciences, 10922180 - Schutte, Aletta Elisabeth, Lozano, R., Fullman, N., Mumford, J. E., Knight, M., Barthelemy, C. M., Abbafati, C., Abbastabar, H., Abd-Allah, F., Abdollahi, M., Abedi, A., Abolhassani, H., Abosetugn, A. E., Abreu, L. G., Abrigo, M. R. M., Abu Haimed, A. K., Abushouk, A. I., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adelson, J., Adetokunboh, O. O., Adham, D., Advani, S. M., Afshin, A., Agarwal, G., Agasthi, P., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Akinyemi, R. O., Alahdab, F., Al-Aly, Z., Alam, K., Albertson, S. B., Alemu, Y. M., Alhassan, R. K., Ali, M., Ali, S., Alipour, V., Aljunid, S. M., Alla, F., Almadi, M. A. H., Almasi, A., Almasi-Hashiani, A., Almasri, N. A., Al-Mekhlafi, H. M., Almulhim, A. M., Alonso, J., Al-Raddadi, R. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amiri, F., Amit, A. M. L., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Andrei, C. L., Androudi, S., Ansari, F., Ansari-Moghaddam, A., Antonio, C. A. T., Antony, C. 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S., Islami, F., Iso, H., Iwu, C. J., Jaafari, J., Jadidi-Niaragh, F., Jafarinia, M., Jahagirdar, D., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Janjani, H., Javaheri, T., Jayatilleke, A. U., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Jia, P., John-Akinola, Y. O., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, Z., Kalankesh, L. R., Kalhor, R., Kamath, A. M., Kanchan, T., Kapoor, N., Karami Matin, B., Karanikolos, M., Karimi, S. M., Kassebaum, N. J., Katikireddi, S. V., Kayode, G. A., Keiyoro, P. N., Khader, Y. S., Khammarnia, M., Khan, M., Khan, E. A., Khang, Y. -H., Khatab, K., Khater, A. M., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khubchandani, J., Kianipour, N., Kim, Y. J., Kimokoti, R. W., Kinfu, Y., Kisa, A., Kissimova-Skarbek, K., Kivimaki, M., Kneib, C. J., Kocarnik, J. M., Kochhar, S., Kohler, S., Kopec, J. A., Korotkova, A. V., Korshunov, V. A., Kosen, S., Kotlo, A., Koul, P. A., Koyanagi, A., Krishan, K., Krohn, K. J., Kugbey, N., Kulkarni, V., Kumar, G. A., Kumar, N., Kumar, M., Kurmi, O. P., Kusuma, D., Kyu, H. H., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Landires, I., Lansingh, V. C., Larsson, A. O., Lasrado, S., Lau, K. M. -M., Lauriola, P., Lazarus, J. V., Ledesma, J. R., Lee, P. H., Lee, S. W. H., Leever, A. T., Legrand, K. E., Leigh, J., Leonardi, M., Li, S., Lim, S. S., Lim, L. -L., Liu, X., Logroscino, G., Lopez, A. D., Lopukhov, P. D., Lotufo, P. A., Lu, A., Ma, J., Madadin, M., Mahasha, P. W., Mahmoudi, M., Majeed, A., Malagon-Rojas, J. N., Maleki, S., Malta, D. C., Mansouri, B., Mansournia, M. A., Martini, S., Martins-Melo, F. R., Martopullo, I., Massenburg, B. B., Mastrogiacomo, C. I., Mathur, M. R., Mcalinden, C., Mckee, M., Medina-Solis, C. E., Meharie, B. G., Mehndiratta, M. M., Mehrabi Nasab, E., Mehri, F., Mehrotra, R., Mekonnen, T., Melese, A., Memiah, P. T. N., Mendoza, W., Menezes, R. G., Mensah, G. A., Meretoja, T. J., Meretoja, A., Mestrovic, T., Miazgowski, B., Michalek, I. M., Mirrakhimov, E. M., Mirzaei, M., Mirzaei-Alavijeh, M., Mitchell, P. B., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Mohammad, D. K., Mohammad Gholi Mezerji, N., Mohammadian-Hafshejani, A., Mohammed, S., Mohammed, J. A., Mokdad, A. H., Monasta, L., Mondello, S., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morgado-da-Costa, J., Morrison, S. D., Mosapour, A., Mosser, J. F., Mousavi Khaneghah, A., Muriithi, M. K., Mustafa, G., Nabhan, A. F., Naderi, M., Nagarajan, A. J., Naghavi, M., Naghshtabrizi, B., Naimzada, M. D., Nangia, V., Nansseu, J. R., Nayak, V. C., Nazari, J., Ndejjo, R., Negoi, I., Negoi, R. I., Neupane, S., Ngari, K. N., Nguefack-Tsague, G., Ngunjiri, J. W., Nguyen, C. T., Nguyen, D. N., Nguyen, H. L. T., Nnaji, C. A., Nomura, S., Norheim, O. F., Noubiap, J. J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Ogbo, F. A., Oghenetega, O. B., Oh, I. -H., Okunga, E. W., Oladnabi, M., Olagunju, A. T., Olusanya, J. O., Olusanya, B. O., Oluwasanu, M. M., Omar Bali, A., Omer, M. O., Ong, K. L., Onwujekwe, O. E., Ortega-Altamirano, D. V. V., Ortiz, A., Ostojic, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., Padubidri, J. R., Pakhale, S., Palladino, R., Pana, A., Panda-Jonas, S., Pangaribuan, H. U., Pathak, M., Patton, G. C., Paudel, S., Pazoki Toroudi, H., Pease, S. A., Peden, A. E., Pennini, A., Peprah, E. K., Pereira, J., Pigott, D. M., Pilgrim, T., Pilz, T. M., Pinheiro, M., Piradov, M. A., Pirsaheb, M., Pokhrel, K. N., Postma, M. J., Pourjafar, H., Pourmalek, F., Pourmirza Kalhori, R., Pourshams, A., Prada, S. I., Pribadi, D. R. A., Pupillo, E., Quazi Syed, Z., Radfar, A., Rafiee, A., Rafiei, A., Raggi, A., Rahim, F., Rahman, M. A., Rajabpour-Sanati, A., Rana, S. M., Ranabhat, C. L., Rao, S. J., Rasella, D., Rashedi, V., Rath, G. K., Rathi, P., Rawaf, S., Rawaf, D. 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Index (economics) ,Servicios de Salud ,SUSTAINABLE DEVELOPMENT GOALS ,030204 cardiovascular system & hematology ,universal health coverage ,sustaibale develpment goal ,global burden of disease ,performance ,systematic analysis ,Global Burden of Disease ,0302 clinical medicine ,Universal Health Insurance ,RA0421 ,11. Sustainability ,Per capita ,Medical economics ,Disease ,030212 general & internal medicine ,10. No inequality ,11 Medical and Health Sciences ,effective coverage of health services ,GBD 2019 Universal Health Coverage Collaborators ,education.field_of_study ,Public health ,Medical care ,Sjúkdómar ,4. Education ,1. No poverty ,Health coverage ,Public Health, Global Health, Social Medicine and Epidemiology ,General Medicine ,Hälsovetenskaper ,3142 Public health care science, environmental and occupational health ,Health services ,3. Good health ,Global burden of disease ,Health Expenditures ,Humans ,World Health Organization ,Purchasing power parity ,Scale (social sciences) ,Lýðheilsa ,universal health coverag ,CANCER SURVIVAL ,ACCESS ,Human ,Heilsuhagfræði ,medicine.medical_specialty ,Health coverage, GBD ,GBD ,Universal health ,GBD 2019 ,Population ,Health expenditures ,3122 Cancers ,Population health ,03 medical and health sciences ,Health systems ,Heilbrigðisvísindi ,SDG 3 - Good Health and Well-being ,General & Internal Medicine ,Development economics ,Health Sciences ,medicine ,Heilbrigðisstefna ,Alþjóðaheilbrigðisstofnunin ,QUALITY ,Global Burden of Disease Study ,education ,PROGRESS ,Disease burden ,Health services accessibility ,CARE ,Heilbrigðisþjónusta ,purl.org/pe-repo/ocde/ford#3.02.00 [https] ,Health Expenditure ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,3121 General medicine, internal medicine and other clinical medicine ,Morbility ,Administración de los Servicios de Salud ,Medical policy ,Business ,Heilbrigðiskerfi - Abstract
Publisher's version (útgefin grein), Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC., Lucas Guimaraes Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior -Brasil (Capes) -Finance Code 001, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). Olatunji O Adetokunboh acknowledges South African Department of Science & Innovation, and National Research Foundation. Anurag Agrawal acknowledges support from the Wellcome Trust DBT India Alliance Senior Fellowship IA/CPHS/14/1/501489. Rufus Olusola Akinyemi acknowledges Grant U01HG010273 from the National Institutes of Health (NIH) as part of the H3Africa Consortium. Rufus Olusola Akinyemi is further supported by the FLAIR fellowship funded by the UK Royal Society and the African Academy of Sciences. Syed Mohamed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Marcel Ausloos, Claudiu Herteliu, and Adrian Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDSUEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Till Winfried Barnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Juan J Carrero was supported by the Swedish Research Council (2019-01059). Felix Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Vera Marisa Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundacao para a Ciencia e a Tecnologia (FCT), IP, under the Norma TransitA3ria DL57/2016/CP1334/CT0006. Jan-Walter De Neve acknowledges support from the Alexander von Humboldt Foundation. Kebede Deribe acknowledges support by Wellcome Trust grant number 201900/Z/16/Z as part of his International Intermediate Fellowship. Claudiu Herteliu acknowledges partial support by a grant co-funded by European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Praveen Hoogar acknowledges the Centre for Bio Cultural Studies (CBiCS), Manipal Academy of Higher Education(MAHE), Manipal and Centre for Holistic Development and Research (CHDR), Kalghatgi. Bing-Fang Hwang acknowledges support from China Medical University (CMU108-MF-95), Taichung, Taiwan. Mihajlo Jakovljevic acknowledges the Serbian part of this GBD contribution was co-funded through the Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Aruna M Kamath acknowledges funding from the National Institutes of Health T32 grant (T32GM086270). Srinivasa Vittal Katikireddi acknowledges funding from the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15) and an NRS Senior Clinical Fellowship (SCAF/15/02). Yun Jin Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). Kewal Krishan acknowledges support from the DST PURSE grant and UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges support from K43 TW010716 Fogarty International Center/NIMH. Ben Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. Ivan Landires is a member of the Sistema Nacional de InvestigaciA3n (SNI), which is supported by the Secretaria Nacional de Ciencia Tecnologia e Innovacion (SENACYT), Panama. Jeffrey V Lazarus acknowledges support by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III/ESF, European Union [CP18/00074]). Peter T N Memiah acknowledges CODESRIA; HISTP. Subas Neupane acknowledges partial support from the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital. Shuhei Nomura acknowledges support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). Alberto Ortiz acknowledges support by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. George C Patton acknowledges support from a National Health & Medical Research Council Fellowship. Marina Pinheiro acknowledges support from FCT for funding through program DL 57/2016 -Norma transitA3ria. Alberto Raggi, David Sattin, and Silvia Schiavolin acknowledge support by a grant from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4 -Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). Daniel Cury Ribeiro acknowledges support from the Sir Charles Hercus Health Research Fellowship -Health Research Council of New Zealand (18/111). Perminder S Sachdev acknowledges funding from the NHMRC Australia. Abdallah M Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena M Santric-Milicevic acknowledges support from the Ministry of Education, Science and Technological Development of the Republic of Serbia (Contract No. 175087). Rodrigo Sarmiento-Suarez acknowledges institutional support from University of Applied and Environmental Sciences in Bogota, Colombia, and Carlos III Institute of Health in Madrid, Spain. Maria Ines Schmidt acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. Sheikh Mohammed Shariful Islam acknowledges a fellowship from the National Heart Foundation of Australia and Deakin University. Aziz Sheikh acknowledges support from Health Data Research UK. Kenji Shibuya acknowledges Japan Ministry of Education, Culture, Sports, Science and Technology. Joan B Soriano acknowledges support by Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Rafael Tabares-Seisdedos acknowledges partial support from grant PI17/00719 from ISCIII-FEDER. Santosh Kumar Tadakamadla acknowledges support from the National Health and Medical Research Council Early Career Fellowship, Australia. Marcello Tonelli acknowledges the David Freeze Chair in Health Services Research at the University of Calgary, AB, Canada., "Peer Reviewed"
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160. Toolkit for Determining the Financial Feasibility of a Health Intervention: Case Study of a Health Fund in Nigeria
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Obinna Onwujekwe, Chima Onoka, and Ifeoma Nwakoby
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Nursing ,Financial feasibility ,Business ,Health intervention - Published
- 2020
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161. Additional file 2 of Exploring factors constraining utilization of contraceptive services among adolescents in Southeast Nigeria: an application of the socio-ecological model
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Ezenwaka, Uchenna, Chinyere Mbachu, Nkoli Ezumah, Eze, Irene, Chibuike Agu, Ifunanya Agu, and Obinna Onwujekwe
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Additional file 2. FGD guide for village heads.
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- 2020
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162. Prevalence and sociodemographic determinants of risky sexual behavior among unmarried adolescents in Southeast Nigeria
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IfunanyaC Agu, IreneI Eze, ChinyereO Mbachu, MildredN Ndubuisi, Nkoli Ezumah, and Obinna Onwujekwe
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- 2022
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163. 'Miracle Examination Centres' as hubs for malpractices in Senior Secondary School Certificate Examination in Nigeria: A systematic review
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Prince Agwu, Charles T. Orjiakor, Aloysius Odii, Chinyere Onalu, Chidi Nzeadibe, Pallavi Roy, Obinna Onwujekwe, and Uzoma Okoye
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Sociology and Political Science ,Development ,Education - Published
- 2022
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164. An Analysis of the Costs and Consequences of Routine Immunization for Measles in Anambra State, Southeast Nigeria
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Florence Tochukwu Sibeudu, Obinna Onwujekwe, and Ijeoma Okoronkwo
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General Medicine - Published
- 2022
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165. Antidiabetic and anti- hyperlipidemic effects of ethanolic extract of Dryopteris dilatata leaves
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Obinna Onwujekwe, Celestine Ani, Jide Uzoigwe, Igwe Uzoma, Adeyemo Mercy, Okorie Pamela, Choice Nworgu, Akpotu Ajirioghene, and Nwaeme Ogochukwu
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medicine.medical_specialty ,medicine.diagnostic_test ,biology ,business.industry ,biology.organism_classification ,medicine.disease ,Dryopteris ,Metformin ,chemistry.chemical_compound ,Anti hyperlipidemic ,Endocrinology ,chemistry ,Phytochemical ,Internal medicine ,Low-density lipoprotein ,Diabetes mellitus ,Dryopteris dilatata ,medicine ,Lipid profile ,business ,medicine.drug - Abstract
The incidence of diabetes mellitus (DM) is increasing globally and it is a major source of concern. This study was undertaken to assess the antidiabetic effect of the ethanolic leaf extract of Dryopteris dilatata (ELEDD).Thirty adult Wistar rats with body weight (BW) of 120-150 g were randomly assigned to groups of five rats each (n=5). Groups 1 served as normal control; Groups 2-6 were diabetic groups; group 2 served as negative control; group 3 received 50 mg/kg of metformin; 4-6 received 200, 400 and 800 mg/kg of ELEDD respectively. The BW and fasting blood glucose level (FBSL) of the rats were monitored weekly. At the end of the experiment, all the rats were anaesthetized with 25% urethane (sigma- Aldrich) intraperitoneally (I.P) and blood samples were collected by cardiac puncture for biochemical analysis. There was an increase in the BW of the metformin treated group and varying doses of ELEDD. It caused 77.00±15.07% decrease in FBSL; 86.94±34.80% and 248.07±20.56% with respect to 400 and 800 mg/kg of ELEDD. There was a significant (p
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- 2018
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166. Which mechanisms explain motivation of primary health workers? Insights from realist evaluation of a maternal and child health programme in Nigeria
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Bassey E. EBENSO, Chinyere Mbachu, Enyi Etiaba, Reinhard Huss, Ana Manzano, Obinna Onwujekwe, Benjamin Uzochukwu, Nkoli Ezumah, Tim Ensor, Joseph Paul Hicks, and Tolib Mirzoev
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Background: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage and the Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all. While there is abundant literature on drivers of workforce motivation, published knowledge on the mechanisms of how motivation works within different contexts is limited, particularly from low- and middle-income countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria. Methods: We adopted a realist evaluation design including scoping review of literature, document review of policies and MCH programme handbook, and in-depth interviews of PHC workers (n=25), facility managers (n=16), policymakers (n=12) and programme managers (n=10) to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing, verification and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers’ motivation and which mechanisms helped explain how motivation works. The developed programme theory drew upon Herzberg’s two-factor and Adam’s equity theories to unpack the influences of contextual conditions on worker motivation. Results: A complex and dynamic interaction between the MCH programme and organizational, societal and policy contexts triggered five mechanisms which explain PHC worker motivation: i) feeling supported, ii) feeling valued and committed to work, iii) morale and confidence to perform tasks, iv) companionship and v) feeling comfortable with work environment. Some mechanisms were mutually reinforcing while others operated in parallel. Further analysis showed that the conditions that enabled worker motivation to occur were organisational values of fairness, recognition of health workers’ contributions and a culture of task-sharing and teamwork. Conclusions: Policy designs and management strategies for improving performance of health workers, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.
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- 2019
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167. The economic burden of malaria in pregnancy: a cross-sectional study
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Obinna Onwujekwe, Vivian Uchenna Onyia, and Maduka D. Ughasoro
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Adult ,Cross-sectional study ,Total fertility rate ,030231 tropical medicine ,Population ,Nigeria ,Gross domestic product ,Antimalarials ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Pregnancy ,Surveys and Questionnaires ,Economic cost ,Environmental health ,parasitic diseases ,medicine ,Humans ,030212 general & internal medicine ,education ,Estimation ,education.field_of_study ,Intermittent preventive therapy ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Health Care Costs ,medicine.disease ,Artemisinins ,Malaria ,Cross-Sectional Studies ,Pregnancy Complications, Parasitic ,Pediatrics, Perinatology and Child Health ,Drug Therapy, Combination ,Female ,business - Abstract
Background: Malaria in pregnancy carries a proven huge health burden; however, the economic challenges have not been properly evaluated in Nigeria.Methodology: The study was a descriptive cross-sectional hospital-based approach. A structured questionnaire was used to collect microeconomic data from pregnant women, on the medical and nonmedical cost of malaria to them.Results: A total of 371 questionnaires were analyzed (93%; 371/400), of 400 respondents interviewed. The average direct medical cost was N3581.78 naira (N) (US$11.86) with SD of N177.9 and mean direct nonmedical cost of N5741.5 (US$18.97). Of the patients, 86.8% received artemisinin-based combination therapy (ACTs) for the treatment of malaria. Nigeria has an estimated population of women of child-bearing age of 40 million and, the fertility rate of 124 per 1000. On the basis of estimation of 56.5% of pregnant women receiving at least one intermittent preventive therapy (IPT), will approximate to 22.8 billion naira (US$75.5 million) national annual expenditure for malaria in pregnancy. This approximates to 0.016% of the Nigerian gross domestic product of 481 billion USD of 2015. The major mechanism that was used to pay for treatment was out-of-pocket (OOP).Conclusions: Malaria carries high-economic burden both on individual and national levels, especially in Nigeria where OOPs is the major payment mechanism. Scaling up malaria control measures will not only improve the lives of pregnant women but will also improve the economy of the nation.
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- 2018
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168. Scaling-up strategic purchasing: analysis of health system governance imperatives for strategic purchasing in a free maternal and child healthcare programme in Enugu State, Nigeria
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Obinna Onwujekwe and Daniel Chukwuemeka Ogbuabor
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Child Health Services ,Nigeria ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Health facility ,Pregnancy ,Universal Health Insurance ,Health care ,Medicine ,Humans ,Maternal Health Services ,030212 general & internal medicine ,Marketing ,Child ,Strategic planning ,Social Responsibility ,business.industry ,030503 health policy & services ,Corporate governance ,Health Policy ,lcsh:Public aspects of medicine ,Stakeholder ,Child Health ,lcsh:RA1-1270 ,Governance, strategic purchasing ,Free healthcare ,Policy implementation ,Purchasing ,Accountability ,Female ,Health Expenditures ,0305 other medical science ,business ,Delivery of Health Care ,Research Article - Abstract
Background Significant knowledge gaps exist in the functioning of institutional designs and organisational practices in purchasing within free healthcare schemes in low resource countries. The study provides evidence of the governance requirements to scale up strategic purchasing in free healthcare policies in Nigeria and other low-resource settings facing similar approaches. Methods The study was conducted at the Ministry of Health and in two health districts in Enugu State, Nigeria, using a qualitative case study design. Semi-structured interviews were conducted with 44 key health system actors (16 policymakers, 16 providers and 12 health facility committee leaders) purposively selected from the Ministry of Health and the two health districts. Data collection and analysis were guided by Siddiqi and colleagues’ health system governance framework. Data were analysed using a framework approach. Results The key findings show that supportive governance practices in purchasing included systems to verify questionable provider claims, pay providers directly for services, compel providers to procure drugs centrally and track transfer of funds to providers. However, strategic vision was undermined by institutional conflicts, absence of purchaser-provider split and lack of selective contracting of providers. Benefit design was not based on stakeholder involvement. Rule of law was limited by delays in provider payment. Benefits and obligations to users were not transparent. The criteria and procedure for resource allocation were unclear. Some target beneficiaries seemed excluded from the scheme. Effectiveness and efficiency was constrained by poor adherence to purchasing rules. Accountability of purchasers and providers to users was weak. Intelligence and information is constrained by paper-based system. Rationing of free services by providers and users’ non-adherence to primary gate-keeping role hindered ethics. Conclusion Weak governance of purchasing function limits potential of FMCHP to contribute towards universal health coverage. Appropriate governance model for strengthening strategic purchasing in the FMCHP and possibly free healthcare interventions in other low-resource countries must pay attention to the creation of an autonomous purchasing agency, clear framework for selective contracting, stakeholder involvement, transparent benefit design, need-based resource allocation, efficient provider payment methods, stronger roles for citizens, enforcement of gatekeeping rules and use of data for decision-making. Electronic supplementary material The online version of this article (10.1186/s12913-018-3078-x) contains supplementary material, which is available to authorized users.
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- 2018
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169. Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia: A Cross-sectional Stated Preference Approach
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Kirit Vaidya, Mohammed Khaled Al-Hanawi, Omar Zayyan Alsharqi, and Obinna Onwujekwe
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Adult ,Male ,Financing, Personal ,Economics and Econometrics ,medicine.medical_specialty ,National Health Programs ,Saudi Arabia ,Sample (statistics) ,Health administration ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Willingness to pay ,Health care ,medicine ,Humans ,Tobit model ,Original Research Article ,030212 general & internal medicine ,Aged ,Contingent valuation ,Actuarial science ,Health economics ,business.industry ,030503 health policy & services ,Health Policy ,Public health ,General Medicine ,Consumer Behavior ,Middle Aged ,Cross-Sectional Studies ,Female ,0305 other medical science ,business - Abstract
Background The Saudi Healthcare System is universal, financed entirely from government revenue principally derived from oil, and is ‘free at the point of delivery’ (non-contributory). However, this system is unlikely to be sustainable in the medium to long term. This study investigates the feasibility and acceptability of healthcare financing reform by examining households’ willingness to pay (WTP) for a contributory national health insurance scheme. Methods Using the contingent valuation method, a pre-tested interviewer-administered questionnaire was used to collect data from 1187 heads of household in Jeddah province over a 5-month period. Multi-stage sampling was employed to select the study sample. Using a double-bounded dichotomous choice with the follow-up elicitation method, respondents were asked to state their WTP for a hypothetical contributory national health insurance scheme. Tobit regression analysis was used to examine the factors associated with WTP and assess the construct validity of elicited WTP. Results Over two-thirds (69.6%) indicated that they were willing to participate in and pay for a contributory national health insurance scheme. The mean WTP was 50 Saudi Riyal (US$13.33) per household member per month. Tobit regression analysis showed that household size, satisfaction with the quality of public healthcare services, perceptions about financing healthcare, education and income were the main determinants of WTP. Conclusions This study demonstrates a theoretically valid WTP for a contributory national health insurance scheme by Saudi people. The research shows that willingness to participate in and pay for a contributory national health insurance scheme depends on participant characteristics. Identifying and understanding the main influencing factors associated with WTP are important to help facilitate establishing and implementing the national health insurance scheme. The results could assist policy-makers to develop and set insurance premiums, thus providing an additional source of healthcare financing. Electronic supplementary material The online version of this article (10.1007/s40258-017-0366-2) contains supplementary material, which is available to authorized users.
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- 2018
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170. Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning
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Fereshteh Ansari, Richard C. Franklin, Naznin Hossain, Rodrigo Sarmiento-Suárez, Mahdi Bohluli, Irena Ilic, Anwar Faraj, Soosanna Kumary Chattu, Sanni Yaya, Hagos Degefa Hidru, Morteza Shamsizadeh, Ehsan Sadeghi, Bach Xuan Tran, Leila Zaki, Mohammad Miri, Maha El Tantawi, Maciej Banach, Hasan Yusefzadeh, Kira A Barbre, Chigozie Jesse Uneke, Mehdi Naderi, Behzad Karami Matin, Yunquan Zhang, Vahid Yazdi-Feyzabadi, Emma Elizabeth Spurlock, Zahid A Butt, Nuruzzaman Khan, Robert L. Thompson, Mehdi Hosseinzadeh, Rovshan Khalilov, Usman Iqbal, K M Shivakumar, Leili Tapak, Chris A Schmidt, Priya Rathi, Shanshan Li, Bhaskaran Unnikrishnan, Chuanhua Yu, Elizabeth A. Cromwell, Davood Anvari, Hoa Thi Do, Abdullah Al Mamun, Obinna Onwujekwe, Serge Resnikoff, Majid Fasihi Harandi, Joshua C. P. Osborne, Farahnaz Joukar, Aso Mohammad Darwesh, Rohollah Kalhor, Turki Alanzi, Katie M Donkers, Amir Kasaeian, Eirini Skiadaresi, Aleksandra Barac, Simon I. Hay, Paul S. F. Yip, Tomislav Mestrovic, Zhi-Jiang Zhang, Katherine Gass, Cuong Tat Nguyen, Gurudatta Naik, Joshua Longbottom, Somayeh Bohlouli, Aziz Rezapour, Huong Lan Thi Nguyen, Khaled Khatab, Mohammed Ibrahim Mohialdeen Gubari, Ahmed Omar Bali, Temesgen Yihunie Akalu, Paul H. Lee, Vahid Alipour, Kebede Deribe, Megan F. Schipp, Ziyad Al-Aly, Biagio Simonetti, Masoud Moradi, Jalal Arabloo, Reza Rawassizadeh, Saif Ullah, Seth Christopher Yaw Appiah, Demelash Abewa Elemineh, Abedin Saghafipour, Fakher Rahim, Tinuke O Olagunju, Kimberly B. Johnson, Souranshu Chatterjee, Salvatore Rubino, Nataliya Foigt, Olayinka Stephen Ilesanmi, Taras Kavetskyy, Carlo La Vecchia, Eduarda Fernandes, Mohsen Mazidi, Claudiu Herteliu, Sojib Bin Zaman, Aziz Sheikh, Yong Yu, David Laith Rawaf, Hassan Magdy Abd El Razek, Natalie V S Vinkeles Melchers, Samath D Dharmaratne, Enrico Rubagotti, Fahad Alanezi, Masood Ali Shaikh, Masoud Foroutan, B. Suresh Kumar Shetty, Milena Ilic, Melese Abate Reta, Dian Kusuma, Ali Manafi, Krittika Bhattacharyya, Giovanni Damiani, Kanaan Hamagharib Abdullah, Desalegn Tadese Mengistu, Van C. Lansingh, Till Bärnighausen, Benjamin F. Arnold, Natalie Maria Cormier, Zulfiqar A Bhutta, Ahmad Daryani, Ali Bijani, Jae Il Shin, Samer Hamidi, Jasvinder A. Singh, Mohsen Bayati, Tomohide Yamada, Zubair Kabir, Muhammed Magdy Abd El Razek, Jonathan F. Mosser, Gbenga A. Kayode, Martin Amogre Ayanore, Shahin Soltani, Arvin Haj-Mirzaian, Mohammad Ali Mansournia, Salah Eddin Karimi, Alan J Thomson, Daniel Diaz, Ahamarshan Jayaraman Nagarajan, Adrian Pana, Salman Rawaf, Oliver J. Brady, Birhanu Geta Meharie, Yousef Fatahi, Sadia Bibi, Bogdan Oancea, Masoud Moghadaszadeh, Kelemu Tilahun Kibret, Valery L. Feigin, Saad M.A. Dahlawi, Ted R. Miller, Nicola Luigi Bragazzi, Atif Amin Baig, Maryam Zamanian, Kate E. LeGrand, Salahuddin Mohammed, Yuming Guo, Irfan Ullah, Hebat Allah Salah A. Yousof, Mowafa Househ, Ionut Negoi, Naohiro Yonemoto, Reza Mohammadpourhodki, Hadi Pourjafar, Navid Manafi, Neda Kianipour, Abraham Getachew Kelbore, Victor Adekanmbi, Seid Tiku Mereta, Olalekan A. Uthman, Arash Ziapour, Olatunji O. Adetokunboh, Trang Huyen Nguyen, Seyed Sina Naghibi Irvani, Francesco Saverio Violante, Monika Sawhney, Paula Moraga, Rahmatollah Moradzadeh, Mu'awiyyah Babale Sufiyan, Mohammad Hifz Ur Rahman, María-Gloria Basáñez, Vijay Kumar Chattu, Mustafa Geleto Ansha, Mona M. Khater, Andrew T Olagunju, Ejaz Ahmad Khan, Davide Guido, Kiomars Sharafi, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Tarig B. Higazi, Afshin Maleki, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Amin Soheili, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Ali Kazemi Karyani, Ehsan Ahmadpour, Thomas R. Unnasch, Mohsen Afarideh, Takahiro Tabuchi, Shreya Shirude, Marcel Ausloos, Maysaa El Sayed Zaki, Haileab Fekadu Wolde, Amira Shaheen, Shafiu Mohammed, Rajan Nikbakhsh, Tewodros Eshete Wonde, Endalkachew Worku Mengesha, Jacek Jerzy Jozwiak, Muktar Beshir Ahmed, Eugenio Traini, Leila R Kalankesh, Kris J. Krohn, Colm McAlinden, Walter Mendoza, Maryam Keramati, Ravi Prakash Jha, David M. Pigott, Elex Hill, Abdallah M. Samy, Farah Daoud, Wanji, Samuel, Public Health, Bill & Melinda Gates Foundation, Medical Research Council (Reino Unido), Department for International Development (Reino Unido), Unión Europea, Cromwell E.A., Osborne J.C.P., Unnasch T.R., Basanez M., Gass K.M., Barbre K.A., Hill E., Johnson K.B., Donkers K.M., Shirude S., Schmidt C.A., Adekanmbi V., Adetokunboh O.O., Afarideh M., Ahmadpour E., Beshir Ahmed M., Yihunie Akalu T., Al-Aly Z., Alanezi F.M., Alanzi T.M., Alipour V., Andrei C.L., Ansari F., Ansha M.G., Anvari D., Yaw Appiah S.C., Arabloo J., Arnold B.F., Ausloos M., Ayanore M.A., Amin Baig A., Banach M., Barac A., Barnighausen T.W., Bayati M., Bhattacharyya K., Bhutta Z.A., Bibi S., Bijani A., Bohlouli S., Bohluli M., Brady O.J., Bragazzi N.L., Butt Z.A., Carvalho F., Chatterjee S., Chattu V.K., Chattu S.K., Cormier N.M., Dahlawi S.M.A., Damiani G., Daoud F., Darwesh A.M., Daryani A., Deribe K., Dharmaratne S.D., Diaz D., Do H.T., El Sayed Zak M., El Tantawi M., Elemineh D.A., Faraj A., Harandi M.F., Fatahi Y., Feigin V.L., Fernandes E., Foigt N.A., Foroutan M., Franklin R.C., Mohialdeen Gubari M.I., Guido D., Guo Y., Haj-Mirzaian A., Abdullah K.H., Hamidi S., Herteliu C., De Hidru H.D., Higazi T.B., Hossain N., Hosseinzadeh M., Househ M., Ilesanmi O.S., Ilic M.D., Ilic I.M., Iqbal U., Naghibi Irvani S.S., Jha R.P., Joukar F., Jozwiak J.J., Kabir Z., Kalankesh L.R., Kalhor R., Matin B.K., Karimi S.E., Kasaeian A., Kavetskyy T., Kayode G.A., Karyani A.K., Kelbore A.G., Keramati M., Khalilov R., Khan E.A., Nuruzzaman Khan M.N., Khatab K., Khater M.M., Kianipour N., Kibret K.T., Kim Y.J., Kosen S., Krohn K.J., Kusuma D., Vecchia C.L., Lansingh Van C., Lee P.H., Legrand K.E., Li S., Longbottom J., Abd El Razek H.M., Abd El Razek M.M., Maleki A., Mamun A.A., Manafi A., Manafi N., Mansournia M.A., Martins-Melo F.R., Mazidi M., McAlinden C., Meharie B.G., Mendoza W., Mengesha E.W., Mengistu D.T., Mereta S.T., Mestrovic T., Miller T.R., Miri M., Moghadaszadeh M., Hafshejani A.M., Mohammadpourhodki R., Mohammed S., Moradi M., Moradzadeh R., Moraga P., Mosser J.F., Naderi M., Nagarajan A.J., Naik G., Negoi I., Nguyen C.T., Nguyen H.L.T., Nguyen T.H., Nikbakhsh R., Oancea B., Olagunju T.O., Olagunju A.T., Bali A.O., Onwujekwe O.E., Pana A., Pourjafar H., Rahim F., Ur Rahman M.H., Rathi P., Rawaf S., Rawaf D.L., Rawassizadeh R., Resnikoff S., Reta M.A., Rezapour A., Rubagotti E., Rubino S., Sadeghi E., Saghafipour A., Sajadi S.M., Samy A.M., Sarmiento-Suarez R., Sawhney M., Schipp M.F., Shaheen A.A., Shaikh M.A., Shamsizadeh M., Sharafi K., Sheikh A., Kumar Shetty B.S., Shin J.I., Shivakumar K.M., Simonetti B., Singh J.A., Skiadaresi E., Soheili A., Soltani S., Spurlock E.E., Sufiyan M.B., Tabuchi T., Tapak L., Thompson R.L., Thomson A.J., Traini E., Tran B.X., Ullah I., Ullah S., Uneke C.J., Unnikrishnan B., Uthman O.A., Melchers N.V.S.V., Violante F.S., Wolde H.F., Wonde T.E., Yamada T., Yaya S., Yazdi Feyzabadi V., Yip P., Yonemoto N., Yousof H.-A.S.A., Yu C., Yu Y., Yusefzadeh H., Zaki L., Zaman S.B., Zamanian M., Zhang Z.-J., Zhang Y., Ziapour A., Hay S.I., Pigott D.M., and Cuidado de la Salud y Desarrollo Sostenible
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Oncocercosis ,Decision Analysis ,RC955-962 ,Onchocerciasis ,law.invention ,Geographical Locations ,Medical Conditions ,0302 clinical medicine ,law ,Arctic medicine. Tropical medicine ,Medicine and Health Sciences ,030212 general & internal medicine ,Onchocerca ,11 Medical and Health Sciences ,Data Management ,biology ,Pharmaceutics ,wc_695 ,Enfermedades Parasitarias ,Onchocerciasi ,3. Good health ,Infectious Diseases ,Geography ,Transmission (mechanics) ,Helminth Infections ,Engineering and Technology ,Mass Drug Administration ,Public aspects of medicine ,RA1-1270 ,Management Engineering ,Cartography ,Human ,Research Article ,Neglected Tropical Diseases ,Computer and Information Sciences ,Drug Administration ,030231 tropical medicine ,Decision tree ,wa_395 ,Dermatology ,wc_765 ,Environment ,wc_885 ,Research and Analysis Methods ,Skin Diseases ,03 medical and health sciences ,Drug Therapy ,SDG 3 - Good Health and Well-being ,Diagnostic Medicine ,Tropical Medicine ,Parasitic Diseases ,medicine ,Humans ,Disease Eradication ,Spatial analysis ,Ivermectin ,Data collection ,Receiver operating characteristic ,Data Visualization ,Decision Trees ,Public Health, Environmental and Occupational Health ,06 Biological Sciences ,Elimination planning ,Africa ,Implementation units ,Public health ,Tropical Diseases ,medicine.disease ,biology.organism_classification ,Health Care ,ROC Curve ,People and Places ,Health Statistics ,Morbidity ,Scale (map) ,Forecasting - Abstract
Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify., Author summary As of 2018, it was unknown if onchocerciasis transmission occurred among approximately 2 400 implementation units (IUs; typically, second administrative-level units, such as districts) considered potentially endemic. These IUs have either never been surveyed for onchocerciasis or historical data are not sufficient to define contemporary endemicity status. Given the large number of IUs for which baseline data collection is likely required to achieve continental elimination, there is a need to prioritise areas for surveys to ensure that those suitable for endemic transmission, and therefore potentially eligible for mass drug administration, are able to initiate interventions as soon as possible. We used boosted regression trees to predict environmental suitability for onchocerciasis, with corresponding measures of uncertainty. We summarized the fine scale spatial predictions at the IU level by using receiver operating characteristic (ROC) curve analysis to identify a threshold that maximized agreement with the occurrence locations to identify IUs that may warrant prioritisation for mapping surveys. This analysis suggests that approximately half of the IUs considered for surveys could be classified as environmentally suitable for onchocerciasis. In order to develop an elimination strategy, many national onchocerciasis elimination programmes (NOEPs) need a mechanism to synthesise historical data to define priority areas for surveys.
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- 2021
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171. Assessment of a free maternal and child health program and the prospects for program re-activation and scale-up using a new health fund in Nigeria
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Chinyere Okeke, Uchenna Ezenwaka, Nkoli Ezumah, Obinna Onwujekwe, F Obi, Bsc Uzochukwu, Hong Wang, and Hyacinth E. Ichoku
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Economic growth ,Financing, Government ,Maternal-Child Health Services ,National Health Programs ,media_common.quotation_subject ,Nigeria ,Federal capital territory ,Health Promotion ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Universal Health Insurance ,Debt ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Child ,media_common ,Corrupt practices ,Health Services Needs and Demand ,Insurance, Health ,business.industry ,Child Health ,030206 dentistry ,General Medicine ,Millennium Development Goals ,The Conceptual Framework ,Female ,Thematic analysis ,Health Expenditures ,business ,Delivery of Health Care ,Public finance - Abstract
Background: A Free Maternal and Child Health program (FMCHP) was implemented in 12 states in Nigeria by the National Health Insurance Scheme (NHIS), between 2009 and 2015, using funds from the debt relief gains. It was called the Millennium Development Goals (MDGs) NHIS-MDG FMCHP. The program ended with the termination of the MDG in 2015. With the creation of the Basic Health Care Provision Fund (BHCPF) in Nigeria, this study sought to examine the past implementation experiences of the NHIS-MCH project with a view to identifying the enabling and constraining factors to program implementation, and the opportunities for adaptation and program scale-up in Nigeria using the BHCPF. Methods: The study was undertaken in the Federal Capital Territory, Abuja, and involved review of relevant documents and in-depth interviews with 21 key informants. The program was assessed in themes from the conceptual framework. Interviews were transcribed and analyzed using thematic analysis. Results: The program enrolled about 1.5 million pregnant women and children during the period of implementation in the country. The respondents perceived the program as pro-poor, efficient, and effective, and led to marked improvement in the functionality of the facilities, availability of services and reduced out-of-pocket expenditure, which led to increased demand and utilization of MCH services. There was inadequate stakeholder consultation, alleged corrupt practices, challenges with registration, issues with counterpart funding and public financing management issues identified. Most respondents supported the idea of using the new fund (BHCPF) to revitalize/scale-up the Free MCH program. Conclusion: This study highlights the key lessons and implementation challenges identified by the respondents. The NHIS-MDG FMCHP had positive impact on the target population though it was not sustained following the conclusion of the MDG program. The findings will inform policy decisions about the appropriateness of sustaining the program and the feasibility of extending healthcare coverage using the proposed BHCPF. The new fund (BHCPF) can be used to reactivate and scale-up the Free MCH program, but the current level of funding will not assure universal health coverage for the target beneficiaries as realized from the costing aspect of this study.
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- 2019
172. Cost analysis of supplemental immunization activities to deliver measles immunization to children in Anambra state, south-east Nigeria
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Obinna Onwujekwe, Florence T. Sibeudu, and Ijeoma L. Okoronkwo
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Total cost ,030231 tropical medicine ,Measles Vaccine ,Nigeria ,Measles ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,South east ,Medicine ,Humans ,030212 general & internal medicine ,Activity-based costing ,Child ,Local government area ,health care economics and organizations ,General Veterinary ,General Immunology and Microbiology ,business.industry ,Immunization Programs ,Public Health, Environmental and Occupational Health ,Infant ,medicine.disease ,Infectious Diseases ,Immunization ,Cost analysis ,Costs and Cost Analysis ,Molecular Medicine ,business ,Measles immunization - Abstract
Background Measles immunization is critical for reducing the societal burden of the disease, especially among children. However, the costs of the measles supplemental immunization activities, which are the main vaccine deployment strategy, are usually high and financing such immunization activities is a serious challenge in Nigeria. In Nigeria, little or no information exists on the costs of measles supplemental immunization activity for planning and sustenance of immunization programmes. This study aimed to determine the cost per child immunized and cost structure of a follow-up supplemental immunization activity (SIA) for measles immunization to children. Method Data on costs and outputs of SIA were collected from six Local Government area (LGAs) immunization offices in Anambra state, southeast Nigeria. The ingredient approach was used for costing, based on the providers’ perspective. The sample results were extrapolated to state estimates using volume weighted mean method. The major indicator considered was cost per child immunized. Two-way sensitivity analysis was used to test the robustness of the results. Result The cost per child immunized through SIA was $1.37 and the cost per child for operational cost only was $0.81. The total cost of the SIA for the sample was $345,069.35 and the operational cost was $204,969.46. The cost of personnel (43.99%) and vaccine (36.22%) contributed the highest percentage to the total cost of SIA. The cost of personnel and transportation took the first (74.6%) and second (7.10%) highest percentages of the operational cost for the sample. The estimated total and operational costs of measles SIA for the state were $1,279,127.84 and $759,795.52 respectively. Conclusion The cost per child immunized with measles containing vaccine through SIA is relatively high in Nigeria. There is a need to review the activities with SIA, so as to ensure that resources are efficiently allocated and used for different activities of the programme.
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- 2019
173. Prescription pattern and adverse effects profile of drugs used for breast, cervical & prostate cancers in Enugu, Nigeria
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Onah Ifeoma, C., Obinna, Onwujekwe, Chijioke Chioli, P., Nwagha, T.U, Okafor Michael, T., and Ossai Okechukwe, P.
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SummaryBackground: Breast, cervical and prostate malignancies are the most common cancers in Enugu, Nigeria. Supportive therapies are given with anticancer drug treatments to mitigate adverse effects. The objectives of this study were to characterize the prescription pattern of anticancer drugs, their adverse effects, and the supportive therapies used to manage these malignancies in Enugu, Nigeria. Materials and methods: A descriptive cross-sectional and retrospective questionnaire-based study. Data relating to breast, cervical and prostate cancer patients in the University of Nigeria Teaching hospital (UNTH), Parklane State Teaching hospital and Annunciation Specialist hospital, Emene, Enugu were collected for 7 months. Data were analysed using SPSS versions 22 and 23. Results: Anti-cancer agents commonly used in managing these cancers include anti-metabolites, mitotic inhibitors, anti-androgens, alkylating agents and anti-tumor anti-biotics. Conclusion: Anti-androgens, anti-metabolites and alkylating agents were the most prescribed anticancer drugs. Vitamin supplements, anti-emetics and analgesics were used to manage some side effects from prescribed anticancer drugs. Failure to document common side effects associated with use of some anticancer drugs in this study suggest a low index of suspicion on the part of the clinicians. AbstraitContexte: Les tumeurs malignes du sein, du col utérin et de la prostate sont les cancers les plus courants à Enugu, au Nigéria. Des traitements de soutien sont administrés avec des médicaments anticancéreux afin d'atténuer les effets indésirables. Les objectifs de cette étude étaient de caractériser le schéma de prescription des médicaments anticancéreux, leurs effets indésirables et les thérapies de soutien utilisées pour gérer ces tumeurs malignes à Enugu, au Nigéria. Matériels et méthodes: Une étude descriptive transversale et rétrospective par questionnaire. Les données relatives aux patients atteints de cancer du sein, du col de l'utérus et de la prostate à l'hôpital universitaire de l'Université du Nigéria (UNTH), à l'hôpital universitaire Parklane State et à l'hôpital spécialisé dans l'annonciation, à Emene (Enugu), ont été recueillies pendant 7 mois. Les données ont été analysées à l'aide des versions 22 et 23 de SPSS. Résultats: Les agents anticancéreux couramment utilisés dans la prise en charge de ces cancers incluent: les anti-métabolites, les inhibiteurs de la mitose, les anti-androgènes, les agents alkylants et les anti-biotiques. Conclusion: les anti-androgènes, les anti-métabolites et les agents alkylants étaient les médicaments anticancéreux les plus prescrits. Des suppléments de vitamines, des anti-émétiques et des analgésiques ont été utilisés pour gérer certains effets secondaires des médicaments anticancéreux prescrits. Aucune documentation sur des effets secondaires courants associés à l'utilisation de certains médicaments anticancéreux dans cette étude suggère un faible indice de suspicion de la part des cliniciens. West Afr. J. Pharmacol. Drug Res. Vol. 32 January – December 2017; 46-64
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- 2019
174. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017
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Mohsen Bayati, Arvin Haj-Mirzaian, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Nasir Salam, Mohamad-Hani Temsah, Fatemeh Heydarpour, Davide Rasella, Kavumpurathu Raman Thankappan, Ghulam Mustafa, Sergey Konstantinovitch Vladimirov, Fereshteh Ansari, Dina Nur Anggraini Ningrum, Leonardo Roever, Oghenowede Eyawo, Koustuv Dalal, Ana-Laura Manda, Ritesh G. Menezes, Molly K. Miller-Petrie, Javad Yoosefi Lebni, Gebreamlak Gebremedhn Gebremeskel, Aziz Eftekhari, Oleguer Plana-Ripoll, Jon Wakefield, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Edris Hasanpoor, Brijesh Sathian, Kala M. Mehta, Moritz U. G. Kraemer, Saeed Amini, Hesham M. Al-Mekhlafi, Abbas Yadegar, João Pedro Silva, Desmond Kuupiel, Anvar Asadi, Hamid Sharifi, Ebrahim Babaee, Dessalegn Ajema Berbada, Taddese Alemu Zerfu, Ian Davis, Mostafa Qorbani, Fatemeh Rajati, Samer Hamidi, Parvaiz A Koul, Foad Abd-Allah, Mojisola Oluwasanu, Syed Mohamed Aljunid, Elias Merdassa Roro, Mihaela Hostiuc, Robert S. Bernstein, Vahid Yazdi-Feyzabadi, Gebre Teklemariam Demoz, Irina Filip, Mu'awiyyah Babale Sufiyan, Amir Khater, Lidia Morawska, Sangram Kishor Patel, Robert C. Reiner, Joshua O. Akinyemi, Telma Zahirian Moghadam, Ali Akbar Fazaeli, Reza Malekzadeh, Olatunde Aremu, Mohammad Reza Salahshoor, Irfan Ullah, Gabrielle B. Britton, Gelin Xu, Nathaniel J Henry, Thomas R. Hird, Ronny Westerman, Vera Marisa Costa, Reza Assadi, Tiffany K. Gill, Chhabi Lal Ranabhat, Meysam Olfatifar, Sezer Kisa, Grant Rodgers Kemp, Mahmoud Yousefifard, Aleksandra Barac, Simon I. Hay, Walter Mendoza, Mohammad Zamani, Nader Jafari Balalami, Mahdi Safdarian, Manfred S. Green, Mahesh P A, Nahid Neamati, Pallab K. Maulik, Ali H. Mokdad, Joshua Longbottom, Somayeh Bohlouli, Ahmad Daryani, Ibrahim Abdollahpour, Mostafa Hosseini, Deborah Carvalho Malta, Nick Golding, Sheikh Mohammed Shariful Islam, Shirin Nosratnejad, Haidong Wang, Shadi Rahimzadeh, Pushpendra Kumar, Mehdi Noroozi, Andre M. N. Renzaho, Brent Bell, Huong Lan Thi Nguyen, Khaled Khatab, Meghdad Pirsaheb, Yousef Veisani, Katie R Nielsen, Ionut Negoi, Seyyed Meysam Mousavi, Amir Ashraf-Ganjouei, Mohammad Hassan Emamian, Joseph L Ward, Sharath Burugina Nagaraja, Songhomitra Panda-Jonas, Ettore Beghi, Azeem Majeed, Ivy Shiue, Delia Hendrie, Roghiyeh Faridnia, Seyed Mostafa Mir, Moslem Soofi, Ghobad Moradi, Mahsa Ghajarzadeh, Chandrashekhar T Sreeramareddy, Milad Hasankhani, Mohamed I Hegazy, Mika Shigematsu, Bryan L. Sykes, Vahid Alipour, Ruth W Kimokoti, Afshin Maleki, Nafiseh Baheiraei, Noore Alam, Jalal Arabloo, Mariam Molokhia, Kimberly B. Johnson, Amber Sligar, Nicole Davis Weaver, Kerem Shuval, Malede Mequanent Sisay, Paul H. Lee, Reza Ghadimi, Mahbobeh Faramarzi, Natalia V. Bhattacharjee, Ehsan Sadeghi, Brandon V. Pickering, Animika Pandey, Ana Isabel Ribeiro, Felix Greaves, Sameer Vali Gopalani, Joel M. Francis, Alyssa N. Sbarra, Yun Jin Kim, Agus Sudaryanto, Hebat Allah Salah A. Yousof, Hadi Pourjafar, Tomohide Yamada, Alireza Rafiei, Rosario Cárdenas, Mohammad Khazaei, Hasan Yusefzadeh, Rahman Shiri, Girmay Teklay Weldesamuel, Zahra Jorjoran Shushtari, Michael Collison, Stanislav S. Otstavnov, Narayanaswamy Venketasubramanian, Yahya Salimi, Naohiro Yonemoto, Ahmad Ghashghaee, Soewarta Kosen, Al Artaman, Surendra Karki, Tariq Jamal Siddiqi, Lorenzo Monasta, Amit Arora, Christopher S Yilgwan, Ahamarshan Jayaraman Nagarajan, Adnan Kisa, Gholamreza Roshandel, Vahid Rashedi, Daniel Diaz, Amir Vahedian-Azimi, Erkin M. Mirrakhimov, Nuworza Kugbey, Zohreh Arefi, Benjamin B. Massenburg, Robert G. Weintraub, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Hosseinzadeh, Milena M Santric Milicevic, Ai Koyanagi, Mehran Shams-Beyranvand, Salman Khazaei, Olalekan A. Uthman, Mohamed Hsairi, Nuno Taveira, Masoud Foroutan, Jayendra Sharma, Hanna Demelash Desyibelew, Max Roser, Keivan Ahmadi, Yousef Khader, Hamideh Salimzadeh, Ali Bijani, Shanshan Li, Mehran Alijanzadeh, Florian Fischer, Aziz Sheikh, Eun-Kee Park, Stefan Listl, Smita Pakhale, Brian J. Hall, Alireza Zangeneh, Ravi Mehrotra, Kidu Gidey Weldegwergs, Mahdi Afshari, Son Hoang Nguyen, Francisco Rogerlândio Martins-Melo, Rupak Desai, Aziz Rezapour, Hassan Magdy Abd El Razek, Gillian I. Hollerich, Reza Saeedi, Iman El Sayed, Olayinka Stephen Ilesanmi, Ben Lacey, Soheil Ebrahimpour, Laura Dwyer-Lindgren, Roya Ebrahimi, Bolajoko O. Olusanya, Tommi Vasankari, Siamak Sabour, Theo Vos, Tuomo J. Meretoja, Job F M van Boven, Nataliya Foigt, Mojtaba Hoseini-Ghahfarokhi, Saleh Salehi Zahabi, Mehdi Fazlzadeh, Neeraj Bedi, Hamed Mirjalali, Payman Salamati, P N Sylaja, Ted R. Miller, George J. Milne, Alaa Badawi, Muhammad Usman, Amir Hasanzadeh, Michelle L. Bell, Giang Thu Vu, Masoud Behzadifar, Manasi Kumar, Mona M. Khater, Josip Car, Nafis Sadat, Mostafa Leili, Mehdi Sharif, Hadi Hassankhani, Mowafa Househ, Joshua A. Salomon, Morteza Mansourian, G Anil Kumar, João C. Fernandes, Tufa Kolola, Arya Haj-Mirzaian, Masood Ali Shaikh, Keyghobad Ghadiri, Andrew T Olagunju, Bahram Armoon, Beatriz Paulina Ayala Quintanilla, Samantha Perkins, Mohsen Mazidi, Stefan Lorkowski, Sagnik Dey, Edward J Mills, Ali Kabir, Maryam Khazaei-Pool, Mohammad Rabiee, Arianna Maever L. Amit, John S. Ji, Sivan Yegnanarayana Iyer Saraswathy, Fares Alahdab, Vafa Rahimi-Movaghar, Martin McKee, Hadi Parsian, Ejaz Ahmad Khan, Amirhossein Sahebkar, Paramjit Gill, Dara K. Mohammad, Naznin Hossain, Karen M. Tabb, Annie J. Browne, Abdallah M. Samy, Elham Ehsani-Chimeh, Nelson G.M. Gomes, Destallem Gebremedhin Gebre, Fakher Rahim, Sheetal D. Lad, Rajat Das Gupta, Yash Jobanputra, Rajesh Sharma, Davoud Adham, Richard Ofori-Asenso, Farah Daoud, Aso Mohammad Darwesh, Meghnath Dhimal, Pranab Chatterjee, Javad Javidnia, Shafiu Mohammed, Amir Abdoli, Josep Maria Haro, Stefanie Watson, Behnam Nabavizadeh, Masoumeh Abbasi, Kefyalew Addis Alene, Marzieh Nojomi, G. K. Mini, Abbas Mosapour, Cyrus Cooper, Yirga Legesse Nirayo, Jagdish Khubchandani, Muhammed Magdy Abd El Razek, Faramarz Shaahmadi, Satar Rezaei, Mahdi Sharif-Alhoseini, Francesco Saverio Violante, Eyal Oren, Erfan Zabeh, Atte Meretoja, Nicholas Graetz, Kris J. Krohn, Anthony Masaka, Oladimeji Adebayo, Mikk Jürisson, Faris Lami, Marcos Roberto Tovani-Palone, Chloe Shields, Yahya Safari, Yasir Waheed, Dilaram Acharya, Seyed Mohammad Riahi, Jan-Walter De Neve, Carlos A Castañeda-Orjuela, Alberto Ortiz, Samad Azari, Shymaa Enany, Maha Ezalarab, Salvatore Rubino, Enayatollah Homaie Rad, Roghayeh Khabiri, Seyed-Mohammad Fereshtehnejad, Yuming Guo, Sonia Saxena, Nicholas J K Breitborde, Takeshi Fukumoto, Hamid Yimam Hassen, Thomas Pilgrim, Yasser Vasseghian, Dragos Virgil Davitoiu, Farid Najafi, Sathish Thirunavukkarasu, Ali Rostami, Efat Mohamadi, Sameh Magdeldin, Hedley Quintana, Cyrus Alinia, Rodrigo Sarmiento-Suarez, Roya Safari-Faramani, Leila Doshmangir, Kewal Krishan, Karen Sliwa, Nazrul Islam, Neal Marquez, Genet Melak Alamene, Andem Effiong, Khanh Bao Tran, Amir Kasaeian, Adeladza Kofi Amegah, Hamidreza Haririan, Maha El Tantawi, Anders Larsson, André Faro, Rushdia Ahmed, Amir Shamshirian, Josephine W. Ngunjiri, Yousef Moradi, Sharareh Eskandarieh, Evanson Z. Sambala, Nelson Alvis-Guzman, Mehdi Moradinazar, Lauren Woyczynski, Parul Puri, Yunquan Zhang, Navid Manafi, Vinay Nangia, Joan B. Soriano, Victor Adekanmbi, Sofia Androudi, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Netsanet Fentahun, Achala Upendra Jayatilleke, David L. Smith, Solomon Sisay, Giuseppe Gorini, Meysam Behzadifar, Charles Shey Wiysonge, Bach Xuan Tran, Lal B. Rawal, Arefeh Babazadeh, Damaris K. Kinyoki, Morteza Shamsizadeh, Ziad El-Khatib, Zohreh Anbari, Abdol Sattar Pagheh, Ranjani Somayaji, Frank B. Osei, Nancy Fullman, Zahid A Butt, Ai-Min Wu, Tahereh Pashaei, Benn Sartorius, Aaron Osgood-Zimmerman, Sachin R Atre, Mehdi Ahmadi, Chalachew Genet Akal, Aubrey J. Levine, Mohammad Fareed, Quique Bassat, Khalid A Altirkawi, Ensiyeh Jenabi, Daem Roshani, Mina Anjomshoa, Jasvinder A. Singh, Yafeng Wang, Samath D Dharmaratne, Enrico Rubagotti, Ruxandra Irina Negoi, Reinhard Busse, Abdullah Al Mamun, Yoshan Moodley, Mohammed Almalki, Peter W. Gething, Alireza Khatony, Usman Iqbal, Soraya Nouraei Motlagh, Roy Burstein, Hamed Zandian, Rakhi Dandona, Mojtaba Bagherzadeh, Majid Pirestani, Jaifred Christian F. Lopez, Chuanhua Yu, Arash Ziapour, Seyed Sina Naghibi Irvani, Bárbara Niegia Garcia Goulart, Pascual R. Valdez, Amir Jalali, Chukwudi A Nnaji, Kelechi Elizabeth Oladimeji, Tomislav Mestrovic, Isidora S. Vujcic, Osayomwanbo Osarenotor, Azin Nahvijou, Chi Linh Hoang, Christopher J L Murray, Mustafa Z. Younis, Veincent Christian Filipino Pepito, Andre Rodrigues Duraes, Yuan-Pang Wang, Felix Akpojene Ogbo, Aniruddha Deshpande, Nicholas J Kassebaum, Jacek Jerzy Jozwiak, Soghra Bagheri, Paul S. F. Yip, Sree Bhushan Raju, Sadaf G. Sepanlou, Kebede Deribe, Junaid Khan, Mohammad Aghaali, Lalit Dandona, Masoud Moradi, Molly R Nixon, Bruno Piassi Sao Jose, Atalay Goshu Muluneh, Mohammad Hasan Imani-Nasab, Naser Mohammad Gholi Mezerji, Abdullah Sulieman Terkawi, Sojib Bin Zaman, Muhammad Shahzeb Khan, Maysaa El Sayed Zaki, Gebrekiros Gebremichael Meles, Suraj Bhattarai, Yared Belete Belay, Ammas Siraj Mohammed, Dawit Zewdu Wondafrash, Abbas Balouchi, Silvano Gallus, Mohammad Abdollahi, Long Hoang Nguyen, Zulfiqar A Bhutta, Jean Jacques Noubiap, Mehdi Naderi, Bernhard T. Baune, Lucas Earl, Doris D. V. Ortega-Altamirano, Michael R.M. Abrigo, Farkhonde Salehi, Hamed Kalani, Mayowa O. Owolabi, Feleke Mekonnen Demeke, Lee Ling Lim, Ulrich O Mueller, Laurie B. Marczak, Peter Njenga Keiyoro, Ehsan Ahmadpour, Navid Rabiee, Dinh-Toi Chu, Vasily Vlassov, Bradford D Gessner, Tsegaye Tewelde Gebrehiwot, Sorin Hostiuc, Bakhtiar Piroozi, Mahdieh Abbasalizad-Farhangi, Takahiro Tabuchi, Philimon Gona, Bahar Ataeinia, Azra Ramezankhani, Duduzile Ndwandwe, Obinna Onwujekwe, Zohreh Rahimi, Seyedmojtaba Seyedmousavi, Wagaye Fentahun Chanie, Neda Kianipour, Rizwan Suliankatchi Abdulkader, Dhirendra N Sinha, Young-Ho Khang, Paula Moraga, Manoochehr Karami, Solomon Olum, Rafael Tabarés-Seisdedos, Zemenu Tadesse Tessema, Amir Radfar, Kiomars Sharafi, Rohollah Kalhor, Benjamin K. Mayala, Mahmood Moosazadeh, David C. Schwebel, Jost B. Jonas, Quyen G. To, Ester Cerin, Martin Amogre Ayanore, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Research Institute for Asthma and COPD (GRIAC), Veritati - Repositório Institucional da Universidade Católica Portuguesa, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, UT-I-ITC-ACQUAL, GeoHealth, HUS Neurocenter, Department of Neurosciences, Neurologian yksikkö, Clinicum, HUS Comprehensive Cancer Center, Staff Services, Department of Surgery, University of Helsinki, Islam, Nazrul [0000-0003-3982-4325], Apollo - University of Cambridge Repository, Burstein R., Henry N.J., Collison M.L., Marczak L.B., Sligar A., Watson S., Marquez N., Abbasalizad-Farhangi M., Abbasi M., Abd-Allah F., Abdoli A., Abdollahi M., Abdollahpour I., Abdulkader R.S., Abrigo M.R.M., Acharya D., Adebayo O.M., Adekanmbi V., Adham D., Afshari M., Aghaali M., Ahmadi K., Ahmadi M., Ahmadpour E., Ahmed R., Akal C.G., Akinyemi J.O., Alahdab F., Alam N., Alamene G.M., Alene K.A., Alijanzadeh M., Alinia C., Alipour V., Aljunid S.M., Almalki M.J., Al-Mekhlafi H.M., Altirkawi K., Alvis-Guzman N., Amegah A.K., Amini S., Amit A.M.L., Anbari Z., Androudi S., Anjomshoa M., Ansari F., Antonio C.A.T., Arabloo J., Arefi Z., Aremu O., Armoon B., Arora A., Artaman A., Asadi A., Asadi-Aliabadi M., Ashraf-Ganjouei A., Assadi R., Ataeinia B., Atre S.R., Quintanilla B.P.A., Ayanore M.A., Azari S., Babaee E., Babazadeh A., Badawi A., Bagheri S., Bagherzadeh M., Baheiraei N., Balouchi A., Barac A., Bassat Q., Baune B.T., Bayati M., Bedi N., Beghi E., Behzadifar M., Belay Y.B., Bell B., Bell M.L., Berbada D.A., Bernstein R.S., Bhattacharjee N.V., Bhattarai S., Bhutta Z.A., Bijani A., Bohlouli S., Breitborde N.J.K., Britton G., Browne A.J., Nagaraja S.B., Busse R., Butt Z.A., Car J., Cardenas R., Castaneda-Orjuela C.A., Cerin E., Chanie W.F., Chatterjee P., Chu D.-T., Cooper C., Costa V.M., Dalal K., Dandona L., Dandona R., Daoud F., Daryani A., Das Gupta R., Davis I., Davis Weaver N., Davitoiu D.V., De Neve J.-W., Demeke F.M., Demoz G.T., Deribe K., Desai R., Deshpande A., Desyibelew H.D., Dey S., Dharmaratne S.D., Dhimal M., Diaz D., Doshmangir L., Duraes A.R., Dwyer-Lindgren L., Earl L., Ebrahimi R., Ebrahimpour S., Effiong A., Eftekhari A., Ehsani-Chimeh E., El Sayed I., El Sayed Zaki M., El Tantawi M., El-Khatib Z., Emamian M.H., Enany S., Eskandarieh S., Eyawo O., Ezalarab M., Faramarzi M., Fareed M., Faridnia R., Faro A., Fazaeli A.A., Fazlzadeh M., Fentahun N., Fereshtehnejad S.-M., Fernandes J.C., Filip I., Fischer F., Foigt N.A., Foroutan M., Francis J.M., Fukumoto T., Fullman N., Gallus S., Gebre D.G., Gebrehiwot T.T., Gebremeskel G.G., Gessner B.D., Geta B., Gething P.W., Ghadimi R., Ghadiri K., Ghajarzadeh M., Ghashghaee A., Gill P.S., Gill T.K., Golding N., Gomes N.G.M., Gona P.N., Gopalani S.V., Gorini G., Goulart B.N.G., Graetz N., Greaves F., Green M.S., Guo Y., Haj-Mirzaian A., Hall B.J., Hamidi S., Haririan H., Haro J.M., Hasankhani M., Hasanpoor E., Hasanzadeh A., Hassankhani H., Hassen H.Y., Hegazy M.I., Hendrie D., Heydarpour F., Hird T.R., Hoang C.L., Hollerich G., Rad E.H., Hoseini-Ghahfarokhi M., Hossain N., Hosseini M., Hosseinzadeh M., Hostiuc M., Hostiuc S., Househ M., Hsairi M., Ilesanmi O.S., Imani-Nasab M.H., Iqbal U., Irvani S.S.N., Islam N., Islam S.M.S., Jurisson M., Balalami N.J., Jalali A., Javidnia J., Jayatilleke A.U., Jenabi E., Ji J.S., Jobanputra Y.B., Johnson K., Jonas J.B., Shushtari Z.J., Jozwiak J.J., Kabir A., Kahsay A., Kalani H., Kalhor R., Karami M., Karki S., Kasaeian A., Kassebaum N.J., Keiyoro P.N., Kemp G.R., Khabiri R., Khader Y.S., Khafaie M.A., Khan E.A., Khan J., Khan M.S., Khang Y.-H., Khatab K., Khater A., Khater M.M., Khatony A., Khazaei M., Khazaei S., Khazaei-Pool M., Khubchandani J., Kianipour N., Kim Y.J., Kimokoti R.W., Kinyoki D.K., Kisa A., Kisa S., Kolola T., Kosen S., Koul P.A., Koyanagi A., Kraemer M.U.G., Krishan K., Krohn K.J., Kugbey N., Kumar G.A., Kumar M., Kumar P., Kuupiel D., Lacey B., Lad S.D., Lami F.H., Larsson A.O., Lee P.H., Leili M., Levine A.J., Li S., Lim L.-L., Listl S., Longbottom J., Lopez J.C.F., Lorkowski S., Magdeldin S., Abd El Razek H.M., Abd El Razek M.M., Majeed A., Maleki A., Malekzadeh R., Malta D.C., Mamun A.A., Manafi N., Manda A.-L., Mansourian M., Martins-Melo F.R., Masaka A., Massenburg B.B., Maulik P.K., Mayala B.K., Mazidi M., McKee M., Mehrotra R., Mehta K.M., Meles G.G., Mendoza W., Menezes R.G., Meretoja A., Meretoja T.J., Mestrovic T., Miller T.R., Miller-Petrie M.K., Mills E.J., Milne G.J., Mini G.K., Mir S.M., Mirjalali H., Mirrakhimov E.M., Mohamadi E., Mohammad D.K., Darwesh A.M., Mezerji N.M.G., Mohammed A.S., Mohammed S., Mokdad A.H., Molokhia M., Monasta L., Moodley Y., Moosazadeh M., Moradi G., Moradi M., Moradi Y., Moradi-Lakeh M., Moradinazar M., Moraga P., Morawska L., Mosapour A., Mousavi S.M., Mueller U.O., Muluneh A.G., Mustafa G., Nabavizadeh B., Naderi M., Nagarajan A.J., Nahvijou A., Najafi F., Nangia V., Ndwandwe D.E., Neamati N., Negoi I., Negoi R.I., Ngunjiri J.W., Thi Nguyen H.L., Nguyen L.H., Nguyen S.H., Nielsen K.R., Ningrum D.N.A., Nirayo Y.L., Nixon M.R., Nnaji C.A., Nojomi M., Noroozi M., Nosratnejad S., Noubiap J.J., Motlagh S.N., Ofori-Asenso R., Ogbo F.A., Oladimeji K.E., Olagunju A.T., Olfatifar M., Olum S., Olusanya B.O., Oluwasanu M.M., Onwujekwe O.E., Oren E., Ortega-Altamirano D.D.V., Ortiz A., Osarenotor O., Osei F.B., Osgood-Zimmerman A.E., Otstavnov S.S., Owolabi M.O., Mahesh P.A., Pagheh A.S., Pakhale S., Panda-Jonas S., Pandey A., Park E.-K., Parsian H., Pashaei T., Patel S.K., Pepito V.C.F., Pereira A., Perkins S., Pickering B.V., Pilgrim T., Pirestani M., Piroozi B., Pirsaheb M., Plana-Ripoll O., Pourjafar H., Puri P., Qorbani M., Quintana H., Rabiee M., Rabiee N., Radfar A., Rafiei A., Rahim F., Rahimi Z., Rahimi-Movaghar V., Rahimzadeh S., Rajati F., Raju S.B., Ramezankhani A., Ranabhat C.L., Rasella D., Rashedi V., Rawal L., Reiner Jr R.C., Renzaho A.M.N., Rezaei S., Rezapour A., Riahi S.M., Ribeiro A.I., Roever L., Roro E.M., Roser M., Roshandel G., Roshani D., Rostami A., Rubagotti E., Rubino S., Sabour S., Sadat N., Sadeghi E., Saeedi R., Safari Y., Safari-Faramani R., Safdarian M., Sahebkar A., Salahshoor M.R., Salam N., Salamati P., Salehi F., Zahabi S.S., Salimi Y., Salimzadeh H., Salomon J.A., Sambala E.Z., Samy A.M., Santric Milicevic M.M., Jose B.P.S., Saraswathy S.Y.I., Sarmiento-Suarez R., Sartorius B., Sathian B., Saxena S., Sbarra A.N., Schaeffer L.E., Schwebel D.C., Sepanlou S.G., Seyedmousavi S., Shaahmadi F., Shaikh M.A., Shams-Beyranvand M., Shamshirian A., Shamsizadeh M., Sharafi K., Sharif M., Sharif-Alhoseini M., Sharifi H., Sharma J., Sharma R., Sheikh A., Shields C., Shigematsu M., Shiri R., Shiue I., Shuval K., Siddiqi T.J., Silva J.P., Singh J.A., Sinha D.N., Sisay M.M., Sisay S., Sliwa K., Smith D.L., Somayaji R., Soofi M., Soriano J.B., Sreeramareddy C.T., Sudaryanto A., Sufiyan M.B., Sykes B.L., Sylaja P.N., Tabares-Seisdedos R., Tabb K.M., Tabuchi T., Taveira N., Temsah M.-H., Terkawi A.S., Tessema Z.T., Thankappan K.R., Thirunavukkarasu S., To Q.G., Tovani-Palone M.R., Tran B.X., Tran K.B., Ullah I., Usman M.S., Uthman O.A., Vahedian-Azimi A., Valdez P.R., van Boven J.F.M., Vasankari T.J., Vasseghian Y., Veisani Y., Venketasubramanian N., Violante F.S., Vladimirov S.K., Vlassov V., Vos T., Vu G.T., Vujcic I.S., Waheed Y., Wakefield J., Wang H., Wang Y., Wang Y.-P., Ward J.L., Weintraub R.G., Weldegwergs K.G., Weldesamuel G.T., Westerman R., Wiysonge C.S., Wondafrash D.Z., Woyczynski L., Wu A.-M., Xu G., Yadegar A., Yamada T., Yazdi-Feyzabadi V., Yilgwan C.S., Yip P., Yonemoto N., Lebni J.Y., Younis M.Z., Yousefifard M., Yousof H.-A.S.A., Yu C., Yusefzadeh H., Zabeh E., Moghadam T.Z., Bin Zaman S., Zamani M., Zandian H., Zangeneh A., Zerfu T.A., Zhang Y., Ziapour A., Zodpey S., Murray C.J.L., and Hay S.I.
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Survival ,RJ101 ,Mortalidad Infantil ,HB ,UNDER-5 MORTALITY ,Global Health ,Pediatrics ,0302 clinical medicine ,3123 Gynaecology and paediatrics ,Child death ,Infant Mortality ,Epidemiology ,Global health ,Middle income country ,Nacimiento vivo ,030212 general & internal medicine ,10. No inequality ,Child ,POPULATION ,Developing world ,education.field_of_study ,Public health ,Multidisciplinary ,Geography ,Mortality rate ,wa_900 ,1. No poverty ,SUCCESS ,Pediatrik ,A900 Others in Medicine and Dentistry ,3142 Public health care science, environmental and occupational health ,3. Good health ,Child Mortality ,Death children ,VACCINATION ,HEALTH ,ws_100 ,INTERVENTIONS ,AFRICA ,medicine.medical_specialty ,United Nations ,General Science & Technology ,030231 tropical medicine ,Population ,Developing country ,Article ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,ITC-HYBRID ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Social Justice ,Recién nacido ,Neonatal deaths ,medicine ,SYSTEMATIC ANALYSIS ,Organizational Objectives ,Humans ,education ,Developing Countries ,business.industry ,Infant, Newborn ,Infant ,CIVIL REGISTRATION ,Paediatrics ,Child survival ,Newborn ,PREVENTION ,Infant mortality ,wa_320 ,ws_200 ,Child mortality ,Socioeconomic Factors ,ITC-ISI-JOURNAL-ARTICLE ,Human medicine ,Paediatrics, Public health, Developing world ,business ,Demography - Abstract
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations., A high-resolution, global atlas of mortality of children under five years of age between 2000 and 2017 highlights subnational geographical inequalities in the distribution, rates and absolute counts of child deaths by age.
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175. Impact of traditional bonesetters on contemporary fracture care in Low and Middle Income Countries (LMICs): a systematic review
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Ugochukwu N. Enweani, Samantha Slinkard, Fiemu E. Nwariaku, Xan Goodman, Okechukwu E. Nwankwo, Echezona E. Ezeanolue, William Nii Ayitey Menson, Benedict C. Nwomeh, Obinna Onwujekwe, and Ndubuisi Oc Onyemaechi
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business.industry ,Low and middle income countries ,Environmental health ,Medicine ,business ,Fracture care ,Health administration - Abstract
Background: The review aimed at systematically examining the evidence in articles that assess the clinical effects and impact of traditional bonesetters on contemporary fracture care in Low and Middle Income Countries (LMICs).Methods: A systematic review was conducted. Articles were identified by database searching ((PubMed, Embase, ScienceDirect, SCOPUS, and Web of Science). Searching, selecting and reporting were conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement. The key words that were used in search for literature were: “Bonesetter”, “fracture healer” and “traditional bone setting”. Publications included for review were original articles, set in an LMIC and directly talked about the role and/or impact of traditional bonesetters in providing fracture care. Papers that focused on Low and Middle Income (LMIC) settings were reviewed.Results: A total of 176 papers were screened for eligibility and 15 studies were finally included. Nine were prospective studies, while 6 were retrospective studies. Most of the studies focused on clinical impacts of bone setter intervention. The evidence from the publications show that the main clinical effects of traditional bonesetters had been deleterious, but they had the potential to contribute positively when trained.Conclusion: Few well designed studies are available that assessed the impact of traditional bonesetters. Reported cases and reviews indicate their impact to be deleterious. However, the potential exist that when trained, these deleterious impact can be reduced through training for traditional bonesetters who contribute to fracture care in many LMICs.
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176. Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen?
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Hyacinth E. Ichoku, Hong Wang, Felix Obi, Nkoli Ezumah, Chinyere Mbachu, Obinna Onwujekwe, and Benjamin Uzochukwu
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medicine.medical_specialty ,Performance ,Nigeria ,Financial risk protection ,Needed change ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Universal Health Insurance ,Universal health coverage ,medicine ,Healthcare Financing ,Humans ,030212 general & internal medicine ,Social determinants of health ,Finance ,Government ,Insurance, Health ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Public health ,Nursing research ,Health financing mechanisms ,Health Maintenance Organizations ,lcsh:RA1-1270 ,Health Services ,Purchasing ,Conceptual framework ,0305 other medical science ,business ,Delivery of Health Care ,Research Article ,Health system actors - Abstract
Background Various attempts to examine health financing mechanisms in Nigeria highlight the fact that there is no single mechanism that fits all contexts and people. This paper sets out findings of an in-depth assessment of different health financing mechanisms in Nigeria. Methods The study was undertaken in the Federal Capital territory of Nigeria and two States (Niger and Kaduna). Data were collected through review of government documents, and in-depth interviews of purposively selected respondents. Data analysis was guided by a conceptual framework which draws from various approaches for assessing health financing mechanisms. Data was examined for current practices, what needs to change and how the change can happen. Results Health financing mechanisms in Nigeria do not operate optimally. Allocation and use of resources are neither evidence-based nor results-driven. Resources are not allocated equitably or in a manner that minimizes wastage and improves efficiency. None of the mechanisms effectively protects individuals/households from catastrophic health expenditure. Issues with social health insurance cut across legal frameworks and use of Health Maintenance Organisations (HMOs) as purchasers. The concomitant effect is that attainment of Universal Health Coverage is greatly compromised. In order to improve efficiency of health financing mechanisms, government needs to allocate more funds for purchasing health services; this spending must be based on evidence (strategic), and appropriately tracked. The legislation that established National Health Insurance Scheme should be amended such that social health insurance becomes mandatory for all citizens. Implementation of the latter should be complemented by revision of benefit package, strict oversight and regulation of HMOs. Conclusion In order to improve health financing in the country, legal and regulatory frameworks need to be revised. Efficient utilization of resources could be improved through strategic purchasing arrangements and strict oversight.
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177. Building the capacity of users and producers of evidence in health policy and systems research for better control of endemic diseases in Nigeria: a situational analysis
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Chinyere Mbachu, Chikezie Nwankwor, Obinna Onwujekwe, Ifeanyi Chikezie, Benjamin Uzochukwu, Ifeyinwa Arize, Enyi Etiaba, and Uchenna Ezenwaka
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Adult ,Male ,medicine.medical_specialty ,Capacity Building ,Systems Analysis ,Endemic Diseases ,Health policy and systems research+ analysis ,media_common.quotation_subject ,Decision Making ,Psychological intervention ,Nigeria ,Users of evidence ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Marketing ,Policy Making ,Health policy ,media_common ,Social policy ,Government ,030503 health policy & services ,Public health ,lcsh:Public aspects of medicine ,Health Policy ,Research ,Public Health, Environmental and Occupational Health ,Health services research ,Administrative Personnel ,Producers of evidence ,Capacity building ,lcsh:RA1-1270 ,Middle Aged ,Evidence-Based Practice ,Female ,Business ,Health Services Research ,0305 other medical science ,Autonomy - Abstract
BackgroundThere is a current need to build the capacity of Health Policy and Systems Research + Analysis (HPSR+A) in low and middle-income countries (LMICs) as this enhances the processes of decision-making at all levels of the health system. This paper provides information on the HPSR+A knowledge and practice among producers and users of evidence in priority setting for HPSR+A regarding control of endemic diseases in two states in Nigeria. It also highlights the HPSR+A capacity building needs and interventions that will lead to increased HPSR+A and use for actual policy and decision making by the government and other policy actors.MethodsData was collected from 96 purposively selected respondents who are either researchers/ academia (producers of evidence) and policy/decision-makers, programme/project managers (users of evidence) in Enugu and Anambra states, southeast Nigeria. A pre-tested questionnaire was the data collection tool. Analysis was by univariate and bivariate analyses.ResultsThe knowledge on HPSR+A was moderate and many respondents understood the importance of evidence-based decision making. Majority of researcher stated their preferred channel of dissemination of research finding to be journal publication. The mean percentage of using HPSR evidence for programme design & implementation of endemic disease among users of evidence was poor (18.8%) in both states. There is a high level of awareness of the use of evidence to inform policy across the two states and some of the respondents have used some evidence in their work.ConclusionThe high level of awareness of the use of HPSR+A evidence for decision making did not translate to the significant actual use of evidence for policy making. The major reasons bordered on lack of autonomy in decision making. Hence, the existing yawning gap in use of evidence has to be bridged for a strengthening of the health system with evidence.
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178. Variations in utilization of health facilities for information and services on sexual and reproductive health among adolescents in South-East, Nigeria
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Ifunanya Agu, Chinyere Mbachu, Uchenna Ezenwaka, Chinyere Okeke, Irene Eze, Chibuike Agu, Mildred Ndubuisi, Ifeyinwa Arize, Chinyere Ikwuakor, Nkoli Ezumah, and Obinna Onwujekwe
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[EXSCINDED] Abstract Background Adolescents’ sexual and reproductive health have an important influence on a country’s long-term national growth. There is high level of burden due to poor adolescent sexual and reproductive health (ASRH) in Nigeria, especially Ebonyi state. Evidence shows that in Sub-Saharan Africa region, most adolescents experience poor access to information and other services relating to their sexual and reproductive health. Many cultures in Africa see matters around sex and sexuality as social taboos. This study aimed to access variations in utilization of health facilities for sexual and reproductive health information and services among adolescents in Ebonyi State, Nigeria. This will inform the design of interventions to improve ASRH.Methods A total of 1057 in-school and out-of-school adolescents aged 13 to18 years were selected using cluster sampling of households from the 6 selected LGAs in this cross sectional survey. Structured questionnaires were used to collect data. Descriptive statistics was performed alongside stratification analysis. Tabulation, bivariate and multivariate logistic regression analysis were undertaken. A household wealth index was calculated using the total household consumption calculated divided by the number of people in the households (per capital household consumption). The per capita household consumption was used to categorize households into socio-economic quintiles. The variable was used to differentiate where key variables into socio-economic quintile equity analysis.Results Majority of respondents had never visited any type of health facility to receive either SRH information (90.2%) or services (97.1%). Utilization rate of health facilities for SRH information was 9.8% while for other SRH services was 2.8%. Patent medicine vendor (PMV) was the most visited type of facility for SRH information and other services. Schooling is a strong predictor of health facilities’ utilization for SRH information (P
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179. Corruption in Anglophone West Africa health systems: a systematic review of its different variants and the factors that sustain them
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Charles T. Orjiakor, Prince Agwu, Uche Obi, Obinna Onwujekwe, Martin McKee, Chinyere Mbachu, Hyacinth E. Ichoku, Dina Balabanova, Pamela Ogbozor, Aloysius Odii, and Eleanor Hutchinson
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Economic growth ,Corruption ,media_common.quotation_subject ,Health Personnel ,Health Care Sector ,Theft ,Review ,health sector corruption ,universal health coverage ,Sierra leone ,03 medical and health sciences ,0302 clinical medicine ,Procurement ,Absenteeism ,Humans ,030212 general & internal medicine ,media_common ,Corrupt practices ,African health systems ,030503 health policy & services ,Health Policy ,Fraud ,Anglophone West Africa ,Health sector ,Africa, Western ,Incentive ,Scale (social sciences) ,Business ,0305 other medical science ,Primary research - Abstract
West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sustainable Development Goals. The first step in tackling corruption systematically is to understand its scale and nature. We present a systematic review of literature that explores corruption involving front-line healthcare providers, their managers and other stakeholders in health sectors in the five Anglophone West African (AWA) countries: Gambia, Ghana, Liberia, Nigeria and Sierra Leone, identifying motivators and drivers of corrupt practices and interventions that have been adopted or proposed. Boolean operators were adopted to optimize search outputs and identify relevant studies. Both grey and published literature were identified from Research Gate, Yahoo, Google Scholar, Google and PubMed, and reviewed and synthesized around key domains, with 61 publications meeting our inclusion criteria. The top five most prevalent/frequently reported corrupt practices were (1) absenteeism; (2) diversion of patients to private facilities; (3) inappropriate procurement; (4) informal payments; and (5) theft of drugs and supplies. Incentives for corrupt practices and other manifestations of corruption in the AWA health sector were also highlighted, while poor working conditions and low wages fuel malpractice. Primary research on anti-corruption strategies in health sectors in AWA remains scarce, with recommendations to curb corrupt practices often drawn from personal views and experience rather that of rigorous studies. We argue that a nuanced understanding of all types of corruption and their impacts is an important precondition to designing viable contextually appropriate anti-corruption strategies. It is a particular challenge to identify and tackle corruption in settings where formal rules are fluid or insufficiently enforced.
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180. Achieving financial risk protection through a national Social Health Insurance Programme in Nigeria: Perspectives of enrollees and healthcare providers
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Maduka D. Ughasoro, Obinna Onwujekwe, Ifeoma Nwakoby, and Gladys N. Ebunoha
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Adult ,Male ,medicine.medical_specialty ,Financing, Personal ,Health Knowledge, Attitudes, Practice ,media_common.quotation_subject ,Nigeria ,Risk Assessment ,Service utilization ,Universal Health Insurance ,Surveys and Questionnaires ,Health care ,medicine ,Health insurance ,Humans ,Social determinants of health ,media_common ,Data collection ,business.industry ,Health Policy ,Financial risk ,Middle Aged ,Payment ,Cross-Sectional Studies ,Family medicine ,Female ,Business ,Healthcare providers - Abstract
Introduction Out-of-pocket (OOP) payment adversely affects universal financial risk protection (UFRP) and the achievement of Universal Health Coverage (UHC). Since the introduction of a Formal Sector Social Health Insurance Programme (FSSHIP) in Nigeria, the extent to which it has provided UFRP is still largely unknown. This study therefore assessed this from the perspectives of both enrollees and healthcare providers. Methods The study was undertaken in Enugu state, Nigeria. The subjects were randomly selected primary enrollees and health care providers. An interviewer-administered questionnaire was used for data collection on service utilization under the FSSHIP, as well as out-of-pocket payment of healthcare expenditure. Results Out of 333 formal sector workers interviewed, 283 (85%) were registered in the FSSHIP and 61.1% of them utilized FSSHIP. Among these, 89.8% of them used OOP to pay for about 95.2% of the healthcare expenditure. From the perspectives of the providers, 97.6%, patients still paid using OOP. Conclusion The FSSHIP is not providing UFRP as expected. This weakens the effectiveness of the FSSHIP to ensure UFRP and ultimately UHC. The NHIS should modify the FSSHIP to provide UFRP and eliminate both the high level of OOP and the proportion of expenditure it covers.
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181. Governance of tuberculosis control programme in Nigeria
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Daniel Chukwuemeka Ogbuabor and Obinna Onwujekwe
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medicine.medical_specialty ,Service delivery framework ,Health Personnel ,Scoping Review ,030231 tropical medicine ,Nigeria ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Tuberculosis ,lcsh:RC109-216 ,Health Workforce ,030212 general & internal medicine ,Human resources ,Governance ,business.industry ,lcsh:Public aspects of medicine ,Health Policy ,Control programme ,Corporate governance ,Public health ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,General Medicine ,Monitoring and evaluation ,Public relations ,Private sector ,Leadership ,Infectious Diseases ,Management system ,Electronic data ,business ,Delivery of Health Care - Abstract
Background The role of governance in strengthening tuberculosis (TB) control has received little research attention. This review provides evidence of how institutional designs and organisational practices influence implementation of the national TB control programme (NTP) in Nigeria. Main text We conducted a scoping review using a five-stage framework to review published and grey literature in English, on implementation of Nigeria’s NTP and identified themes related to governance using a health system governance framework. We included articles, of all study designs and methods, which described or analysed the processes of implementing TB control based on relevance to the research question. The review shows a dearth of studies which examined the role of governance in TB control in Nigeria. Although costed plans and policy coordination framework exist, public spending on TB control is low. While stakeholders’ involvement in TB control is increasing, institutional capacity is limited, especially in the private sector. TB-specific legislation is absent. Deployment and transfer of staff to the NTP are not transparent. Health workers are not transparent in communicating service entitlements to users. Despite existence of supportive policies, integration of TB control into the community and general health services have been weak. Willingness to pay for TB services is high, however, transaction cost and stigma among patients limit equity. Effectiveness and efficiency of the NTP was hindered by inadequate human resources, dilapidated service delivery infrastructure and weak drug supply system. Despite adhering to standardized recording and reporting format, regular monitoring and evaluation, revision of reporting formats, and electronic data management system, TB surveillance system was found to be weak. Delay in TB diagnosis and initiation of care, poor staff attitude to patients, lack of privacy, poor management of drug reactions and absence of infection control measures breach ethical standards for TB care. Conclusions This scoping review of governance of TB control in Nigeria highlights two main issues. Governance for strengthening TB control programmes in low-resource, high TB burden settings like Nigeria, is imperative. Secondly, there is a need for empirical studies involving detailed analysis of different dimensions of governance of TB control. Electronic supplementary material The online version of this article (10.1186/s40249-019-0556-2) contains supplementary material, which is available to authorized users.
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- 2019
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182. Assessment of patients knowledge and attitude towards diabetes and its relationship with glycemic control: a cross-sectional study in a Nigerian tertiary hospital
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Aloysius Nwabugo Maduforo, Ifeyinwa Dorothy Nnakenyi, Chika Ndiokwelu, C.C. Ezenduka, Ekenechukwu E. Young, Chijioke Okoli, Obinna Onwujekwe, and Raphael Anakwue
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medicine.medical_specialty ,knowledge ,business.industry ,Cross-sectional study ,Significant difference ,Good attitude ,General Medicine ,medicine.disease ,glycaemic control ,Internal medicine ,Diabetes mellitus ,attitude ,diabetes mellitus ,medicine ,Outpatient clinic ,Medicine ,Poor correlation ,Positive attitude ,business ,Glycemic - Abstract
Background: It is postulated that increased knowledge of patients about diabetes as well as a positive attitude will lead to improved glycaemic control and better outcome. The aim of this study was to determine the knowledge and attitude of diabetic patients in a tertiary hospital in Enugu and the relationship with their glycaemic control.Methods: A cross-sectional study was done using a structured questionnaire to obtain socio-demographic data and assess knowledge and attitude to diabetes on consecutive patients attending the outpatient clinic in a tertiary hospital. Responses were scored with equal weighting. The fasting blood glucose of the patients was measured and recorded.Result: There were 51(60.7%) females and 33 (39.3%) males, with majority (63.1%) in the age range 41 -64 years and 32(38.1%) had only primary education. The mean knowledge score was 6.19 ± 2.08 and 33(39.3%) demonstrated good knowledge. Knowledge did not differ between males and females (p=0.34), but was highest in those with tertiary education (p = 0.02). Positive attitude to the condition was recorded in 63(75%) subjects. There was poor correlation between knowledge and attitude (r = -0.161, p= 0.14). Those with good knowledge scores were 2 times more likely to have good glycaemic control compared with those with poor knowledge; OR = 2.015, p = 0.02. There was no significant difference between the glycemic control of those with good attitude and those with poor attitude (p= 0.08).Conclusion: Although overall knowledge was poor, patients had a good attitude to their illness. Knowledge, but not attitude was significantly positively associated with glycemic control.Keywords: Diabetes mellitus, Knowledge, Attitude, Glycaemic control
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- 2019
183. Dealing with context in logic model development: Reflections from a realist evaluation of a community health worker programme in Nigeria
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Ana Manzano, Obinna Onwujekwe, Joseph P. Hicks, Tim Ensor, Enyi Etiaba, James N Newell, Reinhard Huss, Tolib Mirzoev, Bassey Ebenso, Nkoli Ezumah, Benjamin Uzochukwu, and Morell, J
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Maternal and child health ,Knowledge management ,Social Psychology ,Programme theory ,Strategy and Management ,Geography, Planning and Development ,Nigeria ,Context (language use) ,Health Promotion ,Logic model ,Article ,03 medical and health sciences ,0302 clinical medicine ,Consolidation (business) ,0504 sociology ,Humans ,Community health workers ,Maternal Health Services ,030212 general & internal medicine ,Sociology ,Business and International Management ,Community Health Workers ,Data collection ,Information Dissemination ,business.industry ,Data Collection ,4. Education ,05 social sciences ,Context ,Public Health, Environmental and Occupational Health ,050401 social sciences methods ,Models, Theoretical ,Knowledge ,Community health ,Community health workers programme ,business ,Realist evaluation ,Program Evaluation - Abstract
Highlights • We describe the process of developing a logic model as part of an ongoing realist evaluation of a community health workers programme in Nigeria. • We also reflect on how other scholars explored context during logic modelling in theory-driven evaluations of complex healthcare programmes. • Creating a logic model is a key step in modelling relations between a programme, its outcomes and contextual conditions that can affect outcomes. • Logic models can also inform identification of initial working theories and evaluation measures for verifying underlying programme theories. • Lessons for researchers and programme planners who wish to develop and use logic models in future evaluations are discussed., Logic models (LMs) have been used in programme evaluation for over four decades. Current debate questions the ability of logic modelling techniques to incorporate contextual factors into logic models. We share experience of developing a logic model within an ongoing realist evaluation which assesses the extent to which, and under what circumstances a community health workers (CHW) programme promotes access to maternity services in Nigeria. The article contributes to logic modelling debate by: i) reflecting on how other scholars captured context during LM development in theory-driven evaluations; and ii) explaining how we explored context during logic model development for realist evaluation of the CHW programme in Nigeria. Data collection methods that informed our logic model development included documents review, email discussions and teleconferences with programme stakeholders and a technical workshop with researchers to clarify programme goals and untangle relationships among programme elements. One of the most important findings is that, rather than being an end in itself, logic model development is an essential step for identifying initial hypotheses for tentative relevant contexts, mechanisms and outcomes (CMOs) and CMO configurations of how programmes produce change. The logic model also informed development of a methodology handbook that is guiding verification and consolidation of underlying programme theories.
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- 2019
184. Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries
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Chandani Kharel, Rumana Huque, Zahidul Quayyem, Riffat Ara Shawon, Irene Akua Agyepong, Justice Nonvignon, Tolib Mirzoev, Benjamin Uzochukwu, Genevieve Cecilia Aryeetey, Bassey Ebenso, Obinna Onwujekwe, Sushil Baral, Sumit Kane, Helen Elsey, and Tim Ensor
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Economic growth ,Context (language use) ,low- and middle- income country ,multi-sector ,03 medical and health sciences ,0302 clinical medicine ,Urbanization ,local government ,030212 general & internal medicine ,Social determinants of health ,ghana ,urbanisation ,030503 health policy & services ,Health Policy ,Corporate governance ,Public Health, Environmental and Occupational Health ,non-communicable diseases ,nigeria ,nepal ,Local government ,Accountability ,bangladesh ,Position paper ,Business ,0305 other medical science ,health systems ,urban ,Slum ,Analysis - Abstract
The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the ‘urban advantage’, the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations.
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- 2019
185. Additional file 1: of Governance of tuberculosis control programme in Nigeria
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Ogbuabor, Daniel and Obinna Onwujekwe
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Multilingual abstracts in the five official working languages of the United Nations. (PDF 567 kb)
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- 2019
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186. Additional file 2: of Governance of tuberculosis control programme in Nigeria
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Ogbuabor, Daniel and Obinna Onwujekwe
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Descriptive content of the 38 selected articles and 11 documents reviewed. The file provides the detailed characteristics of the journal articles and documents included in this scoping review. The table includes authors, year of publication, methods, population and sample, key outcome and conclusion. (DOCX 32 kb)
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- 2019
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187. Achieving universal health coverage in Nigeria: the dilemma of accessing dental care in Enugu state, Nigeria, a mixed methods study
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Obinna Onwujekwe, C.C. Uguru, Nkolika Uguru, and Udochukwu Ugochukwu Ogu
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0301 basic medicine ,medicine.medical_specialty ,Interview ,Population ,Nigeria ,Access to dental care ,03 medical and health sciences ,0302 clinical medicine ,Universal health coverage ,Toothache ,Health care ,medicine ,lcsh:Social sciences (General) ,lcsh:Science (General) ,education ,Socioeconomic status ,education.field_of_study ,Multidisciplinary ,business.industry ,Dental care ,Dilemma ,stomatognathic diseases ,030104 developmental biology ,Family medicine ,lcsh:H1-99 ,medicine.symptom ,business ,Inclusion (education) ,030217 neurology & neurosurgery ,Research Article ,Enugu ,lcsh:Q1-390 ,Qualitative research - Abstract
Objective Equitable access to oral healthcare is a major focus of the Universal health coverage debate in Nigeria. However, a great majority of the population still do not have full coverage for essential oral healthcare services. This study will determine the extent of inequities in accessing oral healthcare services and the factors influencing access to equitable oral healthcare in Enugu state Nigeria. Methods A descriptive cross-sectional, urban and rural study conducted over two months in Enugu state Nigeria, using a mixed method approach. The quantitative study design used interviewer administered questionnaires to elicit information from 774 household members (394 urban and 380 rural) in study area who had sought dental care 6 months prior to study, and dental care providers (52) in selected dental health facilities. The qualitative study design involved in-depth interview of heads of selected dental health facilities to investigate factors influencing provision of dental care. Household data was collected house to house from randomly selected households in the LGA, while a face-to-face in-depth interview was conducted for purposively selected oral health professionals from study facilities. Results Majority of respondents sought care when they had toothache (72%). There was inequity in utilization of dental care across socioeconomic status groups (SES). The least poor SES (Q5) sought dental care in the private facilities, and chose to have dental fillings more than the poorest (Q1) and very poor SES (Q2) who visited public facilities and patent medicine dealer shops more and opted more for tooth extractions.(p < 0.05) Cost of services influenced access and treatment choice more among Q1 and Q2 than Q5 (p < 0.05) Qualitative results show that facility location, low awareness, human resource shortage and oral health financing methods influenced access. Conclusion Increased awareness and inclusion of oral healthcare in all health insurance schemes with expansion of current oral healthcare benefit package will improve access to care and further improve chances of attaining universal health coverage., Enugu; Nigeria; Universal health coverage; Dental care; Access to dental care
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- 2021
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188. Determining the disability adjusted life years lost to childhood and adolescence epilepsy in southeast Nigeria: An exploratory study
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N C Ojinnaka, Maduka D. Ughasoro, and Obinna Onwujekwe
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Male ,Childhood epilepsy ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Population ,Exploratory research ,Psychological intervention ,Nigeria ,Disability Evaluation ,Young Adult ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Cost of Illness ,Surveys and Questionnaires ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Young adult ,Child ,education ,Disease burden ,education.field_of_study ,business.industry ,Age Factors ,Infant ,medicine.disease ,Quality-adjusted life year ,Neurology ,Child, Preschool ,Female ,Quality-Adjusted Life Years ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Demography - Abstract
Objectives Disease burden has always been based on associated mortality. An accurate measurement of the burden of epilepsy should rely on both morbidity and mortality. This will close any existing gap in knowledge and provide useful information to aid evidence-based decision-making. In this study, burden of epilepsy was estimated, using disability-adjusted-life-years (DALYs), using disability weights for epilepsy that were part of the Global Burden of Disease 2010 work. Methods The study was conducted at the University of Nigeria Teaching Hospital, Enugu. Interviewer-administered questionnaire was used to collect information from patients with epilepsy who presented to neurology clinic. The prevalence of epilepsy, and case-fatality were obtained from previous publications. The DALYs were estimated by adding together the years lost to disability (YLDs) and years lost to life (YLLs) to epilepsy (DALYs = YLD + YLL). DALYs were dis-aggregated by age group and by whether or not epilepsy was treated. Results A total of 134 children with epilepsy-interviews were conducted. Some 56% and 44% of the subjects had primary and secondary epilepsy, respectively. The childhood epilepsy caused 1.63 YLLs per 1000 population, 0.45 YLDs per 1000 population and 2.08 DALY per 1000 population. The highest burden was in children within the age group of 5–14 years at 2.18 DALY per 1000 people. The YLDs was higher (0.63/1000 population) among the untreated group, compared with the YLDs (0.27/1000 population) among the treated group. The YLLs lost for children with secondary epilepsy (2.23/1000 population) was higher than primary epilepsy YLLs of 1.07/1000 population. Significance The DALYs due to childhood epilepsy was high. The YLDs was high among children with epilepsy who were not on treatment. The YLLs were found to be the same in all children with epilepsy, irrespective of their treatment status. This imperatively necessitates the de-emphasis on just mortality as an indicator of the burden of childhood epilepsy but rather a holistic approach should be adopted in considering both the mortality and disability in monitoring the outcome of health interventions.
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- 2016
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189. Integrated prevention of mother-to-child HIV transmission services, antiretroviral therapy initiation, and maternal and infant retention in care in rural north-central Nigeria: a cluster-randomised controlled trial
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Sten H. Vermund, Bryan E. Shepherd, Mary Lou Lindegren, Usman I. Gebi, Muktar H. Aliyu, Carolyn M. Audet, C. William Wester, Marcia L. Kalish, Obinna Onwujekwe, and Meridith Blevins
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Adult ,Male ,Rural Population ,0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Referral ,Anti-HIV Agents ,Epidemiology ,Immunology ,Mothers ,Nigeria ,HIV Infections ,Prenatal care ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Pregnancy ,law ,Virology ,Early Intervention, Educational ,Humans ,Medicine ,Family ,Nevirapine ,030212 general & internal medicine ,Cluster randomised controlled trial ,Pregnancy Complications, Infectious ,Young adult ,Acquired Immunodeficiency Syndrome ,Delivery of Health Care, Integrated ,business.industry ,Infant ,Prenatal Care ,030112 virology ,Infectious Disease Transmission, Vertical ,CD4 Lymphocyte Count ,Clinical trial ,Infectious Diseases ,Relative risk ,Marital status ,Female ,business - Abstract
Antiretroviral therapy (ART) and retention in care are essential for the prevention of mother-to-child HIV transmission (PMTCT). We aimed to assess the effect of a family-focused, integrated PMTCT care package.In this parallel, cluster-randomised controlled trial, we pair-matched 12 primary and secondary level health-care facilities located in rural north-central Nigeria. Clinic pairs were randomly assigned to intervention or standard of care (control) by computer-generated sequence. HIV-infected women (and their infants) presenting for antenatal care or delivery were included if they had unknown HIV status at presentation (there was no age limit for the study, but the youngest participant was 16 years old); history of antiretroviral prophylaxis or treatment, but not receiving these at presentation; or known HIV status but had never received treatment. Standard of care included health information, opt-out HIV testing, infant feeding counselling, referral for CD4 cell counts and treatment, home-based services, antiretroviral prophylaxis, and early infant diagnosis. The intervention package added task shifting, point-of-care CD4 testing, integrated mother and infant service provision, and male partner and community engagement. The primary outcomes were the proportion of eligible women who initiated ART and the proportion of women and their infants retained in care at 6 weeks and 12 weeks post partum (assessed by generalised linear mixed effects model with random effects for matched clinic pairs). The trial is registered with ClinicalTrials.gov, number NCT01805752.Between April 1, 2013, and March 31, 2014, we enrolled 369 eligible women (172 intervention, 197 control), similar across groups for marital status, duration of HIV diagnosis, and distance to facility. Median CD4 count was 424 cells per μL (IQR 268-606) in the intervention group and 314 cells per μL (245-406) in the control group (p0·0001). Of the 369 women included in the study, 363 (98%) had WHO clinical stage 1 disease, 364 (99%) had high functional status, and 353 (96%) delivered vaginally. Mothers in the intervention group were more likely to initiate ART (166 [97%] vs 77 [39%]; adjusted relative risk 3·3, 95% CI 1·4-7·8). Mother and infant pairs in the intervention group were more likely to be retained in care at 6 weeks (125 [83%] of 150 vs 15 [9%] of 170; adjusted relative risk 9·1, 5·2-15·9) and 12 weeks (112 [75%] of 150 vs 11 [7%] of 168 pairs; 10·3, 5·4-19·7) post partum.This integrated, family-focused PMTCT service package improved maternal ART initiation and mother and infant retention in care. An effective approach to improve the quality of PMTCT service delivery will positively affect global goals for the elimination of mother-to-child HIV transmission.Eunice Kennedy Shriver National Institute of Child Health and Human Development and US National Institutes of Health.
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- 2016
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190. Using Economic Evidence to Set Healthcare Priorities in Low-Income and Lower-Middle-Income Countries: A Systematic Review of Methodological Frameworks
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Anthony T. Newall, Virginia Wiseman, Stephen Jan, Mary M. Doyle-Waters, Obinna Onwujekwe, Lesong Conteh, Tom Drake, and Craig Mitton
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Economic growth ,Cost–benefit analysis ,Public economics ,business.industry ,030503 health policy & services ,Health Policy ,Psychological intervention ,Cost-effectiveness analysis ,Quality-adjusted life year ,EconLit ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Economic evaluation ,Economics ,030212 general & internal medicine ,0305 other medical science ,business ,Health policy - Abstract
Policy makers in low-income and lower-middle-income countries (LMICs) are increasingly looking to develop 'evidence-based' frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks--which incorporate economic evaluation evidence--for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of 'efficiency' defined as cost per disability-adjusted life year averted. Ranking of health interventions using multi-criteria decision analysis and generalised cost-effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision-makers to act on this evidence.
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- 2016
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191. Which mechanisms explain motivation the of primary health workers? Insights from the realist evaluation of a maternal and child health programme in Nigeria
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Ana Manzano, Reinhard Huss, Joseph P. Hicks, Bassey Ebenso, Chinyere Mbachu, Enyi Etiaba, Nkoli Ezumah, Benjamin Uzochukwu, Tim Ensor, Tolib Mirzoev, Obinna Onwujekwe, and Abimbola, S
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Health Personnel ,media_common.quotation_subject ,qualitative study ,Nigeria ,Context (language use) ,maternal health ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Interpersonal relationship ,0302 clinical medicine ,Humans ,lcsh:RC109-216 ,Health Workforce ,030212 general & internal medicine ,Child ,Health policy ,Original Research ,media_common ,lcsh:R5-920 ,Motivation ,Teamwork ,business.industry ,030503 health policy & services ,Health Policy ,Child Health ,Public Health, Environmental and Occupational Health ,Equity (finance) ,Public relations ,Feeling ,Workforce ,lcsh:Medicine (General) ,0305 other medical science ,Psychology ,business ,health systems evaluation ,Qualitative research - Abstract
IntroductionWell-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria.MethodsWe adopted a realist evaluation design combining document review with 56 in-depth interviews of PHC workers, facility managers and policy-makers to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers’ motivation and which mechanisms explain how motivation works. We drew on Herzberg’s two-factor and Adam’s equity theories to unpack how context shapes worker motivation.ResultsA complex and dynamic interaction between the MCH programme and organisational and wider contexts triggered five mechanisms which explain PHC worker motivation: (1) feeling supported, (2) feeling comfortable with work environment, (3) feeling valued, (4) morale and confidence to perform tasks and (5) companionship. Some mechanisms were mutually reinforcing while others operated in parallel. Other conditions that enabled worker motivation were organisational values of fairness, recognition of workers’ contributions and culture of task-sharing and teamwork.ConclusionsPolicy designs and management strategies for improving workforce performance, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery and promote UHC. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.
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- 2020
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192. Workflow estimation of a radiology department using modelling and simulation
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Felicitas Idigo, Victor Idigo, Kenneth Agwu, Obinna Onwujekwe, Mark Okeji, Angel Mary Anakwue, and Uloma Nwogu
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Organizational Behavior and Human Resource Management ,Management Science and Operations Research - Published
- 2020
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193. Aligning public financial management system and free healthcare policies: lessons from a free maternal and child healthcare programme in Nigeria
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Daniel Chukwuemeka Ogbuabor and Obinna Onwujekwe
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lcsh:R5-920 ,Public financial management ,Health economics ,Descriptive statistics ,business.industry ,030503 health policy & services ,Health Policy ,Research ,Health services research ,Nigeria ,Accounting ,Audit ,Free healthcare ,Policy implementation ,Financial management ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Revenue ,030212 general & internal medicine ,Business ,lcsh:Medicine (General) ,0305 other medical science ,Public finance - Abstract
Background Relatively little is known about how public financial management (PFM) systems and health financing policies align in low- and middle-income countries. This study assessed the alignment of PFM systems with health financing functions in the free maternal and child healthcare programme (FMCHP) of Enugu State, Nigeria. Methods Data were collected through quantitative and qualitative document review, and semi-structured, in-depth interview with 16 purposively selected policymakers involved in FMCHP. Data collection and analysis were by guided a framework for assessing alignment of PFM systems and health financing policies. Revenue and expenditure trend analyses were done using descriptive statistics and analysis of variance (ANOVA). Level of significance was set at ρ
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- 2018
194. Strategic purchasing for universal health coverage: examining the purchaser–provider relationship within a social health insurance scheme in Nigeria
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Kara Hanson, Benjamin Uzochukwu, Ayako Honda, Ogochukwu Ibe, Enyi Etiaba, and Obinna Onwujekwe
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medicine.medical_specialty ,media_common.quotation_subject ,Nigeria ,Formal Sector Social Health Insurance Programme ,provider payment methods ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,contracts ,030212 general & internal medicine ,Social determinants of health ,Marketing ,purchaser provider split ,media_common ,Government ,business.industry ,030503 health policy & services ,Health Policy ,Public health ,Research ,Public Health, Environmental and Occupational Health ,Private sector ,Payment ,Purchasing ,National Health Insurance Scheme ,strategic purchasing ,Stewardship ,0305 other medical science ,business - Abstract
BackgroundIn an attempt to achieve universal health coverage, Nigeria introduced a number of health insurance schemes. One of them, the Formal Sector Social Health Insurance Programme (FSSHIP), was launched in 2005 to provide health cover to federal government and formal private sector employees. It operates with two levels of purchasers, the National Health Insurance Scheme (NHIS) and health maintenance organisations (HMOs). This study critically assesses purchasing arrangements between NHIS, HMOs and healthcare providers and determines how the arrangements function from a strategic purchasing perspective within the FSSHIP.MethodsA qualitative study undertaken in Enugu state, Nigeria, data were gathered through reviews of documents, 17 in-depth interviews (IDIs) with NHIS, HMOs and healthcare providers and two focus group discussions (FGDs) with FSSHIP enrolees. A strategic purchasing lens was used to guide data analysis.ResultsThe purchasing function was not being used strategically to influence provider behaviour and improve efficiency and quality in healthcare service delivery. For the purchaser–provider relationship, these actions are: accreditation of healthcare providers; monitoring of HMOs and healthcare providers and use of appropriate provider payment mechanisms for healthcare services at every level. The government lacks resources and political will to perform their stewardship role while provider dissatisfaction with payments and reimbursements adversely affected service provision to enrolled members. Underlying this inability to purchase, health services strategically is the two-tiered purchasing mechanism wherein NHIS is not adequately exercising its stewardship role to monitor and guide HMOs to fulfil their roles and responsibilities as purchasing administrators.ConclusionsPurchasing under the FSSHIP is more passive than strategic. Governance framework requires strengthening and clarity for optimal implementation so as to ensure that both levels of purchasers undertake strategic purchasing actions. Additional strengthening of NHIS is needed for it to have capacity to play its stewardship role in the FSSHIP.
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- 2018
195. Valuing the unpaid contribution of community health volunteers to mass drug administration programs
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Jaspreet Toor, Yoel Lubell, Christopher Fitzpatrick, Obinna Onwujekwe, Hugo C. Turner, Adrian Hopkins, Shwe Sin Kyaw, Alison A. Bettis, and Guy E. Thwaites
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0301 basic medicine ,Microbiology (medical) ,Volunteers ,medicine.medical_specialty ,Opportunity cost ,030106 microbiology ,education ,Psychological intervention ,Microbiology ,economic costs ,03 medical and health sciences ,0302 clinical medicine ,Economic cost ,Health care ,medicine ,community volunteers ,Humans ,unpaid work ,030212 general & internal medicine ,Mass drug administration ,11 Medical and Health Sciences ,Community Health Workers ,mass drug administration ,business.industry ,06 Biological Sciences ,3. Good health ,Viewpoints ,Infectious Diseases ,Unpaid work ,Family medicine ,Transparency (graphic) ,Community health ,Public Health ,business ,APOC ,Delivery of Health Care - Abstract
Community health volunteers (CHVs) are being used within a growing number of healthcare interventions, and they have become a cornerstone for the delivery of mass drug administration within many neglected tropical disease control programs. However, a greater understanding of the methods used to value the unpaid time CHVs contribute to healthcare programs is needed. We outline the two main approaches used to value CHVs’ unpaid time (the opportunity cost and the replacement cost approaches). We found that for mass drug administration programs the estimates of the economic costs relating to the CHVs’ unpaid time can be significant, with the averages of the different studies varying between US$0.05 and $0.16 per treatment. We estimated that the time donated by CHVs’ to the African Programme for Onchocerciasis Control alone would be valued between US$60 and $90 million. There is a need for greater transparency and consistency in the methods used to value CHVs’ unpaid time., The global health community needs a greater understanding of the opportunity costs community health volunteers incur when contributing to healthcare programs. Focusing on mass drug administration programs as an example, we found that these costs can be significant.
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- 2018
196. Exploring actors roles in formulation of the human resources for health policy in Nigeria
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Reinhard Huss, Enyi Etiaba, Nkoli Uguru, Benjamin Uzochukwu, Obinna Onwujekwe, Giuliano Russo, and Miriam O. Ajuba
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medicine.medical_specialty ,business.industry ,Public health ,General Medicine ,role of actors in policy making ,Incineration ,human resource for health ,Hazardous waste ,Environmental health ,Health care ,Respondent ,Medicine ,BioHazard ,business ,health policy making ,Health policy ,Plastic bag - Abstract
Human activities generate wastes, some are harmful and others are not so harmful to man and the environment. Of concern however, are hospital wastes, which come in the form of hazardous wastes such as chemical, radioactive, pathological and anatomical wastes amongst others. This study therefore investigated the public health implications of prototype of healthcare waste management in Jos Metropolis, Plateau State, Nigeria. Data were collected using quantitative and qualitative methods respectively, while nine (9) key informants were interviewed, and observation was utilized as the qualitative methods. The hospital generates two types of wastes: municipal solid wastes and special healthcare wastes which in most cases are mixed up without proper segregation into different color-coded containers with specified biohazard symbol as being recommended by the international best practices. Two hundred and thirteen (61.4%) of the respondents indicated that safety boxes are used in segregating sharps, 40 (11.5%) of the respondent indicated puncture proof containers, while 72 (20.7%) indicated plastic bags. One hundred and seventy two (59%) of the respondents indicated that colour codes are used for different types of wastes, 108 (37%) of the respondents indicated no. Respondents of 114 (39%) indicated no, showing that wastes were not treated before disposal, 54 (19%) of the respondents indicated yes, that wastes are treated before disposal. A total of 172 (49%) of the respondents indicated that wastes are transported to the final disposal site with enclosed compaction vehicle, while 75 (21.6%) of the respondents indicated that wastes are transported with open vehicle. One hundred and eighty eight (54.2%) of the respondents who are mostly females indicated that diseases/infections were a major effect of wastes on health workers, patients and the residence of Jos metropolis. Three hundred and six (88.2%) of the respondents indicated that hospital waste transmit diseases caused by Staphylococcus aureus, Klebsiella pneumonia, Escherichia coli and Proteus mirabilis. Other diseases include typhoid and cholera. In general, the wastes treatment method is poor as reflected in the disposal of solid wastes in open space without incineration, which gives room for scavengers most of whom are children, whose health implication cannot be overemphasized. There is no existing laid down waste management policy, neither is there record of special training for waste handlers. Workers should imbibe the culture of proper waste management that is in line with international best practices. In addition, injuries should be reported to appropriate hospital authority, where prompt action should be taken to avert the threat of spread of disease or infection.
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- 2018
197. The community is just a small circle: citizen participation in the free maternal and child healthcare programme of Enugu State, Nigeria
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Obinna Onwujekwe and Daniel Chukwuemeka Ogbuabor
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Adult ,Adolescent ,Financial Management ,Maternal-Child Health Services ,media_common.quotation_subject ,Pooling ,Nigeria ,Public administration ,Interviews as Topic ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Health facility ,State (polity) ,Health care ,Humans ,free healthcare ,030212 general & internal medicine ,Developing Countries ,Qualitative Research ,social accountability ,media_common ,Social accounting ,Social Responsibility ,business.industry ,030503 health policy & services ,Corporate governance ,Health Policy ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Focus Groups ,Middle Aged ,Purchasing ,policy implementation ,Investment management ,Female ,Original Article ,0305 other medical science ,business - Abstract
Background: There is a gap in knowledge about how citizen participation impacts governance of free healthcare policies for universal health coverage in low- and middle-income countries. Objective: This study provides evidence about how social accountability initiatives influenced revenue generation, pooling and fund management, purchasing and capacity of health facilities implementing the free maternal and child healthcare programme (FMCHP) in Enugu State, Nigeria. Methods: The study adopted a descriptive, qualitative case-study design to explore how social accountability influenced implementation of the FMCHP at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected from policymakers (n = 16), providers (n = 16) and health facility committee leaders (n = 12) through in-depth interviews. We also conducted focus-group discussions (n = 4) with 42 service users and document review. Data were analysed using thematic analysis. Results: It was found that health facility committees (HFCs) have not been involved in the generation of funds, fund management and tracking of spending in FMCHP. The HFCs did not also seem to have increased transparency of benefits and payment of providers. The HFCs emerged as the dominant social accountability initiative in FMCHP but lacked power in the governance of free health services. The HFCs were constrained by weak legal framework, ineffectual FMCHP committees at the state and district levels, restricted financial information disclosure, distrustful relationships with policymakers and providers, weak patient complaint system and low use of service charter. Conclusion: The HFCs have not played a significant role in health financing and service provision in FMCHP. The gaps in HFCs’ participation in health financing functions and service delivery need to be considered in the design and implementation of free maternal and child healthcare policies that aim to achieve universal health coverage.
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- 2018
198. Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria
- Author
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Obinna Onwujekwe and Daniel Chukwuemeka Ogbuabor
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Economic growth ,Prescription Drugs ,Maternal-Child Health Services ,Nigeria ,Context (language use) ,Affect (psychology) ,management of health facilities ,03 medical and health sciences ,0302 clinical medicine ,Policy implementation ,Health care ,South east ,Humans ,free healthcare ,030212 general & internal medicine ,Qualitative Research ,health care economics and organizations ,business.industry ,030503 health policy & services ,Health Policy ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Child Health ,lcsh:RA1-1270 ,capacity of health facilities ,policy implementation ,Institutional capacity ,Insurance, Health, Reimbursement ,Original Article ,Health Expenditures ,0305 other medical science ,business - Abstract
Background: Studies examining how the capacity of health facilities affect implementation of free healthcare policies in low and middle-income countries are limited. Objective: This study describes how the context and institutional capacity of health facilities influenced implementation of the free maternal and child health programme (FMCHP) in Enugu state, South-east Nigeria. Methods: We conducted a qualitative case study at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected through document review and semi-structured, in-depth interviews with policymakers (n = 16), healthcare providers (n = 16) and health facility committee leaders (n = 12) guided by an existing capacity framework and analysed using a thematic framework approach. Results: The findings reveal that active health facility committees, changes in provider payment process, supportive supervision, drug revolving fund, availability of medical equipment, electronic data transmission and staff sanction system enhanced the capacity of health facilities to offer free healthcare. However, ineffective decentralisation, irregular supervision and weak citizen participation limited this capacity. Uncertain provider payment, evidence of tax payment policy and a co-existing fee-exempt scheme constrained health facilities in following the FMCHP guidelines. Poor recording and reporting skills and lack of support from district officials constrained providers’ adherence to claims’ submission timeline. Poor funding, weak drug supply system, inadequate infrastructure and lack of participatory decision-making constrained delivery of free healthcare. Insufficient trained workforce, mission-inconsistent postings and transfers, and weak staff disciplinary system limited the human resource capacity. Conclusions: Effectiveness of FMCHP at the health facility level depends on the extent of decentralisation, citizen participation, concurrent and conflictive policies, timely payment of providers, organisation of service delivery and human resources practices. Attention to these contextual and institutional factors will enhance responsiveness of health facilities, sustainability of free healthcare policies and progress towards universal health coverage.
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- 2018
199. Additional file 1: of Scaling-up strategic purchasing: analysis of health system governance imperatives for strategic purchasing in a free maternal and child healthcare programme in Enugu State, Nigeria
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Ogbuabor, Daniel and Obinna Onwujekwe
- Abstract
Assessment of governance of the free maternal and child healthcare programme in Enugu State, Nigeria: interview guide for key actors. The tool was used to guide data collection from key actors involved in the implementation of the free care policy at the state and district levels including revenue generation, pooling and fund management, purchasing and provision of free services. However, the data reported in this paper included only data related to purchasing function. (DOCX 15Â kb)
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- 2018
- Full Text
- View/download PDF
200. Corruption in the health sector in Anglophone West Africa: Common forms of corruption and mitigation strategies
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Obinna Onwujekwe, Agwu, Prince, Tochukwu Orjiakor, Chinyere Mbachu, Hutchinson, Eleanor, Odii, Aloysius, Uche Obi, Adaobi Ogbozor, Hyacinth Ichoku, Babalanova, Dina, and Mckee, Martin
- Published
- 2018
- Full Text
- View/download PDF
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