Author: "Christopher B Boyer" - Searchworks@Jio Institute Digital Library Search Results

16 results on '"Christopher B Boyer"'

1. Exploring COVID-19 vaccine hesitancy and uptake in Nairobi’s urban informal settlements: an unsupervised machine learning analysis of a longitudinal prospective cohort study from 2021 to 2022

Author: Edwine Barasa, Timothy Abuya, Jessie Pinchoff, Karen Austrian, Nandita Rajshekhar, Daniel Mwanga, Eva Muluve, Faith Mbushi, and Christopher B Boyer
Subjects: Medicine
Abstract: Objectives To illustrate the utility of unsupervised machine learning compared with traditional methods of analysis by identifying archetypes within the population that may be more or less likely to get the COVID-19 vaccine.Design A longitudinal prospective cohort study (n=2009 households) with recurring phone surveys from 2020 to 2022 to assess COVID-19 knowledge, attitudes and practices. Vaccine questions were added in 2021 (n=1117) and 2022 (n=1121) rounds.Setting Five informal settlements in Nairobi, Kenya.Participants Individuals from 2009 households included.Outcome measures and analysis Respondents were asked about COVID-19 vaccine acceptance (February 2021) and vaccine uptake (March 2022). Three distinct clusters were estimated using K-Means clustering and analysed against vaccine acceptance and vaccine uptake outcomes using regression forest analysis.Results Despite higher educational attainment and fewer concerns regarding the pandemic, young adults (cluster 3) were less likely to intend to get the vaccine compared with cluster 1 (41.5% vs 55.3%, respectively; p
Published: 2023
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2. Problems with evidence assessment in COVID-19 health policy impact evaluation: a systematic review of study design and evidence strength

Author: Elizabeth A Stuart, Emily R Smith, Elizabeth M Stone, Eli Ben-Michael, Cathrine Axfors, Brooke Jarrett, Sarah E Wieten, Van Thu Nguyen, Beth Ann Griffin, Noah A Haber, Emma Clarke-Deelder, Avi Feller, Joshua A. Salomon, Benjamin MacCormack-Gelles, Clara Bolster-Foucault, Jamie R Daw, Laura Anne Hatfield, Carrie E Fry, Christopher B Boyer, Caroline M Joyce, Beth S Linas, Ian Schmid, Eric H Au, and Alyssa Bilinski
Subjects: Medicine
Published: 2022
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3. The evaluation of the Woman's Condom marketing approach: What value did peer-led interpersonal communication add to the promotion of a new female condom in urban Lusaka?

Author: Jessie Pinchoff, Christopher B Boyer, Rachna Nag Chowdhuri, Gina Smith, Namwinga Chintu, and Thoai D Ngo
Subjects: Medicine, Science
Abstract: During a mass media campaign accompanying the launch of the Maximum Diva Woman's Condom (WC) in Lusaka, Zambia, a cluster-randomized evaluation was implemented to measure the added impact of a peer-led interpersonal communication (IPC) intervention on the awareness and uptake of the new female condom (FC). The WC and mass media campaign were introduced simultaneously in 40 urban wards in April 2016; half of the wards were randomly assigned to the treatment (IPC intervention) with cross-sectional surveys conducted before (n = 2,364) and one year after (n = 2,430) the start of the intervention. A pre-specified intention-to-treat (ITT) analysis measured the impact of randomization to IPC at the community level. In adjusted ITT models, there were no statistically significant differences between intervention and control groups. Due to significant implementation challenges, we also conducted exploratory secondary analyses to estimate effects among those who attended an IPC event (n = 66) using instrumental variable and inverse probability weighting analyses. In addition to increases in FC identification (IPC attendees had higher reported use of any condom, improved perceptions of FC's, and were more likely to have discussed contraceptive use with their partner as compared to non-attendees). The introduction of a new FC product combined with an IPC intervention significantly increased general knowledge and awareness in the community as compared to media alone, but did not lead to detectable community level impacts on other primary outcomes of interest. Observational evidence from our study suggests that IPC attendance is associated with increased use and negotiation. Future studies should explore the intensity and duration of IPC programming necessary to achieve detectable community level impacts on behavior. Trial Registration: AEARCTR-0000899.
Published: 2019
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4. The child survival impact of the Ghana Essential Health Interventions Program: A health systems strengthening plausibility trial in Northern Ghana.

Author: Ayaga A Bawah, John Koku Awoonor-Williams, Patrick O Asuming, Elizabeth F Jackson, Christopher B Boyer, Edmund W Kanmiki, Sebastian F Achana, James Akazili, and James F Phillips
Subjects: Medicine, Science
Abstract: BackgroundThe Ghana Health Service in collaboration with partner institutions implemented a five-year primary health systems strengthening program known as the Ghana Essential Health Intervention Program (GEHIP). GEHIP was a plausibility trial implemented in an impoverished region of northern Ghana around the World Health Organizations (WHO) six pillars combined with community engagement, leadership development and grassroots political support, the program organized a program of training and action focused on strategies for saving newborn lives and community-engaged emergency referral services. This paper analyzes the effect of the GEHIP program on child survival.MethodsBirth history data assembled from baseline and endline surveys are used to assess the hazard of child mortality in GEHIP treatment and comparison areas prior to and after the start of treatment. Difference-in-differences (DiD) methods are used to compare mortality change over time among children exposed to GEHIP relative to children in the comparison area over the same time period. Models test the hypothesis that a package of systems strengthening activities improved childhood survival. Models adjusted for the potentially confounding effects of baseline differentials, secular mortality trends, household characteristics such as relative wealth and parental educational attainment, and geographic accessibility of clinical care.ResultsThe GEHIP combination of health systems strengthening activities reduced neonatal mortality by approximately one half (HR = 0.52, 95% CI = 0.28,0.98, p = 0.045). There was a null incremental effect of GEHIP on mortality of post-neonate infants (from 1 to 12 months old) (HR = 0.72; 95% CI = 0.30,1.79; p = 0.480) and post-infants (from 1 year to 5 years old) -(HR = 1.02; 95% CI = 0.55-1.90; p = 0.940). Age-specific analyses show that impact was concentrated among neonates. However, effect ratios for post-infancy were inefficiently assessed owing to extensive survival history censoring for the later months of childhood. Children were observed only rarely for periods over 40 months of age.ConclusionGEHIP results show that a comprehensive approach to newborn care is feasible, if care is augmented by community-based nurses. It supports the assertion that if appropriate mechanisms are put in place to enable the various pillars of the health system as espoused by WHO in rural impoverished settings where childhood mortality is high, it could lead to accelerated reductions in mortality thereby increasing survival of children. Policy implications of the pronounced neonatal effect of GEHIP merit national review for possible scale-up.
Published: 2019
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5. Why don't urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults.

Author: Jessie Pinchoff, Christopher B Boyer, Namuunda Mutombo, Rachna Nag Chowdhuri, and Thoai D Ngo
Subjects: Medicine, Science
Abstract: BACKGROUND:Zambia experiences high unmet need for family planning and high rates of HIV, particularly among youth. While male condoms are widely available and 95% of adults have heard of them, self-reported use in the past 12 months is low among young adults (45%). This study describes factors associated with non-use of male condoms among urban young adults in Zambia. METHODS:A household cross-sectional survey in four urban districts was conducted from November 2015 to January 2016 among sexually active young adults ages 18-24 years. A random walk strategy was implemented in urban areas; eligible, enrolled participants were administered a survey on household characteristics, health access, and knowledge, attitudes and practices related to contraception. Relative risk regression models were built to determine factors associated with the decision to not use a male condom (non-use) at most recent sexual intercourse. RESULTS:A total of 2,388 individuals were interviewed; 69% were female, 35% were married, and average lifetime sex partners was 3.45 (SD±6.15). Non-use of male condoms was 59% at most recent sexual intercourse. In a multivariate model, women were more likely to report non-use of a male condom compared with men (aRR = 1.24 [95% CI: 1.11, 1.38]), married individuals were more likely to report non-use compared with unmarried individuals (aRR = 1.59 [1.46, 1.73]), and those residing in the highest poverty wards were more likely to report non-use compared with those in the lowest poverty wards (aRR = 1.31 [1.16, 1.48]). Those with more negative perceptions of male condom use were 6% more likely to report non-use (aRR = 1.06 [1.03, 1.09]). Discussion regarding contraception with a partner decreased non-use 13% (aRR = 0.87 [0.80, 0.95]) and agreement regarding male condom use with a partner decreased non-use 16% (aRR = 0.84 [0.77, 0.91)]). DISCUSSION:Non-use of male condoms is high among young, married adults, particularly women, who may be interested in contraception for family planning but remain at risk of STI infection. Effective marketing strategy of dual protection methods to this population is critical.
Published: 2017
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6. Problems with evidence assessment in COVID-19 health policy impact evaluation: a systematic review of study design and evidence strength

Author: Alyssa Bilinski, Christopher B. Boyer, Eli Ben-Michael, Beth Ann Griffin, Carrie E. Fry, Elizabeth A. Stuart, Emma Clarke-Deelder, Noah Haber, Caroline M. Joyce, Cathrine Axfors, Elizabeth M. Stone, Sarah Wieten, Avi Feller, Benjamin MacCormack-Gelles, Brooke A. Jarrett, Ian Schmid, Beth S. Linas, Emily R. Smith, Laura A. Hatfield, Jamie R. Daw, Eric Au, Van Thu Nguyen, Clara Bolster-Foucault, and Joshua A. Salomon
Subjects: Actuarial science, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, Impact evaluation, Health Policy, statistics & research methods, MEDLINE, Inference, COVID-19, Sample (statistics), General Medicine, Article, Coronavirus, Cross-Sectional Studies, Research Design, Medicine, Humans, Set (psychology), Psychology, Inclusion (education), Health policy
Abstract: IntroductionAssessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. This study systematically reviewed the strength of evidence in the published COVID-19 policy impact evaluation literature.MethodsWe included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on November 26, 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation, assessing what impact evaluation method was used, graphical display of outcomes data, functional form for the outcomes, timing between policy and impact, concurrent changes to the outcomes, and an overall rating.ResultsAfter 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. The majority (n=23/36) of studies in our sample examined the impact of stay-at-home requirements. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-section), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 1/27 studies passed all of the above checks, and 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes.DiscussionThe reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigor to be actionable by policy-makers. This was largely driven by the circumstances under which policies were passed making it difficult to attribute changes in COVID-19 outcomes to particular policies. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.
Published: 2022

7. Benefits and Limitations of a Community-Engaged Emergency Referral System in a Remote, Impoverished Setting of Northern Ghana

Author: Elizabeth F. Jackson, John Koku Awoonor-Williams, Margaret L. Schmitt, Rofina Asuru, James F. Phillips, Sneha Patel, Janet Awopole Yepakeh Tiah, Robert Alirigia, Christopher B. Boyer, and Mallory C. Sheff
Subjects: Program evaluation, medicine.medical_specialty, Emergency Medical Services, Referral, 030231 tropical medicine, Population, Health intervention, Ghana, 03 medical and health sciences, 0302 clinical medicine, Acute care, Health care, Emergency medical services, Medicine, Humans, 030212 general & internal medicine, Community Health Services, education, Poverty, Referral and Consultation, education.field_of_study, business.industry, General Medicine, medicine.disease, Health indicator, Original Article, Medical emergency, Rural Health Services, business, Program Evaluation
Abstract: A low-cost emergency and communication transportation system used 3-wheeled motorcycles driven by trained community volunteers. Delivery referrals were redirected from health centers to hospitals capable of advanced services including cesarean deliveries, which was associated with reduced facility-based maternal mortality., Although Ghana has a well-organized primary health care system, it lacks policies and guidelines for developing or providing emergency referral services. In 2012, an emergency referral pilot—the Sustainable Emergency Referral Care (SERC) initiative—was launched by the Ghana Health Service in collaboration with community stakeholders and health workers in one subdistrict of the Upper East Region where approximately 20,000 people reside. The pilot program was scaled up in 2013 to a 3-district (12-subdistrict) plausibility trial that served a population of approximately 184,000 over 2 years from 2013 to 2015. The SERC initiative was fielded as a component of a 6-year health systems strengthening and capacity-building project known as the Ghana Essential Health Intervention Program. Implementation research using mixed methods, including quantitative analysis of key process and health indicators over time in the 12 intervention subdistricts compared with comparison districts, a survey of health workers, and qualitative systems appraisal with community members, provided data on effectiveness of the system as well as operational challenges and potential solutions. Monitoring data show that community exposure to SERC was associated with an increased volume of emergency referrals, diminished reliance on primary care facilities not staffed or equipped to provide surgical care, and increased caseloads at facilities capable of providing appropriate acute care (i.e., district hospitals). Community members strongly endorsed the program and expressed appreciation for the service. Low rates of adherence to some care protocols were noted: referring facilities often failed to alert receiving facilities of incoming patients, not all patients transported were accompanied by a health worker, and receiving facilities commonly failed to provide patient outcome feedback to the referring facility. Yet in areas where SERC worked to bypass substandard points of care, overall facility-based maternal mortality as well as accident-related deaths decreased relative to levels observed in facilities located in comparison areas.
Published: 2016

8. The Eric Garner Case: Statewide Survey of New York Voters’ Response to Proposed Police Accountability Legislation

Author: Les Roberts, Anna Andel, Laurene Barlet, Hana T. Hamdi, Cyril Bennouna, Jennifer B. Fearon, Matthew Cato, Kathryn Martin, Anjoli Anand, Eric Cioe-Pena, Priyam Thind, Anaise Williams, Juliana L. Bennington, Courtney A. Clark, Samina Lutfeali, Sara A. Snyder, Lorraine Fei, Angie Hamouie, Saeed Rahman, Jamie K. Hamilton, Ramón Millán, Emily Wilkinson Salamea, Maria C. Quinn, Adrienne D. Pizatella, Christopher B. Boyer, Ian R. Kurashige, Kaitlin Shaw, Mallory C. Sheff, Kate Ross-Hopley, Mary Crippen, and Justine Dowden
Subjects: Household survey, Sociology and Political Science, 05 social sciences, 050501 criminology, Police accountability, 0501 psychology and cognitive sciences, Legislation, Sociology, Public administration, Social Sciences (miscellaneous), 050104 developmental & child psychology, 0505 law
Abstract: The Eric Garner case was unique because this police-induced death was caught on video from before the moment of physical confrontation. A mixed-methods representative household survey and Garner's ...
Published: 2016
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9. The evaluation of the Woman's Condom marketing approach: What value did peer-led interpersonal communication add to the promotion of a new female condom in urban Lusaka?

Author: Thoai D. Ngo, Jessie Pinchoff, Gina Smith, Rachna Nag Chowdhuri, Namwinga Chintu, and Christopher B. Boyer
Subjects: Male, Urban Population, Social Sciences, law.invention, 0508 media and communications, Female condom, Promotion (rank), Sociology, law, Outcome Assessment, Health Care, Medicine and Health Sciences, Psychology, media_common, Marketing, Multidisciplinary, Geography, Communication, 05 social sciences, Attendance, Obstetrics and Gynecology, Social Communication, Drugs, Contraceptives, Social marketing, Intention to Treat Analysis, Contraception, Engineering and Technology, Medicine, Female, Research Article, Biotechnology, Adolescent, Behavior change communication, media_common.quotation_subject, Science, Zambia, Bioengineering, 050801 communication & media studies, Health Promotion, Interpersonal communication, Peer Group, Young Adult, Condom, Intervention (counseling), 0502 economics and business, parasitic diseases, Humans, Female Contraception, Mass Media, Condoms, Female, Probability, Pharmacology, Behavior, Marital Status, Biology and Life Sciences, Communications, Male Contraception, Young Adults, Age Groups, People and Places, Women's Health, Population Groupings, Medical Devices and Equipment, 050203 business & management, Demography
Abstract: During a mass media campaign accompanying the launch of the Maximum Diva Woman's Condom (WC) in Lusaka, Zambia, a cluster-randomized evaluation was implemented to measure the added impact of a peer-led interpersonal communication (IPC) intervention on the awareness and uptake of the new female condom (FC). The WC and mass media campaign were introduced simultaneously in 40 urban wards in April 2016; half of the wards were randomly assigned to the treatment (IPC intervention) with cross-sectional surveys conducted before (n = 2,364) and one year after (n = 2,430) the start of the intervention. A pre-specified intention-to-treat (ITT) analysis measured the impact of randomization to IPC at the community level. In adjusted ITT models, there were no statistically significant differences between intervention and control groups. Due to significant implementation challenges, we also conducted exploratory secondary analyses to estimate effects among those who attended an IPC event (n = 66) using instrumental variable and inverse probability weighting analyses. In addition to increases in FC identification (IPC attendees had higher reported use of any condom, improved perceptions of FC's, and were more likely to have discussed contraceptive use with their partner as compared to non-attendees). The introduction of a new FC product combined with an IPC intervention significantly increased general knowledge and awareness in the community as compared to media alone, but did not lead to detectable community level impacts on other primary outcomes of interest. Observational evidence from our study suggests that IPC attendance is associated with increased use and negotiation. Future studies should explore the intensity and duration of IPC programming necessary to achieve detectable community level impacts on behavior. Trial Registration: AEARCTR-0000899.
Published: 2019

10. The child survival impact of the Ghana Essential Health Interventions Program: A health systems strengthening plausibility trial in Northern Ghana

Author: Christopher B. Boyer, Ayaga A. Bawah, James Akazili, James F. Phillips, Edmund Wedam Kanmiki, John Koku Awoonor-Williams, Patrick O. Asuming, Elizabeth F. Jackson, and Sebastian F. Achana
Subjects: Male, National Health Programs, Health Care Providers, Psychological intervention, Nurses, Ghana, Pediatrics, Geographical Locations, Families, 0302 clinical medicine, Pregnancy, Infant Mortality, Medicine and Health Sciences, Public and Occupational Health, Medical Personnel, Community Health Services, 030212 general & internal medicine, Health Systems Strengthening, Children, Multidisciplinary, Community engagement, 030503 health policy & services, Mortality rate, Child Health, Middle Aged, Government Programs, Professions, Child, Preschool, Child Mortality, Medicine, Female, 0305 other medical science, Research Article, Adult, medicine.medical_specialty, Adolescent, Referral, Death Rates, Science, Health intervention, 03 medical and health sciences, Population Metrics, medicine, Humans, Poverty, Health Care Policy, Medical Assistance, Population Biology, business.industry, Public health, Infant, Newborn, Biology and Life Sciences, Neonates, Infant, Educational attainment, Health Care, Child mortality, Age Groups, People and Places, Africa, Population Groupings, business, Delivery of Health Care, Developmental Biology, Demography
Abstract: BackgroundThe Ghana Health Service in collaboration with partner institutions implemented a five-year primary health systems strengthening program known as the Ghana Essential Health Intervention Program (GEHIP). GEHIP was a plausibility trial implemented in an impoverished region of northern Ghana around the World Health Organizations (WHO) six pillars combined with community engagement, leadership development and grassroots political support, the program organized a program of training and action focused on strategies for saving newborn lives and community-engaged emergency referral services. This paper analyzes the effect of the GEHIP program on child survival.MethodsBirth history data assembled from baseline and endline surveys are used to assess the hazard of child mortality in GEHIP treatment and comparison areas prior to and after the start of treatment. Difference-in-differences (DiD) methods are used to compare mortality change over time among children exposed to GEHIP relative to children in the comparison area over the same time period. Models test the hypothesis that a package of systems strengthening activities improved childhood survival. Models adjusted for the potentially confounding effects of baseline differentials, secular mortality trends, household characteristics such as relative wealth and parental educational attainment, and geographic accessibility of clinical care.ResultsThe GEHIP combination of health systems strengthening activities reduced neonatal mortality by approximately one half (HR = 0.52, 95% CI = 0.28,0.98, p = 0.045). There was a null incremental effect of GEHIP on mortality of post-neonate infants (from 1 to 12 months old) (HR = 0.72; 95% CI = 0.30,1.79; p = 0.480) and post-infants (from 1 year to 5 years old) -(HR = 1.02; 95% CI = 0.55-1.90; p = 0.940). Age-specific analyses show that impact was concentrated among neonates. However, effect ratios for post-infancy were inefficiently assessed owing to extensive survival history censoring for the later months of childhood. Children were observed only rarely for periods over 40 months of age.ConclusionGEHIP results show that a comprehensive approach to newborn care is feasible, if care is augmented by community-based nurses. It supports the assertion that if appropriate mechanisms are put in place to enable the various pillars of the health system as espoused by WHO in rural impoverished settings where childhood mortality is high, it could lead to accelerated reductions in mortality thereby increasing survival of children. Policy implications of the pronounced neonatal effect of GEHIP merit national review for possible scale-up.
Published: 2019

11. Exploring gender and partner communication: Theory of planned behavior predictors for condom use among urban youth in Zambia

Author: Jessie Pinchoff, Thoai D. Ngo, Rachna Nag Chowdhuri, and Christopher B. Boyer
Subjects: Adult, Male, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Adolescent, Behavior change communication, Sexual Behavior, Zambia, Peer Group, Odds, law.invention, Condoms, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Sex Factors, Condom, law, Surveys and Questionnaires, medicine, Odds Ratio, Humans, Interpersonal Relations, 030212 general & internal medicine, Reproductive health, 030219 obstetrics & reproductive medicine, business.industry, Public health, Theory of planned behavior, Obstetrics and Gynecology, General Medicine, Odds ratio, Confidence interval, Contraception, Cross-Sectional Studies, Sexual Partners, Female, business, Demography
Abstract: Objective To understand how knowledge and perceptions of condoms and partner communication influence use of condoms in a high HIV prevalence setting and gender-specific differences. Methods A cross-sectional study was conducted in Zambia from 2015 to 2016. The survey included questions on demographics, sexual behavior, contraceptive perceptions, and behaviors. We constructed multivariate regression models using the Theory of Planned Behavior to determine associations between knowledge, perceptions, and perceived control with intended, communicated, and reported use of condoms by gender. Results The participants were 2388 sexually active urban residents aged 18-24 years. In the sample, 1646 (69%) were female, 841 (35%) married, and 1894 (61%) unemployed. Partner communication was the predictor most associated with use of condoms. Among women, partner communication was associated with over three times higher odds of condom use (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65-4.65) but being married reduced the odds of condom use by 76% (OR 0.24, 95% CI 0.17-0.33). For men, a network of friends that was supportive of the use of contraception was associated with increased odds of 55% for use of condoms (OR 1.55, 95% CI 1.10-2.18). Conclusion Public health programs aimed at increasing safer sexual behavior and use of condoms must consider improving gender equity and partner communication, as knowledge of contraceptives and positive perceptions are not enough to ensure their use.
Published: 2018

12. The Astronomy of Africa’s Health Systems Literature During the MDG Era: Where Are the Systems Clusters?

Author: Mallory C. Sheff, Christopher B. Boyer, and James F. Phillips
Subjects: Economic growth, Health services administration, Medical care, Databases, Factual, Corruption, Medical care--Research, Corporate governance, media_common.quotation_subject, Capacity building, General Medicine, Bibliometrics, Trend analysis, Scientific writing, Systems science, Humans, Original Article, Social determinants of health, Sociology, Delivery of Health Care, Africa South of the Sahara, media_common
Abstract: The volume of literature on health systems in sub-Saharan Africa has been expanding since the 2000 MDG era. Focus has remained generally on categorical health themes rather than systems concepts. Topics such as scaling-up, organizational development, data use for decision making, logistics, and financial planning remain underrepresented. And quite surprisingly, implementation science remains something of a “black hole.” But bibliometric evidence suggests there is a shift in focus that may soon address these gaps., Growing international concern about the need for improved health systems in Africa has catalyzed an expansion of the health systems literature. This review applies a bibliometric procedure to analyze the acceleration of scientific writing on this theme. We focus on research published during the Millennium Development Goal (MDG) era between 1990 and 2014, reporting findings from a systematic review of a database comprised of 17,655 articles about health systems themes from sub-Saharan African countries or subregions. Using bibliometric tools for co-word textual analysis, we analyzed the incidence and associations of keywords and phrases to generate and visualize topical foci on health systems as clusters of themes, much in the manner that astronomers represent groupings of stars as galaxies of celestial entities. The association of keywords defines their relative position, with the size of images weighted by the relative frequency of terms. Sets of associated keywords are arrayed as stars that cluster as “galaxies” of concepts in the knowledge universe represented by health systems research from sub-Saharan Africa. Results show that health systems research is dominated by literature on diseases and categorical systems research topics, rather than on systems science that cuts across diseases or specific systemic themes. Systems research is highly developed in South Africa but relatively uncommon elsewhere in the region. “Black holes” are identified by searching for terms in our keyword library related to terms in widely cited reviews of health systems. Results identify several themes that are unexpectedly uncommon in the country-specific health systems literature. This includes research on the processes of achieving systems change, the health impact of systems strengthening, processes that explain the systems determinants of health outcomes, or systematic study of organizational dysfunction and ways to improve system performance. Research quantifying the relationship of governance indicators to health systems strengthening is nearly absent from the literature. Long-term experimental studies and statistically rigorous research on cross-cutting themes of health systems strengthening are rare. Studies of organizational malaise or corruption are virtually absent. Trend analysis shows the emergence of organizational research on specific priority diseases, such as on HIV/AIDS, malaria, and tuberculosis, but portrays a lack of focus on integrated systems research on the general burden of disease. If health systems in Africa are to be strengthened, then organizational change research must be a more concerted focus in the future than has been the case in the past.
Published: 2015
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13. Why don't urban youth in Zambia use condoms? The influence of gender and marriage on non-use of male condoms among young adults

Author: Thoai D. Ngo, Namuunda Mutombo, Christopher B. Boyer, Jessie Pinchoff, and Rachna Nag Chowdhuri
Subjects: Gerontology, Male, Safe Sex, Health Knowledge, Attitudes, Practice, Urban Population, Cross-sectional study, Physiology, lcsh:Medicine, Sex Education, law.invention, Condoms, Geographical Locations, 0302 clinical medicine, law, Reproductive Physiology, Surveys and Questionnaires, Copulation, Medicine and Health Sciences, Medicine, 030212 general & internal medicine, Young adult, Marriage, lcsh:Science, education.field_of_study, 030219 obstetrics & reproductive medicine, Multidisciplinary, Obstetrics and Gynecology, Drugs, Contraceptives, Contraception, Sexual Partners, Infectious Diseases, Family planning, Female, Research Article, Biotechnology, Adult, Sexual Behavior, Population, Sexually Transmitted Diseases, Zambia, 03 medical and health sciences, Young Adult, Risk-Taking, Condom, Humans, Female Contraception, education, Poverty, Demography, Pharmacology, business.industry, lcsh:R, Biology and Life Sciences, Male Contraception, Young Adults, Sexual intercourse, Cross-Sectional Studies, Age Groups, Relative risk, People and Places, Africa, Women's Health, Population Groupings, Medical Devices and Equipment, lcsh:Q, business
Abstract: Background Zambia experiences high unmet need for family planning and high rates of HIV, particularly among youth. While male condoms are widely available and 95% of adults have heard of them, self-reported use in the past 12 months is low among young adults (45%). This study describes factors associated with non-use of male condoms among urban young adults in Zambia. Methods A household cross-sectional survey in four urban districts was conducted from November 2015 to January 2016 among sexually active young adults ages 18–24 years. A random walk strategy was implemented in urban areas; eligible, enrolled participants were administered a survey on household characteristics, health access, and knowledge, attitudes and practices related to contraception. Relative risk regression models were built to determine factors associated with the decision to not use a male condom (non-use) at most recent sexual intercourse. Results A total of 2,388 individuals were interviewed; 69% were female, 35% were married, and average lifetime sex partners was 3.45 (SD±6.15). Non-use of male condoms was 59% at most recent sexual intercourse. In a multivariate model, women were more likely to report non-use of a male condom compared with men (aRR = 1.24 [95% CI: 1.11, 1.38]), married individuals were more likely to report non-use compared with unmarried individuals (aRR = 1.59 [1.46, 1.73]), and those residing in the highest poverty wards were more likely to report non-use compared with those in the lowest poverty wards (aRR = 1.31 [1.16, 1.48]). Those with more negative perceptions of male condom use were 6% more likely to report non-use (aRR = 1.06 [1.03, 1.09]). Discussion regarding contraception with a partner decreased non-use 13% (aRR = 0.87 [0.80, 0.95]) and agreement regarding male condom use with a partner decreased non-use 16% (aRR = 0.84 [0.77, 0.91)]). Discussion Non-use of male condoms is high among young, married adults, particularly women, who may be interested in contraception for family planning but remain at risk of STI infection. Effective marketing strategy of dual protection methods to this population is critical.
Published: 2017

14. Estimating indices of health system readiness: an example from rural northern Ghana

Author: Margaret L. Schmitt, Christopher B. Boyer, Ayaga A. Bawah, Elizabeth F. Jackson, John Koku Awoonor-Williams, and James F. Phillips
Subjects: Economic growth, Index (economics), lcsh:Public aspects of medicine, Psychological intervention, Sample (statistics), lcsh:RA1-1270, General Medicine, Population health, Millennium Development Goals, External validity, Environmental health, Psychology, Socioeconomic status, Factor analysis
Abstract: Background There is growing recognition that stronger health systems are necessary to accelerate progress towards the Millennium Development Goals (MDGs). However, a departure from disease-specific programmes and interventions requires the development of a new empirical framework for programme evaluation that focuses on indicators of health system strengthening. Service provision assessment (SPA) surveys provide a wealth of data about health system resources, but they often include too many indicators to provide useful insight into general systems strength or service readiness. To improve the usefulness of such data, we have applied multidimensional statistical data reduction techniques to SPA data with the aim of developing robust measures of health system capabilities. Methods Data for the construction of indices were derived from the 2010 Ghana Emergency Obstetric and Newborn Care (EmONC) survey published by the Ghanaian Ministry of Health. This survey included a saturated sample of 147 health facilities in the Upper East Region. The instrument assessed facility readiness and performance using 3872 service and outcome indicators of: infrastructure; human resources; availability of drugs, equipment, and supplies; and knowledge of essential procedures. Of those indicators, 872 were identified as corresponding to one of the six WHO health system building blocks. Dimensionality reduction was done using principal component analysis. Where appropriate, we reorganised binary indicators into ordinal categorical variables, as is commonly done in the socioeconomic status literature. We also assessed the external validity of the new index. Findings Results from the principal component analysis of the 872 health systems indicators suggest that a single component (PC1) explains more than 30% of the common variance among the health facilities surveyed. An index composed of the factor loadings from PC1 showed marked variation between facilities (SD 13·077) with easily identifiable clusters of facility type (hospital, health centre, clinic, community compound). The distribution of PC1 also suggested concentration of resources among a few high-level facilities (Gini 0·508). Compared with EmONC signal functions, the index scores were better predictors of the number of deliveries (R 2 0·61 vs R 2 0·31) and the number of low birthweight babies (0·68 vs 0·26) as well as maternal deaths (0·81 vs 0·34) and neonatal deaths (0·79 vs 0·36). Interpretation Our findings suggest that an index of health system readiness that captures a large portion of facility variance can be constructed from SPA data using principal component analysis. In practice, such an index could be used to monitor progress towards stronger health systems. However, further research is needed to determine how an increase in index score which is input-focused, affects population health. Particular attention must also be paid to the performance determinants that maximise the efficient use of health system inputs. Funding Support for this study was provided by the African Health Initiative with funding from the Doris Duke Charitable Foundation.
Published: 2015

15. Infectious disease dynamics and restrictions on social gathering size

Author: Christopher B. Boyer, Eva Rumpler, Stephen M. Kissler, and Marc Lipsitch
Subjects: Epidemiology, Gatherings, COVID-19, SARS-coV-2, Non-pharmaceutical intervention, Infectious and parasitic diseases, RC109-216
Abstract: Social gatherings can be an important locus of transmission for many pathogens including SARS-CoV-2. During an outbreak, restricting the size of these gatherings is one of several non-pharmaceutical interventions available to policy-makers to reduce transmission. Often these restrictions take the form of prohibitions on gatherings above a certain size. While it is generally agreed that such restrictions reduce contacts, the specific size threshold separating “allowed” from “prohibited” gatherings often does not have a clear scientific basis, which leads to dramatic differences in guidance across location and time. Building on the observation that gathering size distributions are often heavy-tailed, we develop a theoretical model of transmission during gatherings and their contribution to general disease dynamics. We find that a key, but often overlooked, determinant of the optimal threshold is the distribution of gathering sizes. Using data on pre-pandemic contact patterns from several sources as well as empirical estimates of transmission parameters for SARS-CoV-2, we apply our model to better understand the relationship between restriction threshold and reduction in cases. We find that, under reasonable transmission parameter ranges, restrictions may have to be set quite low to have any demonstrable effect on cases due to relative frequency of smaller gatherings. We compare our conceptual model with observed changes in reported contacts during lockdown in March of 2020.
Published: 2022
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16. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Author: Zhou, B, Carrillo-Larco, Rm, Danaei, G, Riley, Lm, Paciorek, Cj, Stevens, Ga, Gregg, Ew, Bennett, Je, Solomon, B, Singleton, Rk, Sophiea, Mk, Iurilli, Mlc, Lhoste, Vpf, Cowan, Mj, Savin, S, Woodward, M, Balanova, Y, Cifkova, R, Damasceno, A, Elliott, P, Farzadfar, F, He, J, Ikeda, N, Kengne, Ap, Khang, Yh, Kim, Hc, Laxmaiah, A, Lin, Hh, Maira, Pm, Miranda, Jj, Neuhauser, H, Sundstrom, J, Varghese, C, Widyahening, Is, Zdrojewski, T, Ezzati, M, Abarca-Gomez, L, Abdeen, Za, Rahim, Hfa, Abu-Rmeileh, Nm, Acosta-Cazares, B, Adams, Rj, Aekplakorn, W, Afsana, K, Afzal, S, Agdeppa, Ia, Aghazadeh-Attari, J, Aguilar-Salinas, Ca, Agyemang, C, Ahmad, Na, Ahmadi, A, Ahmadi, N, Ahmadizar, F, Ahmed, Sh, Ahrens, W, Ajlouni, K, Al-Raddadi, R, Alarouj, M, Albuhairan, F, Aldhukair, S, Ali, Mm, Alkandari, A, Alkerwi, A, Allin, K, Aly, E, Amarapurkar, Dn, Amougou, N, Amouyel, P, Andersen, Lb, Anderssen, Sa, Anjana, Rm, Ansari-Moghaddam, A, Ansong, D, Aounallah-Skhiri, H, Araujo, J, Ariansen, I, Aris, T, Arku, Re, Arlappa, N, Aryal, Kk, Aspelund, T, Assah, Fk, Assuncao, Mcf, Auvinen, J, Avdicova, M, Azevedo, A, Azimi-Nezhad, M, Azizi, F, Azmin, M, Babu, Bv, Bahijri, S, Balakrishna, N, Bamoshmoosh, M, Banach, M, Banadinovic, M, Bandosz, P, Banegas, Jr, Baran, J, Barbagallo, Cm, Barcelo, A, Barkat, A, Barreto, M, Barros, Ajd, Barros, Mvg, Bartosiewicz, A, Basit, A, Bastos, Jld, Bata, I, Batieha, Am, Batyrbek, A, Baur, La, Beaglehole, R, Belavendra, A, Ben Romdhane, H, Benet, M, Benson, Ls, Berkinbayev, S, Bernabe-Ortiz, A, Bettiol, H, Bezerra, J, Bhagyalaxmi, A, Bhargava, Sk, Bia, D, Biasch, K, Lele, Ecb, Bikbov, Mm, Bista, B, Bjerregaard, P, Bjertness, E, Bjertness, Mb, Bjorkelund, C, Bloch, Kv, Blokstra, A, Bo, S, Bobak, M, Boeing, H, Boggia, Jg, Boissonnet, Cp, Bojesen, Se, Bongard, V, Bonilla-Vargas, A, Bopp, M, Borghs, H, Bovet, P, Boyer, Cb, Braeckman, L, Brajkovich, I, Branca, F, Breckenkamp, J, Brenner, H, Brewster, Lm, Briceno, Y, Brito, M, Bruno, G, Bueno-de-Mesquita, Hb, Bueno, G, Bugge, A, Burns, C, Bursztyn, M, de Leon, Ac, Cacciottolo, J, Cameron, C, Can, G, Candido, Apc, Capanzana, Mv, Capkova, N, Capuano, E, Capuano, V, Cardoso, Vc, Carlsson, Ac, Carvalho, J, Casanueva, Ff, Censi, L, Cervantes-Loaiza, M, Chadjigeorgiou, Ca, Chamukuttan, S, Chan, Aw, Chan, Q, Chaturvedi, Hk, Chaturvedi, N, Chee, Ml, Chen, Cj, Chen, Ff, Chen, Hs, Chen, Sh, Chen, Zm, Cheng, Cy, Cheraghian, B, Dekkaki, Ic, Chetrit, A, Chien, Kl, Chiolero, A, Chiou, St, Chirita-Emandi, A, Chirlaque, Md, Cho, B, Christensen, K, Christofaro, Dg, Chudek, J, Cinteza, E, Claessens, F, Clarke, J, Clays, E, Cohen, E, Concin, H, Cooper, C, Coppinger, Tc, Costanzo, S, Cottel, D, Cowell, C, Craig, Cl, Crampin, Ac, Crujeiras, Ab, Cruz, Jj, Csilla, S, Cui, Lf, Cureau, Fv, Cuschieri, S, D'Arrigo, G, D'Orsi, E, Dallongeville, J, Dankner, R, Dantoft, Tm, Dauchet, L, Davletov, K, De Backer, G, De Bacquer, D, De Curtis, A, de Gaetano, G, De Henauw, S, de Oliveira, Pd, De Ridder, D, De Smedt, D, 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Csilla, Liufu Cui, Felipe V Cureau, Sarah Cuschieri, Graziella D'Arrigo, Eleonora d'Orsi, Jean Dallongeville, Rachel Dankner, Thomas M Dantoft, Luc Dauchet, Kairat Davletov, Guy De Backer, Dirk De Bacquer, Amalia De Curtis, Giovanni de Gaetano, Stefaan De Henauw, Paula Duarte de Oliveira, David De Ridder, Delphine De Smedt, Mohan Deepa, Alexander D Deev, Vincent Jr DeGennaro, Hélène Delisle, Stefaan Demarest, Elaine Dennison, Valérie Deschamps, Meghnath Dhimal, Augusto F Di Castelnuovo, Juvenal Soares Dias-da-Costa, Alejandro Diaz, Ty T Dickerson, Zivka Dika, Shirin Djalalinia, Ha Tp Do, Annette J Dobson, Chiara Donfrancesco, Silvana P Donoso, Angela Döring, Maria Dorobantu, Marcus Dörr, Kouamelan Doua, Nico Dragano, Wojciech Drygas, Charmaine A Duante, Priscilla Duboz, Rosemary B Duda, Virginija Dulskiene, Anar Dushpanova, Aleksandar Džakula, Vilnis Dzerve, Elzbieta Dziankowska-Zaborszczyk, Ricky Eddie, Ebrahim Eftekhar, Robert Eggertsen, Sareh Eghtesad, Gabriele Eiben, Ulf Ekelund, 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Andre L Guimaraes, Martin C Gulliford, Johanna Gunnlaugsdottir, Marc J Gunter, Prakash C Gupta, Rajeev Gupta, Oye Gureje, Beata Gurzkowska, Laura Gutierrez, Felix Gutzwiller, Seongjun Ha, Farzad Hadaegh, Rosa Haghshenas, Hamid Hakimi, Jytte Halkjær, Ian R Hambleton, Behrooz Hamzeh, Dominique Hange, Abu Am Hanif, Sari Hantunen, Jie Hao, Carla Menêses Hardman, Rachakulla Hari Kumar, Seyed Mohammad Hashemi-Shahri, Jun Hata, Teresa Haugsgjerd, Alison J Hayes, Yuna He, Margit Heier, Marleen Elisabeth Hendriks, Rafael Dos Santos Henrique, Ana Henriques, Leticia Hernandez Cadena, Herqutanto, Sauli Herrala, Ramin Heshmat, Allan G Hill, Sai Yin Ho, Suzanne C Ho, Michael Hobbs, Michelle Holdsworth, Reza Homayounfar, Gonul Horasan Dinc, Andrea Rvr Horimoto, Claudia M Hormiga, Bernardo L Horta, Leila Houti, Christina Howitt, Thein Thein Htay, Aung Soe Htet, Maung Maung Than Htike, Yonghua Hu, José María Huerta, Ilpo Tapani Huhtaniemi, Laetitia Huiart, Martijn Huisman, Abdullatif S Husseini, Inge Huybrechts, Nahla Hwalla, Licia Iacoviello, Anna G Iannone, Mohsen M Ibrahim, Norazizah Ibrahim Wong, M Arfan Ikram, Violeta Iotova, Vilma E Irazola, Takafumi Ishida, Godsent C Isiguzo, Muhammad Islam, Sheikh Mohammed Shariful Islam, Masanori Iwasaki, Rod T Jackson, Jeremy M Jacobs, Hashem Y Jaddou, Tazeen Jafar, Kenneth James, Konrad Jamrozik, Imre Janszky, Edward Janus, Marjo-Riitta Jarvelin, Grazyna Jasienska, Ana Jelaković, Bojan Jelaković, Garry Jennings, Anjani Kumar Jha, Chao Qiang Jiang, Ramon O Jimenez, Karl-Heinz Jöckel, Michel Joffres, Mattias Johansson, Jari J Jokelainen, Jost B Jonas, Torben Jørgensen, Pradeep Joshi, Farahnaz Joukar, Jacek Jóżwiak, Anne Juolevi, Gregor Jurak, Vesna Jureša, Rudolf Kaaks, Anthony Kafatos, Eero O Kajantie, Zhanna Kalmatayeva, Natasa Kalpourtzi, Ofra Kalter-Leibovici, Freja B Kampmann, Srinivasan Kannan, Eva Karaglani, Line L Kårhus, Khem B Karki, Marzieh Katibeh, Joanne Katz, Jussi Kauhanen, Prabhdeep Kaur, Maryam Kavousi, Gyulli M Kazakbaeva, Ulrich Keil, Lital Keinan Boker, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Han Cg Kemper, Maryam Keramati, Alina Kerimkulova, Mathilde Kersting, Timothy Key, Yousef Saleh Khader, Davood Khalili, Kay-Tee Khaw, Bahareh Kheiri, Motahareh Kheradmand, Alireza Khosravi, Ursula Kiechl-Kohlendorfer, Stefan Kiechl, Japhet Killewo, Dong Wook Kim, Jeongseon Kim, Heidi Klakk, Magdalena Klimek, Jurate Klumbiene, Michael Knoflach, Elin Kolle, Patrick Kolsteren, Jukka P Kontto, Raija Korpelainen, Paul Korrovits, Jelena Kos, Seppo Koskinen, Katsuyasu Kouda, Sudhir Kowlessur, Slawomir Koziel, Jana Kratenova, Vilma Kriaucioniene, Peter Lund Kristensen, Steiner Krokstad, Daan Kromhout, Herculina S Kruger, Ruzena Kubinova, Renata Kuciene, Urho M Kujala, Zbigniew Kulaga, R Krishna Kumar, Pawel Kurjata, Yadlapalli S Kusuma, Vladimir Kutsenko, Kari Kuulasmaa, Catherine Kyobutungi, Tiina Laatikainen, Carl Lachat, Youcef Laid, Tai Hing Lam, Orlando Landrove, Vera Lanska, Georg Lappas, Bagher 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Mansour-Ghanaei, Enzo Manzato, Anie Marcil, Staffan B Mårild, Mihalea Marinović Glavić, Pedro Marques-Vidal, Larissa Pruner Marques, Jaume Marrugat, Reynaldo Martorell, Luis P Mascarenhas, Marija Matasin, Ellisiv B Mathiesen, Prashant Mathur, Alicia Matijasevich, Piotr Matlosz, Tandi E Matsha, Christina Mavrogianni, Jean Claude N Mbanya, Anselmo J Mc Donald Posso, Shelly R McFarlane, Stephen T McGarvey, Stela McLachlan, Rachael M McLean, Scott B McLean, Breige A McNulty, Sounnia Mediene Benchekor, Jurate Medzioniene, Parinaz Mehdipour, Kirsten Mehlig, Amir Houshang Mehrparvar, Aline Meirhaeghe, Christa Meisinger, Carlos Mendoza Montano, Ana Maria B Menezes, Geetha R Menon, Alibek Mereke, Indrapal I Meshram, Andres Metspalu, Haakon E Meyer, Jie Mi, Nathalie Michels, Kairit Mikkel, Karolina Milkowska, Jody C Miller, Cláudia S Minderico, G K Mini, Mohammad Reza Mirjalili, Erkin Mirrakhimov, Marjeta Mišigoj-Duraković, Pietro A Modesti, Sahar Saeedi Moghaddam, Bahram Mohajer, Mostafa K 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D. A., Peres, Marco A., Peters, Annette, Petkeviciene, Janina, Peykari, Niloofar, Son Thai Pham, Pichardo, Rafael N., Pigeot, Iris, Pikhart, Hynek, Pilav, Aida, Pilotto, Lorenza, Pitakaka, Freda, Piwonska, Aleksandra, Pizarro, Andreia N., Plans-Rubio, Pedro, Polasek, Ozren, Porta, Miquel, Poudyal, Anil, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J., Price, Jacqueline F., Providencia, Rui, Puhakka, Soile E., Puiu, Maria, Punab, Margus, Qasrawi, Radwan F., Qorbani, Mostafa, Queiroz, Daniel, Tran Quoc Bao, Radic, Ivana, Radisauskas, Ricardas, Rahimikazerooni, Salar, Rahman, Mahfuzar, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina M., Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramos, Elisabete, Rampal, Lekhraj, Rampal, Sanjay, Rangel Reina, Daniel A., Rarra, Vayia, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M., Regecova, Valeria, Revilla, Luis, Rezaianzadeh, Abbas, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, de Wit, Tobias F. 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M., van Zutphen, Elisabeth M., Vanuzzo, Diego, Varbo, Anette, Vasan, Senthil K., Vega, Tomas, Veidebaum, Toomas, Velasquez-Melendez, Gustavo, Veronesi, Giovanni, Verschuren, W. M. Monique, Verstraeten, Roosmarijn, Victora, Cesar G., Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesus, Virtanen, Jyrki K., Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vlasoff, Tiina, Vollenweider, Peter, Voutilainen, Ari, Wade, Alisha N., Walton, Janette, Wambiya, Elvis O. A., Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, Wanderley Junior, Rildo de Souza, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S. Goya, Wareham, Nicholas, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H., Widhalm, Kurt, Wiecek, Andrzej, Wilks, Rainford J., Willeit, Johann, Willeit, Peter, Williams, Emmanuel A., Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A., Wong, Andrew, Wong, Tien Yin, Woo, Jean, Wu, Frederick C., Wu, Shouling, Wyszynska, Justyna, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K., Yoosefi, Moein, Yoshihara, Akihiro, You, San-Lin, Younger-Coleman, Novie O., Yusoff, Ahmad Faudzi, Zainuddin, Ahmad A., Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antonis, Elisa Zapata, Maria, Zaw, Ko Ko, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhao, Dong, Zhao, Ming-Hui, Zhen, Shiqi, Zheng, Yingfeng, Zholdin, Bekbolat, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Zoghlami, Nada, Zuniga Cisneros, Julio., School of Medicine, ACS - Diabetes & metabolism, APH - Global Health, Pulmonology, Medical Informatics, Adult Psychiatry, Global Health, APH - Quality of Care, APH - Methodology, Vascular Medicine, ACS - Atherosclerosis & ischemic syndromes, Anesthesiology, Graduate School, and ACS - Heart failure & arrhythmias
Subjects: Male, Latin Americans, Nutrition and Disease, Epidemiology, [SDV]Life Sciences [q-bio], Medizin, BLOOD-PRESSURE, 030204 cardiovascular system & hematology, Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants, Hypertension, Prevalence, Control, Tretament, GUIDELINES, Global Health, Worldwide trends, 0302 clinical medicine, Hypertension prevalence, Voeding en Ziekte, Medicine and Health Sciences, kohonnut verenpaine, Medicine, 030212 general & internal medicine, Prevention and Control, 11 Medical and Health Sciences, ComputingMilieux_MISCELLANEOUS, education.field_of_study, food and beverages, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Noncommunicable diseases, Period prevalence, Middle Aged, kansainvälinen vertailu, 3142 Public health care science, environmental and occupational health, 3. Good health, MIDDLE-INCOME, Pooled analysis, SYSTEMATIC ANALYSIS, INCOME COUNTRIES, ADULTS, PREVENTION, MANAGEMENT, ADHERENCE, DIAGNOSIS, Western europe, [SDE]Environmental Sciences, Hypertension/diagnosis, NCD Risk Factor Collaboration (NCD-RisC), Female, B990 Subjects Allied to Medicine not elsewhere classified, Life Sciences & Biomedicine, Adult, health-care, esiintyvyys, Central asia, Population, Nursing, 3121 Internal medicine, 03 medical and health sciences, Medicine, General & Internal, Drug Therapy, General & Internal Medicine, Life Science, Humans, ddc:610, education, Antihypertensive Agents, VLAG, Aged, Science & Technology, Antihypertensive Agents/therapeutic use, business.industry, Omvårdnad, fungi, General and internal medicine, Estados de Saúde e de Doença, Taking medication, Treatment, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Blood pressure, Faculdade de Ciências Sociais, 3121 General medicine, internal medicine and other clinical medicine, lääkehoito, 1182 Biochemistry, cell and molecular biology, business, Demography
Abstract: Background: hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods: we used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings: the number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings., British Heart Foundation Centre of Research Excellence Grant; World Health Organization (WHO); Abdul Latif Jameel Institute for Disease and Emergency Analytics Fellowship
Published: 2021
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16 results on '"Christopher B Boyer"'

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10. The child survival impact of the Ghana Essential Health Interventions Program: A health systems strengthening plausibility trial in Northern Ghana

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16. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

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16 results on '"Christopher B Boyer"'

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