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7. The Role of the Private Sector in the COVID-19 Pandemic: Experiences From Four Health Systems

Author

Wallace, LJ, Agyepong, I, Baral, S, Barua, D, Das, M, Huque, R, Joshi, D, Mbachu, C, Naznin, B, Nonvignon, J, Ofosu, A, Onwujekwe, O, Sharma, S, Quayyum, Z, Ensor, T, and Elsey, H

Subjects
Public Health, Environmental and Occupational Health, COVID-19, Humans, Private Sector, Emergencies, Pandemics, Public-Private Sector Partnerships
Abstract

As societies urbanize, their populations have become increasingly dependent on the private sector for essential services. The way the private sector responds to health emergencies such as the COVID-19 pandemic can determine the health and economic wellbeing of urban populations, an effect amplified for poorer communities. Here we present a qualitative document analysis of media reports and policy documents in four low resource settings-Bangladesh, Ghana, Nepal, Nigeria-between January and September 2020. The review focuses on two questions: (i) Who are the private sector actors who have engaged in the COVID-19 first wave response and what was their role?; and (ii) How have national and sub-national governments engaged in, and with, the private sector response and what have been the effects of these engagements? Three main roles of the private sector were identified in the review. (1) Providing resources to support the public health response. (2) Mitigating the financial impact of the pandemic on individuals and businesses. (3) Adjustment of services delivered by the private sector, within and beyond the health sector, to respond to pandemic-related business challenges and opportunities. The findings suggest that a combination of public-private partnerships, contracting, and regulation have been used by governments to influence private sector involvement. Government strategies to engage the private sector developed quickly, reflecting the importance of private services to populations. However, implementation of regulatory responses, especially in the health sector, has often been weak reflecting the difficulty governments have in ensuring affordable, quality private services. Lessons for future pandemics and other health emergencies include the need to ensure that essential non-pandemic health services in the government and non-government sector can continue despite elevated risks, surge capacity to minimize shortages of vital public health supplies is available, and plans are in place to ensure private workplaces remain safe and livelihoods protected.

Published
2022

9. Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

Author

Stubbs B, Siddiqi K, Elsey H, Siddiqi N, Ma R, Romano E, Siddiqi S, and Koyanagi A

Subjects
tuberculosis, multimorbidity, low- and middle-income countries, non-communicable diseases, comorbidities
Abstract

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and =1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38-4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and =5 NCDs had 2.61 (95% confidence interval (CI) = 2.14-3.22), 4.71 (95%CI = 3.67-6.11), 6.96 (95%CI = 4.95-9.87), 10.59 (95%CI = 7.10-15.80), and 19.89 (95%CI = 11.13-35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

Published
2021

10. Contributions of scale: What we stand to gain from Indigenous and local inclusion in climate-health monitoring and surveillance systems

Author

van Bavel, B, Berrang Ford, L, Harper, SL, Ford, J, Elsey, H, Lwasa, S, and King, R

Abstract

Understanding how climate change will affect global health is a defining challenge this century. This is predicated, however, on our ability to combine climate and health data to investigate the ways in which variations in climate, weather, and health outcomes interact. There is growing evidence to support the value of place- and community-based monitoring and surveillance efforts, which can contribute to improving both the quality and equity of data collection needed to investigate and understand the impacts of climate change on health. The inclusion of multiple and diverse knowledge systems in climate-health surveillance presents many benefits, as well as challenges. We conducted a systematic review, synthesis, and confidence assessment of the published literature on integrated monitoring and surveillance systems for climate change and public health. We examined the inclusion of diverse knowledge systems in climate-health literature, focusing on: 1) analytical framing of integrated monitoring and surveillance system processes 2) key contributions of Indigenous knowledge and local knowledge systems to integrated monitoring and surveillance systems processes; and 3) patterns of inclusion within these processes. In total, 24 studies met the inclusion criteria and were included for data extraction, appraisal, and analysis. Our findings indicate that the inclusion of diverse knowledge systems contributes to integrated climate-health monitoring and surveillance systems across multiple processes of detection, attribution, and action. These contributions include: the definition of meaningful problems; the collection of more responsive data; the reduction of selection and source biases; the processing and interpretation of more comprehensive datasets; the reduction of scale dependent biases; the development of multi-scale policy; long-term future planning; immediate decision making and prioritization of key issues; as well as creating effective knowledge-information-action pathways. The value of our findings and this review is to demonstrate how neither scientific, Indigenous, nor local knowledge systems alone will be able to contribute the breadth and depth of information necessary to detect, attribute, and inform action along these pathways of climate-health impact. Rather, it is the divergence or discordance between the methodologies and evidences of different knowledge systems that can contribute uniquely to this understanding. We critically discuss the possibility of what we, mainly local communities and experts, stand to lose if these processes of inclusion are not equitable. We explore how to shift the existing patterns of inclusion into balance by ensuring the equity of contributions and justice of inclusion in these integrated monitoring and surveillance system processes.

Published
2020

12. Additional file 1 of Understanding demand for, and feasibility of, centre-based child-care for poor urban households: a mixed methods study in Dhaka, Bangladesh

Author

Elsey, H., F. Fieroze, R. A. Shawon, S. Nasreen, J. P. Hicks, M. Das, R. Huque, I. Hirano, H. J. Wallace, and M. Saidur

Abstract

Additional file 1: Table S1. Questionnaire design: concepts and respondents. Table S2. Characteristics of the qualitative sample of parents, care-givers, community leaders, centre staff, ECD experts and policy makers. Table S3. Key features of urban childcare centre model following co-design and shaping during 10 months of implementation. Table S4. Child-care centre user group meetings. Table S5. The development of meta-inference across the methods used in all phases of the study.

Published
2020
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13. Need for an integrated deprived area 'slum' mapping system (IDEAMAPS) in low-and middle-income countries (LMICS)

Author

Thomson, D.R. (Dana R.), Kuffer, M. (Monika), Boo, G. (Gianluca), Hati, B. (Beatrice), Grippa, T. (Tais), Elsey, H. (Helen), Linard, C. (Catherine), Mahabir, R. (Ron), Kyobutungi, C. (Catherine), Maviti, J. (Joshua), Mwaniki, D. (Dennis), Ndugwa, R. (Robert), Makau, J. (Jack), Sliuzas, R. (Richard), Cheruiyot, S. (Salome), Nyambuga, K. (Kilion), Mboga, N. (Nicholus), Kimani, N.W. (Nicera Wanjiru), de Albuquerque, J.P. (Joao Porto), Kabaria, C. (Caroline), Thomson, D.R. (Dana R.), Kuffer, M. (Monika), Boo, G. (Gianluca), Hati, B. (Beatrice), Grippa, T. (Tais), Elsey, H. (Helen), Linard, C. (Catherine), Mahabir, R. (Ron), Kyobutungi, C. (Catherine), Maviti, J. (Joshua), Mwaniki, D. (Dennis), Ndugwa, R. (Robert), Makau, J. (Jack), Sliuzas, R. (Richard), Cheruiyot, S. (Salome), Nyambuga, K. (Kilion), Mboga, N. (Nicholus), Kimani, N.W. (Nicera Wanjiru), de Albuquerque, J.P. (Joao Porto), and Kabaria, C. (Caroline)

Abstract

Ninety percent of the people added to the planet over the next 30 years will live in African and Asian cities, and a large portion of these populations will reside in deprived neighborhoods defined by slum conditions, informal settlement, or inadequate housing. The four current approaches to neighborhood deprivation mapping are largely siloed, and each fall short of producing accurate, timely, and comparable maps that reflect local contexts. The first approach, classifying "slum households" in census and survey data, reflects household-level rather than neighborhood-level deprivation. The second approach, field-based mapping, can produce the most accurate and context-relevant maps for a given neighborhood, however it requires substantial resources, preventing up-scaling. The third and fourth approaches, human (visual) interpretation and machine classification of air or spaceborne imagery, both overemphasize informal settlements, and fail to represent key social characteristics of deprived areas such as lack of tenure, exposure to pollution, and lack of public services. We summarize common areas of understanding, and present a set of requirements and a framework to produce routine, accurate maps of deprived urban areas that can be used by local-to-international stakeholders for advocacy, planning, and decision-making across Low-and Middle-Income Countries (LMICs). We suggest that machine learning models be extended to incorporate social area-level covariates and regular contributions of up-to-date and context-relevant field-based classification of deprived urban areas.

Published
2020
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14. Impact and cost-effectiveness of care farms on health and well-being of offenders on probation: a pilot study

Author

Elsey, H., Bragg, R., Elings, M., Brennan, C., Farragher, T., Tubeuf, S., Gold, R., Shickle, D., Wickramasekera, N., Richardson, Z., Cade, J., and Murray, J.

Subjects
medicine.medical_specialty, Cost effectiveness, lcsh:Public aspects of medicine, 030503 health policy & services, Public health, MEDLINE, lcsh:RA1-1270, Mental health, 03 medical and health sciences, Care farming, 0302 clinical medicine, Quality of life (healthcare), Family medicine, Well-being, medicine, 030212 general & internal medicine, 0305 other medical science, Psychology, Criminal justice
Abstract

BackgroundCare farms (CFs), in which all or part of the farm is used for therapeutic purposes, show potential for improving well-being for disadvantaged groups. We assessed the feasibility of determining the cost-effectiveness of CFs in improving quality of life compared with comparator sites among probationers undertaking community orders (COs).Objectives(1) To conduct a systematic review of CF impacts and mechanisms in improving health and logic model development; (2) to inform future studies by estimating differences in quality of life and other outcomes, identifying factors driving CO allocation and ways to maximise recruitment and follow-up; and (3) to assess feasibility of cost-effectiveness analysis.Review methodsA mixed-methods synthesis following Campbell Collaboration guidelines. Pilot study: three probation service regions in England, each with a CF and a comparator CO site. Participants were adult offenders (aged ≥ 18 years) serving COs. The primary outcome was quality of life [as measured via the Clinical Outcome in Routine Evaluation–Outcome Measure (CORE-OM)]. Other outcomes were health behaviours, mental well-being, connectedness to nature and reconvictions.Data sourcesIn November 2014, we searched 22 health, education, environmental, criminal justice and social science electronic databases, databases of grey literature and care farming websites across Europe. There were no language restrictions. A full list of databases searched is given inAppendix 1; some examples include Web of Science, Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), The Campbell Library, Criminal Justice Abstracts (via EBSCOhost), MEDLINE (via Ovid) and Scopus (Elsevier B.V., Amsterdam, the Netherlands).ResultsOur systematic review identified 1659 articles: 14 qualitative, 12 quantitative and one mixed-methods study. Small sample sizes and poor design meant that all were rated as being at a high risk of bias. Components of CFs that potentially improve health are being in a group, the role of the farmer and meaningful work, and interaction with animals. There was a lack of quantitative evidence indicating that CFs improve quality of life and there was weak evidence of improved mental health, self-efficacy, self-esteem, affect and mood. In the pilot study we recruited 134 respondents, and only 21 declined; 37% were allocated to three CFs and the remainder to comparators. This was below our recruitment target of 300. Recruitment proved challenging as a result of the changes in probation (probation trusts were disbanded in 2014) and closure of one CF. We found significant differences between CFs and comparator users: those at CFs were more likely to be male, smokers, substance users, at higher risk of reoffending (a confounder) and have more missing CORE-OM questions. Despite these differences, the use of propensity analysis facilitated comparison. Participants consented to our team accessing, and we were able to link, probation and police reconviction data for 90% of respondents. We gained follow-up questionnaire data from 52% of respondents, including health and social care use cost data. We transformed CORE-OM into CORE-6D, allowing derivation of quality-adjusted life-years. As a pilot, our study was not powered to identify significant differences in outcomes. Qualitatively, we observed that within COs, CFs can be formally recognised as rehabilitative but in practice can be seen as punitive.LimitationsChanges in probation presented many challenges that limited recruitment and collection of cost data.ConclusionsRecruitment is likely to be feasible in a more stable probation environment. Retention among probationers is challenging but assessing reconvictions from existing data is feasible. We found worse health and risk of reoffending among offenders at CFs, reflecting the use of CFs by probation to manage challenging offenders.Future workA sufficiently powered natural experiment is feasible and of value. Using reconvictions (from police data) as a primary outcome is one solution to challenges with retention. Propensity analysis provides a viable method for comparison despite differences in participants at CFs and comparator sites. However, future work is dependent on stability and support for CFs within probation services.Study registrationThis study is registered as PROSPERO CRD42014013892 and SW2013–04 (the Campbell Collaboration).Funding detailsThe National Institute for Health Research Public Health Research programme.

Published
2018

17. Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries

Author

Elsey, H, Agyepong, I, Huque, R, Quayyem, Z, Baral, S, Ebenso, B, Kharel, C, Shawon, RA, Onwujekwe, O, Uzochukwu, B, Nonvignon, J, Aryeetey, GC, Kane, S, Ensor, T, Mirzoev, T, Elsey, H, Agyepong, I, Huque, R, Quayyem, Z, Baral, S, Ebenso, B, Kharel, C, Shawon, RA, Onwujekwe, O, Uzochukwu, B, Nonvignon, J, Aryeetey, GC, Kane, S, Ensor, T, and Mirzoev, T

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.

Published
2019

18. Cost‐effectiveness analysis of a multi‐dimensional intervention to reduce inappropriate antibiotic prescribing for children with upper respiratory tract infections in China

Author

Zhang, Z, Dawkins, B, Hicks, JP, Walley, JD, Hulme, C, Elsey, H, Deng, S, Lin, M, Zeng, J, and Wei, X

Subjects
health care economics and organizations
Abstract

We developed a multifaceted intervention to reduce antibiotic prescription rate for children with upper respiratory tract infections (URTIs) among primary care doctors in township hospitals in China. The intervention achieved a 29% (95% CI: 16% to 42%) absolute risk reduction in antibiotic prescribing. This study was to assess the cost-effectiveness of our intervention at reducing antibiotic prescribing in rural primary care facilities as measured by the intervention's effect on the APR for childhood URTIs.We took a health-care provider perspective, measuring costs of consultation (time cost of doctor), prescription monitoring process and peer-review meetings (time cost of participants) and medication costs. Costs on provider side were collected through a bespoke questionnaire from all 25 township hospitals in December 2016, while medication costs were collected prospectively in the trial. Incremental cost-effectiveness ratios were calculated by dividing the mean difference in cost of the two trial arms by the mean difference in antibiotic prescribing rate.This showed an incremental cost of $0.03 per percentage point reduction in antibiotic prescribing. In addition to this incremental cost, the cost of implementing the intervention, including training and materials delivered by township hospitals was $390.65 (SD $145.68) per healthcare facility.This study shows that a multifaceted intervention programme, when embedded into routine practice, is very cost-effective at reducing antibiotic prescribing in primary care facilities, and has the potential of scale-up in similar resource limited settings.

Published
2018

22. Protocol for a mixed methods realist evaluation of a health service user feedback system in Bangladesh

Author

Ebenso, B, Huque, R, Azdi, Z, Elsey, H, Nasreen, S, and Mirzoev, T

Abstract

Introduction: Responsiveness to service users’ views is a widely-recognised objective of health systems. A key component of responsive health systems is effective interaction between users and service providers. Despite a growing literature on patient feedback from high-income settings, less is known about effectiveness of such systems in low and middle income countries. Methodology and analysis: This paper disseminates the protocol for an 18-month ‘RESPOND’ project that aims to evaluate the system of collecting and responding to user feedback in Bangladesh. This mixed-method study uses a Realist Evaluation approach to examine user feedback systems at two Upazila Health Complexes in Comilla district of Bangladesh, and comprises three steps: i) initial theory development; ii) theory validation; and iii) theory refinement and development of lessons learned. The project also utilises: i) Process evaluation to understand causal mechanisms and contexts of implementation; ii) Statistical analysis of patient feedback to clarify the nature of issues reported; iii) Social science methods to illuminate feedback processes and user and provider experiences; and iv) Health policy and systems research to clarify issues related to integration of feedback systems with quality assurance and human resource management. During data analysis, qualitative and quantitative findings will be integrated throughout to help achieve study objectives. Analysis of qualitative and quantitative data will be done using a convergent mixed methods model, involving continuous triangulation of multiple datasets to facilitate greater understanding of the context of user feedback systems including the links with relevant policies, practices and programmes. Ethics and dissemination: Ethics approvals were obtained from the University of Leeds and the Bangladesh Medical Research Council. All data collected for this study will be anonymised and identifying characteristics of respondents will not appear in a final manuscript or reports. The study findings will be presented at scientific conferences and published in peer-reviewed journals.

Published
2017

24. Protocol for a pragmatic cluster randomised controlled trial for reducing irrational antibiotic prescribing among children with upper respiratory infections in rural China

Author

Zou, G, Wei, X, Hicks, JP, Hu, Y, Walley, J, Zeng, J, Elsey, H, King, R, Zhang, Z, Deng, S, Huang, Y, Blacklock, C, Yin, J, Sun, Q, Lin, M, Zou, G, Wei, X, Hicks, JP, Hu, Y, Walley, J, Zeng, J, Elsey, H, King, R, Zhang, Z, Deng, S, Huang, Y, Blacklock, C, Yin, J, Sun, Q, and Lin, M

Abstract

INTRODUCTION: Irrational use of antibiotics is a serious issue within China and internationally. In 2012, the Chinese Ministry of Health issued a regulation for antibiotic prescriptions limiting them to <20% of all prescriptions for outpatients, but no operational details have been issued regarding policy implementation. This study aims to test the effectiveness of a multidimensional intervention designed to reduce the use of antibiotics among children (aged 2-14 years old) with acute upper respiratory infections in rural primary care settings in China, through changing doctors' prescribing behaviours and educating parents/caregivers. METHODS AND ANALYSIS: This is a pragmatic, parallel-group, controlled, cluster-randomised superiority trial, with blinded evaluation of outcomes and data analysis, and un-blinded treatment. From two counties in Guangxi Province, 12 township hospitals will be randomised to the intervention arm and 13 to the control arm. In the control arm, the management of antibiotics prescriptions will continue through usual care via clinical consultations. In the intervention arm, a provider and patient/caregiver focused intervention will be embedded within routine primary care practice. The provider intervention includes operational guidelines, systematic training, peer review of antibiotic prescribing and provision of health education to patient caregivers. We will also provide printed educational materials and educational videos to patients' caregivers. The primary outcome is the proportion of all prescriptions issued by providers for upper respiratory infections in children aged 2-14 years old, which include at least one antibiotic. ETHICS AND DISSEMINATION: The trial has received ethical approval from the Ethics Committee of Guangxi Provincial Centre for Disease Control and Prevention, China. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, local and international conferences. TRIAL REGISTRATION NUMB

Published
2016

27. Allgemeine Mikrochemie

Author

Emich, F., Benedetti-Pichler, A., Henrich, F., Moser, L., Strebinger, R., Pregl, F., Zaribnicky, F., Rosenthaler, L., Chamot, E. M., Herbst, H., Fitting, H., Ambronn, H., Frey, A., Wright, L., John, K., Reinsch, F. K., Zimmern, A., Coutin, M., Lehmann, E., Pech, J. L., Harder, R., Siedentopf, H., Spierer, C., Lieberkühn, Kaiser, W., Rheinberger, Kraemer, W., Kern, Ch., Pohle, H., Wachenfeldt, S. v., Lossen, F., Köhler, A., Proell, Linde, O., Saxl, E., Schäffer, W., Kisser, J., Studnićka, F. K., Roll, F., Huzella, Th., Chambers, R., Péterfi, T., Taylor, Ch. V., de Mottoni, G., Parkhurst, D. L., Utermöhl, H., Goring, Naumann, E., Volk, Lunde, G., Hill, E. A., Adams, E. Q., Linzenmeier, G., Kaufmann, E., Kirkpatrick, P., Magarian, M. C., Wolff, R., Schuhecker, K., Hagedorn, H. C., Jensen, B. N., Geilmann, W., Höltie, R., Dienes, L., Pincussen, L., Rehberg, P. B., Wermuth, S., Shepherd, M., Rasmussen, H. B., Christensen, C. E., Mellet, R., Bischoff, M. A., Hiller, H., Hopfield, J. J., Paneth, F., Peters, K., Günther, P., Elsey, H. M., Crespi, M., Moles, E., Kliefoth, W., Frivold, O. E., Burk, R. E., Noyes, Jr., Br., Ewald, W., Whytlaw-Gray, R., Whitaker, H., Figour, H., Sautier, F., Verzár, F., Barcroft, J., Condorelli, L., Poulton, E. P., Spurrell, W. R., Warner, E. C., Suhrmann, R., Clusius, Kl., Manley, J. J., Roth, W. A., Naeser, G., Döpke, O., Leontjew, H., Patterson, H. S., Gray, R. W., Millikan, R. A., Barbour, H. G., Hamilton, W. F., Dickinson, Vuilleumier, E. A., Klemm, W., Biltz, W., Stock, A., and Ritter, G.

Published
1928
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28. Understanding the impacts of care farms on health and well-being of disadvantaged populations: a protocol of the Evaluating Community Orders (ECO) pilot study

Author

Elsey, H., Bragg, R., Elings, M., Cade, J.E., Brennan, C., Farragher, T., Tubeuf, S., Gold, R., Shickle, D., Wickramasekera, N., Richardson, Z., Murray, J., Elsey, H., Bragg, R., Elings, M., Cade, J.E., Brennan, C., Farragher, T., Tubeuf, S., Gold, R., Shickle, D., Wickramasekera, N., Richardson, Z., and Murray, J.

Abstract

Introduction: Care farms, where all or part of the farm is used for therapeutic purposes, show much potential for improving the health and well-being of a range of disadvantaged groups. Studies to date have been qualitative or observational, with limited empirical evidence of the effectiveness of care farms in improving health and well-being. Understanding the underlying mechanisms that lead to improvements for different disadvantaged groups is a further gap in the evidence. Participants in this study are offenders serving community orders. Their low socioeconomic status and poor health outcomes relative to the general population exemplifies disadvantage. Methods and analysis: This paper describes the protocol of a study to understand the impacts of care farms and to pilot the design and tools for a study to assess cost-effectiveness of care farms in improving the quality of life of offenders. As a pilot study, no power calculation has been conducted. However, 150 offenders serving community sentences on care farms and 150 on other probation locations (eg, litter picking, painting) will be recruited over a 1-year period. Changes in quality of life, measured by Clinical Outcome in Routine Evaluation-Outcome Measure, health and reconvictions of offenders at care farms compared to other probation locations will be analysed to inform the sample size calculation for the follow on study. The feasibility of recruitment, retention, collecting cost data and modelling cost-effectiveness will also be assessed. The study will use qualitative methods to explore the experiences of offenders attending care farms and perceptions of probation and care farm staff on the processes and impacts of the intervention. Ethics and dissemination: Findings will be published and inform development of a natural experiment and will be disseminated to probation services, care farms and academics. University of Leeds Ethical Review Board approved: SoMREC/13/014. National Offender Management Service

Published
2014

29. Understanding the impacts of care farms on health and well-being of disadvantaged populations: a protocol of the Evaluating Community Orders (ECO) pilot study

Author

Elsey, H, primary, Bragg, R, additional, Elings, M, additional, Cade, J E, additional, Brennan, C, additional, Farragher, T, additional, Tubeuf, S, additional, Gold, R, additional, Shickle, D, additional, Wickramasekera, N, additional, Richardson, Z, additional, and Murray, J, additional

Published
2014
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40. READERS SAY.

Author

ELSEY, H. F.

Subjects
STOCKHOLDERS, PROXY
Abstract

A letter to the editor is presented as of July 15, 1950 in which the reader discusses the editorial "Are Proxies Outmoded?"

Published
1950

41. READERS SAY.

Author

SUTCLIFFE, JOHN A. and ELSEY, H. F.

Subjects
STOCK management (Finance)
Abstract

A letter to the editor is presented in response to a letter by John A. Sutcliffe regarding Sutcliffe's decision to sell the stocks of U.S. aerospace company Lockheed Aircraft Corp. he owns.

Published
1950

42. Uncovering the determinants of health in deprived urban neighborhoods in Accra, Ghana: a qualitative and participatory reconnaissance study.

Author

Amedzro N, Anaseba D, Darkwa AG, Twumasi A, Ayim A, Ansah-Ofei AM, Dovlo D, Awoonor-Williams JK, Agongo EEA, Agyepong IA, and Elsey H

Subjects
Humans, Ghana, Female, Male, Adult, Middle Aged, Health Services Accessibility statistics & numerical data, Social Determinants of Health, Primary Health Care statistics & numerical data, Community-Based Participatory Research, Residence Characteristics statistics & numerical data, Adolescent, Community Health Services statistics & numerical data, Qualitative Research, Urban Population statistics & numerical data, Focus Groups
Abstract

Background: Delivering primary care services within the context of rapid urbanization and a changing disease burden is a major challenge in sub-Saharan Africa. Rural models of primary care, including the "Community-based Health Planning and Services" (CHPS) programme in Ghana, have shown improved health outcomes. However, adapting these to the urban context has proved problematic. Differences in the determinants of health found in these settings may help to explain the challenges of delivering CHPS in poor urban neighborhoods in Accra. To inform the redesign of CHPS for the urban context, we aimed to understand the determinants driving health and engagement with health services in three informal settlements in Accra., Methods: This study formed a reconnaissance phase for a subsequent participatory action research study. We used qualitative and participatory methods to explore the influence of wider and proximal determinants on health and the use and perceptions of CHPS. Three transect walks with community leaders across the study settings informed interview guides and the recruitment of suitable participants for key informant and focus group interviews. Using a Framework Approach, we analysed transcripts and reports from these activities and developed themes and sub-themes in participants' experiences accessing healthcare., Results: Our findings highlight the importance of wider and proximal determinants of health including physical environment, gender and other social stratifiers including age, ethnicity, religion and disability, on health, health seeking behavior and personal behaviors such as substance misuse, tobacco use and alcohol. Utilization of CHPS was low and seen primarily as a service for maternal and child health. Private providers, ranging from informal drug stores to private clinics, were used most commonly. Community leaders and groups were active, but engagement was limited by opportunity costs for members., Conclusion: Traditional service delivery packages need to be adapted to include non-communicable diseases driven by risk behaviors such as tobacco, unhealthy diet, alcohol and substance abuse. Assets such as volunteerism and nurses embedded within communities are challenging to attain in complex urban settings, yet other assets exist including occupational associations and a range of informal and private providers that could support delivery of preventive and promotive health care with equitable reach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Amedzro, Anaseba, Darkwa, Twumasi, Ayim, Ansah-Ofei, Dovlo, Awoonor-Williams, Agongo, Agyepong and Elsey.)

Published
2024
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44. The Perspectives of Lagos Healthcare Leaders on Faith-Institution Involvement in Hypertension Health.

Author

Sanusi A, Golder S, Elsey H, and Todowede O

Subjects
Humans, Nigeria, Male, Cross-Sectional Studies, Female, Surveys and Questionnaires, Adult, Leadership, Health Promotion methods, Middle Aged, Faith-Based Organizations, Hypertension
Abstract

Background: Hypertension is an important challenge for the Nigerian healthcare system and multiple stakeholder mitigation is imperative. Faith institution mitigation is evolving but the opinion of healthcare leaders on their involvement in hypertension remains an important gap., Objective: To explore the perspectives of a cross-section of leaders of healthcare institutions in Lagos (Nigeria) on faith institution-facilitated hyper tension inter vention against the background of current practice., Methods: Attempts were made to recruit 152 healthcare institution leaders who were contacted using electronic mails, telephone conversations, institutional social media communication, institutions' web-mails and other contacts. The views of consenting leaders were gathered using an exploratory questionnaire survey, and analysed., Results: The views of 23 leaders from the variety of institutions were that most (60%) hypertension cases were diagnosed during emergency presentations; and the public's hypertension health knowledge remains generally inadequate. Hypertension information dissemination was mostly verbal rather than in written/print form. Basic resources are deployed in hypertension management. There was majority support for collaboration in hypertension health promotion (90.0%), blood pressure screening (95.7%) and hypertension referral (95.5%). Fewer institutions had the resources to support hypertension health promotion (55.0%) and blood pressure screening (42.1%) compared to hypertension referral (90.9%)., Conclusion: There is good support for faith institution involvement in hypertension health, with a particular interest in and capacity for health system referral. Deploying scarce resources to collaborate may be challenging. However, collaboration and better resources could improve hypertension prevention and management. Further work is needed for context specific innovation so faith institutions can contribute to hypertension health., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Published
2024

45. Editorial: Day-care for healthy child development and wider social and economic gain in urban areas in low- and middle income countries.

Author

Nampijja M, Kitsao-Wekulo P, Hughes RC, Griffiths P, and Elsey H

Subjects
Child, Humans, Socioeconomic Factors, Urban Population, Developing Countries, Child Development
Abstract

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Published
2024
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46. Health inequalities at the intersection of multiple social determinants among under five children residing Nairobi urban slums: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Author

Kibuchi E, Chumo I, Kabaria C, Elsey H, Phillips-Howard P, de Siqueira-Filha NT, Whittaker L, Leyland AH, Mberu B, and Gray L

Abstract

In this analysis we examine through an intersectionality lens how key social determinants of health (SDOH) are associated with health conditions among under-five children (<5y) residing in Nairobi slums, Kenya. We used cross-sectional data collected from Nairobi slums between June and November 2012 to explore how multiple interactions of SDoH shape health inequalities in slums. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. We constructed intersectional strata for each health condition from combinations of significant SDoH obtained using univariate analyses. We then estimated the intersectional effects of health condition in a series of MAIHDA logistic regression models distinguishing between additive and interaction effects. We quantified discriminatory accuracy (DA) of the intersectional strata by means of the variance partitioning coefficient (VPC) and the area under the receiver operating characteristic curve (AUC-ROC). The total participants were 2,199 <5y, with 120 records (5.5%) dropped because health conditions were recorded as "not applicable". The main outcome variables were three health conditions: 1) whether a child had diarrhea or not, 2) whether a child had fever or not, and 3) whether a child had cough or not in the previous two weeks. We found non-significant intersectional effects for each health condition. The head of household ethnic group was significantly associated with each health condition. We found good DA for diarrhea (VPC = 9.0%, AUC-ROC = 76.6%) an indication of large intersectional effects. However, fever (VPC = 1.9%, AUC-ROC = 66.3%) and cough (VPC = 0.5%, AUC-ROC = 61.8%) had weak DA indicating existence of small intersectional effects. Our study shows pathways for SDoH that affect diarrhea, cough, and fever for <5y living in slums are multiplicative and shared. The findings show that <5y from Luo and Luhya ethnic groups, recent migrants (less than 2 years), and households experiencing CHE are more likely to face worse health outcomes. We recommend relevant stakeholders to develop strategies aimed at identifying these groups for targeted proportionate universalism based on the level of their need., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kibuchi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2024
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47. Predictors of quality of childcare centers in low-income settings: findings from a cross-sectional study in two Nairobi slums.

Author

Nampijja M, Langat N, Oloo L, Okelo K, Muendo R, Kiyeng M, Amboka P, Abboah-Offei M, Ray A, Kitsao-Wekulo P, Kimani-Murage EW, and Elsey H

Subjects
Humans, Female, Child, Preschool, Child, Cross-Sectional Studies, Kenya, Child Day Care Centers, Child Care, Poverty Areas
Abstract

Background: Rapid urbanization and increased women's involvement in paid work have contributed to the upsurge of informal childcare centers, especially in low-income settings where quality is a major issue. However, there are limited data on the factors associated with the quality of childcare centers in informal settlements in Africa., Methods: We conducted a quantitative observation and questionnaire survey of 66 childcare centers to identify the factors associated with the quality of childcare services in two informal settlements (Korogocho and Viwandani) in Nairobi. The quality of the centers (outcome variable) was assessed using a locally developed tool. Data on center characteristics including type, size, location, length of operation, charges, and number of staff were collected. Center providers' knowledge, attitude, and practices (KAP) in childcare were assessed through a questionnaire, focusing on nurturing care and business management. Data were described using means and standard deviation or frequencies and percentages. Associations between quality center score (outcome variable) and other variables were examined using multivariable linear regression to identify potential predictors of the quality of the center environment., Findings: A total of 129 childcare centers were identified and categorized as home-based ( n  = 45), center-based ( n  = 14), school-based ( n  = 61), and church-based ( n  = 9). The number of home-based centers was particularly high in Viwandani ( n  = 40; 52%). Only 9% of home-based centers reported any external support and 20% had any training on early childhood development. Of the 129 centers, 66 had complete detailed assessment of predictors of quality reported here. Unadjusted linear regressions revealed associations between quality of childcare center and center providers' education level, type of center, support received, caregiver-child ratio, number of children in the center, and center providers' KAP score ( p  < 0.05). However, in the multivariable regression, only higher levels of center provider KAP ( β = 0.51; 95% CI: 0.18, 0.84; p  = 0.003) and center type ( β = 8.68; 95% CI: 2.32, 15.04; p  = 0.008) were significantly associated with center quality score., Implication: Our results show that center providers' knowledge and practices are a major driver of the quality of childcare centers in informal settlements in Nairobi. Interventions for improving the quality of childcare services in such settings should invest in equipping center providers with the necessary knowledge and skills through training and supportive supervision., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nampijja, Langat, Oloo, Okelo, Muendo, Kiyeng, Amboka, Abboah-Offei, Ray, Kitsao-Wekulo, Kimani-Murage and Elsey.)

Published
2023
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48. The feasibility, acceptability, cost and benefits of a "communities of practice" model for improving the quality of childcare centres: a mixed-methods study in the informal settlements in Nairobi.

Author

Nampijja M, Langat N, Oloo L, Amboka P, Okelo K, Muendo R, Habib S, Kiyeng M, Ray A, Abboah-Offei M, Kitsao-Wekulo P, Kimani-Murage E, Li J, and Elsey H

Subjects
Child, Humans, Cost-Benefit Analysis, Feasibility Studies, Kenya, Child Care, Community Health Services
Abstract

Background: Informal childcare centres have mushroomed in the informal settlements of Nairobi, Kenya to meet the increasing demand. However, centre providers are untrained and the facilities are below standard putting children at risk of poor health and development. We aimed to co-design and test the feasibility, acceptability, cost and potential benefits of a communities of practice (CoP) model where trained community health volunteers (CHVs) provide group training sessions to build skills and improve practices in informal childcare centres., Methods: A CoP model was co-designed with sub-county health teams, centre providers and parents with inputs from Kidogo, government nutritionists and ECD experts and implemented in 68 childcare centres by trained CHVs. Its feasibility and potential benefits were measured quantitatively and qualitatively. Centre provider ( n = 68) and CHV ( n = 20) knowledge and practice scores before and after the intervention were assessed and compared. Intervention benefits were examined using linear regressions adjusting for potential confounding factors. We conducted in-depth interviews with 10 parents, 10 CHVs, 10 centre providers and 20 local government officials, and two focus groups with CHVs and centre providers. Qualitative data were analysed, focusing on feasibility, acceptability, potential benefits, challenges and ideas for improvement. Cost for delivering and accessing the intervention were examined., Results: The intervention was acceptable and feasible to deliver within existing government community health systems; 16 CHVs successfully facilitated CoP sessions to 58 centre providers grouped into 13 groups each with 5-6 centre providers, each group receiving four sessions representing the four modules. There were significant improvements in provider knowledge and practice (effect size = 0.40; p < 0.05) and quality of centre environment (effect size = 0.56; p < 0.01) following the intervention. CHVs' scores showed no significant changes due to pre-existing high knowledge levels. Qualitative interviews also reported improvements in knowledge and practices and the desire among the different participants for the support to be continued. The total explicit costs were USD 22,598 and the total opportunity costs were USD 3,632 (IQR; USD 3,570, USD 4,049)., Conclusion: A simple model delivered by CHVs was feasible and has potential to improve the quality of informal childcare centres. Leveraging these teams and integration of the intervention into the health system is likely to enable scale-up and sustainability in Kenya and similar contexts., Competing Interests: SH and MK were employed by Kidogo Innovations, Nairobi, Kenya. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nampijja, Langat, Oloo, Amboka, Okelo, Muendo, Habib, Kiyeng, Ray, Abboah-Offei, Kitsao-Wekulo, Kimani-Murage, Li and Elsey.)

Published
2023
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49. Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya.

Author

Oloo L, Elsey H, Abboah-Offei M, Kiyeng M, Amboka P, Okelo K, Kitsao-Wekulo P, Kimani-Murage E, Langa't N, and Nampijja M

Subjects
Child, Humans, Child, Preschool, Kenya, Child Care, Poverty
Abstract

Background: Globally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya., Methods: This mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents ( n = 44), childcare providers, and community health teams ( n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers ( n = 22) and childcare center providers ( n = 66) were conducted., Results: In total, 129 childcare centers were identified -55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention., Conclusion: Implementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Oloo, Elsey, Abboah-Offei, Kiyeng, Amboka, Okelo, Kitsao-Wekulo, Kimani-Murage, Langa't and Nampijja.)

Published
2023
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50. Correction: Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries.

Author

Jarde A, Siqueira N, Afaq S, Naz F, Irfan M, Tufail P, Aslam F, Todowede O, Rakhshanda S, Khalid H, Lin Y, Biermann O, Elsony A, Elsey H, Siddiqi N, and Siddiqi K

Abstract

[This corrects the article DOI: 10.1371/journal.pgph.0001205.]., (Copyright: © 2023 Jarde et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2023
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