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BMJ Global Health

Andrew Booth, Jane Noyes, Kate Flemming, Graham Moore, Özge Tunçalp, Elham Shakibazadeh
When making decisions about complex interventions, guideline development groups need to factor in the sociocultural acceptability of an intervention, as well as contextual factors that impact on the feasibility of that intervention. Qualitative evidence synthesis offers one method of exploring these issues. This paper considers the extent to which current methods of question formulation are meeting this challenge. It builds on a rapid review of 38 different frameworks for formulating questions. To be useful, a question framework should recognise context (as setting, environment or context); acknowledge the criticality of different stakeholder perspectives (differentiated from the target population); accommodate elements of time/timing and place; be sensitive to qualitative data (eg, eliciting themes or findings)...
2019: BMJ Global Health
Susan L Norris, Eva A Rehfuess, Helen Smith, Özge Tunçalp, Jeremy M Grimshaw, Nathan P Ford, Anayda Portela
No abstract text is available yet for this article.
2019: BMJ Global Health
Mark Petticrew, Cécile Knai, James Thomas, Eva Annette Rehfuess, Jane Noyes, Ansgar Gerhardus, Jeremy M Grimshaw, Harry Rutter, Elizabeth McGill
There is growing interest in the potential for complex systems perspectives in evaluation. This reflects a move away from interest in linear chains of cause-and-effect, towards considering health as an outcome of interlinked elements within a connected whole. Although systems-based approaches have a long history, their concrete implications for health decisions are still being assessed. Similarly, the implications of systems perspectives for the conduct of systematic reviews require further consideration. Such reviews underpin decisions about the implementation of effective interventions, and are a crucial part of the development of guidelines...
2019: BMJ Global Health
Jane Noyes, Andrew Booth, Graham Moore, Kate Flemming, Özge Tunçalp, Elham Shakibazadeh
Guideline developers are increasingly dealing with more difficult decisions concerning whether to recommend complex interventions in complex and highly variable health systems. There is greater recognition that both quantitative and qualitative evidence can be combined in a mixed-method synthesis and that this can be helpful in understanding how complexity impacts on interventions in specific contexts. This paper aims to clarify the different purposes, review designs, questions, synthesis methods and opportunities to combine quantitative and qualitative evidence to explore the complexity of complex interventions and health systems...
2019: BMJ Global Health
Kate Flemming, Andrew Booth, Ruth Garside, Özge Tunçalp, Jane Noyes
This paper is one of a series exploring the implications of complexity for systematic reviews and guideline development, commissioned by the WHO. The paper specifically explores the role of qualitative evidence synthesis. Qualitative evidence synthesis is the broad term for the group of methods used to undertake systematic reviews of qualitative research evidence. As an approach, qualitative evidence synthesis is increasingly recognised as having a key role to play in addressing questions relating to intervention or system complexity, and guideline development processes...
2019: BMJ Global Health
Julian P T Higgins, José A López-López, Betsy J Becker, Sarah R Davies, Sarah Dawson, Jeremy M Grimshaw, Luke A McGuinness, Theresa H M Moore, Eva A Rehfuess, James Thomas, Deborah M Caldwell
Public health and health service interventions are typically complex: they are multifaceted, with impacts at multiple levels and on multiple stakeholders. Systematic reviews evaluating the effects of complex health interventions can be challenging to conduct. This paper is part of a special series of papers considering these challenges particularly in the context of WHO guideline development. We outline established and innovative methods for synthesising quantitative evidence within a systematic review of a complex intervention, including considerations of the complexity of the system into which the intervention is introduced...
2019: BMJ Global Health
Paul Montgomery, Ani Movsisyan, Sean P Grant, Geraldine Macdonald, Eva Annette Rehfuess
Public health interventions and health technologies are commonly described as 'complex', as they involve multiple interacting components and outcomes, and their effects are largely influenced by contextual interactions and system-level processes. Systematic reviewers and guideline developers evaluating the effects of these complex interventions and technologies report difficulties in using existing methods and frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE)...
2019: BMJ Global Health
Eva A Rehfuess, Jan M Stratil, Inger B Scheel, Anayda Portela, Susan L Norris, Rob Baltussen
Introduction: Evidence-to-decision (EtD) frameworks intend to ensure that all criteria of relevance to a health decision are systematically considered. This paper, part of a series commissioned by the WHO, reports on the development of an EtD framework that is rooted in WHO norms and values, reflective of the changing global health landscape, and suitable for a range of interventions and complexity features. We also sought to assess the value of this framework to decision-makers at global and national levels, and to facilitate uptake through suggestions on how to prioritise criteria and methods to collect evidence...
2019: BMJ Global Health
Andrew Booth, Graham Moore, Kate Flemming, Ruth Garside, Nigel Rollins, Özge Tunçalp, Jane Noyes
Systematic review teams and guideline development groups face considerable challenges when considering context within the evidence production process. Many complex interventions are context-dependent and are frequently evaluated within considerable contextual variation and change. This paper considers the extent to which current tools used within systematic reviews and guideline development are suitable in meeting these challenges. The paper briefly reviews strengths and weaknesses of existing approaches to specifying context...
2019: BMJ Global Health
Ben J Marais, Stephanie Williams, Ailan Li, Roderico Ofrin, Angela Merianos, Joel Negin, Jenny Firman, Robin Davies, Tania Sorrell
No abstract text is available yet for this article.
2019: BMJ Global Health
Charley E Willison, Phillip M Singer, Melissa S Creary, Scott L Greer
If disaster responses vary in their effectiveness across communities, health equity is affected. This paper aims to evaluate and describe variation in the federal disaster responses to 2017 Hurricanes Harvey, Irma and Maria, compared with the need and severity of storm damage through a retrospective analysis. Our analysis spans from landfall to 6 months after landfall for each hurricane. To examine differences in disaster responses across the hurricanes, we focus on measures of federal spending, federal resources distributed and direct and indirect storm-mortality counts...
2019: BMJ Global Health
Aduragbemi Banke-Thomas, Barbara Madaj, Nynke van den Broek
Introduction: Emergency obstetric care (EmOC) training is considered a key strategy for reducing maternal and perinatal morbidity and mortality. Although generally considered effective, there is minimal evidence on the broader social impact and/or value-for-money (VfM). This study assessed the social impact and VfM of EmOC training in Kenya using social return on investment (SROI) methodology. Methods: Mixed-methods approach was used, including interviews (n=21), focus group discussions (n=18) incorporating a value game, secondary data analysis and literature review, to obtain all relevant data for the SROI analysis...
2019: BMJ Global Health
Angela E Micah, Catherine S Chen, Bianca S Zlavog, Golsum Hashimi, Abigail Chapin, Joseph L Dieleman
Introduction: Government health spending is a primary source of funding in the health sector across the world. However, in sub-Saharan Africa, only about a third of all health spending is sourced from the government. The objectives of this study are to describe the growth in government health spending, examine its determinants and explain the variation in government health spending across sub-Saharan African countries. Methods: We used panel data on domestic government health spending in 46 countries in sub-Saharan Africa from 1995 to 2015 from the Institute for Health Metrics and Evaluation...
2019: BMJ Global Health
Ben Oppenheim, Mark Gallivan, Nita K Madhav, Naor Brown, Volodymyr Serhiyenko, Nathan D Wolfe, Patrick Ayscue
Introduction: Robust metrics for national-level preparedness are critical for assessing global resilience to epidemic and pandemic outbreaks. However, existing preparedness assessments focus primarily on public health systems or specific legislative frameworks, and do not measure other essential capacities that enable and support public health preparedness and response. Methods: We developed an Epidemic Preparedness Index (EPI) to assess national-level preparedness...
2019: BMJ Global Health
Elizabeth L Prado, Elizabeth Yakes Jimenez, Stephen Vosti, Robert Stewart, Christine P Stewart, Jérôme Somé, Anna Pulakka, Jean Bosco Ouédraogo, Harriet Okronipa, Eugenia Ocansey, Brietta Oaks, Kenneth Maleta, Anna Lartey, Emma Kortekangas, Sonja Y Hess, Kenneth Brown, Jaden Bendabenda, Ulla Ashorn, Per Ashorn, Mary Arimond, Seth Adu-Afarwuah, Souheila Abbeddou, Kathryn Dewey
Stunting prevalence is an indicator of a country's progress towards United Nations' Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619)...
2019: BMJ Global Health
Abi Beane, Ambepitiyawaduge Pubudu De Silva, Priyantha Lakmini Athapattu, Saroj Jayasinghe, Anuja Unnathie Abayadeera, Mandika Wijerathne, Ishara Udayanga, Shriyananda Rathnayake, Arjen M Dondorp, Rashan Haniffa
Lack of investment in low-income and middle-income countries (LMICs) in systems capturing continuous information regarding care of the acutely unwell patient is hindering global efforts to address inequalities, both at facility and national level. Furthermore, this of lack of data is disempowering frontline staff and those seeking to support them, from progressing setting-relevant research and quality improvement. In contrast to high-income country (HIC) settings, where electronic surveillance has boosted the capability of governments, clinicians and researchers to engage in service-wide healthcare evaluation, healthcare information in resource-limited settings remains almost exclusively paper based...
2019: BMJ Global Health
Felix Limbani, Margaret Thorogood, Francesc Xavier Gómez-Olivé, Chodziwadziwa Kabudula, Jane Goudge
Introduction: Task shifting is a potential solution to the shortage of healthcare personnel in low/middle-income countries, but contextual factors often dilute its effectiveness. We report on a task shifting intervention using lay health workers to support clinic staff in providing chronic disease care in rural South Africa, where the HIV epidemic and an ageing population have increased demand for care. Methods: We conducted a realist evaluation in a cluster randomised controlled trial...
2019: BMJ Global Health
Kiesha Prem, Sok Heng Pheng, Alvin Kuo Jing Teo, Konstantin Evdokimov, Ei Ei Khaing Nang, Li Yang Hsu, Vonthanak Saphonn, Sivanna Tieng, Tan Eang Mao, Alex R Cook
Introduction: Cambodia is among the 30 highest burden of tuberculosis (TB) countries. Active TB prevalence has been estimated using nationally representative multistage sampling that represents urban, rural and remote parts of the country, but the prevalence in non-sampled communes remains unknown. This study uses geospatial Bayesian statistics to estimate point prevalence across Cambodia, and demographic modelling that accounts for secular trends in fertility, mortality, urbanisation and prevalence rates to project the future burden of active TB...
2019: BMJ Global Health
Daniel J Carter, Rhian Daniel, Ana W Torrens, Mauro N Sanchez, Ethel Leonor N Maciel, Patricia Bartholomay, Draurio C Barreira, Davide Rasella, Mauricio L Barreto, Laura C Rodrigues, Delia Boccia
Background: Evidence suggests that social protection policies such as Brazil's Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB treatment success rate. Methods: Propensity scores were estimated from a complete-case logistic regression using covariates from a linked data set, including the Brazil's TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll...
2019: BMJ Global Health
Rosa de Groot, Katja van den Hurk, Linda J Schoonmade, Wim L A M de Kort, Johannes Brug, Jeroen Lakerveld
Introduction: The built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults. Methods: PubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years)...
2019: BMJ Global Health
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