While global newborn hearing screening programmes (NHSP) are far from the optimal level, the combined hearing and genetic screening has emerged as an innovative approach of early healthcare interventions. There is a clear need for economic evaluation to establish whether newborn deafness gene screening (NDGS), currently mandated by many cities in China, is a good investment.A decision-tree model was constructed to simulate a hypothetical 10-million Chinese newborn cohort over a lifetime with three strategies: (1) no screening, (2) NHSP (standard screening) and (3) NHSP+NDGS (combined screening). The presence of permanent congenital hearing loss (PCHL) and genetic mutation were assigned at birth and held constant for all strategies. Input parameters were obtained from the Cohort of Deafness-gene Screening study and literature review. The government contract price for genetic screening was US$77/child. Outcomes of interest included the number of early diagnosed PCHL, prelingual deafness, total deafness, special education referral, incremental cost-effectiveness ratio (ICER) and benefit–cost ratio (BCR).Both standard and combined screening strategies were more effective and more costly than ‘no screening’. Compared with standard screening, combined screening led to 9112 (28.0%) more PCHL cases early detected, avoiding 4071 (66.9%) prelingual deafness cases and 3977 (15.6%) special education referrals. The ICER and BCR for combined screening were US$ 4995/disability-adjusted life-year (95% uncertainty interval, 2963 to 9265) and 1.78 (1.19 to 2.39), from healthcare sector perspective. Combined screening would dominate standard screening from societal perspective. Moreover, it remained cost-effective even in pessimistic scenarios.Our findings have particular implication for the ‘scale-up’ of genetic screening at the national level in China. The model may serve as a feasible example for hearing screening strategies in other countries, as well as genetic screening for other diseases.
{"title":"Economic evaluation of newborn deafness gene screening as a public health intervention in China: a modelling study","authors":"Jun-Tao Shu, Yuan-Yuan Gu, Pei-Yao Zhai, Cheng Wen, Min Qian, You-Jia Wu, Xun Zhuang, Qi Zhu, Lu-Ping Zhang, Shan Jiang, Xiao-Mo Wang, Yin-Hua Jiang, Li-Hui Huang, Gang Qin","doi":"10.1136/bmjph-2023-000838","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000838","url":null,"abstract":"While global newborn hearing screening programmes (NHSP) are far from the optimal level, the combined hearing and genetic screening has emerged as an innovative approach of early healthcare interventions. There is a clear need for economic evaluation to establish whether newborn deafness gene screening (NDGS), currently mandated by many cities in China, is a good investment.A decision-tree model was constructed to simulate a hypothetical 10-million Chinese newborn cohort over a lifetime with three strategies: (1) no screening, (2) NHSP (standard screening) and (3) NHSP+NDGS (combined screening). The presence of permanent congenital hearing loss (PCHL) and genetic mutation were assigned at birth and held constant for all strategies. Input parameters were obtained from the Cohort of Deafness-gene Screening study and literature review. The government contract price for genetic screening was US$77/child. Outcomes of interest included the number of early diagnosed PCHL, prelingual deafness, total deafness, special education referral, incremental cost-effectiveness ratio (ICER) and benefit–cost ratio (BCR).Both standard and combined screening strategies were more effective and more costly than ‘no screening’. Compared with standard screening, combined screening led to 9112 (28.0%) more PCHL cases early detected, avoiding 4071 (66.9%) prelingual deafness cases and 3977 (15.6%) special education referrals. The ICER and BCR for combined screening were US$ 4995/disability-adjusted life-year (95% uncertainty interval, 2963 to 9265) and 1.78 (1.19 to 2.39), from healthcare sector perspective. Combined screening would dominate standard screening from societal perspective. Moreover, it remained cost-effective even in pessimistic scenarios.Our findings have particular implication for the ‘scale-up’ of genetic screening at the national level in China. The model may serve as a feasible example for hearing screening strategies in other countries, as well as genetic screening for other diseases.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"20 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjph-2023-000154
Yaxu Zheng, Bo Zheng, X. Gong, Hao Pan, Chenyan Jiang, S. Mao, Sheng Lin, B. Jin, D. Kong, Ye Yao, Genming Zhao, Huanyu Wu, Weibing Wang
To characterise age-mixing patterns among index cases and contacts of COVID-19, and explore when patients are most infectious during the disease process.This study examined all initial 90 885 confirmed index cases in Shanghai and their 450 770 close contacts. A generalised additive mixed model was used to analyse the associations of the number of close contacts with different demographic and clinical characteristics. The effect of different exposure time windows on the infection of close contacts was evaluated using a modified mixed-effects Poisson regression.Analysis of contacts indicated that 82 467 (18.29%; 95% CI 18.17%, 18.42%) were second-generation cases. Our result indicated the q-index was 0.300 (95% CI 0.298, 0.302) for overall contact matrix, and that assortativity was greatest for students (q-index=0.377; 95% CI 0.357, 0.396) and weakest for people working age not in the labour force (q-index=0.246; 95% CI 0.240, 0.252). The number of contacts was 4.96 individuals per index case (95% CI 4.86, 5.06). Contacts had a higher risk if they were exposed from 1 day before to 3 days after the onset of symptoms in the index patient, with a maximum at day 0 (adjusted relative risk (aRR)=1.52; 95% CI 1.30, 1.76). Contacts exposed from 3 days before to 3 days after an asymptomatic index case had a positive reverse transcriptase-PCR (RT-PCR) result had a higher risk, with a maximum on day 0 (aRR=1.48; 95% CI 1.37, 1.59).The greatest assortativity was for students and weakest for people working age not in the labour force. Contact in the household was a significant contributor to the infection of close contacts. Contact tracing should focus on individuals who had contact soon before or soon after the onset of symptoms (or positive RT-PCR test) in the index case.
本研究调查了上海所有最初的 90 885 例确诊病例及其 450 770 名密切接触者。研究采用广义相加混合模型分析了密切接触者人数与不同人口统计学和临床特征之间的关系。对接触者的分析表明，82 467人（18.29%；95% CI 18.17%，18.42%）为第二代病例。我们的结果显示，总体接触矩阵的 q 指数为 0.300（95% CI 0.298，0.302），学生的同类性最大（q 指数=0.377；95% CI 0.357，0.396），而非劳动力的工作年龄人群的同类性最小（q 指数=0.246；95% CI 0.240，0.252）。每个指数病例的接触者人数为 4.96 人（95% CI 4.86，5.06）。如果接触者在指数患者发病前 1 天至发病后 3 天内接触过病毒，则其风险较高，其中第 0 天的风险最高（调整后相对风险 (aRR)=1.52; 95% CI 1.30, 1.76）。在无症状的指数病例出现逆转录酶-PCR（RT-PCR）阳性结果的前 3 天至后 3 天接触该病毒的人的风险较高，第 0 天的风险最高（aRR=1.48；95% CI 1.37，1.59）。家庭中的接触是导致密切接触者感染的重要因素。密切接触者追踪的重点应是在发病病例出现症状（或 RT-PCR 检测呈阳性）前后不久有过接触的人。
{"title":"Contact patterns between index patients and their close contacts and assessing risk for COVID-19 transmission during different exposure time windows: a large retrospective observational study of 450 770 close contacts in Shanghai","authors":"Yaxu Zheng, Bo Zheng, X. Gong, Hao Pan, Chenyan Jiang, S. Mao, Sheng Lin, B. Jin, D. Kong, Ye Yao, Genming Zhao, Huanyu Wu, Weibing Wang","doi":"10.1136/bmjph-2023-000154","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000154","url":null,"abstract":"To characterise age-mixing patterns among index cases and contacts of COVID-19, and explore when patients are most infectious during the disease process.This study examined all initial 90 885 confirmed index cases in Shanghai and their 450 770 close contacts. A generalised additive mixed model was used to analyse the associations of the number of close contacts with different demographic and clinical characteristics. The effect of different exposure time windows on the infection of close contacts was evaluated using a modified mixed-effects Poisson regression.Analysis of contacts indicated that 82 467 (18.29%; 95% CI 18.17%, 18.42%) were second-generation cases. Our result indicated the q-index was 0.300 (95% CI 0.298, 0.302) for overall contact matrix, and that assortativity was greatest for students (q-index=0.377; 95% CI 0.357, 0.396) and weakest for people working age not in the labour force (q-index=0.246; 95% CI 0.240, 0.252). The number of contacts was 4.96 individuals per index case (95% CI 4.86, 5.06). Contacts had a higher risk if they were exposed from 1 day before to 3 days after the onset of symptoms in the index patient, with a maximum at day 0 (adjusted relative risk (aRR)=1.52; 95% CI 1.30, 1.76). Contacts exposed from 3 days before to 3 days after an asymptomatic index case had a positive reverse transcriptase-PCR (RT-PCR) result had a higher risk, with a maximum on day 0 (aRR=1.48; 95% CI 1.37, 1.59).The greatest assortativity was for students and weakest for people working age not in the labour force. Contact in the household was a significant contributor to the infection of close contacts. Contact tracing should focus on individuals who had contact soon before or soon after the onset of symptoms (or positive RT-PCR test) in the index case.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"55 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140788367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjph-2023-000618
Abraham Norman Nortey, Amanda Adjoda, Amidu Alhassan, G. Y. Scott
Tuberculosis (TB) is the ninth leading cause of death worldwide, and the leading cause of death from a single infectious agent prior to COVID-19 pandemic. TB substantially affects adults during their most productive years. However, all age groups are at risk. More than 25% of cases and deaths occur in Africa. People infected with HIV are 20–30 times more likely to develop active TB. In this study, we determined the level of TB medication adherence, risk factors and complications of TB in outpatients attending the Nsawam Government Hospital.This cross-sectional study randomly recruited 277 patients with TB attending the Nsawam Government Hospital for care. Structured questionnaires were used to collect sociodemographic information, adherence and lifestyle characteristics. Associations and multivariate logistic regression analysis were performed with 95% CIs. All p<0.05 were considered statistically significant.Majority (36.1%) of the patients were between the ages of 29 and 38. Majority (63.9%) of them had high adherence to TB medication. Participants earning less than 500 Ghana Cedis (Ghc) (adjusted OR (aOR)=8.85. 95% CI (1.59 to 49.24), p=0.013), patients with TB who indicated having complication (joint pain, spinal pain, heart disorders, liver or kidney problems) as a result of TB (aOR=2.81, 95% CI (1.58 to 4.99), p<0.001), respondents who mentioned living with people infected with TB (aOR=3.23. 95% CI (1.24 to 8.37), p=0.016) were the independent predictors of adherence to TB medication.The study findings revealed that participants exhibited commendable adherence to TB medication. Notably, adherence levels were found to be linked to several factors, including income, medication side effects and cohabitation with individuals infected with TB. The positive trend in adherence underscores the importance of considering socioeconomic factors, as lower income was identified as a potential barrier to consistent medication adherence
结核病（TB）是全球第九大死因，也是 COVID-19 大流行之前单一传染源导致死亡的主要原因。结核病主要影响生产力最旺盛时期的成年人。然而，所有年龄段的人群都面临风险。超过 25% 的病例和死亡发生在非洲。艾滋病毒感染者罹患活动性肺结核的几率是普通人的 20-30 倍。在这项研究中，我们确定了恩萨瓦姆政府医院门诊患者的结核病服药依从性、风险因素和结核病并发症水平。这项横断面研究随机招募了 277 名到恩萨瓦姆政府医院就诊的肺结核患者，并使用结构化问卷收集了他们的社会人口学信息、依从性和生活方式特征。研究人员进行了相关性分析和多变量逻辑回归分析，并得出了 95% 的 CIs。大多数患者（36.1%）的年龄在 29 岁至 38 岁之间。大多数患者（63.9%）对结核病药物治疗的依从性较高。收入低于 500 加纳塞地（Ghc）的参与者（调整 OR (aOR)=8.85.95% CI (1.59 to 49.24)，p=0.013），表示因结核病而出现并发症（关节痛、脊柱痛、心脏疾病、肝脏或肾脏问题）的结核病患者（aOR=2.81，95% CI (1.58 to 4.99)，p<0.001），提到与结核病感染者共同生活的受访者（aOR=3.23。研究结果显示，参与者对结核病药物治疗的依从性值得称赞。值得注意的是，研究发现坚持服药的程度与几个因素有关，包括收入、药物副作用以及与结核病感染者同居。坚持服药的积极趋势强调了考虑社会经济因素的重要性，因为收入较低被认为是坚持服药的潜在障碍。
{"title":"Adherence patterns, risk factors and complications among patients with tuberculosis: a cross-sectional study at Nsawam Government Hospital","authors":"Abraham Norman Nortey, Amanda Adjoda, Amidu Alhassan, G. Y. Scott","doi":"10.1136/bmjph-2023-000618","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000618","url":null,"abstract":"Tuberculosis (TB) is the ninth leading cause of death worldwide, and the leading cause of death from a single infectious agent prior to COVID-19 pandemic. TB substantially affects adults during their most productive years. However, all age groups are at risk. More than 25% of cases and deaths occur in Africa. People infected with HIV are 20–30 times more likely to develop active TB. In this study, we determined the level of TB medication adherence, risk factors and complications of TB in outpatients attending the Nsawam Government Hospital.This cross-sectional study randomly recruited 277 patients with TB attending the Nsawam Government Hospital for care. Structured questionnaires were used to collect sociodemographic information, adherence and lifestyle characteristics. Associations and multivariate logistic regression analysis were performed with 95% CIs. All p<0.05 were considered statistically significant.Majority (36.1%) of the patients were between the ages of 29 and 38. Majority (63.9%) of them had high adherence to TB medication. Participants earning less than 500 Ghana Cedis (Ghc) (adjusted OR (aOR)=8.85. 95% CI (1.59 to 49.24), p=0.013), patients with TB who indicated having complication (joint pain, spinal pain, heart disorders, liver or kidney problems) as a result of TB (aOR=2.81, 95% CI (1.58 to 4.99), p<0.001), respondents who mentioned living with people infected with TB (aOR=3.23. 95% CI (1.24 to 8.37), p=0.016) were the independent predictors of adherence to TB medication.The study findings revealed that participants exhibited commendable adherence to TB medication. Notably, adherence levels were found to be linked to several factors, including income, medication side effects and cohabitation with individuals infected with TB. The positive trend in adherence underscores the importance of considering socioeconomic factors, as lower income was identified as a potential barrier to consistent medication adherence","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"31 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140772194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjph-2023-000556
Raphael G Frankfurter, Victoria Willet, Eugene T Richardson, George W. Rutherford, April Baller, J. D. Kelly
To review evidence pertaining to methods for preventing healthcare-associated filovirus infections (including the survivability of filoviruses in clinical environments and the chlorine concentration required for effective disinfection), and to assess protocols for determining the risk of health worker (HW) exposures to filoviruses.Integrative review.PubMed, Embase, Google Scholar, internet-based sources of international health organisations (eg, WHO, CDC), references of the included literature and grey literature.Laboratory science, clinical research and real-world observational studies identified through comprehensive search strings that pertained to Ebola disease and Marburg disease and the three research objectives.Using the framework of population, intervention or exposure, outcomes, study types and report characteristics, reviewers extracted data and critically appraised the evidence using predefined data extraction forms and summary tables. The extraction forms, summary tables and critical appraisals varied based on the included literature; we used both the QUIPS Risk-of-Bias tool when possible and an internally developed instrument to systematically extract and review the evidence from observational and experimental studies. Evidence was then synthesised and summarised to create summary recommendations.Thirty-six studies (including duplicates across research questions) were included in our reviews. All studies that related to the review questions were either (1) descriptive, real-world studies (ie, environmental audits of various surfaces in operational Ebola Treatment Units) or (2) controlled, laboratory studies (ie, experimental studies on the survivability of ebolaviruses in controlled conditions), presenting a range of concerns pertaining to bias and external validity. Our reviews of viral survivability evidence revealed significant disconnections between laboratory-based and real-world findings. However, there is greater viral persistence in liquid than dried body fluids, with the possible exception of blood, and ebolaviruses can survive for significant periods of time in dried substrate. Evidence suggests that 0.5% hypochlorite solution should be used for disinfection activity. Spills should be cleaned with covering and soaking for 15 min. Existing literature suggests that within a well-resourced clinical environment with trained, foreign HWs and established protocols, transmission of ebolaviruses as an occupational risk is a rare event. Despite the high rates of HW infections within public African healthcare settings, no evidence with low risk of bias exists to assess the risk of various occupational exposures given that all high-quality studies were conducted on foreign Ebola clinicians who had low overall rates of infection. This review underscores the critical need for better-quality evidence to inform best practices to ensure HW safety during filovirus disease epidemics.
{"title":"Infection prevention and control studies for care of patients with suspected or confirmed filovirus disease in healthcare settings, with focus on Ebola and Marburg: an integrative review","authors":"Raphael G Frankfurter, Victoria Willet, Eugene T Richardson, George W. Rutherford, April Baller, J. D. Kelly","doi":"10.1136/bmjph-2023-000556","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000556","url":null,"abstract":"To review evidence pertaining to methods for preventing healthcare-associated filovirus infections (including the survivability of filoviruses in clinical environments and the chlorine concentration required for effective disinfection), and to assess protocols for determining the risk of health worker (HW) exposures to filoviruses.Integrative review.PubMed, Embase, Google Scholar, internet-based sources of international health organisations (eg, WHO, CDC), references of the included literature and grey literature.Laboratory science, clinical research and real-world observational studies identified through comprehensive search strings that pertained to Ebola disease and Marburg disease and the three research objectives.Using the framework of population, intervention or exposure, outcomes, study types and report characteristics, reviewers extracted data and critically appraised the evidence using predefined data extraction forms and summary tables. The extraction forms, summary tables and critical appraisals varied based on the included literature; we used both the QUIPS Risk-of-Bias tool when possible and an internally developed instrument to systematically extract and review the evidence from observational and experimental studies. Evidence was then synthesised and summarised to create summary recommendations.Thirty-six studies (including duplicates across research questions) were included in our reviews. All studies that related to the review questions were either (1) descriptive, real-world studies (ie, environmental audits of various surfaces in operational Ebola Treatment Units) or (2) controlled, laboratory studies (ie, experimental studies on the survivability of ebolaviruses in controlled conditions), presenting a range of concerns pertaining to bias and external validity. Our reviews of viral survivability evidence revealed significant disconnections between laboratory-based and real-world findings. However, there is greater viral persistence in liquid than dried body fluids, with the possible exception of blood, and ebolaviruses can survive for significant periods of time in dried substrate. Evidence suggests that 0.5% hypochlorite solution should be used for disinfection activity. Spills should be cleaned with covering and soaking for 15 min. Existing literature suggests that within a well-resourced clinical environment with trained, foreign HWs and established protocols, transmission of ebolaviruses as an occupational risk is a rare event. Despite the high rates of HW infections within public African healthcare settings, no evidence with low risk of bias exists to assess the risk of various occupational exposures given that all high-quality studies were conducted on foreign Ebola clinicians who had low overall rates of infection. This review underscores the critical need for better-quality evidence to inform best practices to ensure HW safety during filovirus disease epidemics.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjph-2023-000510
A. Naef, Nadine Fischbock, Hürrem Tezcan-Güntekin, V. Amelung
Adolescents with type 1 diabetes mellitus (T1D) require a high level of health literacy (HL) to prevent complications. It remains unclear what potential digital interventions have for promoting HL among adolescents with T1D, as viewed by physicians working with this target group. Additionally, it is unclear how the institutions (inpatient care and outpatient care) can support and facilitate the use of digital interventions to promote HL.An exploratory study was conducted using semistructured interviews with physicians (n=12) in Germany. The interview questions are based on a previous systematic review. The coding was conducted deductively and inductively using MAXQDA software. Subsequently, the interviews were analysed systematically through an iterative process of content analyses in line with Kuckartzet al.It was reported by the physicians that digital interventions are underused due to technical resources, lack of structural conditions, information and legal constraints. The utilisation of digital interventions to promote HL was heterogeneous and depended primarily on the willingness of the physicians. Communication strategy techniques were widely employed to motivate patients, an activity occurring mainly in-person, thus limiting the opportunity for the deployment of digital interventions.To increase the use of digital interventions and improve HL, support for digital literacy skills could be implemented. Capacity building through patient-centred, interdisciplinary and participatory culture should be considered. The findings of this study can provide valuable insights for practice, research and policy.
{"title":"Digital interventions for adolescents with type 1 diabetes to promote health literacy? A qualitative study on physicians’ perspective in Germany","authors":"A. Naef, Nadine Fischbock, Hürrem Tezcan-Güntekin, V. Amelung","doi":"10.1136/bmjph-2023-000510","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000510","url":null,"abstract":"Adolescents with type 1 diabetes mellitus (T1D) require a high level of health literacy (HL) to prevent complications. It remains unclear what potential digital interventions have for promoting HL among adolescents with T1D, as viewed by physicians working with this target group. Additionally, it is unclear how the institutions (inpatient care and outpatient care) can support and facilitate the use of digital interventions to promote HL.An exploratory study was conducted using semistructured interviews with physicians (n=12) in Germany. The interview questions are based on a previous systematic review. The coding was conducted deductively and inductively using MAXQDA software. Subsequently, the interviews were analysed systematically through an iterative process of content analyses in line with Kuckartzet al.It was reported by the physicians that digital interventions are underused due to technical resources, lack of structural conditions, information and legal constraints. The utilisation of digital interventions to promote HL was heterogeneous and depended primarily on the willingness of the physicians. Communication strategy techniques were widely employed to motivate patients, an activity occurring mainly in-person, thus limiting the opportunity for the deployment of digital interventions.To increase the use of digital interventions and improve HL, support for digital literacy skills could be implemented. Capacity building through patient-centred, interdisciplinary and participatory culture should be considered. The findings of this study can provide valuable insights for practice, research and policy.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"1 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjph-2023-000276
Tom Ockhuisen, A. de Nooy, H. E. Jenkins, Alvin X. Han, Colin A Russell, Shaukat Khan, Sarah J Girdwood, Morten Ruhwald, Mikashmi Kohli, Brooke E Nichols
The objective of this scoping review is to understand the cost-effectiveness of current and future tools/strategies for screening and diagnosis of tuberculosis (TB) infection and disease. To this end, PubMed, EMBASE and SCOPUS were used to identify any English language reports on the cost-effectiveness of TB infection/disease screening/diagnostic strategies published between 1 January 2017 and 7 October 2023. Studies included high-burden/risk TB populations, compared diagnostic/screening methods and conducted a cost-effectiveness/economic evaluation. We stratified the included articles in four groups (cost-effectiveness of diagnosing TB disease/infection and cost-effectiveness of screening for TB disease/infection). A full-text review was conducted, and relevant costing data extracted. Of the 2417 articles identified in the initial search, 112 duplicates were removed, and 2305 articles were screened for title and abstract. 23 full articles were reviewed, and 17 fulfilled all inclusion criteria. While sputum smear microscopy (SSM) has been the primary method of diagnosing TB disease in high-burden countries, the current body of literature suggests that SSM is likely to be the least cost-effective tool for the diagnosis of TB disease. Further scale-up with molecular diagnostics, such as GeneXpert and Truenat, was shown to be broadly cost-effective, with a multitest approach likely to be cost-effective for both screening and diagnosis. There is an urgent need to increase access and remove barriers to implementation of diagnostics that have been repeatedly shown to be cost-effective, as well as to develop new diagnostic and screening technologies/strategies to address current barriers to scale-up.
{"title":"Cost-effectiveness of diagnostic tools and strategies for the screening and diagnosis of tuberculosis disease and infection: a scoping review","authors":"Tom Ockhuisen, A. de Nooy, H. E. Jenkins, Alvin X. Han, Colin A Russell, Shaukat Khan, Sarah J Girdwood, Morten Ruhwald, Mikashmi Kohli, Brooke E Nichols","doi":"10.1136/bmjph-2023-000276","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000276","url":null,"abstract":"The objective of this scoping review is to understand the cost-effectiveness of current and future tools/strategies for screening and diagnosis of tuberculosis (TB) infection and disease. To this end, PubMed, EMBASE and SCOPUS were used to identify any English language reports on the cost-effectiveness of TB infection/disease screening/diagnostic strategies published between 1 January 2017 and 7 October 2023. Studies included high-burden/risk TB populations, compared diagnostic/screening methods and conducted a cost-effectiveness/economic evaluation. We stratified the included articles in four groups (cost-effectiveness of diagnosing TB disease/infection and cost-effectiveness of screening for TB disease/infection). A full-text review was conducted, and relevant costing data extracted. Of the 2417 articles identified in the initial search, 112 duplicates were removed, and 2305 articles were screened for title and abstract. 23 full articles were reviewed, and 17 fulfilled all inclusion criteria. While sputum smear microscopy (SSM) has been the primary method of diagnosing TB disease in high-burden countries, the current body of literature suggests that SSM is likely to be the least cost-effective tool for the diagnosis of TB disease. Further scale-up with molecular diagnostics, such as GeneXpert and Truenat, was shown to be broadly cost-effective, with a multitest approach likely to be cost-effective for both screening and diagnosis. There is an urgent need to increase access and remove barriers to implementation of diagnostics that have been repeatedly shown to be cost-effective, as well as to develop new diagnostic and screening technologies/strategies to address current barriers to scale-up.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"49 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjph-2023-000682
Felix Kizito, R. M. Kananura, J. N. Ssanyu, Joseph Akuze, D. Amongin, P. Waiswa
Neonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings and health accessibility challenges surrounding neonatal deaths in the Luuka district from 1 January 2017 to 31 December 2019.We analysed data from 172 neonatal verbal and social autopsies (VASA) conducted over 3 years, as part of a maternal and neonatal demand and supply health system strengthening intervention. Cause-of-death coding was done by two independent medical officers using WHO-ICD-10 guidelines to ascertain the causes of death. VASA-coded data analysis of the causes of death was done in STATA V.14.0. In addition, 16 key informant interviews were conducted, including 2 community health workers,6 household members and 8 health workers, with qualitative data analysed through thematic content analysis.Among the 172 neonate deaths, 95.9% occurred in the early neonatal period (0–6 days) and 4.1% in the late neonatal period (7–27 days). The primary causes of death were birth asphyxia (42.4%), low birth weight/prematurity (18.6%), other perinatal causes (12.8%) and neonatal sepsis (9.3%). Delays in getting appropriate care at the facility (delay 3) and delays in seeking care (delay 1) (51.2% and 44.2%, respectively) were linked to newborn mortality. Qualitative insights underscored inadequate awareness of neonatal danger signs, deficient referral systems, drug shortages, reliance on unskilled traditional birth attendants and insufficient neonatal care facilities as significant contributors.Addressing delays in both home-based care (delay 1) and timely access to appropriate care in healthcare facilities (delays 2 and 3) is pivotal in mitigating neonatal mortality. Comprehensive interventions targeting improved access to maternal services and enhanced quality of care in health facilities are imperative for advancing newborn survival in rural settings.
{"title":"Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda","authors":"Felix Kizito, R. M. Kananura, J. N. Ssanyu, Joseph Akuze, D. Amongin, P. Waiswa","doi":"10.1136/bmjph-2023-000682","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000682","url":null,"abstract":"Neonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings and health accessibility challenges surrounding neonatal deaths in the Luuka district from 1 January 2017 to 31 December 2019.We analysed data from 172 neonatal verbal and social autopsies (VASA) conducted over 3 years, as part of a maternal and neonatal demand and supply health system strengthening intervention. Cause-of-death coding was done by two independent medical officers using WHO-ICD-10 guidelines to ascertain the causes of death. VASA-coded data analysis of the causes of death was done in STATA V.14.0. In addition, 16 key informant interviews were conducted, including 2 community health workers,6 household members and 8 health workers, with qualitative data analysed through thematic content analysis.Among the 172 neonate deaths, 95.9% occurred in the early neonatal period (0–6 days) and 4.1% in the late neonatal period (7–27 days). The primary causes of death were birth asphyxia (42.4%), low birth weight/prematurity (18.6%), other perinatal causes (12.8%) and neonatal sepsis (9.3%). Delays in getting appropriate care at the facility (delay 3) and delays in seeking care (delay 1) (51.2% and 44.2%, respectively) were linked to newborn mortality. Qualitative insights underscored inadequate awareness of neonatal danger signs, deficient referral systems, drug shortages, reliance on unskilled traditional birth attendants and insufficient neonatal care facilities as significant contributors.Addressing delays in both home-based care (delay 1) and timely access to appropriate care in healthcare facilities (delays 2 and 3) is pivotal in mitigating neonatal mortality. Comprehensive interventions targeting improved access to maternal services and enhanced quality of care in health facilities are imperative for advancing newborn survival in rural settings.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"336 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjph-2023-000262
B. Siziba, N. Mgodi, B. Ngara, T. D. Chawana, Miria Chitukuta, P. Mukwekwerere, Muchaneta Bhondai-Mhuri, Z. M. Chirenje, Felix Godwin Sivukile Mhlanga
There is limited evidence on pre-exposure prophylaxis (PrEP) uptake post-trial participation for women vulnerable to HIV. This study investigates the prevalence and factors associated with PrEP uptake post-participation in an HIV prevention trial.Former Antibody Mediated Prevention (AMP) study participants were invited to the three AMP clinical research sites in Zimbabwe after at least a year of exiting the study. The AMP study evaluated the safety and efficacy of Vaccine Research Center 01 broadly neutralising monoclonal antibody in reducing acquisition of HIV-1 infection in women in sub-Saharan Africa. Participants vulnerable to HIV were enrolled and risk reduction counselling was done throughout study participation. In a cross-sectional study, semi-structured interview administered questionnaires were completed. The primary outcome was uptake of PrEP after the study exit.From February 2022 to August 2022, out of 434 participants enrolled in the AMP study, a total of 298 were invited and 225 participated in the study; 28% made an attempt to access PrEP after study participation, 20% used PrEP at some point after study participation and 15% were on PrEP at the time of questionnaire administration. PrEP uptake was associated with new sexual partners after study participation and higher average number of sexual encounters in the previous month. Challenges faced in accessing PrEP included those related to the health facility, transport problems and stigma.The majority (85%) of former AMP participants were not on PrEP at the time of questionnaire administration. We observed poor uptake of PrEP post-study exit among participants who had received risk reduction counselling through study duration. Measures to improve PrEP uptake should be considered on participants vulnerable to HIV when exiting HIV prevention trials.
{"title":"Prevalence and factors associated with uptake of pre-exposure prophylaxis amongst women vulnerable to HIV who received HIV antibodies in Antibody Mediated Prevention HVTN703/HPTN081 trial in Harare, Zimbabwe: a cross-sectional study","authors":"B. Siziba, N. Mgodi, B. Ngara, T. D. Chawana, Miria Chitukuta, P. Mukwekwerere, Muchaneta Bhondai-Mhuri, Z. M. Chirenje, Felix Godwin Sivukile Mhlanga","doi":"10.1136/bmjph-2023-000262","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000262","url":null,"abstract":"There is limited evidence on pre-exposure prophylaxis (PrEP) uptake post-trial participation for women vulnerable to HIV. This study investigates the prevalence and factors associated with PrEP uptake post-participation in an HIV prevention trial.Former Antibody Mediated Prevention (AMP) study participants were invited to the three AMP clinical research sites in Zimbabwe after at least a year of exiting the study. The AMP study evaluated the safety and efficacy of Vaccine Research Center 01 broadly neutralising monoclonal antibody in reducing acquisition of HIV-1 infection in women in sub-Saharan Africa. Participants vulnerable to HIV were enrolled and risk reduction counselling was done throughout study participation. In a cross-sectional study, semi-structured interview administered questionnaires were completed. The primary outcome was uptake of PrEP after the study exit.From February 2022 to August 2022, out of 434 participants enrolled in the AMP study, a total of 298 were invited and 225 participated in the study; 28% made an attempt to access PrEP after study participation, 20% used PrEP at some point after study participation and 15% were on PrEP at the time of questionnaire administration. PrEP uptake was associated with new sexual partners after study participation and higher average number of sexual encounters in the previous month. Challenges faced in accessing PrEP included those related to the health facility, transport problems and stigma.The majority (85%) of former AMP participants were not on PrEP at the time of questionnaire administration. We observed poor uptake of PrEP post-study exit among participants who had received risk reduction counselling through study duration. Measures to improve PrEP uptake should be considered on participants vulnerable to HIV when exiting HIV prevention trials.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"48 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjph-2023-000359
Sofia Ardiles-Ruesjas, Edgar Sanabria, Victor Hugo Segovia Portillo, Lorena Jara Oroa, Viviana de Egea, Guillermo Sequera, Julio Alonso-Padilla, Irene Losada, M. Pinazo
Snakebite envenoming (SBE) is a public health problem in Paraguay where the presence of 15 medically important snake species has been reported. Blessed with large forested areas, its economy largely relies on agricultural production which increases the exposure of outdoor workers to the morbidity and mortality of SBE. Lack of sufficient and accurate epidemiological data highlights the importance of drawing an updated picture of SBE burden in the country.We performed a retrospective descriptive study on secondary SBE data reported to the national surveillance system between 2015 and 2021. We addressed the availability and quality of the data and assessed its epidemiological and sociodemographic burden in Paraguay over that time period.In total, 1651 cases of SBE were reported between 2015 and 2021 representing an average of 235 cases per year (3.33 cases per 100 000 population). Overall, young males (68%, n=1125) of productive age (25 years old, IQR 29) in agricultural and/or livestock settings (47%, n=653) were the most affected population. Departments with a higher number of notifications were San Pedro (12%, n=191), Caazapá and Alto Paraná (10%, n=163). Regarding data quality, variables about clinical outcomes, treatment administration and case management were the worst reported.SBE is a public health issue that affects young workers in rural areas in Paraguay. It mostly remains unattended and improvements in its reporting need to be done in order to gain a better insight into both the health and social burden of this neglected disease.
{"title":"Epidemiological and sociodemographic description of snakebite envenoming cases in Paraguay reported between 2015 and 2021","authors":"Sofia Ardiles-Ruesjas, Edgar Sanabria, Victor Hugo Segovia Portillo, Lorena Jara Oroa, Viviana de Egea, Guillermo Sequera, Julio Alonso-Padilla, Irene Losada, M. Pinazo","doi":"10.1136/bmjph-2023-000359","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000359","url":null,"abstract":"Snakebite envenoming (SBE) is a public health problem in Paraguay where the presence of 15 medically important snake species has been reported. Blessed with large forested areas, its economy largely relies on agricultural production which increases the exposure of outdoor workers to the morbidity and mortality of SBE. Lack of sufficient and accurate epidemiological data highlights the importance of drawing an updated picture of SBE burden in the country.We performed a retrospective descriptive study on secondary SBE data reported to the national surveillance system between 2015 and 2021. We addressed the availability and quality of the data and assessed its epidemiological and sociodemographic burden in Paraguay over that time period.In total, 1651 cases of SBE were reported between 2015 and 2021 representing an average of 235 cases per year (3.33 cases per 100 000 population). Overall, young males (68%, n=1125) of productive age (25 years old, IQR 29) in agricultural and/or livestock settings (47%, n=653) were the most affected population. Departments with a higher number of notifications were San Pedro (12%, n=191), Caazapá and Alto Paraná (10%, n=163). Regarding data quality, variables about clinical outcomes, treatment administration and case management were the worst reported.SBE is a public health issue that affects young workers in rural areas in Paraguay. It mostly remains unattended and improvements in its reporting need to be done in order to gain a better insight into both the health and social burden of this neglected disease.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"818 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140772728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/bmjph-2023-000219
Richard Lowrie, Andrew McPherson, Frances Mair, K. Stock, Donogh Maguire, V. Paudyal, Clare Duncan, Rebecca Blair, C. Lombard, Steven Ross, Fiona Hughes, J. Moir, Ailsa Scott, Frank Reilly, L. Sills, Jennifer Hislop, Stephen Wishart, David Brannan, James Roy Robertson, Rebekah Ramage, Alison Boyle, Nicola Greenlaw, Andrea E Williamson
To examine randomised controlled trial (RCT) progression criteria including emergency department (ED) attendance and non-fatal overdose, from a holistic, integrated health and social care outreach intervention (PHOENIx), for people experiencing homelessness with recent non-fatal street drug overdose.Pilot RCT. 1:1 randomisation to PHOENIx plus usual care (UC) or UC.Glasgow, Scotland.128 adults experiencing homelessness with at least one non-fatal street drug overdose in the preceding 6 months.Pharmacists from the National Health Service and third sector homelessness workers offered weekly outreach. PHOENIx teams develop therapeutic relationships to address health (physical health, mental health and problem drug use) and social care (housing, welfare benefits and social prescribing) in addition to UC. UC comprised building-based primary and secondary health, social and third sector services.Primary: progression criteria: recruitment (≥100 participants in 4 months); ≥80% of participants with data collected at baseline, 6 and 9 months; ≥60% of participants retained in the trial at each follow-up period (6 and 9 months); ≥60% of participants receiving the intervention weekly; any reduction in the rate of presentation to ED and overdoses, at 6- or 9-month follow-up. Secondary: participants with, and time to: hospitalisations; health-related quality of life (QoL); treatment uptake for physical and mental health conditions, and problematic drug use.Progression criteria were exceeded. In PHOENIx compared with UC, there appeared to be a delay in the median time to ED visit, overdose and hospitalisation but no improvement in number of participants with ED visits, overdoses or hospitalisations. QoL and treatment uptake appeared to be higher in PHOENIx versus UC at 6 and 9 months.A definitive RCT is merited, to assess the impact of PHOENIx on people with multiple, severe disadvantages.ISRCTN10585019.
{"title":"Holistic health and social care outreach for people experiencing homelessness with recent non-fatal overdose in Glasgow, Scotland: the Pharmacist and third sector Homeless charity worker Outreach Engagement Non-medical Independent prescriber Rx (PHOENIx) pilot randomised controlled trial","authors":"Richard Lowrie, Andrew McPherson, Frances Mair, K. Stock, Donogh Maguire, V. Paudyal, Clare Duncan, Rebecca Blair, C. Lombard, Steven Ross, Fiona Hughes, J. Moir, Ailsa Scott, Frank Reilly, L. Sills, Jennifer Hislop, Stephen Wishart, David Brannan, James Roy Robertson, Rebekah Ramage, Alison Boyle, Nicola Greenlaw, Andrea E Williamson","doi":"10.1136/bmjph-2023-000219","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000219","url":null,"abstract":"To examine randomised controlled trial (RCT) progression criteria including emergency department (ED) attendance and non-fatal overdose, from a holistic, integrated health and social care outreach intervention (PHOENIx), for people experiencing homelessness with recent non-fatal street drug overdose.Pilot RCT. 1:1 randomisation to PHOENIx plus usual care (UC) or UC.Glasgow, Scotland.128 adults experiencing homelessness with at least one non-fatal street drug overdose in the preceding 6 months.Pharmacists from the National Health Service and third sector homelessness workers offered weekly outreach. PHOENIx teams develop therapeutic relationships to address health (physical health, mental health and problem drug use) and social care (housing, welfare benefits and social prescribing) in addition to UC. UC comprised building-based primary and secondary health, social and third sector services.Primary: progression criteria: recruitment (≥100 participants in 4 months); ≥80% of participants with data collected at baseline, 6 and 9 months; ≥60% of participants retained in the trial at each follow-up period (6 and 9 months); ≥60% of participants receiving the intervention weekly; any reduction in the rate of presentation to ED and overdoses, at 6- or 9-month follow-up. Secondary: participants with, and time to: hospitalisations; health-related quality of life (QoL); treatment uptake for physical and mental health conditions, and problematic drug use.Progression criteria were exceeded. In PHOENIx compared with UC, there appeared to be a delay in the median time to ED visit, overdose and hospitalisation but no improvement in number of participants with ED visits, overdoses or hospitalisations. QoL and treatment uptake appeared to be higher in PHOENIx versus UC at 6 and 9 months.A definitive RCT is merited, to assess the impact of PHOENIx on people with multiple, severe disadvantages.ISRCTN10585019.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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