Social networking sites (SNS) have become the contemporary platform of choice for advertising, promoting, sponsoring, boosting and expanding tobacco marketing. A youth-led campaign was conducted to (i) identify and collate violations of tobacco advertisement, promotion, and sponsorship on SNS; and (ii) undertake content analysis of the collated violations. After a series of capacity-building webinars aimed at empowering youths, they were tasked with collating posts (photos and videos) that showcased the promotion and sale of tobacco products online. Additionally, the youth identified relevant hashtags used to promote tobacco. The youth identified 748 posts (photos and videos) on SNS where tobacco was being promoted. Most of these posts (84.7%) promoted the ‘smoking form’ of tobacco. Renowned celebrities and influencers with massive followership actively endorsed tobacco products. The youth identified 148 pages that were involved in selling tobacco online. Instagram (62.7%) accounted for the majority, followed by Facebook (23.7%). The most commonly available forms of tobacco in these online stores were ‘smoked forms’ (73.5%). In their efforts, the youth collated 1412 hashtags related to tobacco promotion. The most commonly reported hashtags were #smoking and #hookah. The maximum numbers of tobacco posts were for #vape (296 million) and #smoke (218 million). There is an urgent need to revise Section 5 of “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act, 2003” to broaden the coverage of tobacco advertising, promotion, and sponsorship (TAPS) prohibition on all internet-based platforms including SNS to protect Indian youth.
{"title":"Tobacco-related content on social networking sites: evidence from a youth-led campaign in India","authors":"Deepika Bahl, Shalini Bassi, Nishibha Thapliyal, Praveen Sinha, Monika Arora, Munish S. Gill","doi":"10.29392/001c.85126","DOIUrl":"https://doi.org/10.29392/001c.85126","url":null,"abstract":"Social networking sites (SNS) have become the contemporary platform of choice for advertising, promoting, sponsoring, boosting and expanding tobacco marketing. A youth-led campaign was conducted to (i) identify and collate violations of tobacco advertisement, promotion, and sponsorship on SNS; and (ii) undertake content analysis of the collated violations. After a series of capacity-building webinars aimed at empowering youths, they were tasked with collating posts (photos and videos) that showcased the promotion and sale of tobacco products online. Additionally, the youth identified relevant hashtags used to promote tobacco. The youth identified 748 posts (photos and videos) on SNS where tobacco was being promoted. Most of these posts (84.7%) promoted the ‘smoking form’ of tobacco. Renowned celebrities and influencers with massive followership actively endorsed tobacco products. The youth identified 148 pages that were involved in selling tobacco online. Instagram (62.7%) accounted for the majority, followed by Facebook (23.7%). The most commonly available forms of tobacco in these online stores were ‘smoked forms’ (73.5%). In their efforts, the youth collated 1412 hashtags related to tobacco promotion. The most commonly reported hashtags were #smoking and #hookah. The maximum numbers of tobacco posts were for #vape (296 million) and #smoke (218 million). There is an urgent need to revise Section 5 of “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act, 2003” to broaden the coverage of tobacco advertising, promotion, and sponsorship (TAPS) prohibition on all internet-based platforms including SNS to protect Indian youth.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138973786","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}
Gloria Mutimbwa Siseho, Thubelihle Mathole, Debra Jackson
Attention to quality-of-care is increasing in low- and-middle-income countries. Nevertheless, few studies exist on the impact of these approaches to caregiving. This paper presents results on the quality-of-care mothers and neonates receive during labour, childbirth, and early postnatal care, pre-and-post-implementation of the World Health Organization/United Nations Children’s Fund/United Population Fund (WHO/UNICEF/UNFPA) quality improvement interventions. A quasi-experimental study design was used to assess the quality-of-care measures/interventions around childbirth and the immediate postnatal care period; we purposively sampled a high-volume hospital, northeast Namibia. Using the Every Mother Every Newborn (EMEN) childbirth quantitative survey questionnaire, we interviewed (pre=100; post=102) women who delivered prior to their discharge home and observed (pre=53; post=60) different women at admission, of which 19 of 53 and 50 of 60, respectively, progressed to deliver on the same day of data collection. Twenty (pre) and 24 (post) staff, and one facility manager (pre-and-post) were also interviewed. Descriptive statistics were used to present results. Postintervention, we found improvements in most assessed quality-of-care measures/interventions, e.g., thorough drying (94.7-100%), babies placed skin-to-skin with their mothers (89.5-98%) and assessed for resuscitation (69.8-98%) needs. Monitoring labour using partograph remained low (11.3-19.3%). During admission, women’s history taking (75.5-95%), blood pressure (98.1%-100%), urine testing (77.4-93.3%), foetal heart rate (94.3-100%), abdominal (86.8-100%) and vaginal examinations (96.2-100%) all improved. Yet, quality-of-care gaps were identified for labour monitoring, and routine postnatal care. Less 50% of women received counselling on family planning (5.3-42%), postnatal care (5.3-40%), maternal (0-38%) and newborn (0-40%) danger signs. Women’s satisfaction with information on breastfeeding and post-partum care and hygiene was 48-56.9% and 41-43.0% respectively. This is the first study in Namibia to assess pre-and-post implementation of quality-of-care practices around childbirth, and postnatal period. Inconsistency and noteworthy quality-of-care gaps exist in the early postnatal care period. Postnatal care management and interpersonal communication skills trainings are likely to improve and sustain high evidence-based care beyond labour and delivery. The poor quality-of-care practices for labour and postnatal care requires further investigation.
{"title":"Implementing quality-of-care during labour, childbirth, and early postnatal care, northeast Namibia: a quasi-experimental study","authors":"Gloria Mutimbwa Siseho, Thubelihle Mathole, Debra Jackson","doi":"10.29392/001c.90725","DOIUrl":"https://doi.org/10.29392/001c.90725","url":null,"abstract":"Attention to quality-of-care is increasing in low- and-middle-income countries. Nevertheless, few studies exist on the impact of these approaches to caregiving. This paper presents results on the quality-of-care mothers and neonates receive during labour, childbirth, and early postnatal care, pre-and-post-implementation of the World Health Organization/United Nations Children’s Fund/United Population Fund (WHO/UNICEF/UNFPA) quality improvement interventions. A quasi-experimental study design was used to assess the quality-of-care measures/interventions around childbirth and the immediate postnatal care period; we purposively sampled a high-volume hospital, northeast Namibia. Using the Every Mother Every Newborn (EMEN) childbirth quantitative survey questionnaire, we interviewed (pre=100; post=102) women who delivered prior to their discharge home and observed (pre=53; post=60) different women at admission, of which 19 of 53 and 50 of 60, respectively, progressed to deliver on the same day of data collection. Twenty (pre) and 24 (post) staff, and one facility manager (pre-and-post) were also interviewed. Descriptive statistics were used to present results. Postintervention, we found improvements in most assessed quality-of-care measures/interventions, e.g., thorough drying (94.7-100%), babies placed skin-to-skin with their mothers (89.5-98%) and assessed for resuscitation (69.8-98%) needs. Monitoring labour using partograph remained low (11.3-19.3%). During admission, women’s history taking (75.5-95%), blood pressure (98.1%-100%), urine testing (77.4-93.3%), foetal heart rate (94.3-100%), abdominal (86.8-100%) and vaginal examinations (96.2-100%) all improved. Yet, quality-of-care gaps were identified for labour monitoring, and routine postnatal care. Less 50% of women received counselling on family planning (5.3-42%), postnatal care (5.3-40%), maternal (0-38%) and newborn (0-40%) danger signs. Women’s satisfaction with information on breastfeeding and post-partum care and hygiene was 48-56.9% and 41-43.0% respectively. This is the first study in Namibia to assess pre-and-post implementation of quality-of-care practices around childbirth, and postnatal period. Inconsistency and noteworthy quality-of-care gaps exist in the early postnatal care period. Postnatal care management and interpersonal communication skills trainings are likely to improve and sustain high evidence-based care beyond labour and delivery. The poor quality-of-care practices for labour and postnatal care requires further investigation.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138979419","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}
Small but stable low birth weight (LBW) neonates have needs similar to babies of normal weight with the need for extra support with feeding and temperature maintenance. Most health facilities admit such infants in the neonatal unit leading to the separation of the mother and baby. This separation exposes the infant to a potentially contaminated environment of the Neonatal intensive care unit (NICU) which is hazardous for stable infants (Invasive interventions, Intravenous alimentation, Infections) and also hampers the establishment of breastfeeding. This study evaluated short-term outcomes of stable neonates weighing 1500-2000 grams at birth cared for in the mother-baby unit in the same room. as their mothers as per the ‘Zero-separation Policy’. Neonates born vaginally with a birth weight of 1500-2000 grams with stable vitals were moved with their mothers to a 12-bed ’’mother-baby unit (MBU)“. Mothers were counseled regarding breastfeeding (BF), Kangaroo mother care (KMC), maintenance of general hygiene, and identification of danger signs. Infants developing moderate to severe hypothermia, hypoglycemia, feed intolerance (FI), jaundice nearing exchange transfusion range, respiratory difficulty, sepsis, seizures, or apnea, were moved to a neonatal unit for further management. Over 3 years, 489 neonates with a mean (± SD) birth weight of 1738 ± 102 grams and median gestation of 34 weeks (range: 32-41 weeks) were cared for with their mothers at the MBU. Seventy percent of infants exclusively received their mother’s own milk on day 1, which increased to more than 95% from day 4 onwards. Similarly, two-thirds of the mothers provided KMC for at least 5-8 hours on day 1, increasing to 85% by day 5. Neonatal hyperbilirubinemia requiring treatment was the most common morbidity (28.8%), most of which was managed at the bedside, followed by hypoglycemia (4.7%). Only 8% of neonates (n= 39/489) required transfer to the neonatal unit, mostly for hypoglycemia and hyperbilirubinemia. No baby developed hypothermia, apnea, FI, seizures, or hemodynamic instability. Successful discharge to home was accomplished in all neonates with no mortality. Zero-separation policy is feasible in clinically stable low-weight or small neonates (of 1500-2000 grams) who can be nurtured with their mothers right from birth, ensuring timely feeding, KMC, and good hygienic practices.
{"title":"Zero separation policy in small but stable neonates weighing 1500-2000 grams at birth: a single center study in New Delhi, India","authors":"Rohit Anand, Srishti Goel, Sugandha Saxena, Bhawna Dubey, Gunjana Kumar, Sushma Nangia","doi":"10.29392/001c.90041","DOIUrl":"https://doi.org/10.29392/001c.90041","url":null,"abstract":"Small but stable low birth weight (LBW) neonates have needs similar to babies of normal weight with the need for extra support with feeding and temperature maintenance. Most health facilities admit such infants in the neonatal unit leading to the separation of the mother and baby. This separation exposes the infant to a potentially contaminated environment of the Neonatal intensive care unit (NICU) which is hazardous for stable infants (Invasive interventions, Intravenous alimentation, Infections) and also hampers the establishment of breastfeeding. This study evaluated short-term outcomes of stable neonates weighing 1500-2000 grams at birth cared for in the mother-baby unit in the same room. as their mothers as per the ‘Zero-separation Policy’. Neonates born vaginally with a birth weight of 1500-2000 grams with stable vitals were moved with their mothers to a 12-bed ’’mother-baby unit (MBU)“. Mothers were counseled regarding breastfeeding (BF), Kangaroo mother care (KMC), maintenance of general hygiene, and identification of danger signs. Infants developing moderate to severe hypothermia, hypoglycemia, feed intolerance (FI), jaundice nearing exchange transfusion range, respiratory difficulty, sepsis, seizures, or apnea, were moved to a neonatal unit for further management. Over 3 years, 489 neonates with a mean (± SD) birth weight of 1738 ± 102 grams and median gestation of 34 weeks (range: 32-41 weeks) were cared for with their mothers at the MBU. Seventy percent of infants exclusively received their mother’s own milk on day 1, which increased to more than 95% from day 4 onwards. Similarly, two-thirds of the mothers provided KMC for at least 5-8 hours on day 1, increasing to 85% by day 5. Neonatal hyperbilirubinemia requiring treatment was the most common morbidity (28.8%), most of which was managed at the bedside, followed by hypoglycemia (4.7%). Only 8% of neonates (n= 39/489) required transfer to the neonatal unit, mostly for hypoglycemia and hyperbilirubinemia. No baby developed hypothermia, apnea, FI, seizures, or hemodynamic instability. Successful discharge to home was accomplished in all neonates with no mortality. Zero-separation policy is feasible in clinically stable low-weight or small neonates (of 1500-2000 grams) who can be nurtured with their mothers right from birth, ensuring timely feeding, KMC, and good hygienic practices.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138981539","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}
C. Dieteren, Alexander Christiaan Boers, Tatiana Mossus, Frida Essomba, Guy Wafeu, Berthe Agnouanang, William Thomas, O. Njoya, Roel Arnold Coutihno
Many governments in low- and middle-income countries (LMICs) have difficulties paying healthcare costs upfront leading to high out-of-pocket payments for patients. A Development Impact Bond (DIB) is an innovative financing mechanism in which pr ivate investors provide pre-payment of development program expenses. At the same time, public agencies or donors repay the investor’s investment with a reasonable interest rate if the program succeeds in delivering independently measurable results that are contractually agreed upon. This study assessed quantitatively and qualitatively the feasibility of a DIB for hepatitis C Virus (HCV) diagnosis and treatment in Cameroon. A revolving fund of up to €230,000 was made available by the investor. The outcome payor reimbursed the investor only in case of good performance, defined as cured patients (HCV-RNA negative). HCV carriers who were identified were referred for treatment and tested for cure 12 weeks after completion of treatment, the outcome being validated by an independent assessor. The evaluation was guided by the six-agents model, involving interviews with relevant stakeholders (N= 22). In total, 253 (98%) patients completed treatment, of which 244 (96%) are cured at week 24. We estimated that the average per-patient outcome payment for HCV diagnosis and treatment is €1,542, and the average costs per treated patient is €1,858. The investor was fully repaid, including the agreed interest and bonus. Themes or findings from the interviews confirmed the feasibility of a DIB in a low-resource setting. This study demonstrates that a DIB can be a suitable financing mechanism for HCV services, supporting the path towards elimination. When governments in LMICs do not have sufficient resources to fund such elimination programs upfront, such public-private partnerships can offer a solution.
{"title":"A small-scale ‘Development Impact Bond’ for hepatitis C diagnosis and treatment financing in Cameroon: the way to elimination?","authors":"C. Dieteren, Alexander Christiaan Boers, Tatiana Mossus, Frida Essomba, Guy Wafeu, Berthe Agnouanang, William Thomas, O. Njoya, Roel Arnold Coutihno","doi":"10.29392/001c.90723","DOIUrl":"https://doi.org/10.29392/001c.90723","url":null,"abstract":"Many governments in low- and middle-income countries (LMICs) have difficulties paying healthcare costs upfront leading to high out-of-pocket payments for patients. A Development Impact Bond (DIB) is an innovative financing mechanism in which pr ivate investors provide pre-payment of development program expenses. At the same time, public agencies or donors repay the investor’s investment with a reasonable interest rate if the program succeeds in delivering independently measurable results that are contractually agreed upon. This study assessed quantitatively and qualitatively the feasibility of a DIB for hepatitis C Virus (HCV) diagnosis and treatment in Cameroon. A revolving fund of up to €230,000 was made available by the investor. The outcome payor reimbursed the investor only in case of good performance, defined as cured patients (HCV-RNA negative). HCV carriers who were identified were referred for treatment and tested for cure 12 weeks after completion of treatment, the outcome being validated by an independent assessor. The evaluation was guided by the six-agents model, involving interviews with relevant stakeholders (N= 22). In total, 253 (98%) patients completed treatment, of which 244 (96%) are cured at week 24. We estimated that the average per-patient outcome payment for HCV diagnosis and treatment is €1,542, and the average costs per treated patient is €1,858. The investor was fully repaid, including the agreed interest and bonus. Themes or findings from the interviews confirmed the feasibility of a DIB in a low-resource setting. This study demonstrates that a DIB can be a suitable financing mechanism for HCV services, supporting the path towards elimination. When governments in LMICs do not have sufficient resources to fund such elimination programs upfront, such public-private partnerships can offer a solution.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138980963","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}
S. Batman, M. Piya, Sandhya Chapagain, Poonam Lama, Pabitra Maharjan, Binod Aryal, Maya Neupane, Shashwat Pariyar, N. Phoolcharoen, Vanessa J. Eaton, V. Sarchet, Megan Kremzier, Jenny Carns, R. Richards-Kortum, Ellen Baker, Melissa López Varón, M. Pontremoli Salcedo, Jessica Milan, Kathleen M Schmeler, Jitendra Pariyar
Cervical cancer remains the leading cause of cancer-related death among Nepalese women. To this effect, Cancer Care Nepal established an international collaboration to implement a ‘training of trainers’ (TOT) program to expand the reach of cervical cancer prevention techniques. The Nepal cervical cancer prevention program began with an in-person TOT session in Kathmandu in November 2019. Due to the COVID-19 pandemic, two additional TOT courses were held in October and November 2021 with virtual support, didactic lectures from international faculty, and a hands-on component by Nepalese faculty. The Nepalese providers underwent training in these courses and then held further training in five collaborating centers across Nepal. Participants completed pre- and post-course knowledge assessments. The trainings were supplemented by the creation of a new Project ECHO® (Extension for Community Healthcare Outcomes) telementoring hub at Cancer Care Nepal. A capstone refresher course was held in November 2022. 42 participants attended the initial TOT course in 2019. The two follow-up TOT courses held in October/November 2021 were two days long and included providers from five participating regions in Nepal. The courses included virtual didactic sessions followed by hands-on stations led by the Nepalese faculty who had participated in the 2019 TOT course. The stations included: visual inspection with acetic acid (VIA), colposcopy, thermal ablation, and loop electrosurgical excision procedure (LEEP). There were 41 participants in the October/November TOT courses. The trainers who received the TOT education then conducted local courses of similar content in each of the five regions for 152 local providers. Participants had improved mean knowledge scores after the training (0.70, 95% CI=0.67-0.72) in comparison to prior to training (0.50, 95% CI=0.47-0.53), p<0.001. The program concluded with a capstone course in November 2022 attended by 26 participants. To date, 11 Project ECHO sessions have been held, with an average of 20 participants per session. Nepal’s cervical cancer prevention program has increased the number of providers trained in cervical cancer prevention techniques. By increasing provider capacity, individuals will have increased access to cervical cancer screening and treatment of pre-invasive disease, hopefully decreasing the burden of cervical cancer in Nepal.
{"title":"Cervical cancer prevention program in Nepal: a ‘training of trainers’ approach","authors":"S. Batman, M. Piya, Sandhya Chapagain, Poonam Lama, Pabitra Maharjan, Binod Aryal, Maya Neupane, Shashwat Pariyar, N. Phoolcharoen, Vanessa J. Eaton, V. Sarchet, Megan Kremzier, Jenny Carns, R. Richards-Kortum, Ellen Baker, Melissa López Varón, M. Pontremoli Salcedo, Jessica Milan, Kathleen M Schmeler, Jitendra Pariyar","doi":"10.29392/001c.90042","DOIUrl":"https://doi.org/10.29392/001c.90042","url":null,"abstract":"Cervical cancer remains the leading cause of cancer-related death among Nepalese women. To this effect, Cancer Care Nepal established an international collaboration to implement a ‘training of trainers’ (TOT) program to expand the reach of cervical cancer prevention techniques. The Nepal cervical cancer prevention program began with an in-person TOT session in Kathmandu in November 2019. Due to the COVID-19 pandemic, two additional TOT courses were held in October and November 2021 with virtual support, didactic lectures from international faculty, and a hands-on component by Nepalese faculty. The Nepalese providers underwent training in these courses and then held further training in five collaborating centers across Nepal. Participants completed pre- and post-course knowledge assessments. The trainings were supplemented by the creation of a new Project ECHO® (Extension for Community Healthcare Outcomes) telementoring hub at Cancer Care Nepal. A capstone refresher course was held in November 2022. 42 participants attended the initial TOT course in 2019. The two follow-up TOT courses held in October/November 2021 were two days long and included providers from five participating regions in Nepal. The courses included virtual didactic sessions followed by hands-on stations led by the Nepalese faculty who had participated in the 2019 TOT course. The stations included: visual inspection with acetic acid (VIA), colposcopy, thermal ablation, and loop electrosurgical excision procedure (LEEP). There were 41 participants in the October/November TOT courses. The trainers who received the TOT education then conducted local courses of similar content in each of the five regions for 152 local providers. Participants had improved mean knowledge scores after the training (0.70, 95% CI=0.67-0.72) in comparison to prior to training (0.50, 95% CI=0.47-0.53), p<0.001. The program concluded with a capstone course in November 2022 attended by 26 participants. To date, 11 Project ECHO sessions have been held, with an average of 20 participants per session. Nepal’s cervical cancer prevention program has increased the number of providers trained in cervical cancer prevention techniques. By increasing provider capacity, individuals will have increased access to cervical cancer screening and treatment of pre-invasive disease, hopefully decreasing the burden of cervical cancer in Nepal.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196868","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}
Nyashadzaishe Mafirakureva, Sushant Mukherjee, Lise Denoeud-Ndam, Rose Otieno-Masaba, Boris Tchounga, Millicent Anyango Ouma, Stephen Siamba, Saint-Just Petnga, Patrice Tchendjou, Martina Casenghi, Appolinaire Tiam, Peter J Dodd
Background Elimination of catastrophic costs due to tuberculosis (TB) is one of the three targets of the World Health Organization (WHO) End TB Strategy. Limited data have yet been reported on the costs experienced by households of children receiving TB services. We quantified the economic impact on households with children seeking and receiving TB services during the Catalyzing Pediatric TB Innovations (CaP-TB) project in Cameroon and Kenya. Methods Within the INPUT stepped-wedge cluster-randomised study evaluating the effect of CaP-TB integration of TB services in paediatric entry points, we designed a cross-sectional facility-based survey with retrospective data collection using a standardised questionnaire adapted from the WHO Global taskforce on TB patient cost generic survey instrument. Caregivers of children receiving TB services (screening, diagnosis and treatment of drug-sensitive TB) during the CaP-TB project were interviewed between November 2020 and June 2021. Direct medical, direct non-medical, and indirect costs for TB services were analysed following WHO Global taskforce recommendations. We used the human capital and output-based approaches to estimating income loss. All costs are presented in 2021 US dollars. Results A total of 56 caregivers representing their households (Cameroon, 26, and Kenya, 30) were interviewed. The median household costs for TB services, estimated using the human capital approach, were $255 (IQR; $130-631) in Cameroon and $120 ($65-236) in Kenya. The main cost drivers across both countries were direct non-medical costs (transportation and food), 52%; and medical costs, 34%. Approximately 50% of households reported experiencing dissavings (taking a loan, or selling an asset) to deal with costs related to TB disease. Using a threshold of 20% of annual household income, 50% (95%CI; 37-63%) of households experienced catastrophic costs when using the human capital approach; (46% (95%CI; 29-65%) in Cameroon and 53% (95%CI; 36-70%) in Kenya). Estimated costs and incidence of catastrophic costs increased when using the output-based approach in a sensitivity analysis. Conclusions Accessing and receiving TB services for children results in high levels of cost to households, despite the provision of free TB services. Strategies to reduce costs for TB services for children need to address social protection measures or explore decentralisation. Registration: https://clinicaltrials.gov/ct2/show/NCT03862261.
{"title":"Household costs incurred when seeking and receiving paediatric tuberculosis services: a survey in Cameroon and Kenya","authors":"Nyashadzaishe Mafirakureva, Sushant Mukherjee, Lise Denoeud-Ndam, Rose Otieno-Masaba, Boris Tchounga, Millicent Anyango Ouma, Stephen Siamba, Saint-Just Petnga, Patrice Tchendjou, Martina Casenghi, Appolinaire Tiam, Peter J Dodd","doi":"10.29392/001c.88168","DOIUrl":"https://doi.org/10.29392/001c.88168","url":null,"abstract":"Background Elimination of catastrophic costs due to tuberculosis (TB) is one of the three targets of the World Health Organization (WHO) End TB Strategy. Limited data have yet been reported on the costs experienced by households of children receiving TB services. We quantified the economic impact on households with children seeking and receiving TB services during the Catalyzing Pediatric TB Innovations (CaP-TB) project in Cameroon and Kenya. Methods Within the INPUT stepped-wedge cluster-randomised study evaluating the effect of CaP-TB integration of TB services in paediatric entry points, we designed a cross-sectional facility-based survey with retrospective data collection using a standardised questionnaire adapted from the WHO Global taskforce on TB patient cost generic survey instrument. Caregivers of children receiving TB services (screening, diagnosis and treatment of drug-sensitive TB) during the CaP-TB project were interviewed between November 2020 and June 2021. Direct medical, direct non-medical, and indirect costs for TB services were analysed following WHO Global taskforce recommendations. We used the human capital and output-based approaches to estimating income loss. All costs are presented in 2021 US dollars. Results A total of 56 caregivers representing their households (Cameroon, 26, and Kenya, 30) were interviewed. The median household costs for TB services, estimated using the human capital approach, were $255 (IQR; $130-631) in Cameroon and $120 ($65-236) in Kenya. The main cost drivers across both countries were direct non-medical costs (transportation and food), 52%; and medical costs, 34%. Approximately 50% of households reported experiencing dissavings (taking a loan, or selling an asset) to deal with costs related to TB disease. Using a threshold of 20% of annual household income, 50% (95%CI; 37-63%) of households experienced catastrophic costs when using the human capital approach; (46% (95%CI; 29-65%) in Cameroon and 53% (95%CI; 36-70%) in Kenya). Estimated costs and incidence of catastrophic costs increased when using the output-based approach in a sensitivity analysis. Conclusions Accessing and receiving TB services for children results in high levels of cost to households, despite the provision of free TB services. Strategies to reduce costs for TB services for children need to address social protection measures or explore decentralisation. Registration: https://clinicaltrials.gov/ct2/show/NCT03862261.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135475597","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}
Nyashadzaishe Mafirakureva, Sushant Mukherjee, Boris Tchounga, Daniel Atwine, Boris Tchakounte Youngui, Bob Ssekyanzi, Richard Okello, Simo Leonie, Jennifer Cohn, Martina Casenghi, Anca Vasiliu, Maryline Bonnet, Peter J Dodd
Background Tuberculosis preventive treatment (TPT) in child household contacts is recommended by World Health Organization (WHO) but limited data has been reported on the costs experienced by households with children receiving TPT. Methods We evaluated the economic impact on households with children receiving TPT within a service-delivery model cluster-randomised controlled trial in Cameroon and Uganda. The intervention included community health worker-led home-based child-contact screening, TPT initiation and monitoring, and referral of children with presumptive tuberculosis or side effects, and was compared with each country’s facility-based standard of care (control). We used a retrospective cross-sectional survey adapted from the WHO Global task force on tuberculosis patient cost surveys. All costs were collected between February 2021 and March 2021 and are presented in 2021 US$. Results The median household costs estimated using the human capital approach were higher in the control arm ($62.96 [interquartile range, IQR; $19.78-239.74] in Cameroon and $35.95 [IQR; $29.03-91.26] in Uganda) compared to the intervention arm ($2.73 [IQR; $2.73-14.18] in Cameroon and $4.55 [IQR; $3.03-6.06] in Uganda). Using a threshold of 20% of annual household income, 15% (95%CI; 5-31%) of households in Cameroon and 14% (95%CI; 4-26%) in Uganda experienced catastrophic costs in the control compared to 3% (95%CI; 1- 8%) in Cameroon and 3% (95%CI; 1-8%) in Uganda in the intervention. Using the output-based approach to estimate income losses increased costs by 14-32% in the control and 13-19% in the intervention across the two countries. The proportion of participants experiencing any dissaving was higher in the control, 53% (95%CI; 36-71%) in Cameroon and 50% (95%CI; 31-69%) in Uganda, compared to 18% (95%CI; 10-29%) in Cameroon and 17% (95%CI; 8-28%) in Uganda in the intervention. Conclusions Households with child contacts initiated on TPT under a facility-based model incur significant costs. Community-based interventions help to reduce these costs but do not eliminate catastrophic expenditures. Registration https://clinicaltrials.gov/ct2/show/NCT03832023.
{"title":"Household costs incurred under community- and facility-based service-delivery models of tuberculosis preventive therapy for children: a survey in Cameroon and Uganda","authors":"Nyashadzaishe Mafirakureva, Sushant Mukherjee, Boris Tchounga, Daniel Atwine, Boris Tchakounte Youngui, Bob Ssekyanzi, Richard Okello, Simo Leonie, Jennifer Cohn, Martina Casenghi, Anca Vasiliu, Maryline Bonnet, Peter J Dodd","doi":"10.29392/001c.88170","DOIUrl":"https://doi.org/10.29392/001c.88170","url":null,"abstract":"Background Tuberculosis preventive treatment (TPT) in child household contacts is recommended by World Health Organization (WHO) but limited data has been reported on the costs experienced by households with children receiving TPT. Methods We evaluated the economic impact on households with children receiving TPT within a service-delivery model cluster-randomised controlled trial in Cameroon and Uganda. The intervention included community health worker-led home-based child-contact screening, TPT initiation and monitoring, and referral of children with presumptive tuberculosis or side effects, and was compared with each country’s facility-based standard of care (control). We used a retrospective cross-sectional survey adapted from the WHO Global task force on tuberculosis patient cost surveys. All costs were collected between February 2021 and March 2021 and are presented in 2021 US$. Results The median household costs estimated using the human capital approach were higher in the control arm ($62.96 [interquartile range, IQR; $19.78-239.74] in Cameroon and $35.95 [IQR; $29.03-91.26] in Uganda) compared to the intervention arm ($2.73 [IQR; $2.73-14.18] in Cameroon and $4.55 [IQR; $3.03-6.06] in Uganda). Using a threshold of 20% of annual household income, 15% (95%CI; 5-31%) of households in Cameroon and 14% (95%CI; 4-26%) in Uganda experienced catastrophic costs in the control compared to 3% (95%CI; 1- 8%) in Cameroon and 3% (95%CI; 1-8%) in Uganda in the intervention. Using the output-based approach to estimate income losses increased costs by 14-32% in the control and 13-19% in the intervention across the two countries. The proportion of participants experiencing any dissaving was higher in the control, 53% (95%CI; 36-71%) in Cameroon and 50% (95%CI; 31-69%) in Uganda, compared to 18% (95%CI; 10-29%) in Cameroon and 17% (95%CI; 8-28%) in Uganda in the intervention. Conclusions Households with child contacts initiated on TPT under a facility-based model incur significant costs. Community-based interventions help to reduce these costs but do not eliminate catastrophic expenditures. Registration https://clinicaltrials.gov/ct2/show/NCT03832023.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135475080","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}
Background The health sector is essential in delivering high-quality nutrition interventions to women and children in low and middle-income countries, and Mozambique is no exception. Still, the quality and readiness of health services to deliver nutritional services have yet to be comprehensively mapped across the country. We assessed the accessibility and readiness of health facilities to deliver maternal and child nutrition services in Mozambique. Methods Using multiple data sources within a geographic information system (GIS) environment, we calculated facility readiness to deliver nutritional services, population access to health facilities, and health facilities ready to deliver nutrition services. Data from Mozambique’s 2018 Service Availability and Readiness Assessment (SARA) was used to calculate readiness scores for each facility in the country. We used geospatial data from the ´WorldPop´ initiative to estimate the proportion of people in Mozambique within 10 kilometers of a ready facility. For each province and the country as a whole, we calculated the proportion of people with access to a ready facility for maternal and child nutrition interventions. Results At the national level, 29.1% and 37.3% of the population were within 10 kilometers of a facility ready to deliver all maternal and child nutrition services, respectively. Pregnancy growth monitoring (73.8%) and vitamin A supplementation (72.4%) were the most available interventions to the population. In contrast, anemia testing/iron supplementation (45.1%) was the least available nutritional intervention. The Center (30.5%) and North (26.9%) regions of Mozambique had much lower coverage than the South region (71.7%) across the maternal and child nutrition interventions. Nampula (14.9%) and Zambézia (17.9%) provinces were the least ready to deliver maternal nutrition services while Nampula (20.4%) and Cabo Delgado (21.2%) provinces were the least ready to deliver nutrition services to children. Conclusions To achieve high coverage of nutrition interventions, facilities need a full suite of commodities and equipment. Currently, too many facilities in Mozambique have only some of these supplies, meaning that only a minority of the children and pregnant women will receive effective nutrition services when they need them. Multi-sectoral efforts, including those outside the health system, are necessary to improve nutrition in Mozambique.
{"title":"Structural readiness of health facilities in Mozambique: how is Mozambique positioned to deliver nutrition-specific interventions to women and children?","authors":"Réka Maulide Cane, Ashely Sheffel, Cristolde Salomão, Júlia Sambo, Elias Matusse, Edmilson Ismail, Ananias António, Érica Manuel, Talata Sawadogo-Lewis, Timothy Roberton","doi":"10.29392/001c.89000","DOIUrl":"https://doi.org/10.29392/001c.89000","url":null,"abstract":"Background The health sector is essential in delivering high-quality nutrition interventions to women and children in low and middle-income countries, and Mozambique is no exception. Still, the quality and readiness of health services to deliver nutritional services have yet to be comprehensively mapped across the country. We assessed the accessibility and readiness of health facilities to deliver maternal and child nutrition services in Mozambique. Methods Using multiple data sources within a geographic information system (GIS) environment, we calculated facility readiness to deliver nutritional services, population access to health facilities, and health facilities ready to deliver nutrition services. Data from Mozambique’s 2018 Service Availability and Readiness Assessment (SARA) was used to calculate readiness scores for each facility in the country. We used geospatial data from the ´WorldPop´ initiative to estimate the proportion of people in Mozambique within 10 kilometers of a ready facility. For each province and the country as a whole, we calculated the proportion of people with access to a ready facility for maternal and child nutrition interventions. Results At the national level, 29.1% and 37.3% of the population were within 10 kilometers of a facility ready to deliver all maternal and child nutrition services, respectively. Pregnancy growth monitoring (73.8%) and vitamin A supplementation (72.4%) were the most available interventions to the population. In contrast, anemia testing/iron supplementation (45.1%) was the least available nutritional intervention. The Center (30.5%) and North (26.9%) regions of Mozambique had much lower coverage than the South region (71.7%) across the maternal and child nutrition interventions. Nampula (14.9%) and Zambézia (17.9%) provinces were the least ready to deliver maternal nutrition services while Nampula (20.4%) and Cabo Delgado (21.2%) provinces were the least ready to deliver nutrition services to children. Conclusions To achieve high coverage of nutrition interventions, facilities need a full suite of commodities and equipment. Currently, too many facilities in Mozambique have only some of these supplies, meaning that only a minority of the children and pregnant women will receive effective nutrition services when they need them. Multi-sectoral efforts, including those outside the health system, are necessary to improve nutrition in Mozambique.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136317178","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}
Background In Nepal, child marriage affects approximately 33% of girls prior to the age of 18, and 8% of girls by the age of 15. The practice has various causes, which include a lack of education, poverty and societal norms. Literature indicates that child marriages have a more significant impact on women’s health because of early pregnancies and the consequences of dropping out of school. This study aims to understand the impact of child marriage on health by exploring the perceptions held by women in Nepal. Understanding the opinions of those most affected is imperative to influence and improve policy. Methods 13 semi-structured interviews occurred in the Kathmandu Valley in May 2019. Participants were selected purposively by the project host who acted as a gatekeeper and further participants were identified via snowballing. The data was analysed thematically. Results The perceived causes of child marriage in Nepal were a lack of school level education, poverty, having numerous siblings, a low social status and societal views. The impacts on health include a high incidence of early pregnancy complications, and the effects of dropping out of school. The mental health of young brides was perceived to be affected by pressures to work in the home, being isolated and being too young for marriage. Factors such as awareness, availability, societal pressures and independence affected the health-seeking behaviours of child brides. The participants highlighted that raising awareness, reaching out rurally, and educating and employing women would tackle the problem. Conclusions Many of the themes discussed agreed with the existing literature. The effect of dropping out of school and the impact of child marriage on mental health have not yet been explored qualitatively. Factors that affect health-seeking agree with the limited research available, indicating a need to make services more accessible.
{"title":"Child marriage and its impact on health: a study of perceptions and attitudes in Nepal","authors":"Reena Seta","doi":"10.29392/001c.88951","DOIUrl":"https://doi.org/10.29392/001c.88951","url":null,"abstract":"Background In Nepal, child marriage affects approximately 33% of girls prior to the age of 18, and 8% of girls by the age of 15. The practice has various causes, which include a lack of education, poverty and societal norms. Literature indicates that child marriages have a more significant impact on women’s health because of early pregnancies and the consequences of dropping out of school. This study aims to understand the impact of child marriage on health by exploring the perceptions held by women in Nepal. Understanding the opinions of those most affected is imperative to influence and improve policy. Methods 13 semi-structured interviews occurred in the Kathmandu Valley in May 2019. Participants were selected purposively by the project host who acted as a gatekeeper and further participants were identified via snowballing. The data was analysed thematically. Results The perceived causes of child marriage in Nepal were a lack of school level education, poverty, having numerous siblings, a low social status and societal views. The impacts on health include a high incidence of early pregnancy complications, and the effects of dropping out of school. The mental health of young brides was perceived to be affected by pressures to work in the home, being isolated and being too young for marriage. Factors such as awareness, availability, societal pressures and independence affected the health-seeking behaviours of child brides. The participants highlighted that raising awareness, reaching out rurally, and educating and employing women would tackle the problem. Conclusions Many of the themes discussed agreed with the existing literature. The effect of dropping out of school and the impact of child marriage on mental health have not yet been explored qualitatively. Factors that affect health-seeking agree with the limited research available, indicating a need to make services more accessible.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135266295","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}
Bryan E. Shepherd, Nafiu N. Hussaini, Donna J. Ingles, Chelsea van Wyk, Holly M. Cassell, C. William Wester, Muktar H Aliyu
Biomedical HIV research is growing in West Africa, but biostatistical expertise is lagging. The Vanderbilt-Nigeria Biostatistics Training Program (VN-BioStat) seeks to establish a research and training platform for biostatisticians doing HIV-related research in Nigeria. The objectives of the program are: (i) Host two Nigerian data scientists per year (a total of 10 over 5 years) at Vanderbilt University Medical Center to gain hands-on biostatistics training and experience via one-year fellowships. Eligible trainees will be junior investigators with PhDs or nearing completion of their PhDs in statistics or related fields, including mathematics and computer science. (ii) Conduct annual workshops in Nigeria to provide biostatistics training. Trainees will undertake biostatistics coursework and hands-on training and participate in mentorship as biostatisticians involved in HIV research. Trainees will be at Vanderbilt for a full year and be part of an active biostatistics department. They will be immersed in a dry-lab HIV biostatistics project in collaboration with a Nigerian HIV research project and lead a methodologically focused research project. They will also participate in a one-month research training/grant writing program in Nashville. The VN-BioStat program will build on the existing momentum of ongoing initiatives to enhance research capacity in Nigeria by developing biostatistics leadership. VN-BioStat trainees will interact with investigators from Nigeria to provide collaborative biostatistical assistance with study design and data analysis, thus gaining real-world experience that will benefit the trainees and the broader research community in Nigeria.
西非的艾滋病毒生物医学研究正在增长，但是生物统计专业知识却落后了。范德比尔特-尼日利亚生物统计培训计划(VN-BioStat)旨在为尼日利亚从事艾滋病毒相关研究的生物统计学家建立一个研究和培训平台。该计划的目标是:(i)每年在范德比尔特大学医学中心(Vanderbilt University Medical Center)接待两名尼日利亚数据科学家(5年共10人)，通过为期一年的奖学金获得实际的生物统计学培训和经验。合格的学员将是在统计学或相关领域(包括数学和计算机科学)拥有博士学位或接近完成博士学位的初级研究人员。每年在尼日利亚举办讲习班，提供生物统计学培训。学员将参加生物统计学课程和实践培训，并作为参与艾滋病毒研究的生物统计学家参加指导。受训者将在范德比尔特大学学习一整年，并成为活跃的生物统计部门的一员。他们将与尼日利亚的一个艾滋病毒研究项目合作，参与一个干实验室艾滋病毒生物统计学项目，并领导一个以方法为重点的研究项目。他们还将在纳什维尔参加一个为期一个月的研究培训/拨款写作项目。VN-BioStat计划将利用正在开展的倡议的现有势头，通过培养生物统计学领导能力来提高尼日利亚的研究能力。VN-BioStat的学员将与尼日利亚的研究人员互动，在研究设计和数据分析方面提供合作性的生物统计学援助，从而获得现实世界的经验，这将使学员和尼日利亚更广泛的研究界受益。
{"title":"Training the next generation of Biostatisticians in West Africa: The Vanderbilt Nigeria Biostatistics Training Program (VN-BioStat)","authors":"Bryan E. Shepherd, Nafiu N. Hussaini, Donna J. Ingles, Chelsea van Wyk, Holly M. Cassell, C. William Wester, Muktar H Aliyu","doi":"10.29392/001c.88939","DOIUrl":"https://doi.org/10.29392/001c.88939","url":null,"abstract":"Biomedical HIV research is growing in West Africa, but biostatistical expertise is lagging. The Vanderbilt-Nigeria Biostatistics Training Program (VN-BioStat) seeks to establish a research and training platform for biostatisticians doing HIV-related research in Nigeria. The objectives of the program are: (i) Host two Nigerian data scientists per year (a total of 10 over 5 years) at Vanderbilt University Medical Center to gain hands-on biostatistics training and experience via one-year fellowships. Eligible trainees will be junior investigators with PhDs or nearing completion of their PhDs in statistics or related fields, including mathematics and computer science. (ii) Conduct annual workshops in Nigeria to provide biostatistics training. Trainees will undertake biostatistics coursework and hands-on training and participate in mentorship as biostatisticians involved in HIV research. Trainees will be at Vanderbilt for a full year and be part of an active biostatistics department. They will be immersed in a dry-lab HIV biostatistics project in collaboration with a Nigerian HIV research project and lead a methodologically focused research project. They will also participate in a one-month research training/grant writing program in Nashville. The VN-BioStat program will build on the existing momentum of ongoing initiatives to enhance research capacity in Nigeria by developing biostatistics leadership. VN-BioStat trainees will interact with investigators from Nigeria to provide collaborative biostatistical assistance with study design and data analysis, thus gaining real-world experience that will benefit the trainees and the broader research community in Nigeria.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135266704","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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