Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto p...Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto public health emergencies under the International Health Regulations (2005), the actions of most countriesto combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This crosssectionalstudy aimed to examine the health system resilience of selected countries and analyze their strategiesand measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K.,and the U.S., based on the severity of the national epidemic, the geographical location, and the developmentlevel. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure theseverity of the impact of the pandemic in each country;WHO State Parties Self-Assessment Annual Reporting (SPAR)Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience;and research articles and press materials were summarized to identify the strategies and measures adopted bycountries during response to COVID-19. This study applied the resilient health systems framework to analyzehealth system resilience in the selected countries from five dimensions, including awareness, diversity, selfregulation,integration and adaptation.Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and theU.S. were above the global and regional averages;the SPAR Scores of Iran were above the global average whilethe GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. investedmore health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategyof extensive testing and identification of suspected patients. In terms of specific measures, all the five countriesadopted measures such as restrictions on entry and international travel, closure of schools and industries,lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied acrosscountries, based on the response strategies.Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparednessand response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries stilldo not build resilient health systems in response to public health emergencies. Health system strengtheningand health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach todeveloping resilient health systems.展开更多
The first International Conference on Environment and Human Health Systems Engineering was held on July 8,2017 in Northwestern Polytechnical University(NPU),Xi’an.This conference was jointly held by the School of Lif...The first International Conference on Environment and Human Health Systems Engineering was held on July 8,2017 in Northwestern Polytechnical University(NPU),Xi’an.This conference was jointly held by the School of Life Sciences of NPU,the Office of International Cooperation of NPU and the China Aerospace Academy of Systems Science and Engineering(CAASSE).Experts and scientists from Pakistan universities and institutes展开更多
1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%o...1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Preventable maternal and newborn mortalities still occur in local com...<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Preventable maternal and newborn mortalities still occur in local communities in Kenya since access to maternal and newborn healthcare services remains a big challenge. Barriers to access in resource-constrained settings have not been examined adequately in literature. The World Health Organization (WHO) has 6 building blocks for strengthening healthcare systems that informed this study. This paper examines how user-side and institutional factors influence access and use of Maternal and Newborn Healthcare (MNH) Services in Matayos sub-County-Busia County. <b></b></span><b><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">A mixed method approach, with an ethnographic inquiry and a descriptive cross-sectional design, was adopted to assess access to MNH services in Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months and health care providers in the study area were recruited as respondents. A total of 348 postpartum women were selected through stratified systematic random sampling for the survey. Purposive sampling was used to select postpartum women, conventional and traditional health care providers for 16 in-depth interviews and 7 focus group discussions. Data were analyzed using descriptive and inferential statistics. Qualitative data analysis was done thematically. <b></b></span><b><b><span style="font-family:Verdana;">Results</span><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> Institutional delivery was low at 68% and family planning at 75% although demand for services was high at 99%. User-side barriers to access included shared beliefs and practices in the community;high direct transport costs from home;and high costs for missing drugs and other supplies in hospitals. Middle (5</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;">-7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;">) order deliveries occurred at home with traditional birth attendants. The choice of place of delivery in households was influenced by spouses to respondents and communities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed system-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> pillar for user-community engagement was absent. The underlying factors were weak governance and underfunding for healthcare.</span> <b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">The six WHO building blocks were inadequate due to weak governance and inadequate funding. User-community engagement, the 7<sup>th</sup> Pillar, was absent in these resource-limited settings. We recommend user-community empowerment, engagement and participation, adoption of a system thinking approach and adequate funding.</span>展开更多
Objective:To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province,Iran.Methods:In order to determine the baseline number of deaths,we used univariate time series analyses for mont...Objective:To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province,Iran.Methods:In order to determine the baseline number of deaths,we used univariate time series analyses for monthly data from the monthly vital statistics reports(From April 2015 to March 2022).For excess mortalities,these baselines were subtracted from reported deaths with a 95%prediction interval.To compare time and causes,a P-score was calculated.Results:From March 2020 to March 2022,there were 61949 registered deaths,and the estimated deaths with a 95%confidence interval(CI)were 43246.16(35718.28,50774.05).So,in 2020-2021 and 2021-2022,the death counts were 35.15%and 51.33%higher than projected.A total of 18666 cardiovascular diseases were reported and a total of 15704.46(12006.95,19401.96)was estimated.The P-score for this duration was 14.49%and 23.23%higher than expected.Infectious and parasitic diseases plus COVID-19 were 16633 and estimated to be 1044.87(456.77,1632.96).A total of 4420 diseases of the respiratory system were reported,and 4564.94 deaths were predicted(2277.43,6852.43).In the first year of the pandemic,the P-score dropped to-35.28%and in the second year,it jumped sharply to 22.38%.Conclusions:Excess mortality,along with cause-specific mortality,can be helpful for monitoring trends and developing public health policies at the local,national,and international levels.展开更多
Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that hea...Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that health care systems focus on improving access to quality continu-ous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.Objective:To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.Methods:Six databases were examined for quantitative,qualitative,and mixed-methods stud-ies that included the integration of CHWs,their motivation and supervision,and CHW policy making and implementation in developing countries.Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs.Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.Results:CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health.Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings.Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work,as well as financial and nonfinancial incentives,motivation,collaborative and supportive supervision,and a manageable workload.Conclusions:For sustainable integration of CHWs into health care systems,high-performing health systems with sound governance,adequate financing,well-organized service delivery,and adequate supplies and equipment are essential.Similarly,competent communities could contrib-ute to better CHW performance through sound governance of community resources,promotion of inclusiveness and cohesion,engagement in participatory decision making,and mobilization of local resources for community welfare.展开更多
In order to allow the guardians to monitor the physiological parameters of the infant more intuitively and to be able to respond to sudden irregularities in the pulse rate,abnormal blood oxygen,high or low body temper...In order to allow the guardians to monitor the physiological parameters of the infant more intuitively and to be able to respond to sudden irregularities in the pulse rate,abnormal blood oxygen,high or low body temperature and other conditions,and to facilitate communication with the medical staff or to request assistance in treatment,an STM32 microcontroller-based infant health monitoring system is designed.The digital signal acquisition module for pulse,blood oxygen and body temperature acquire the raw data,and the microcontroller performs algorithmic processing to display the physiological parameters such as pulse,blood oxygen and body temperature of the infant,and configures the threshold alarms for the physiological parameters by means of a keypad module.Finally,the test results are compared and tested against the standard physiological parameters of infants and children to verify that the system meets the requirements of medical precision and accuracy.展开更多
Aims:To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019(COVID-19)and the challenges associated with their use.Metiiods:To determine the sta...Aims:To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019(COVID-19)and the challenges associated with their use.Metiiods:To determine the status of digital health utilization during COVID-19 in South Africa,the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study.We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021.Results:Total of 24 articles were included into this study.This study revealed that South Africa adopted digital technologies such as SMS-based solutions,mobile health applications,telemedicine and telehealth,WhatsApp-based systems,artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic.These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases,disease surveillance and monitoring,medication and treatment compliance,creating awareness and communication.The study also revealed that teleconsultation and e-prescription,telelaboratory and telepharmacy,teleeducation and teletraining,teledermatology,teleradiology,telecardiology,teleophthalmology,teleneurology,telerehabilitation,teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa.However,these smart digital health technologies face several impediments such as infrastructural and technological barriers,organization and financial barriers,policy and regulatory barriers as well as cultural barriers.Conclusion:Although COVID-19 has invigorated the use of digital health technologies,there are still some shortcomings.The outbreak of pandemics like COVID-19 in the future is not inevitable.Therefore,we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth policy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.展开更多
This paper analyses the five years' monitored strains collected from a long-term health monitoring system installed on a bridge with wavelet transform.In the analysis,the monitored strains are pre-processed,featur...This paper analyses the five years' monitored strains collected from a long-term health monitoring system installed on a bridge with wavelet transform.In the analysis,the monitored strains are pre-processed,features of the monitored data are summarized briefly.The influences of the base functions on the results of wavelet analysis are studied simultaneously.The results show that the db wavelet is a good mother wavelet function in the analysis,and the order N should be larger than 20,but less than 46 in decomposing the monitored strains of the bridge.According to the strain variation features of concrete bridge,the proper decomposition level is 4 in the wavelet multi-resolution analysis.With the present method,the strains caused by random loads and daily sunlight can be accurately extracted from the monitored strains.The decomposed components of the monitored strains show that the amplitudes of the strains caused by random loads,daily sunlight,and annual temperature effect,are about 5 με,25 με,and 50 με respectively.The structural response under random load is smaller than the other parts.展开更多
Background: Health information systems (HIS) play a major role in decision-making. The aim is to identify the components of computerized HIS and their relationship to administrative decisions at the main referral hosp...Background: Health information systems (HIS) play a major role in decision-making. The aim is to identify the components of computerized HIS and their relationship to administrative decisions at the main referral hospitals for Sana’a city. Method: This applied research is a descriptive, cross-sectional study in which the HIS of 7 hospitals affiliated with Sana’a city hospitals during “2017-2020”, was evaluated based on Self-administered questionnaires. Data were collected by using Self-administered questionnaires and analyzed in SPSS 16 by using descriptive statistics. Results: A total of 626 users (95.7%) had responded. 73%, 75%, 69%, 70%, 71% of users mentioned that resources were available, for physical, software, human, organizational, and decision computerized HIS, respectively. The study showed a strong relationship between computerized information systems with their physical, software, human and organizational components, and medical and administrative decisions. While the study showed the absence of a relationship between demographic factors and computerized information systems with their hardware, software, human and organizational components, medical and administrative decisions, except for gender with organizational components, age, qualification with hardware and software components, and years of experience with all study variables. Conclusion: The application of HIS at hospitals in decision-making has several challenges, including the lack of updating of hardware and software components Furthermore, the absence of specific, focusing on developing their technical staffs, and mobilizing financial resources to achieve implementation properly. Therefore, establishing the technical management with clear roles and tasks with multi-disciplinary, and increasing the support of the administrative leadership in the process of implementing HIS are recommended.展开更多
With the advent of the pandemic, the Brazilian Ministry of Health structured in record time the Telehealth Service of the Unified Health System called TeleSUS, an ecosystem based on the intensive use of information te...With the advent of the pandemic, the Brazilian Ministry of Health structured in record time the Telehealth Service of the Unified Health System called TeleSUS, an ecosystem based on the intensive use of information technology involving automated mechanisms and a personalized health care center at distance. In addition to constant evaluations carried out in the service as a public health strategy, at clinical and epidemiological levels, the team involved in the project was also concerned with evaluating the system developed to enable the operation of remote care, from the conception of the organization of health actions to the technological development of the digital health tool. The objective of this study was to carry out an evaluation of a telehealth system, measuring the degree of satisfaction of users of health professionals regarding its usability and identifying factors that positively and/or negatively influence the evaluation.展开更多
Background: Radiation therapy has the potential to improve cure rates and provide palliative relief for cervical cancer patients. Despite adherence to radiation therapy being a key treatment modality, patients rarely ...Background: Radiation therapy has the potential to improve cure rates and provide palliative relief for cervical cancer patients. Despite adherence to radiation therapy being a key treatment modality, patients rarely follow prescriptions. Poor adherence to radiation therapy is associated with low survival and high mortality rates. This study therefore sought to investigate the levels of adherence and factors influencing adherence to radiation therapy among cervical cancer patients being treated at Cancer Diseases Hospital. Methods: A cross-sectional analytical study design was used, 142 patients were selected from the outpatient department using a fishbowl sampling method. A structured interview schedule was used to collect data. Data was entered and analyzed using SPSS, the binary logistic regression analysis was used to predict levels of adherence to treatment and to identify factors associated with adherence to RT among cervical cancer patients. Results: The findings showed that 93% of the participants adhered to radiation therapy while 7% did not adhere to treatment. Majority of the patients 77.1% had experienced side effects of radiation therapy. About 28% of patients had severe psychological distress. By using binary logistic regression, there was a statistically significant association between adherence and perceived quality of health care services (p = 0.001). The analysis showed that patients who perceived poor quality of health care services were 0.005 (99.5%) times less likely to adhere to radiation therapy. The other independent variables were not statistically significant despite being associated with adherence among cervical cancer patients. Conclusions and Recommendations: The findings showed that patients who perceived good quality of health care services had higher chances of adherence compared to those who perceived poor quality of health care services. There is therefore a need for quality service provision which could include good maintenance of radiation machines. Furthermore, there is a need to develop guidelines for follow-up in case of any disease outbreak to avoid interference with patients’ treatment schedules and appointments for reviews.展开更多
The current cyber-attack environment has put even the most protected systems at risk as the hackers are nowmodifying technologies to exploit even the tiniest of weaknesses and infiltrate networks.In this situation,it...The current cyber-attack environment has put even the most protected systems at risk as the hackers are nowmodifying technologies to exploit even the tiniest of weaknesses and infiltrate networks.In this situation,it’s critical to design and construct software that is both secure and long-lasting.While security is the most well-defined aspect of health information software systems,it is equally significant to prioritise sustainability because any health information software system will be more effective if it provides both security and sustainability to the customers at the same time.In this league,it is crucial to determine those characteristics in the systems that can help in the accurate assessment of the sustainable-security of the health information software during the development stage.This research work employed the Fuzzy Analytic Network Process(Fuzzy ANP)to estimate the impact of the overall sustainable-security of health information software systems and their characteristics in order to achieve a high level of sustainable-security.Furthermore,the study validates the efficacy of the Fuzzy ANP procedure by testing it on five different versions of a health information software system through Fuzzy Technique for Order of Preference by Similarity to Ideal Solutions(Fuzzy TOPSIS).Despite the sensitivity of the health information software systems,this study employedmultiple versions of health information software system.When compared with the existing procedures for testing the sustainable-security of health information software systems,the outcomes were conclusive and significantly more effective.Besides saving time and resources,the mechanism suggested in this research work aims to establish an outline that software practitioners can follow to enhance the sustainablesecurity of health information software systems.展开更多
The peer-reviewed journal Infectious Diseases of Poverty provides a new platform to engage with,and disseminate in an open-access format,science outside traditional disciplinary boundaries.The current piece reviews a ...The peer-reviewed journal Infectious Diseases of Poverty provides a new platform to engage with,and disseminate in an open-access format,science outside traditional disciplinary boundaries.The current piece reviews a thematic series on surveillance-response systems for elimination of tropical diseases.Overall,22 contributions covering a broad array of diseases are featured–i.e.clonorchiasis,dengue,hepatitis,human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS),H7N9 avian influenza,lymphatic filariasis,malaria,Middle East respiratory syndrome(MERS),rabies,schistosomiasis and tuberculosis(TB).There are five scoping reviews,a commentary,a letter to the editor,an opinion piece and an editorial pertaining to the theme“Elimination of tropical disease through surveillance and response”.The remaining 13 articles are original contributions mainly covering(i)drug resistance;(ii)innovation and validation in the field of mathematical modelling;(iii)elimination of infectious diseases;and(iv)social media reports on disease outbreak notifications released by national health authorities.Analysis of the authors’affiliations reveals that scientists from the People’s Republic of China(P.R.China)are prominently represented.Possible explanations include the fact that the 2012 and 2014 international conferences pertaining to surveillance-response mechanisms were both hosted by the National Institute of Parasitic Diseases(NIPD)in Shanghai,coupled with P.R.China’s growing importance with regard to the control of infectious diseases.Within 4 to 22 months of publication,three of the 22 contributions were viewed more than 10000 times each.With sustained efforts focusing on relevant and strategic information towards control and elimination of infectious diseases,Infectious Diseases of Poverty has become a leading journal in the field of surveillance and response systems in infectious diseases and beyond.展开更多
Although we know that there are benefits to individual patients from electronic data,the next potential,and potentially the biggest,benefit will come from the technologies known as big data,machine learning,and artifi...Although we know that there are benefits to individual patients from electronic data,the next potential,and potentially the biggest,benefit will come from the technologies known as big data,machine learning,and artificial intelligence.Harnessing the potential of computers to sift through large amounts of data will result in the possibility of generating insights into individual patients,and into whole populations,predicting the risk of hospital admission for an individual,or track-ing influenza epidemics to prepare adequate responses.Once the data are reliable,recorded in a computer-interpretable way,new horizons will open.展开更多
Poverty magnifies limitations posed by traditional biases and environmental risks.Any approach towards disease control needs to recognise that socially embedded vulnerabilities can be as powerful as externally imposed...Poverty magnifies limitations posed by traditional biases and environmental risks.Any approach towards disease control needs to recognise that socially embedded vulnerabilities can be as powerful as externally imposed infections.Asia Pacific has a specific panorama of infectious diseases,which,in common with other endemic areas,have a tendency to emerge or re-emerge if not carefully monitored.Sustained control aiming at elimination requires strong emphasis on surveillance and response.Well-designed informatics platforms can improve support systems and strengthen control activities,as they rapidly locate high-risk areas and provide detailed,up-to-date information on the performance of ongoing control programmes.展开更多
In recent years,blockchain technologies have expanded from the finance field to other areas that rely on trustbased solutions.The healthcare industry represents one such area,as digital transformation disrupts relatio...In recent years,blockchain technologies have expanded from the finance field to other areas that rely on trustbased solutions.The healthcare industry represents one such area,as digital transformation disrupts relationships between patients,healthcare professionals,and healthcare institutes.Patients and healthcare institutes lack a proficient tool to verify the credentials of medical professionals in a digital environment.Furthermore,healthcare professionals lack a tool where they are in control over their credentials.The first contribution of this paper is a proposal of a solution that leverages the private permissioned Hyperledger Fabric blockchain and smart contracts to provide a source of transparent trust for relationships within the healthcare industry.Second,we pave the ground for GDPR compliance by storing only the hash values on the blockchain.Third,we solve the problem of patient authentication by utilizing cryptographic techniques.Finally,we prove the usability of the proposed solution by implementing a user interface and creating a live deployment.展开更多
Background:Continuing progress in the global pediatric human immunodeficiency virus(HIV)response depends on timely identification and care of infants with HIV.As countries scale-out improvements to HIV early infant di...Background:Continuing progress in the global pediatric human immunodeficiency virus(HIV)response depends on timely identification and care of infants with HIV.As countries scale-out improvements to HIV early infant diagnosis(EID),economic evaluations are needed to inform program design and implementation.This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases(Embase,MEDLINE and EconLit)and grey literature for economic analyses of HIV EID in low-and middle-income countries published between January 2008 and June 2021.We extracted data on unit costs,cost savings,and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats.We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records,we included 29 studies:17 cost analyses and 12 model-based cost-effectiveness analyses.Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests.All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective.Most studies reported costs of EID testing strategies;however,few studies assessed the same intervention or reported costs in the same way,making comparison of costs across studies challenging.Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV,while not directly comparable across studies,covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving.Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.展开更多
Background:Social Innovation in health initiatives have the potential to address unmet community health needs.For sustainable change to occur,we need to understand how and why a given intervention is effective.Bringin...Background:Social Innovation in health initiatives have the potential to address unmet community health needs.For sustainable change to occur,we need to understand how and why a given intervention is effective.Bringing together communities,innovators,researchers,and policy makers is a powerful way to address this knowledge gap but differing priorities and epistemological backgrounds can make collaboration challenging.Main text:To overcome these barriers,stakeholders will need to design policies and work in ways that provide an enabling environment for innovative products and services.Inherently about people,the incorporation of community engagement approaches is necessary for both the development of social innovations and accompanying research methodologies.Whilst the'appropriate'level of participation is linked to intended outcomes,researchers have a role to play in better understanding how to harness the power of community engagement and to ensure that community perspectives form part of the evidence base that informs policy and practice.Conclusions:To effectively operate at the intersection between policy,social innovation,and research,all collaborators need to enter the process with the mindset of learners,rather than experts.Methods-quantitative and qualitative-must be selected according to research questions.The fields of implementation research,community-based participatory research,and realist research,amongst others,have much to offer.So do other sectors,notably education and business.In all this,researchers must assume the mantel of responsibility for research and not transfer the onus to communities under the guise of participation.By leveraging the expertise and knowledge of different ecosystem actors,we can design responsive health systems that integrate innovative approaches in ways that are greater than the sum of their parts.展开更多
Background:Despite progress towards End TB Strategy targets for reducing tuberculosis(TB)incidence and deaths by 2035,South Africa remains among the top ten high-burden tuberculosis countries globally.A large challeng...Background:Despite progress towards End TB Strategy targets for reducing tuberculosis(TB)incidence and deaths by 2035,South Africa remains among the top ten high-burden tuberculosis countries globally.A large challenge lies in how policies to improve detection,diagnosis and treatment completion interact with social and structural drivers ofTB.Detailed understanding and theoretical development of the contextual determinants of problems inTB care is required for developing effective interventions.This article reports findings from the pre-implementation phase of a study ofTB care in South Africa,contributing to HeAlth System StrEngThening in Sub-Saharan Africa(ASSET)-a five-year research programme developing and evaluating health system strengthening interventions in sub-Saharan Africa.The study aimed to develop hypothetical propositions regarding contextual determinants of problems inTB care to inform intervention development to reduce TB deaths and incidence whilst ensuring the delivery of quality integrated,person-centred care.Methods:Theory-building case study design using the Context and Implementation of Complex Interventions(CICI)framework to identify contextual determinants of problems in TB care.Between February and November 2019,we used mixed methods in six public-sector primary healthcare facilities and one public-sector hospital serving impoverished urban and rural communities in the Amajuba District of KwaZulu-Natal Province,South Africa.Qualitative data included stakeholder interviews,observations and documentary analysis.Quantitative data included routine data on sputum testing andTB deaths.Data were inductively analysed and mapped onto the seven CICI contextual domains.Results:Delayed diagnosis was caused by interactions between fragmented healthcare provision;limited resources;verticalised care;poorTB screening,sputum collection and record-keeping.One nurse responsible forTB care,with limited integration ofTB with other conditions,and policy focused on treatment adherence contributed to staff stress and limited consideration of patientsz psychosocial needs.Patients were lost to follow up due to discontinuity of information,poverty,employment restrictions and limited support for treatment side-effects.Infection control measures appeared to be compromised by efforts to integrate care.Conclusions:Delayed diagnosis,limited psychosocial support for patients and staff,patients lost to follow-up and inadequate infection control are caused by an interaction between multiple interacting contextual determinants.TB policy needs to resolve tensions between treating TB as epidemic and individually-experienced social problem supporting interventions which strengthen case detection,infection control and treatment,and also promote person-centred support for healthcare professionals and patients.展开更多
基金supported by the National Natural Science Foundationof China (No. 72042014).
文摘Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto public health emergencies under the International Health Regulations (2005), the actions of most countriesto combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This crosssectionalstudy aimed to examine the health system resilience of selected countries and analyze their strategiesand measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K.,and the U.S., based on the severity of the national epidemic, the geographical location, and the developmentlevel. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure theseverity of the impact of the pandemic in each country;WHO State Parties Self-Assessment Annual Reporting (SPAR)Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience;and research articles and press materials were summarized to identify the strategies and measures adopted bycountries during response to COVID-19. This study applied the resilient health systems framework to analyzehealth system resilience in the selected countries from five dimensions, including awareness, diversity, selfregulation,integration and adaptation.Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and theU.S. were above the global and regional averages;the SPAR Scores of Iran were above the global average whilethe GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. investedmore health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategyof extensive testing and identification of suspected patients. In terms of specific measures, all the five countriesadopted measures such as restrictions on entry and international travel, closure of schools and industries,lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied acrosscountries, based on the response strategies.Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparednessand response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries stilldo not build resilient health systems in response to public health emergencies. Health system strengtheningand health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach todeveloping resilient health systems.
文摘The first International Conference on Environment and Human Health Systems Engineering was held on July 8,2017 in Northwestern Polytechnical University(NPU),Xi’an.This conference was jointly held by the School of Life Sciences of NPU,the Office of International Cooperation of NPU and the China Aerospace Academy of Systems Science and Engineering(CAASSE).Experts and scientists from Pakistan universities and institutes
文摘1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Preventable maternal and newborn mortalities still occur in local communities in Kenya since access to maternal and newborn healthcare services remains a big challenge. Barriers to access in resource-constrained settings have not been examined adequately in literature. The World Health Organization (WHO) has 6 building blocks for strengthening healthcare systems that informed this study. This paper examines how user-side and institutional factors influence access and use of Maternal and Newborn Healthcare (MNH) Services in Matayos sub-County-Busia County. <b></b></span><b><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">A mixed method approach, with an ethnographic inquiry and a descriptive cross-sectional design, was adopted to assess access to MNH services in Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months and health care providers in the study area were recruited as respondents. A total of 348 postpartum women were selected through stratified systematic random sampling for the survey. Purposive sampling was used to select postpartum women, conventional and traditional health care providers for 16 in-depth interviews and 7 focus group discussions. Data were analyzed using descriptive and inferential statistics. Qualitative data analysis was done thematically. <b></b></span><b><b><span style="font-family:Verdana;">Results</span><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> Institutional delivery was low at 68% and family planning at 75% although demand for services was high at 99%. User-side barriers to access included shared beliefs and practices in the community;high direct transport costs from home;and high costs for missing drugs and other supplies in hospitals. Middle (5</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;">-7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;">) order deliveries occurred at home with traditional birth attendants. The choice of place of delivery in households was influenced by spouses to respondents and communities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed system-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> pillar for user-community engagement was absent. The underlying factors were weak governance and underfunding for healthcare.</span> <b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b><b> </b><span style="font-family:Verdana;">The six WHO building blocks were inadequate due to weak governance and inadequate funding. User-community engagement, the 7<sup>th</sup> Pillar, was absent in these resource-limited settings. We recommend user-community empowerment, engagement and participation, adoption of a system thinking approach and adequate funding.</span>
基金supported by Mashhad University of Medical Sciencesapproved by the Ethics Committee of Mashhad University of Medical Sciences(Ethics ID:IR.MUMS.REC.1400.144).
文摘Objective:To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province,Iran.Methods:In order to determine the baseline number of deaths,we used univariate time series analyses for monthly data from the monthly vital statistics reports(From April 2015 to March 2022).For excess mortalities,these baselines were subtracted from reported deaths with a 95%prediction interval.To compare time and causes,a P-score was calculated.Results:From March 2020 to March 2022,there were 61949 registered deaths,and the estimated deaths with a 95%confidence interval(CI)were 43246.16(35718.28,50774.05).So,in 2020-2021 and 2021-2022,the death counts were 35.15%and 51.33%higher than projected.A total of 18666 cardiovascular diseases were reported and a total of 15704.46(12006.95,19401.96)was estimated.The P-score for this duration was 14.49%and 23.23%higher than expected.Infectious and parasitic diseases plus COVID-19 were 16633 and estimated to be 1044.87(456.77,1632.96).A total of 4420 diseases of the respiratory system were reported,and 4564.94 deaths were predicted(2277.43,6852.43).In the first year of the pandemic,the P-score dropped to-35.28%and in the second year,it jumped sharply to 22.38%.Conclusions:Excess mortality,along with cause-specific mortality,can be helpful for monitoring trends and developing public health policies at the local,national,and international levels.
文摘Background:Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health work-ers(CHWs).It is imperative that health care systems focus on improving access to quality continu-ous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness.Objective:To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries.Methods:Six databases were examined for quantitative,qualitative,and mixed-methods stud-ies that included the integration of CHWs,their motivation and supervision,and CHW policy making and implementation in developing countries.Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs.Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized.Results:CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health.Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings.Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work,as well as financial and nonfinancial incentives,motivation,collaborative and supportive supervision,and a manageable workload.Conclusions:For sustainable integration of CHWs into health care systems,high-performing health systems with sound governance,adequate financing,well-organized service delivery,and adequate supplies and equipment are essential.Similarly,competent communities could contrib-ute to better CHW performance through sound governance of community resources,promotion of inclusiveness and cohesion,engagement in participatory decision making,and mobilization of local resources for community welfare.
文摘In order to allow the guardians to monitor the physiological parameters of the infant more intuitively and to be able to respond to sudden irregularities in the pulse rate,abnormal blood oxygen,high or low body temperature and other conditions,and to facilitate communication with the medical staff or to request assistance in treatment,an STM32 microcontroller-based infant health monitoring system is designed.The digital signal acquisition module for pulse,blood oxygen and body temperature acquire the raw data,and the microcontroller performs algorithmic processing to display the physiological parameters such as pulse,blood oxygen and body temperature of the infant,and configures the threshold alarms for the physiological parameters by means of a keypad module.Finally,the test results are compared and tested against the standard physiological parameters of infants and children to verify that the system meets the requirements of medical precision and accuracy.
文摘Aims:To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019(COVID-19)and the challenges associated with their use.Metiiods:To determine the status of digital health utilization during COVID-19 in South Africa,the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study.We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021.Results:Total of 24 articles were included into this study.This study revealed that South Africa adopted digital technologies such as SMS-based solutions,mobile health applications,telemedicine and telehealth,WhatsApp-based systems,artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic.These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases,disease surveillance and monitoring,medication and treatment compliance,creating awareness and communication.The study also revealed that teleconsultation and e-prescription,telelaboratory and telepharmacy,teleeducation and teletraining,teledermatology,teleradiology,telecardiology,teleophthalmology,teleneurology,telerehabilitation,teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa.However,these smart digital health technologies face several impediments such as infrastructural and technological barriers,organization and financial barriers,policy and regulatory barriers as well as cultural barriers.Conclusion:Although COVID-19 has invigorated the use of digital health technologies,there are still some shortcomings.The outbreak of pandemics like COVID-19 in the future is not inevitable.Therefore,we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth policy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.
文摘This paper analyses the five years' monitored strains collected from a long-term health monitoring system installed on a bridge with wavelet transform.In the analysis,the monitored strains are pre-processed,features of the monitored data are summarized briefly.The influences of the base functions on the results of wavelet analysis are studied simultaneously.The results show that the db wavelet is a good mother wavelet function in the analysis,and the order N should be larger than 20,but less than 46 in decomposing the monitored strains of the bridge.According to the strain variation features of concrete bridge,the proper decomposition level is 4 in the wavelet multi-resolution analysis.With the present method,the strains caused by random loads and daily sunlight can be accurately extracted from the monitored strains.The decomposed components of the monitored strains show that the amplitudes of the strains caused by random loads,daily sunlight,and annual temperature effect,are about 5 με,25 με,and 50 με respectively.The structural response under random load is smaller than the other parts.
文摘Background: Health information systems (HIS) play a major role in decision-making. The aim is to identify the components of computerized HIS and their relationship to administrative decisions at the main referral hospitals for Sana’a city. Method: This applied research is a descriptive, cross-sectional study in which the HIS of 7 hospitals affiliated with Sana’a city hospitals during “2017-2020”, was evaluated based on Self-administered questionnaires. Data were collected by using Self-administered questionnaires and analyzed in SPSS 16 by using descriptive statistics. Results: A total of 626 users (95.7%) had responded. 73%, 75%, 69%, 70%, 71% of users mentioned that resources were available, for physical, software, human, organizational, and decision computerized HIS, respectively. The study showed a strong relationship between computerized information systems with their physical, software, human and organizational components, and medical and administrative decisions. While the study showed the absence of a relationship between demographic factors and computerized information systems with their hardware, software, human and organizational components, medical and administrative decisions, except for gender with organizational components, age, qualification with hardware and software components, and years of experience with all study variables. Conclusion: The application of HIS at hospitals in decision-making has several challenges, including the lack of updating of hardware and software components Furthermore, the absence of specific, focusing on developing their technical staffs, and mobilizing financial resources to achieve implementation properly. Therefore, establishing the technical management with clear roles and tasks with multi-disciplinary, and increasing the support of the administrative leadership in the process of implementing HIS are recommended.
文摘With the advent of the pandemic, the Brazilian Ministry of Health structured in record time the Telehealth Service of the Unified Health System called TeleSUS, an ecosystem based on the intensive use of information technology involving automated mechanisms and a personalized health care center at distance. In addition to constant evaluations carried out in the service as a public health strategy, at clinical and epidemiological levels, the team involved in the project was also concerned with evaluating the system developed to enable the operation of remote care, from the conception of the organization of health actions to the technological development of the digital health tool. The objective of this study was to carry out an evaluation of a telehealth system, measuring the degree of satisfaction of users of health professionals regarding its usability and identifying factors that positively and/or negatively influence the evaluation.
文摘Background: Radiation therapy has the potential to improve cure rates and provide palliative relief for cervical cancer patients. Despite adherence to radiation therapy being a key treatment modality, patients rarely follow prescriptions. Poor adherence to radiation therapy is associated with low survival and high mortality rates. This study therefore sought to investigate the levels of adherence and factors influencing adherence to radiation therapy among cervical cancer patients being treated at Cancer Diseases Hospital. Methods: A cross-sectional analytical study design was used, 142 patients were selected from the outpatient department using a fishbowl sampling method. A structured interview schedule was used to collect data. Data was entered and analyzed using SPSS, the binary logistic regression analysis was used to predict levels of adherence to treatment and to identify factors associated with adherence to RT among cervical cancer patients. Results: The findings showed that 93% of the participants adhered to radiation therapy while 7% did not adhere to treatment. Majority of the patients 77.1% had experienced side effects of radiation therapy. About 28% of patients had severe psychological distress. By using binary logistic regression, there was a statistically significant association between adherence and perceived quality of health care services (p = 0.001). The analysis showed that patients who perceived poor quality of health care services were 0.005 (99.5%) times less likely to adhere to radiation therapy. The other independent variables were not statistically significant despite being associated with adherence among cervical cancer patients. Conclusions and Recommendations: The findings showed that patients who perceived good quality of health care services had higher chances of adherence compared to those who perceived poor quality of health care services. There is therefore a need for quality service provision which could include good maintenance of radiation machines. Furthermore, there is a need to develop guidelines for follow-up in case of any disease outbreak to avoid interference with patients’ treatment schedules and appointments for reviews.
基金Funding for this study was received fromthe Ministry of Education and Deanship of Scientific Research at King Abdulaziz University,Kingdom of Saudi Arabia under Grant No.IFPHI-287-611-2020.
文摘The current cyber-attack environment has put even the most protected systems at risk as the hackers are nowmodifying technologies to exploit even the tiniest of weaknesses and infiltrate networks.In this situation,it’s critical to design and construct software that is both secure and long-lasting.While security is the most well-defined aspect of health information software systems,it is equally significant to prioritise sustainability because any health information software system will be more effective if it provides both security and sustainability to the customers at the same time.In this league,it is crucial to determine those characteristics in the systems that can help in the accurate assessment of the sustainable-security of the health information software during the development stage.This research work employed the Fuzzy Analytic Network Process(Fuzzy ANP)to estimate the impact of the overall sustainable-security of health information software systems and their characteristics in order to achieve a high level of sustainable-security.Furthermore,the study validates the efficacy of the Fuzzy ANP procedure by testing it on five different versions of a health information software system through Fuzzy Technique for Order of Preference by Similarity to Ideal Solutions(Fuzzy TOPSIS).Despite the sensitivity of the health information software systems,this study employedmultiple versions of health information software system.When compared with the existing procedures for testing the sustainable-security of health information software systems,the outcomes were conclusive and significantly more effective.Besides saving time and resources,the mechanism suggested in this research work aims to establish an outline that software practitioners can follow to enhance the sustainablesecurity of health information software systems.
基金supported by the National S&T Major Program(grant no.2012ZX10004220)the fourth round of Three-year Public Health Action Plan of Shanghai(2015-2017,No.GWIV-29).
文摘The peer-reviewed journal Infectious Diseases of Poverty provides a new platform to engage with,and disseminate in an open-access format,science outside traditional disciplinary boundaries.The current piece reviews a thematic series on surveillance-response systems for elimination of tropical diseases.Overall,22 contributions covering a broad array of diseases are featured–i.e.clonorchiasis,dengue,hepatitis,human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS),H7N9 avian influenza,lymphatic filariasis,malaria,Middle East respiratory syndrome(MERS),rabies,schistosomiasis and tuberculosis(TB).There are five scoping reviews,a commentary,a letter to the editor,an opinion piece and an editorial pertaining to the theme“Elimination of tropical disease through surveillance and response”.The remaining 13 articles are original contributions mainly covering(i)drug resistance;(ii)innovation and validation in the field of mathematical modelling;(iii)elimination of infectious diseases;and(iv)social media reports on disease outbreak notifications released by national health authorities.Analysis of the authors’affiliations reveals that scientists from the People’s Republic of China(P.R.China)are prominently represented.Possible explanations include the fact that the 2012 and 2014 international conferences pertaining to surveillance-response mechanisms were both hosted by the National Institute of Parasitic Diseases(NIPD)in Shanghai,coupled with P.R.China’s growing importance with regard to the control of infectious diseases.Within 4 to 22 months of publication,three of the 22 contributions were viewed more than 10000 times each.With sustained efforts focusing on relevant and strategic information towards control and elimination of infectious diseases,Infectious Diseases of Poverty has become a leading journal in the field of surveillance and response systems in infectious diseases and beyond.
文摘Although we know that there are benefits to individual patients from electronic data,the next potential,and potentially the biggest,benefit will come from the technologies known as big data,machine learning,and artificial intelligence.Harnessing the potential of computers to sift through large amounts of data will result in the possibility of generating insights into individual patients,and into whole populations,predicting the risk of hospital admission for an individual,or track-ing influenza epidemics to prepare adequate responses.Once the data are reliable,recorded in a computer-interpretable way,new horizons will open.
基金This work was supported by the Australian Agency for International Development(AusAID)grant[grant number 44913]to the Health Information Systems Knowledge Hub,at the School of Population Health,the University of Queensland.
文摘Poverty magnifies limitations posed by traditional biases and environmental risks.Any approach towards disease control needs to recognise that socially embedded vulnerabilities can be as powerful as externally imposed infections.Asia Pacific has a specific panorama of infectious diseases,which,in common with other endemic areas,have a tendency to emerge or re-emerge if not carefully monitored.Sustained control aiming at elimination requires strong emphasis on surveillance and response.Well-designed informatics platforms can improve support systems and strengthen control activities,as they rapidly locate high-risk areas and provide detailed,up-to-date information on the performance of ongoing control programmes.
文摘In recent years,blockchain technologies have expanded from the finance field to other areas that rely on trustbased solutions.The healthcare industry represents one such area,as digital transformation disrupts relationships between patients,healthcare professionals,and healthcare institutes.Patients and healthcare institutes lack a proficient tool to verify the credentials of medical professionals in a digital environment.Furthermore,healthcare professionals lack a tool where they are in control over their credentials.The first contribution of this paper is a proposal of a solution that leverages the private permissioned Hyperledger Fabric blockchain and smart contracts to provide a source of transparent trust for relationships within the healthcare industry.Second,we pave the ground for GDPR compliance by storing only the hash values on the blockchain.Third,we solve the problem of patient authentication by utilizing cryptographic techniques.Finally,we prove the usability of the proposed solution by implementing a user interface and creating a live deployment.
基金Open Access funding enabled and organized by Projekt DEALThis project was supported by the German Center for Infection Research (DZIF) (Grant No. TTU 04.918) .
文摘Background:Continuing progress in the global pediatric human immunodeficiency virus(HIV)response depends on timely identification and care of infants with HIV.As countries scale-out improvements to HIV early infant diagnosis(EID),economic evaluations are needed to inform program design and implementation.This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases(Embase,MEDLINE and EconLit)and grey literature for economic analyses of HIV EID in low-and middle-income countries published between January 2008 and June 2021.We extracted data on unit costs,cost savings,and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats.We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records,we included 29 studies:17 cost analyses and 12 model-based cost-effectiveness analyses.Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests.All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective.Most studies reported costs of EID testing strategies;however,few studies assessed the same intervention or reported costs in the same way,making comparison of costs across studies challenging.Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV,while not directly comparable across studies,covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving.Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.
文摘Background:Social Innovation in health initiatives have the potential to address unmet community health needs.For sustainable change to occur,we need to understand how and why a given intervention is effective.Bringing together communities,innovators,researchers,and policy makers is a powerful way to address this knowledge gap but differing priorities and epistemological backgrounds can make collaboration challenging.Main text:To overcome these barriers,stakeholders will need to design policies and work in ways that provide an enabling environment for innovative products and services.Inherently about people,the incorporation of community engagement approaches is necessary for both the development of social innovations and accompanying research methodologies.Whilst the'appropriate'level of participation is linked to intended outcomes,researchers have a role to play in better understanding how to harness the power of community engagement and to ensure that community perspectives form part of the evidence base that informs policy and practice.Conclusions:To effectively operate at the intersection between policy,social innovation,and research,all collaborators need to enter the process with the mindset of learners,rather than experts.Methods-quantitative and qualitative-must be selected according to research questions.The fields of implementation research,community-based participatory research,and realist research,amongst others,have much to offer.So do other sectors,notably education and business.In all this,researchers must assume the mantel of responsibility for research and not transfer the onus to communities under the guise of participation.By leveraging the expertise and knowledge of different ecosystem actors,we can design responsive health systems that integrate innovative approaches in ways that are greater than the sum of their parts.
基金funded by the National Institute for Health Research(NIHR)Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa,King's College London(GHRU 16/136/54)using UK aid from the UK Government to support global health research.The views expressed in this publication are those of the author(s)and not necessarily those of the NIHR or the Department of Health and Social Care.
文摘Background:Despite progress towards End TB Strategy targets for reducing tuberculosis(TB)incidence and deaths by 2035,South Africa remains among the top ten high-burden tuberculosis countries globally.A large challenge lies in how policies to improve detection,diagnosis and treatment completion interact with social and structural drivers ofTB.Detailed understanding and theoretical development of the contextual determinants of problems inTB care is required for developing effective interventions.This article reports findings from the pre-implementation phase of a study ofTB care in South Africa,contributing to HeAlth System StrEngThening in Sub-Saharan Africa(ASSET)-a five-year research programme developing and evaluating health system strengthening interventions in sub-Saharan Africa.The study aimed to develop hypothetical propositions regarding contextual determinants of problems inTB care to inform intervention development to reduce TB deaths and incidence whilst ensuring the delivery of quality integrated,person-centred care.Methods:Theory-building case study design using the Context and Implementation of Complex Interventions(CICI)framework to identify contextual determinants of problems in TB care.Between February and November 2019,we used mixed methods in six public-sector primary healthcare facilities and one public-sector hospital serving impoverished urban and rural communities in the Amajuba District of KwaZulu-Natal Province,South Africa.Qualitative data included stakeholder interviews,observations and documentary analysis.Quantitative data included routine data on sputum testing andTB deaths.Data were inductively analysed and mapped onto the seven CICI contextual domains.Results:Delayed diagnosis was caused by interactions between fragmented healthcare provision;limited resources;verticalised care;poorTB screening,sputum collection and record-keeping.One nurse responsible forTB care,with limited integration ofTB with other conditions,and policy focused on treatment adherence contributed to staff stress and limited consideration of patientsz psychosocial needs.Patients were lost to follow up due to discontinuity of information,poverty,employment restrictions and limited support for treatment side-effects.Infection control measures appeared to be compromised by efforts to integrate care.Conclusions:Delayed diagnosis,limited psychosocial support for patients and staff,patients lost to follow-up and inadequate infection control are caused by an interaction between multiple interacting contextual determinants.TB policy needs to resolve tensions between treating TB as epidemic and individually-experienced social problem supporting interventions which strengthen case detection,infection control and treatment,and also promote person-centred support for healthcare professionals and patients.
