Development assistance for health (DAH) has increased dramatically over the past two decades, and this increase has led to a debate on the benefits and perverse effects of scaling-up vs scaling back DAH, and the type of interventions DAH should support. Nutrition remains a contested category viewed as essential to achieving primary healthcare objectives but as falling outside of the direct ambit of the health system. Thus, despite the increase in DAH, it continues to remain an underfunded area and little is known about the relationship between aid for nutrition-specific and nutrition-sensitive interventions and the proportion of stunted children across low- and middle-income countries. We hypothesize that as nutrition-specific aid targets local needs of countries and is less fungible than nutrition-sensitive aid, it will contribute more to a reduction in the proportion of stunted children, with the steepest gains among countries that have the highest burden of malnutrition. We use fixed-effects regressions to examine the relationship between the proportion of stunted children and aid for nutrition interventions (specific and sensitive) to 116 low- and middle-income countries (2002–16). We construct our panel using the Creditor Reporting System, Institute of Health Metrics and Evaluation, Food and Agriculture Organization, World Health Organization and World Development indicators databases. We find a one-dollar increase in per capita nutrition-specific aid is associated with a reduction in the proportion of stunted children by 0.004 (P < 0.05). When stratified by burden of malnutrition, a one-dollar increase in per capita nutrition-specific aid to countries with the highest burden of malnutrition is associated with sharper reductions in the proportion of stunted children (0.013, P < 0.01). We also find a significant association for per capita nutrition-sensitive aid and proportion of stunted children when per capita aid for nutrition is lagged by 3 and 4 years (0.0002, P < 0.05), suggesting a long-run association between nutrition-sensitive aid and proportion of stunted children. Our findings suggest that in spite of criticisms that development assistance fails to adequately reach its intended beneficiaries, aid for nutrition has been successful at reducing the proportion of stunted children. Our findings imply a need to scale-up nutrition funding and improve targeting of aid.
Contact investigation, the systematic evaluation of individuals in close contact with an infectious tuberculosis (TB) patient, is a key active case-finding strategy for global TB control. Better estimates of the yield of contact investigation can guide strategies to reduce the number of underreported and underdiagnosed TB cases, approximately three million cases per year globally. A systematic review (Prospero ID # CRD42019133380) and meta-analysis was conducted to update and enhance the estimates of the yield of TB contact investigation in low- and middle-income countries (LMIC). Pubmed, Web of Science, Embase and the WHO Global Index Medicus were searched for peer-reviewed studies (published between January 2006–April 2019); studies reporting the number of active TB or latent tuberculosis infection (LTBI) found through contact investigation were included. Pooled data were meta-analyzed using a random effects model and risk of bias was assessed.
Of 1,644 unique citations obtained from database searches, 110 studies met eligibility criteria for descriptive data synthesis and 95 for meta-analysis. The pooled yields of contact investigation activities for different outcomes were: secondary cases of all active TB (defined as those bacteriologically confirmed or clinically diagnosed) 2.87% (2.61–3.14, I2 97.79%), bacteriologically confirmed active TB 2.04% (1.77–2.31, I2 98.06%), and LTBI 43.83% (38.11–49.55, I2 99.36%). Yields are interpreted as the percent of contacts screened who are diagnosed with active TB as a result of TB contact investigation activities. Pooled estimates were substantially heterogenous (I2 ≥ 75%).
This study provides methodologically rigorous and up-to-date estimates for the yield of TB contact investigation activities in low- and middle-income countries (LMIC). While the data are heterogenous, these findings can inform strategic and programmatic planning for scale up of TB contact investigation activities.
Humanitarian crises increase the burden of mental disorders due to exposure to traumatic events and ongoing daily stressors. Effective mental health and psychosocial support (MHPSS) interventions exist, but barriers and facilitators for scaling up those interventions are less understood. The study aim was to identify barriers and facilitators for scaling up MHPSS interventions for populations affected by humanitarian crises in low- and middle-income countries.
A systematic review following PRISMA guidelines was conducted. Types of scale up were summarised, and barriers and facilitators analysed using the World Health Organization’s Expandnet framework of scaling up. Evidence quality was appraised using the Mixed Methods Appraisal Tool.
Fourteen eligible studies were identified. Most described horizontal types of scale up, integrating services into primary and community care through staff training, task-sharing, and establishing referral and supervision mechanisms. Barriers were reported in a range of framework elements, but primarily related to those in the health system. The overall quality of studies were limited.
Few MHPSS interventions in humanitarian crises appear to have been scaled up, and scaling up efforts were largely horizontal which challenges long-term sustainability. Greater focus should be on both horizontal and vertical scaling up, which should be accompanied by higher quality research.