scholarly journals Making the Health System Work for Nutrition (P10-139-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Shannon King ◽  
Timothy Roberton
Keyword(s):  
Health System ◽  
Health Workforce ◽  
Logic Model ◽  
Care Seeking ◽  
Nutrition Interventions ◽  
Middle Income ◽  
Household Level ◽  
Individual Level ◽  
Causal Pathways ◽  
System Components

Abstract Objectives The many factors underlying malnutrition highlight the need for nutrition strategies that are comprehensive and multi-sectoral. Within a multi-sectoral approach, the health system is uniquely placed to deliver ten nutrition-specific interventions, which, if scaled up, could substantially reduce under-5 deaths in high-burden countries (Bhutta et al, 2013). This study aims to clarify the role of key health system components, illuminating opportunities for increased uptake of nutrition-specific interventions and potential bottlenecks and challenges for programs and policies. Methods We reviewed existing nutrition frameworks to develop a comprehensive logic model illustrating the causal pathways by which health system components influence household-level determinants of nutrition and individual-level health outcomes. Concurrently, we reviewed literature on health and nutrition interventions that have a proven, quantifiable impact on morbidity and mortality in low- and middle-income countries. We mapped data from the gathered literature onto the logic model, allowing us to identify key causal pathways for the delivery of nutrition-specific interventions, and highlighting areas where evidence is lacking. Results There exists a large gap in the literature about how health system components influence the ability to delivery appropriate and high-quality nutrition care. Based on the nature of the intervention (i.e., supplement delivery, counselling, SAM/MAM management) several unique delivery pathways were identified and three common themes cut across all interventions: namely, the importance of a motivated and trained health workforce; reliable and efficient supply chains; and generating demand and increased care-seeking for nutrition interventions. Evidence from the broader health systems literature supports the importance of these three themes; however, this remains a research gap in the nutrition literature. Conclusions Three core health system components - a health workforce, supply chain and demand generation - play a pivotal role in the delivery of nutrition interventions. A better understanding of these components in relation to nutrition, based on evidence, will help to improve the design and implementation of future nutrition programs. Funding Sources Global Affairs Canada, under the project “Real Accountability: Data Analysis for Results”.

scholarly journals Improving pathways to care through interventions cocreated with communities: a qualitative investigation of men’s barriers to tuberculosis care-seeking in an informal settlement in Blantyre, Malawi

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044944
Author(s):  
Mackwellings Maganizo Phiri ◽  
Effie Makepeace ◽  
Margaret Nyali ◽  
Moses Kumwenda ◽  
Liz Corbett ◽  
...  
Keyword(s):  
Health System ◽  
Social Dynamics ◽  
Informal Settlement ◽  
Pathways To Care ◽  
Second Phase ◽  
Structural Factors ◽  
Care Seeking ◽  
Individual Level ◽  
Two Phases ◽  
Health Rights

IntroductionMen have a higher prevalence of undiagnosed tuberculosis (TB) than women and can spend up to a year longer contributing to ongoing transmission in the community before receiving treatment. Health outcomes are often worse for patients with TB living in informal settlements especially men. This study aimed to understand the barriers preventing men from seeking care for TB and cocreate interventions to address these barriers.MethodsWe used qualitative research methods including in-depth interviews and participatory workshops. Researchers worked with women and men living in Bangwe, an informal settlement in Blantyre, Malawi to develop interventions that reflected their lived realities. The study took place over two phases, in the first phase we undertook interviews with men and women to explore barrier to care seeking, in the second phase we used participatory workshops to cocreate interventions to address barriers and followed up on issues emerging from the workshops with further interviews. In total, 30 interviews were conducted, and 23 participants joined participatory workshops. The team used a thematic analysis to analyse the data.ResultsThree interconnected thematic areas shaped men’s health TB seeking behaviour: precarious socioeconomic conditions; gendered social norms; and constraints in the health system. Insecurity of day labour with no provision for sick leave; pressure to provide for the household and a gendered desire not to appear weak and a severely under-resourced health system all contributed to men delaying care in this context. Identified interventions included improved patient–provider relations within the health-system, improved workers’ health rights and broader social support for households.ConclusionImproving mens’ pathways to care requires interventions that consider contextual issues by addressing individual level socioeconomic factors but also broader structural factors of gendered social dynamics and health systems environment.

scholarly journals "Even though I am alone, I feel that we are many" - An appreciative inquiry study of asynchronous, provider-to-provider teleconsultations in Turkana, Kenya

2020 ◽  
Author(s):  
M Whitney Fry ◽  
Salima Saidi ◽  
Abdirahman Musa ◽  
Vanessa Kithyoma ◽  
Pratap Kumar
Keyword(s):  
Health System ◽  
Appreciative Inquiry ◽  
Health Service Delivery ◽  
Team Work ◽  
Mobile Technologies ◽  
Care Seeking ◽  
Specialist Care ◽  
Hub And Spoke ◽  
Middle Income ◽  
The Impact

Non-physician clinicians (NPCs) in low and middle-income countries (LMICs) often have little physical proximity to the resources - equipment, supplies or skills - needed to deliver effective care, forcing them to refer patients to distant sites. Unlike equipment or supplies, which require dedicated supply chains, physician/specialist skills needed to support NPCs can be sourced and delivered through telecommunication technologies. In LMICs however, these skills are scarce and sparsely distributed, making it difficult to implement commonly used real-time (synchronous), hub-and-spoke telemedicine paradigms. An asynchronous teleconsultations service was implemented in Turkana County, Kenya, connecting NPCs with a volunteer network of remote physicians and specialists. In 2017-18, the service supported over 100 teleconsultations and referrals across 20 primary healthcare clinics and two hospitals. This qualitative study aimed to explore the impact of the telemedicine intervention on health system stakeholders, and perceived health-related benefits to patients. Data were collected using Appreciative Inquiry, a strengths-based, positive approach to assessing interventions and informing systems change. We highlight the impact of provider-to-provider asynchronous teleconsultations on multiple stakeholders and healthcare processes. Provider benefits include improved communication and team work, increased confidence and capacity to deliver services in remote sites, and professional satisfaction for both NPCs and remote physicians. Health system benefits include efficiency improvements through improved care coordination and avoiding unnecessary referrals, and increased equity and access to physician/specialist care by reducing geographical, financial and social barriers. Providers and health system managers recognised several non-health benefits to patients including increased trust and care seeking from NPCs, and social benefits of avoiding unnecessary referrals (reduced social disruption, displacement and costs). The findings reveal the wider impact that modern teleconsultation services enabled by mobile technologies and algorithms can have on LMIC communities and health systems. The study highlights the importance of viewing provider-to-provider teleconsultations as complex health service delivery interventions with multiple pathways and processes that can ultimately improve health outcomes.

Doctor Retention in Ireland - What it may mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

2020 ◽  
Author(s):  
Bernard Hope Taderera
Keyword(s):  
Global Health ◽  
Health Workforce ◽  
Cross Sectional Study ◽  
Early Career ◽  
Healthcare Personnel ◽  
Health Coverage ◽  
Cross Sectional ◽  
Middle Income ◽  
Reform Agenda ◽  
Medical Graduates

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals Understanding Food Waste, Food Insecurity, and the Gap between the Two: A Nationwide Cross-Sectional Study in Saudi Arabia

Foods ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 681
Author(s):  
Nora A. Althumiri ◽  
Mada H. Basyouni ◽  
Ali F. Duhaim ◽  
Norah AlMousa ◽  
Mohammed F. AlJuwaysim ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Food Insecurity ◽  
Food Waste ◽  
Cross Sectional ◽  
Household Level ◽  
Individual Level ◽  
Factors Associated ◽  
Household Factors ◽  
Cooked Food ◽  
The Individual

Background: Food waste and food insecurity may co-exist in various balances in developing and developed countries. This study aimed to explore the levels of food waste and food insecurity, the factors associated with them, and their relationships at the household and individual levels in Saudi Arabia. Methods: This study was a nationwide cross-sectional survey conducted via computer-assisted phone interviews in January 2021. Quota sampling was utilized to generate balanced distributions of participants by gender across all the administrative regions of Saudi Arabia. Data collection included household demographics, food waste and disposal, the Food Insecurity Experience Scale (FIES), and the Household Food Insecurity Access Scale (HFIAS). Results: Out of the 2807 potential participants contacted, 2454 (87.4%) completed the interview. The mean age was 31.4 (SD = 11.7; range = 18–99) and 50.1% were female. The weighted prevalence of uncooked food waste in the last four weeks was 63.6% and the cooked food waste was 74.4%. However, the food insecurity weighted prevalence at the individual level (FIES) was 6.8%. In terms of food insecurity at the household level (HFIAS), 13.3% were in the “severely food insecure” category. Moreover, this study found that “moderately food insecure” households were associated with an increased likelihood to waste uncooked food (relative risk (RR) = 1.25), and the “mildly food insecure” (RR = 1.21) and “moderately food insecure” (RR = 1.17) households were associated with an increased likelihood to waste cooked food. However, “food secure” households were associated with a decreased likelihood to waste cooked food (RR = 0.56). Finally, this study identified four household factors associated with food waste and three household factors that were associated with “severe food insecurity.” Conclusions: This first national coverage study to explore food waste and food insecurity at the individual level and household level, identified household factors associated with food waste and food insecurity and identified new associations between food waste and food insecurity in Saudi Arabia. The associations found between food waste and food insecurity are potential areas of intervention to reduce both food waste and food insecurity at the same time, toward achieving the Sustainable Development Goal (SDG) targets related to food waste and food security.

The Potential Contribution of the Health System to Reducing Stunting in SUN Countries

2021 ◽  
pp. 037957212199812
Author(s):  
Talata Sawadogo-Lewis ◽  
Shannon E. King ◽  
Tricia Aung ◽  
Timothy Roberton
Keyword(s):  
Health System ◽  
Universal Coverage ◽  
Reproductive Age ◽  
World Health ◽  
Potential Contribution ◽  
Nutrition Interventions ◽  
Lives Saved Tool ◽  
Potential Impact ◽  
Nutrition Sensitive ◽  
Global Nutrition

Background: The global nutrition community has called for a multisectoral approach to improve nutritional outcomes. While most essential nutrition interventions are delivered through the health system, nutrition-sensitive interventions from other sectors are critical. Objective: We modeled the potential impact that Scaling Up Nutrition (SUN) interventions delivered by the health system would have on reaching World Health Assembly (WHA) stunting targets. We also included results for targets 2, 3, and 5. Methods: Using all available countries enrolled in the SUN movement, we identified nutrition interventions that are delivered by the health system available in the Lives Saved Tool. We then scaled these interventions linearly from 2012 up to nearly universal coverage (90%) in 2025 and estimated the potential impact that this increase would have with regard to the WHA targets. Results: Our results show that only 16 countries out of 56 would reach the 40% reduction in the number of stunted children by 2025, with a combined total reduction of 32% across all countries. Similarly, only 2 countries would achieve the 50% reduction in anemia for women of reproductive age, 41 countries would reach at least 50% exclusive breastfeeding in children under 6 months of age, and 0 countries would reach the 30% reduction in low birth weight. Conclusions: While the health system has an important role to play in the delivery of health interventions, focusing investments and efforts on the health system alone will not allow countries to reach the WHA targets by 2025. Concerted efforts across multiple sectors are necessary.

scholarly journals Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments

2021 ◽  
Vol 6 (5) ◽  
pp. e004324
Author(s):  
John Whitaker ◽  
Nollaig O'Donohoe ◽  
Max Denning ◽  
Dan Poenaru ◽  
Elena Guadagno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Evidence Synthesis ◽  
Rapid Assessment ◽  
Sub Saharan Africa ◽  
Trauma Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Three Delays

BackgroundThe large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles.MethodsWe conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment.ResultsOf 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment.ConclusionsWhole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.

scholarly journals Childlessness, Individual Socioeconomic Resources, and Health: Exploring Variation in 20 Countries

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 515-516
Author(s):  
Nekehia Quashie ◽  
Christine Mair ◽  
Radoslaw Antczak ◽  
Bruno Arpino
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Health Indicators ◽  
Data Repository ◽  
Middle Income ◽  
Individual Level ◽  
Socioeconomic Resources ◽  
Middle Income Countries ◽  
Using Data ◽  
The Impact

Abstract Childless older adults may be at risk for poorer health cross-nationally, yet most studies on this topic analyze only a small number of countries and only 1 or 2 health outcomes. To our knowledge, two papers exist that explore associations between childlessness and multiple indicators of health using data from a large number of regionally diverse countries (e.g., 20 countries from North America, Asia, and Europe), but neither study includes an examination of socioeconomic resources. The level of health risk faced by childless older adults is likely to be distinctly shaped by older adults’ socioeconomic resources (e.g., education, income, wealth). Associations between childlessness, socioeconomic resources, and health may also differ by country context. Using harmonized, cross-national data for adults aged 50 and older across 20 high- and middle-income countries (United States (HRS), European Union (SHARE), Mexico (MHAS), and China (CHARLS) from the Gateway to Global Aging data repository), we explore if and how individual-level socioeconomic resources (income, education, wealth) moderate associations between childlessness and five health indicators (self-rated health, ADL limitations, IADL limitations, chronic conditions, and depression). Results suggest that associations between childlessness and health outcomes vary by individual socioeconomic resources in some country contexts, but not in others. We discuss these findings in light of the impact of individual-level socioeconomic resources on older adults’ support options and health outcomes cross-nationally.

The utility of household Grocery Purchase Quality Index scores as an individual diet quality metric

2020 ◽  
pp. 1-28
Author(s):  
Haley Wynne Parker ◽  
Carolina de Araujo ◽  
Anne N. Thorndike ◽  
Maya Vadiveloo
Keyword(s):  
Diet Quality ◽  
Quality Index ◽  
Secondary Analysis ◽  
Weighted Kappa ◽  
Healthy Eating Index ◽  
Bachelor's Degree ◽  
Dietary Recommendations ◽  
Household Level ◽  
Individual Level ◽  
Grocery Purchase

Abstract The validated Grocery Purchase Quality Index (GPQI) reflects concordance between household grocery purchases and US dietary recommendations. However, it is unclear whether GPQI scores calculated from partial purchasing records validly reflect individual-level diet quality. Within the 9-month randomized controlled Smart Cart study examining the effect of targeted coupons on grocery purchase quality (n=209), this secondary analysis examined concordance between the GPQI (range 0-75, scaled to 100) calculated from 3-months of loyalty-card linked partial (≥50%) household grocery purchasing data and individual-level Healthy Eating Index (HEI) scores at baseline and 3-months calculated from food frequency questionnaires. HEI and GPQI concordance was assessed with overall and demographic-stratified partially-adjusted correlations; covariate-adjusted percent score differences, cross-classification, and weighted kappa coefficients assessed concordance across GPQI tertiles (T). Participants were mostly middle-aged (55.4(13.9) years), female (90.3%), from non-smoking households (96.4%), without children (70.7%). Mean GPQI (54.8(9.1)%) scores were lower than HEI scores (baseline: 73.2(9.1)%, 3-months: 72.4(9.4)%), and moderately correlated (baseline r=0.41 vs. 3-month r=0.31, p<0.001). Correlations were stronger among participants with ≤ bachelor’s degree, obesity, and children. Concordance was highest in T3. Participants with high (T3) vs. low (T1) GPQI scores had 7.3-10.6 higher odds of having HEI scores >80% at both timepoints. Weighted kappas (k=0.25) indicated moderate agreement between scores. Household-level GPQI derived from partial grocery purchasing data were moderately correlated with self-reported intake, indicating their promise for evaluating diet quality. Partial purchasing data appears to moderately reflect individual diet quality and may be useful in interventions monitoring changes in diet quality.

Prevalence and clustering of diarrhoea within households in India: some evidence from NFHS-4, 2015–16

2020 ◽  
Vol 53 (1) ◽  
pp. 108-120 ◽  
Author(s):  
Bevin Vijayan ◽  
Mala Ramanathan
Keyword(s):  
Water Supply ◽  
Diarrhoeal Disease ◽  
Household Level ◽  
Individual Level ◽  
Under Five ◽  
Safe Water ◽  
Chi Squared ◽  
Improved Sanitation ◽  
Nationally Representative ◽  
Water Supply And Sanitation

AbstractDiarrhoeal disease is one of the major causes of morbidity and mortality in children and is usually measured at individual level. Shared household attributes, such as improved water supply and sanitation, expose those living in the same household to these same risk factors for diarrhoea. The occurrence of diarrhoea in two or more children in the same household is termed ‘diarrhoea clustering’. The aim of this study was to examine the role of improved water supply and sanitation in the occurrence of diarrhoea, and the clustering of diarrhoea in households, among under-five children in India. Data were taken from the fourth round of the National Family and Health Survey (NFHS-4), a nationally representative survey which interviewed 699,686 women from 601,509 households in the country. If any child was reported to have diarrhoea in a household in the 2 weeks preceding the survey, the household was designated a diarrhoeal household. Household clustering of diarrhoea was defined the occurrence of diarrhoea in more than one child in households with two or more children. The analysis was done at the household level separately for diarrhoeal households and clustering of diarrhoea in households. The presence of clustering was tested using a chi-squared test. The overall prevalences of diarrhoea and clustering of diarrhoea were examined using exogenous variables. Odds ratios, standardized to allow comparison across categories, were computed. The household prevalence of diarrhoea was 12% and that of clustering of diarrhoea was 2.4%. About 6.5% of households contributed 12.6% of the total diarrhoeal cases. Access to safe water and sanitation was shown to have a great impact on reducing diarrhoeal prevalence and clustering across different household groups. Safe water alone had a greater impact on reducing the prevalence in the absence of improved sanitation when compared with the presence of improved sanitation. It may be possible to reduce the prevalence of diarrhoea in households by targeting those households with more than one child in the under-five age group with the provision of safe water and improved sanitation.

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