Coherence for Nutrition: Insights From Nutrition-Relevant Policies and Programs in Burkina Faso and Nigeria

ABSTRACT There is consensus that policy coherence is necessary for implementing effective and sustainable approaches to tackle malnutrition. We look at whether policies and programmes provide a coherent pathway to address nutrition priorities and if programmes are designed to deliver interventions aligned to the nutrition policy agenda in Nigeria and Burkina Faso. A systematic desk review was performed on nutrition-relevant policy and programme documents, obtained through grey literature searches and expert recommendations. We developed a framework with an impact pathway structure that includes five process steps, which was used to guide coding, data reduction and synthesis and structure the analysis. We assessed internal coherence along process steps within a given document and external coherence across process steps for explicitly linked policy/programme pairs. The majority of policies and programmes had partial internal coherence for both countries. The identification of relevant nutrition interventions to address challenges and reach objectives was the strongest connection within policies (16 out of 45 had complete coherence) while among programmes the strongest connection was coverage indicators that measure interventions (9 out of 21 had complete coherence). Eight programmes explicitly referenced at least one nutrition-relevant policy with a total of 16 linked policy/programme pairs (13 pairs for Burkina Faso and 3 for Nigeria) across health, nutrition, agriculture, and social focus areas. However, none of the linked pairs were assessed to have complete external coherence suggesting that priorities at policy level are not fully realised nor translated at programme level. This study offers a new approach for assessment of policy and program coherence and specifically examines policy and program linkages. We conclude that improved leadership on country priority setting and better alignment for nutrition within and across sectors is needed to enhance the effectiveness of nutrition investments.

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Measuring Housing Affordability Using Residual Income Method for Million-plus Cities in India

Proceedings Article ◽

10.38027/iccaua2021257n3 ◽

2021 ◽

Author(s):

Prabhat Kumar Rao ◽

◽

Arindam Biswas ◽

Keyword(s):

Affordable Housing ◽

Poverty Line ◽

Housing Affordability ◽

Residual Income ◽

Ratio Method ◽

New Approach ◽

Policies And Programs ◽

The City ◽

Indian Cities ◽

Living Cost

Housing affordability is an ever-growing concern in rapidly urbanizing countries like India. The need for affordable housing can hardly be overemphasis in India. Government has many policies and programs running for fulfilling the requirement. But it is essential to define affordability standards for the success of any such policies and programs. The Ratio Method, which is currently used as the base for determining affordable housing, doesn’t have the flexibility to match the varied scale and standards across Indian cities. This paper is based on Michel E stone’s residual income’ method to measure housing affordability for India’s million-plus city. It gives a new approach for measuring housing affordability based on the minimum living cost for survival. It uses Poverty Line data (2014) and NSSO economic survey data (2012) for defining the minimum standard of living in the city. Stakeholders can use the city-specific measurement for affordable housing generated from this paper in affordable housing policies and programs.

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Gaps in the implementation and uptake of maternal nutrition interventions in antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India

Maternal and Child Nutrition ◽

10.1111/mcn.13293 ◽

2021 ◽

Author(s):

Tina Sanghvi ◽

Phuong H. Nguyen ◽

Manisha Tharaney ◽

Sebanti Ghosh ◽

Jessica Escobar‐Alegria ◽

...

Keyword(s):

Antenatal Care ◽

Burkina Faso ◽

Maternal Nutrition ◽

Nutrition Interventions ◽

Care Services

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LO046: Factors associated with hospital admission following asthma exacerbations: a systematic review

CJEM ◽

10.1017/cem.2016.83 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S46-S46 ◽

Cited By ~ 1

Author(s):

B.H. Rowe ◽

N. Arrotta ◽

J. Hill ◽

E. Dennett ◽

M. Harries

Keyword(s):

Hospital Admissions ◽

Data Extraction ◽

Statistical Significance ◽

Grey Literature ◽

Included Study ◽

Significance Level ◽

Factors Associated ◽

Admission Rates ◽

Literature Searches ◽

Number Of Patients

Introduction: Patients with asthma frequently present to the emergency department (ED) with exacerbations; however, a select number of patients require admission to hospital. The objective of this study was to summarize the evidence regarding asthma-related hospital admissions and factors associated with these admissions following ED presentation. Methods: Comprehensive literature searches were conducted in seven electronic databases (database inception to 2015); manual and grey literature searches were also performed. Studies reporting disposition for adults after ED presentation were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS); standardized data-collection forms were used for data extraction. Admission proportions and factors associated with admission at a statistical significance level (p<0.05) were reported. Results: Out of an initial 5865 identified articles, 37 articles met full inclusion criteria. Admission proportions were reported in 25/37 studies, ranged from 1% to 37%, and collectively demonstrated a decline of ~9% in admissions between 1993 and 2012. Studies including a >50% Caucasian ethnicity were found to have a median admission proportion of 13% (interquartile range [IQR]= 7, 20) versus studies with >50% non-Caucasian ethnicity at 22% (IQR=20, 28). Age, female sex, and previous hospitalizations for asthma exacerbation were the most individually identifiable factors associated with admission. Presenting features and medication profile were the most frequent domains associated with admission. Conclusion: Admission rates have decreased approximately 9% in a nearly 20-year span and seem to be higher in studies involving mostly non-Caucasian ethnic groups. Demographic factors, markers of severity obtained by history or at ED presentation, and medication profile could be assessed by ED clinicians to effectively discern patients at high risk for admission.

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Identifying approaches for synthesizing and summarizing information to support informed citizen deliberations in health policy: a scoping review

Journal of Health Services Research & Policy ◽

10.1177/1355819619872221 ◽

2019 ◽

Vol 25 (1) ◽

pp. 59-66 ◽

Cited By ~ 2

Author(s):

Michael G Wilson ◽

Aditya Nidumolu ◽

Inna Berditchevskaia ◽

Francois-Pierre Gauvin ◽

Julia Abelson ◽

...

Keyword(s):

Health Policy ◽

Scoping Review ◽

Empirical Studies ◽

Grey Literature ◽

Policy Issue ◽

Optimal Strategies ◽

Policy Issues ◽

Stakeholder Perspectives ◽

Literature Searches ◽

Citizen Deliberation

Objective Public deliberations are an increasingly popular tool to engage citizens in the development of health policies and programmes. However, limited research has been conducted on how to best synthesize and summarize information on health policy issues for citizens. To begin to address this gap, our aim was to map the literature on the preparation of information to support informed citizen deliberations related to health policy issues. Methods We conducted a scoping review where two reviewers screened the results of electronic database searches, grey literature searches and hand searches of organizational websites to identify empirical studies, scholarly commentaries, and publicly available organizational documents focused on synthesizing and summarizing information to inform citizen deliberation about health policy issues. Two reviewers categorized each included document according to themes/topics of deliberation, purpose of deliberation and the form of deliberation, and developed a summary of the key findings related to synthesizing and summarizing information to support informed citizen deliberations. Results There was limited reporting about whether and how information was synthesized. Evidence was typically organized based on the source used (e.g. by comparing the views of stakeholders or experts) or according to the areas that policymakers need to consider when making decisions (e.g. benefits, harms, costs and stakeholder perspectives related to policy options). Information was presented primarily through written materials (e.g. briefs and brochures), audiovisual resources (e.g. videos or presentations from stakeholders), but some interactive presentation approaches were also identified (e.g. through interactive arts-based approaches). Conclusions The choice and framing of information to inform citizen deliberations about health policy can strongly influence their understanding of a policy issue, and has the potential to impact the discussions and recommendations that emerge from deliberations. Our review confirmed that there remains a dearth of literature describing methods of the preparation of information to inform citizen deliberations about health policy issues. This highlights the need for further exploration of optimal strategies for citizen-friendly approaches to synthesizing and summarizing information for deliberations.

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The Curated Food System: A Limiting Aspirational Vision of What Constitutes “Good” Food

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176157 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6157

Author(s):

Lauri Andress ◽

Carmen Byker Shanks ◽

Annie Hardison-Moody ◽

T. Elaine Prewitt ◽

Paul Kinder ◽

...

Keyword(s):

Rural Communities ◽

Food Insecurity ◽

Food System ◽

Grey Literature ◽

Rural Populations ◽

System A ◽

Production Distribution ◽

Policies And Programs ◽

Good Food ◽

Distribution Of Income

In an effort to elucidate an aspirational vision for the food system and explore whether the characteristics of such a system inadvertently set unattainable standards for low-wealth rural communities, we applied discourse analysis to the following qualitative datasets: (1) interviews with food experts and advocates, (2) scholarly and grey literature, (3) industry websites, and (4) email exchanges between food advocates. The analysis revealed eight aspirational food system discourses: production, distribution, and infrastructure; healthy, organic, local food; behavioral health and education; sustainability; finance and investment; hunger relief; demand-side preferences; romanticized, community led transformations. Study findings reveal that of eight discourses, only three encompass the experiences of low-wealth rural residents. This aspirational food system may aggravate the lack of autonomy and powerlessness already experienced by low-wealth rural groups, perpetuate a sense of failure by groups who will be unable to reach the aspirational food vision, silence discourses that might question those that play a role in the inequitable distribution of income while sanctioning discourses that focus on personal or community solutions, and leave out other policy-based solutions that address issues located within the food system. Further research might explore how to draw attention to silenced discourses on the needs and preferences of low-wealth rural populations to ensure that the policies and programs promoted by food system experts mitigate poor diets caused by food insecurity. Further research is needed to inform policies and programs to mitigate food insecurity in low-wealth rural populations.

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New approach to simplifying and optimising acute malnutrition treatment in children aged 6–59 months: the OptiMA single-arm proof-of-concept trial in Burkina Faso

British Journal Of Nutrition ◽

10.1017/s0007114519003258 ◽

2019 ◽

Vol 123 (7) ◽

pp. 756-767 ◽

Cited By ~ 3

Author(s):

Maguy Daures ◽

Kevin Phelan ◽

Mariama Issoufou ◽

Séni Kouanda ◽

Ousmane Sawadogo ◽

...

Keyword(s):

Burkina Faso ◽

Real Life ◽

Acute Malnutrition ◽

Proof Of Concept ◽

New Approach ◽

Multivariate Survival ◽

Arm Circumference ◽

Mid Upper Arm Circumference ◽

Programme Outcomes ◽

Therapeutic Food

AbstractThe Optimising treatment for acute MAlnutrition (OptiMA) strategy trains mothers to use mid upper arm circumference (MUAC) bracelets for screening and targets treatment to children with MUAC < 125 mm or oedema with one therapeutic food at a gradually reduced dose. This study seeks to determine whether OptiMA conforms to SPHERE standards (recovery rate > 75 %). A single-arm proof-of-concept trial was conducted in 2017 in Yako district, Burkina Faso including children aged 6–59 months in outpatient health centres with MUAC < 125 mm or oedema. Outcomes were stratified by MUAC category at admission. Multivariate survival analysis was carried out to identify variables predictive of recovery. Among 4958 children included, 824 (16·6 %) were admitted with MUAC < 115 mm or oedema, 1070 (21·6 %) with MUAC 115–119 mm and 3064 (61·8 %) with MUAC 120–124 mm. The new dosage was correctly implemented at all visits for 75·9 % of children. Global recovery was 86·3 (95 % CI 85·4, 87·2) % and 70·5 (95 % CI 67·5, 73·5) % for children admitted with MUAC < 115 mm or oedema. Average therapeutic food consumption was 60·8 sachets per child treated. Recovery was positively associated with mothers trained to use MUAC prior to child’s admission (adjusted hazard ratio 1·09; 95 % CI 1·01, 1·19). OptiMA was successfully implemented at the scale of an entire district under ‘real-life’ conditions. Programme outcomes exceeded SPHERE standards, but further study is needed to determine if increasing therapeutic food dosages for the most severely malnourished will improve recovery.

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OP83 Iterative Formative Research Informing Primary Care Education Design

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319001387 ◽

2019 ◽

Vol 35 (S1) ◽

pp. 21-21

Author(s):

Josephine Belcher ◽

Woroud Alzaher ◽

Pradnya Naik-Panvelkar ◽

Renee Granger

Keyword(s):

Program Design ◽

Contextual Information ◽

Grey Literature ◽

Research Process ◽

Educational Programs ◽

Formative Research ◽

Advisory Group ◽

Design And Development ◽

New Approach ◽

Research Questions

IntroductionNPS MedicineWise delivers nationwide educational programs for Australian general practitioners and community pharmacists. Extensive searching and synthesis of published and grey literature is undertaken to inform program design and development. However, this formative research process is lengthy, labour intensive and attempts to pre-emptively answer questions that could arise during design and development, prompting a process re-evaluation.MethodsA more targeted and iterative process was piloted entailing: (i) rapid collation (two weeks maximum) of basic contextual information into a pre-scoping briefing document including high-level statistics on medicines or test usage, key guidelines identification and collation of findings from relevant government and stakeholder reports, (ii) an internal advisory group reviewing the pre-scoping brief and identifying the highest priority research questions that must be answered to inform the design and development of the educational program, (iii) iterative work to answer the highest priority research questions with findings provided to the advisory group fortnightly, involving ad hoc search methods and snowballing techniques to identify pertinent literature quickly, (iv) iterative feedback from the advisory group as to whether the resulting work is adequate and development or whether further information is required, and reprioritisation of the work plan if necessary, and (v) completion of the formative research process within four or five iterations. The new approach was evaluated via surveys of the internal advisory group and staff involved in design and development. Administrative data on staffing and costs using the new approach were also compared with previous data.ResultsThis approach was trialled for three different educational programs. The resulting reports are more targeted, answer specific advisory group questions and take half the time to produce.ConclusionsThis approach can rapidly provide appropriate information to inform program design. The iterative approach has allowed greater responsiveness to changing advisory group priorities and process improvements.

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Visceral Leishmaniasis in West Africa: Clinical Characteristics, Vectors, and Reservoirs

Journal of Parasitology Research ◽

10.1155/2019/9282690 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Abdoulaye K. Kone ◽

Doumbo Safiatou Niaré ◽

Martine Piarroux ◽

Arezki Izri ◽

Pierre Marty ◽

...

Keyword(s):

Visceral Leishmaniasis ◽

West Africa ◽

Burkina Faso ◽

Ivory Coast ◽

Clinical Characteristics ◽

Leishmania Donovani ◽

Grey Literature ◽

The Gambia ◽

Number Of Patients ◽

Persons Living With Hiv

Visceral leishmaniasis (VL) is the most serious form of human leishmaniasis. VL is understudied in West Africa. The increasing number of patients at-risk, including persons living with HIV and other chronic immunosuppressive diseases, and likely underreporting of VL related to diagnostic challenges advocate for review of existing data to understand VL regional epidemiology. Our review aims to describe the clinical characteristics and epidemiology of Human VL (HVL) in West Africa. We conducted a literature search to identify peer-reviewed articles and grey literature sources using the search terms “Visceral leishmaniasis West Africa”, “Leishmania donovani West Africa”; and “Leishmania infantum West Africa”. Thirty published articles report HVL from seven countries, including The Gambia, Niger, Nigeria, Ivory Coast, Togo, Burkina Faso, and Guinea Bissau. Three countries report cases of Canine Visceral Leishmaniasis (CVL), including The Gambia, Senegal, and Burkina Faso. Niger, Nigeria, and Ivory Coast report the greatest number of HVL cases. As VL is present in West Africa, active surveillance, increased diagnostic capacity, and studies of vectors and reservoirs are essential to better understand VL epidemiology in the region.

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Multicomponent interventions for enhancing primary care: a systematic review

British Journal of General Practice ◽

10.3399/bjgp20x714199 ◽

2020 ◽

Vol 71 (702) ◽

pp. e10-e21

Author(s):

Geronimo Jimenez ◽

David Matchar ◽

Gerald Choon-Huat Koh ◽

Josip Car

Keyword(s):

Systematic Review ◽

Primary Care ◽

Hospital Admissions ◽

Grey Literature ◽

Emergency Department Visits ◽

Narrative Form ◽

Provider Satisfaction ◽

Quadruple Aim ◽

Literature Searches ◽

Multicomponent Interventions

BackgroundMany countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes.AimTo identify multiple-feature interventions aimed at enhancing primary care and their effects on measures of system success — that is, population health, healthcare costs and utilisation, patient satisfaction, and provider satisfaction (quadruple-aim outcomes).Design and settingSystematic review and narrative synthesis.MethodElectronic, manual, and grey-literature searches were performed for articles describing multicomponent primary care interventions, providing details of their innovation features, relationship to the ‘4Cs’ (first contact, comprehensiveness, coordination, and continuity), and impact on quadruple-aim outcomes. After abstract and full-text screening, articles were selected and their quality appraised. Results were synthesised in a narrative form.ResultsFrom 37 included articles, most interventions aimed to improve access, enhance incentives for providers, provide team-based care, and introduce technologies. The most consistent improvements related to increased primary care visits and screening/preventive services, and improved patient and provider satisfaction; mixed results were found for hospital admissions, emergency department visits, and expenditures. The available data were not sufficient to link interventions, achievement of the 4Cs, and outcomes.ConclusionMost analysed interventions improved some aspects of primary care while, simultaneously, producing non-statistically significant impacts, depending on the features of the interventions, the measured outcome(s), and the populations being studied. A critical research gap was revealed, namely, in terms of which intervention features to enhance primary care (alone or in combination) produce the most consistent benefits.

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Prognostic awareness in advanced cancer: an integrative literature review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002287 ◽

2020 ◽

pp. bmjspcare-2020-002287

Author(s):

Sara Mone ◽

Helen Kerr

Keyword(s):

Literature Review ◽

Advanced Cancer ◽

English Language ◽

Grey Literature ◽

Cochrane Library ◽

Prognostic Information ◽

Informed Decisions ◽

Literature Searches ◽

Life Trajectory ◽

The Individual

Individuals with advanced cancer who have accurate prognostic awareness are reported to make more informed decisions about their plan of care. Despite this, it is reported that individuals do not always have accurate prognostic awareness with the rationale for this discordance unclear. The primary aim of the integrative literature review was to identify if there is concordance between actual prognosis and accurate prognostic awareness in individuals with advanced cancer. The secondary aim was to identify the rationale for any discordance between actual prognosis and prognostic awareness in individuals with advanced cancer. This is an integrative literature review using a systematic approach. Literature searches were undertaken in March 2018 in four databases; CINAHL, MEDLINE, PsycINFO and Cochrane Library. Searches were limited to between 2008 and 2018 and those written in the English language. Database searches were supplemented with papers from reference lists of included papers and grey literature. Two reviewers independently completed the literature search and independently reviewed the papers. Fourteen eligible research papers were identified. The majority of individuals with advanced cancer in the included studies did not have accurate prognostic awareness. When identified, the rationale for discordance relates to the individual not being communicated accurate prognostic information, not being able to recall prognostic conversations or prognosis being discussed in vague terms. As individuals with advanced cancer with accurate prognostic awareness make more informed decisions at a crucial time in their life trajectory, it is imperative that healthcare professionals are equipped to effectively deliver accurate prognostic information, ensuring understanding is assessed.

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