scholarly journals MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Éimhín Ansbro ◽  
Tobias Homan ◽  
Jamil Qasem ◽  
Karla Bil ◽  
Mohammed Rasoul Tarawneh ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Household Survey ◽  
Host Population ◽  
Syrian Refugees ◽  
Programme Implementation ◽  
Cross Sectional ◽  
Implementation Framework ◽  
Primary Level ◽  
Number Of Patients ◽  
The Impact

Abstract Background In response to the rising global NCD burden, humanitarian actors have rapidly scaled-up NCD services in crisis-affected low-and-middle income countries. Using the RE-AIM implementation framework, we evaluated a multidisciplinary, primary level model of NCD care for Syrian refugees and vulnerable Jordanians delivered by MSF in Irbid, Jordan. We examined the programme’s Reach, Effectiveness, Adoption and acceptance, Implementation and Maintenance over time. Methods This mixed methods retrospective evaluation, undertaken in 2017, comprised secondary analysis of pre-existing cross-sectional household survey data; analysis of routine cohort data from 2014 to 2017; descriptive costing analysis of total annual, per-patient and per-consultation costs for 2015–2017 from the provider-perspective; a clinical audit; a medication adherence survey; and qualitative research involving thematic analysis of individual interviews and focus group discussions. Results The programme enrolled 23% of Syrian adult refugees with NCDs in Irbid governorate. The cohort mean age was 54.7 years; 71% had multi-morbidity and 9.9% self-reported a disability. The programme was acceptable to patients, staff and stakeholders. Blood pressure and glycaemic control improved as the programme matured and by 6.6 mmHg and 1.12 mmol/l respectively within 6 months of patient enrolment. Per patient per year cost increased 23% from INT$ 1424 (2015) to 1751 (2016), and by 9% to 1904 (2017). Cost per consultation increased from INT$ 209 to 253 (2015–2017). Staff reported that clinical guidelines were usable and patients’ self-reported medication adherence was high. Individual, programmatic and organisational challenges to programme implementation and maintenance included the impact of war and the refugee experience on Syrian refugees’ ability to engage; inadequate low-cost referral options; and challenges for MSF to rapidly adapt to operating in a highly regulated and complex health system. Essential programme adaptations included refinement of health education, development of mental health and psychosocial services and addition of essential referral pathways, home visit, physiotherapy and social worker services. Conclusion RE-AIM proved a valuable tool in evaluating a complex intervention in a protracted humanitarian crisis setting. This multidisciplinary programme was largely acceptable, achieving good clinical outcomes, but for a limited number of patients and at relatively high cost. We propose that model simplification, adapted procurement practices and use of technology could improve cost effectiveness without reducing acceptability, and may facilitate replication.

scholarly journals MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

2020 ◽  
Author(s):  
Éimhín Ansbro ◽  
Tobias Homan ◽  
Jamil Quasim ◽  
Karla Bil ◽  
Mohammed Rasoul Tarawneh ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Host Population ◽  
Syrian Refugees ◽  
Programme Implementation ◽  
Cross Sectional ◽  
Implementation Framework ◽  
Middle Income ◽  
Primary Level ◽  
Number Of Patients ◽  
The Impact

Abstract Background: In response to the rising global NCD burden, humanitarian actors have rapidly scaled-up NCD services in crisis-affected low-and-middle income countries. Using the RE-AIM implementation framework, we evaluated a multidisciplinary, primary-level model of NCD care for Syrian refugees and vulnerable Jordanians in Irbid, Jordan. We examined the programme’s Reach, Effectiveness, Adoption and acceptance; Implementation and Maintenance over time.Methods: This mixed methods, retrospective evaluation, undertaken in 2017, comprised secondary analysis of pre-existing cross-sectional household survey data; analysis of routine cohort data from December 2014 - December 2017; descriptive costing analysis of total annual, per-patient and per-consultation costs for 2015-2017 from the provider-perspective; clinical audit; medication adherence survey of 300 patients; and qualitative research involving thematic analysis of individual interviews and focus group discussions. Results: The programme enrolled 23% of Syrian adult refugees with NCDs in Irbid governorate. The cohort mean age was 54.7 years; 71% had multi-morbidity and 9.9% self-reported a disability. The programme was acceptable to patients, staff and stakeholders. Blood pressure and glycaemic control improved as the programme matured and by 7 mmHg and 26 mg/dL respectively within six months of patient enrolment. Total costs increased in parallel with increased service complexity from INT$ 4,206,481 in 2015 to 6,739,438 in 2017. Staff reported that clinical guidelines were usable and patients’ self-reported medication adherence was high. Individual and organisational challenges to programme implementation and maintenance included the impact of war and the refugee experience on Syrian refugees’ ability to engage; inadequate low-cost referral options; and challenges of operating in a regulated, middle-income country. Essential programme adaptations included refinement of health education, development of mental health and psychosocial services and addition of essential referral pathways, home visit, physiotherapy and social worker services.Conclusion: RE-AIM proved a valuable tool in evaluating a complex intervention in a protracted humanitarian crisis setting. This multidisciplinary programme was highly acceptable. It achieved good clinical outcomes but for a limited number of patients and at relatively high cost. We propose that model simplification, adapted procurement practices and use of technology could improve cost effectiveness without reducing acceptability, and may facilitate replication.

scholarly journals MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

2020 ◽  
Author(s):  
Éimhín Ansbro ◽  
Tobias Homan ◽  
Jamil Quasim ◽  
Karla Bil ◽  
Mohammed Rasoul Tarawneh ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Secondary Analysis ◽  
Household Survey ◽  
Host Population ◽  
Syrian Refugees ◽  
Programme Implementation ◽  
Cross Sectional ◽  
Implementation Framework ◽  
Middle Income ◽  
Primary Level

Abstract Background: Humanitarian actors have rapidly scaled-up NCD services in crisis-affected low-and-middle income countries, in response to the rising global NCD burden. Using the RE-AIM implementation framework, we evaluated a multidisciplinary, primary-level model of NCD care for Syrian refugees and vulnerable Jordanians in Irbid, Jordan. We examined the Reach, Effectiveness, Adoption and acceptance of the programme; the fidelity, adaptation and costs of Implementation; and its Maintenance over time.Methods: This mixed methods, retrospective evaluation, undertaken in 2017, comprised secondary analysis of pre-existing cross-sectional household survey data; analysis of routine cohort data from January 2015 - December 2017; provider-perspective, descriptive costing analysis of total annual, per-patient and per-consultation costs for 2015-2017; clinical audit; medication adherence survey of 300 patients; and qualitative research. The latter involved thematic analysis of individual interviews with patients, staff and stakeholders and two focus group discussions with patients.Results: The programme reached 5.9% of Syrian adults with NCDs in Irbid governorate. The cohort mean age was 54.7 years; 71% had multi-morbidity and 9.9% self-reported a disability. The programme was highly acceptable to patients, staff and stakeholders. Blood pressure and glycaemic control improved as the programme matured and within six months of patient enrolment (with a drop of 7mmHg and 26.8 mg/dL from baseline, respectively). Total costs increased in parallel with increased service complexity from INT$ 4,206,481 in 2015 to 6,739,438 in 2017. Clinical guidelines were reportedly usable and self-reported medication adherence was high. Individual and organisational challenges to programme implementation and maintenance included the impacts of war and the refugee experience on Syrian refugees’ engagement; inadequate low-cost referral options; and operating in a regulated, middle-income country. Essential programme adaptations included refinement of health education and introduction of: mental health and psychosocial services, essential referral pathways, home visit services and a social worker role.Conclusion: RE-AIM proved a valuable tool in evaluating a complex intervention in a protracted humanitarian crisis setting. This programme provided high quality, reliable, free, holistic NCD care and was highly acceptable to patients, providers and stakeholders. We propose that model simplification, cost reduction and use of technology could improve effectiveness and efficiency without reducing acceptability.

scholarly journals Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study

2020 ◽  
Vol 35 (8) ◽  
pp. 931-940
Author(s):  
Éimhín Ansbro ◽  
Sylvia Garry ◽  
Veena Karir ◽  
Amulya Reddy ◽  
Kiran Jobanputra ◽  
...  
Keyword(s):  
Low Income ◽  
Care Delivery ◽  
Communicable Disease ◽  
Host Population ◽  
Syrian Refugees ◽  
Task Sharing ◽  
Primary Level ◽  
Costing Study ◽  
The Impact ◽  
Non Communicable Disease

Abstract The Syrian conflict has caused enormous displacement of a population with a high non-communicable disease (NCD) burden into surrounding countries, overwhelming health systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the response. Cost data, which are currently lacking, may support programme adaptation and system scale up of such NCD services. This descriptive costing study from the provider perspective explored financial costs of the MSF NCD programme. We estimated annual total, per patient and per consultation costs for 2015–17 using a combined ingredients-based and step-down allocation approach. Data were collected via programme budgets, facility records, direct observation and informal interviews. Scenario analyses explored the impact of varying procurement processes, consultation frequency and task sharing. Total annual programme cost ranged from 4 to 6 million International Dollars (INT$), increasing annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to 1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209 to 253 (2015–17). Annual cost increases reflected growing patient load and increasing service complexity throughout 2015–17. A scenario importing all medications cut total costs by 31%, while negotiating importation of high-cost items offered 13% savings. Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more sensitive to reducing clinical review frequency than to task sharing review to nurses. Over 1000 extra patients could be enrolled without additional staffing cost if care delivery was restructured. Total costs significantly exceeded costs reported for NCD care in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or restructuring consultation models could confer cost savings or facilitate cohort expansion. Cost effectiveness studies of adapted models are recommended.

scholarly journals Characteristics of those most vulnerable to employment changes during the COVID-19 pandemic: a nationally representative cross-sectional study in Wales

2021 ◽  
pp. jech-2020-216030
Author(s):  
Benjamin J Gray ◽  
Richard G Kyle ◽  
Jiao Song ◽  
Alisha R Davies
Keyword(s):  
Multinomial Logistic Regression ◽  
Household Survey ◽  
Well Being ◽  
Employment Outcomes ◽  
Cross Sectional Study ◽  
Public Health Response ◽  
Cross Sectional ◽  
Exact Test ◽  
Nationally Representative ◽  
The Impact

BackgroundThe public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest among the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the early months of the pandemic.MethodsData were collected from a cross-sectional, nationally representative household survey of the working age population (18–64 years) in Wales in May/June 2020 (n=1379). We looked at changes in employment and being placed on furlough since February 2020 across demographics, contract type, job skill level, health status and household factors. χ2 or Fisher’s exact test and multinomial logistic regression models examined associations between demographics, subgroups and employment outcomes.ResultsOf our respondents, 91.0% remained in the same job in May/June 2020 as they were in February 2020, 5.7% were now in a new job and 3.3% experienced unemployment. In addition, 24% of our respondents reported being placed on furlough. Non-permanent contract types, individuals who reported low mental well-being and household financial difficulties were all significant factors in experiencing unemployment. Being placed on ‘furlough’ was more likely in younger (18–29 years) and older (60–64 years) workers, those in lower skilled jobs and from households with less financial security.ConclusionA number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.

scholarly journals Psychosocial Impact of Acne: A Community Based Cross Sectional Study

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Mohammad Sarwar Mir
Keyword(s):  
Quality Of Life ◽  
Social Impact ◽  
Acne Vulgaris ◽  
Clinical Severity ◽  
Age Group ◽  
Cross Sectional ◽  
Severe Acne ◽  
Number Of Patients ◽  
The Impact

Background: It is well-known that acne vulgaris is a common malady of adolescence and is easily recognized Objective: To evaluate the level of impact among acne patients on their quality of life. Methods: A total of 200 patients studied. Acne severity was graded using Global Acne Grading System (GAGS) after the clinical diagnosis. All the patients went through self-administered questionnaire of Cardiff Acne Disability Index (CADI) to fill out, to assess the reflection of patients’ experiences and perceptions. Result: Out of 200 patients, 114(57.0%) were females and 86(43.0%) were males. The maximum number of patients was in the age group of 16-20 years (142/200, 71%). Out of total 86 males, 50 (58.3%) had moderate to severe acne, whereas 62(54.38%) females had such a severe acne. 50.87% (58/114) of females had high CADI scores in comparison to only 27.9(24/86) of males. The impact on quality of life was more in the age-group of 21-30 years even though in this age group clinical severity of acne was mild to moderate only. Conclusion: Study found that individuals with acne had profound emotional, as well as, social impact on their quality of life.

scholarly journals THE IMPACT OF MEDICATION ADHERENCE ON HEALTH-RELATED QUALITY OF LIFE OF DIABETIC PATIENTS IN THE KINGDOM OF SAUDI ARABIA: FINDINGS FROM A CROSS-SECTIONAL STUDY

2020 ◽  
Vol 17 (34) ◽  
pp. 867-873
Author(s):  
Dhfer ALSHAYBAN ◽  
Royes JOSEPH
Keyword(s):  
Quality Of Life ◽  
Medication Adherence ◽  
Cross Sectional Study ◽  
P Value ◽  
Diabetic Patients ◽  
Health State ◽  
Cross Sectional ◽  
Related Quality ◽  
The Impact

Diabetes is a common chronic disease that is considered as one of the fastest-growing health problems in the world. Adherence to medications could be an important factor in reducing these complications and improving the quality of life. The purpose of this research was to assess the impact of treatment adherence on health-related quality of life in patients with type 2 diabetes. A multicenter cross-sectional study was carried out among 368 diabetes patients. General Medication Adherence Scale was used to assess the adherence level and EuroQol-5D to assess the quality of life. The results show that 19%, 21%, and 23% of patients had maintained low medication adherence due to patient’s intentional or unintentional behavior due to additional diseases or pills burden and due to financial constraints, respectively. Overall, 43% (n=162) participants had maintained high medication adherence, and 37% (n=138) had maintained low medication adherence to antidiabetic drugs. Nearly one-third (31%) of patients with high overall adherence had perfect health state in comparison with 4% among patients with low adherence. Further, the lower proportion (21%) of patients with high overall adherence had perfect health state in comparison with that among patients with low adherence (34%). In addition to the overall adherence, the association was statistically significant for the domains related to non-adherence due to the patient’s intentional or unintentional behavior (p-value 0.001) and non-adherence due to additional diseases or pills burden (p-value 0.001) after taking into account of socio-demographic and clinical characteristics. In conclusion, the findings suggest that the policymakers should establish an intervention to improve adherence to diabetic treatment, and thus improve the quality of life for the type 2 diabetic patients.

The Social and Psychological Impact of Superficial Dermatophytic Infection using Dlqi and Ghq-12: A Cross-Sectional Study in 174 Patients at a Tertiary Care Centre in Southern-East Rajasthan

2021 ◽  
pp. 1-6
Author(s):  
Shivani Saini ◽  
◽  
Agarwal Shail ◽  
Jain Manish ◽  
Yadav Devendra ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Impact ◽  
Cross Sectional Study ◽  
World Population ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
The Mean ◽  
The Impact

Background: Dermatophytosis is a common fungal infection affecting 20-25% of the world population. Aims: Our study was aimed to assess its impact on health-related quality of life(QoL), mental health, and various variables. Materials and Methods: A cross-sectional study was done from April 2019 to September 2019 on 174 patients of dermatophytosis of aged more than 16 years with their informed consent. The impact of infection on the quality of life was assessed by using the Dermatology life quality index questionnaire and General health questionnaire-12 was used to assess psychological impact. A visual analogue scale was used to assess the severity of pruritus. Appropriate statistical tests were applied. Results: Males to females ratio was 1.4:1. The age group of 21-30 was having the highest number of patients with the mean age of 27.8±9.97. Most patients had BSA under 10%. The mean value of DLQI and GHQ-12 were found 15.989±7.407 and 2.8563±2.8964, respectively. We found that dermatophytosis had a very large effect on the quality of life as the maximum number of patients(39%) were within this category. The “work and school” part in the questionnaire gained maximum importance(52.8%). The mean VAS score was 6±2.733 with most patients(32.7%) had moderate itching. We found a positive correlation between VAS and DLQI, VAS and GHQ-12, DLQI, and GHQ-12 with the statistical significance. Conclusion: In our study dermatophytosis affected the quality of life as well as the psychological health of patients. Therefore proper treatment of superficial dermatophtytosis is essential to prevent it from further complications

scholarly journals Cutaneous manifestations in overweight and obese children and adolescent

2021 ◽  
Vol 8 (10) ◽  
pp. 1662
Author(s):  
Anuja Sunkwad ◽  
Sunanda Mahajan
Keyword(s):  
Acne Vulgaris ◽  
Overweight And Obesity ◽  
Striae Distensae ◽  
Cross Sectional ◽  
Cutaneous Manifestations ◽  
Children And Adolescent ◽  
Number Of Patients ◽  
Severely Obese ◽  
Prevalence Of Obesity ◽  
The Impact

Background: Obesity currently is regarded as universal disease of epidemic prevalence and known as the evil of the twentieth century. The last 3 decades we have seen an unprecedented increase in the prevalence of obesity throughout the world including India. Overweight and obesity are the fifth leading risks of global deaths worldwide. However, despite all above mentioned problems, the impact of obesity on the skin has received minimal attention though it can be a window for obesity markers.Methods: It was a cross-sectional descriptive observational study. A total of 131 patients of age 5 to 18 years with BMI greater than 85 percentiles for age and sex and those willing to give consent for participation in the study were selected.Results: Maximum number of patients were obese with their BMI (body mass index) range falling between 95-99 percentile; according to IAP guidelines obese were 83 (63.35%), followed by overweight 27 (20.61%) and 21(16.03%) patients were severely obese. Acanthosis nigricans was the major cutaneous finding seen in 100% cases. Other common manifestations were striae distensae, acrocordons, hyperhidrosis, miliaria, frictional dermatitis and intertrigo, acne vulgaris, atopic dermatitis and hypertrichosis.Conclusions: Obesity is associated significantly with certain dermatoses in children as well as in adults. Skin care of obese patients deserves particular attention, not only because of the high prevalence of cutaneous alteration but mainly because many of these disorders are preventable and could be treated which may improve patient’s quality of life.

scholarly journals Impact of food price increases on poverty in Indonesia: empirical evidence from cross-sectional data

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Faharuddin Faharuddin ◽  
M. Yamin ◽  
Andy Mulyana ◽  
Y. Yunita
Keyword(s):  
Rural Areas ◽  
Household Survey ◽  
Food Prices ◽  
Food Price ◽  
Food Groups ◽  
Cross Sectional ◽  
Content Type ◽  
Price Increases ◽  
Household Survey Data ◽  
The Impact

PurposeUsing cross-sectional household survey data, this paper aims to determine the impact of food price increases on poverty in Indonesia.Design/methodology/approachThis paper uses the quadratic almost ideal demand system applied to the 2013 Indonesian household survey data. The impact of food price increase on household welfare is calculated using a welfare measure, compensating variation.FindingsThree food groups with the most outstanding price impact on poverty are rice, vegetables and fish were studied. The 20% increase in the price of each food group causes an increase in the headcount ratio by 1.360 points (rice), 0.737 points (vegetables) and 0.636 points (fish). Maintaining food price stability for these food groups is very important because the more price increases, the more impact on poverty. Food price policies in rural areas are also more critical than in urban areas because the impact of food price increases in rural areas is higher.Research limitations/implicationsThis paper does not consider the positive impact of rising food prices on food-producing households.Practical implicationsImplementing appropriate poverty alleviation policies through food policies for main food groups and social protection.Social implicationsPromoting rural development policies and agricultural growth.Originality/valueThis paper contributes to the existing literature by providing empirical results regarding the impact of domestic food prices increase on poverty in Indonesia.

scholarly journals UNEXPLAINED WAGE GAPS IN THE TRADABLE AND NONTRADABLE SECTORS: CROSS-SECTIONAL EVIDENCE BY GENDER IN BOLIVIA

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
Oscar Molina-Tejerina ◽  
Luis Castro-Peñarrieta
Keyword(s):  
International Trade ◽  
Gender Gap ◽  
Gender Wage Gap ◽  
Wage Gap ◽  
Household Survey ◽  
Standard Industrial Classification ◽  
Cross Sectional ◽  
International Standard Industrial Classification ◽  
Tradable Sector ◽  
The Impact

This document analyzes the gender wage gap between in tradable and non-tradable sectors. The tradable sector is defined by the value of exports and imports in an industry based on the four-digit codes of the International Standard Industrial Classification. Based on Gary Becker's work, in an economy prone to discrimination against women, the document proposes a model from which discrimination is possible if companies generate supra-normal profits. These benefits will be determined by market power, which in turn depends on the number of companies participating in the industry, so under the assumption that tradable sectors are directly influenced by international trade and with the possibility of greater competition, this competition will generate a trend towards normal benefits, making it impossible to finance discrimination against women, so the wage gender gap should be lower in tradable than non-tradable sectors. Using the traditional Oaxaca-Blinder decomposition and the Oaxaca-Blinder decomposition with Recentered Influence Function (RIF) regressions for the 2013 Household Survey, we find that unexplained wage differences against women are significantly lower in the tradable sector, suggesting that the impact of international trade on the tradable sector helps to reduce the gender wage gap in Bolivia.

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