“In Africa there are so few people trained in research methods.  Without skills in research methods and training, one cannot publish in top journals. What then can be done to change this?”

Professor Ron LaPorte, Emeritus Professor of Epidemiology and co-founder of the Supercourse of Epidemiology, University of Pittsburgh WHO collaborating Center.

In answer to the challenge posed in the quote by Professor LaPorte, in collaboration with the team at the Library of Alexandria, we have developed a completely free (open access) research methods library that is one of the largest in the world where faculty and students can go to have their research methods answers answered, and we encourage researchers, faculties and students across Africa to be part of the new Africa Rising in research.

Let me share this abstract by some of my colleagues on the work we are doing at in an article presented to the Society for the Advancement of Science in Africa (SASA) 3rd International Annual Conference, which held in Toronto, Canada in August 29015, with the title : “Research Methods Library of Alexandria to Boost Scientific Productivity in Africa”.   It was led by Ronald LaPorte, Ph.D, (University of Pittsburgh) with Ismail Serageldin, Ph.D., (Library of Alexandria), Musa Kana, M.D. , Eugene Schubnikov, M.D., and Faina Linkov, Ph.D. as co-authors . The abstract read:

“During the past decade there has been a threefold marked acceleration of research in Africa.  Despite this increase, still only 2.5% of the world’s literature is published from Africa. We want to markedly increase this. Often, when people see this fact, they argue that more international and national money should be spent. However, it is unlikely in the near future that there will be a marked increase in funding for science.

We have taken a different, potentially very effective, but frugal approach. For 76% of the articles that are rejected, the reason is due to poor research methods. In Africa, there are brilliant young investigators with outstanding research ideas, yet they have problems publishing. The reason for the difficulty is what we call “stataphobia”, which is the fear of statistics and not having access to help. In Africa, in many countries, there are few people trained in research methods. It does not matter how bright a young person is, they cannot publish without a knowledge of statistics.

We therefore have built the “Research Methods Library of Alexandria (RMLA)”.

http://ssc.bibalex.org/helpdesk/introduction.jsf

This is a one-stop shopping center for answers to research methods. We have over 2,000 research and YouTube presentations, an “ask a research librarian”, numerous courses, free statistics books and software, scientific apps, and a survey portal. It is the largest library of research methods yet created. Everyone can use it for free.

We have just built a network of users. We have identified over 10,000 faculty members in medical schools in Africa and provided information about the program. Over 200 universities have put a “RMLA Button” on their site so that if one has a question about research methods, they click on the button and are whisked to the RMLA to find answers. We are also planning a top quality scientific journal that is peer reviewed, in the English Language, and of open access. It will also be one of the first “mentored” journals where the editors help authors with good ideas and data.

We are starting with health research, but will shortly expand to agriculture, climate, and computer engineering.”

Research Methods Library of Alexandria to Boost Scientific Productivity in Africa. Available from:https://www.researchgate.net/publication/280884374_Research_Methods_Library_of_Alexandria_to_Boost_Scientific_Productivity_in_Africa  

Do you want to become a champion for strengthening scientific research publication in Africa and also become a foundation member of the RMLA ? Or do you desire more   information for yourself or your institution?, It is simple. Just write to us and we will have you participate.

There are two requests that we ask in the beginning:

Go and examine the RMLA.  http://ssc.bibalex.org/helpdesk/introduction.jsf

Distribute this information to all students and faculty you can reach, as we believe that not only researchers should know a little about research methods, but all students in higher education in Africa should have some grounding in at least basic research. For example in the US most people think that in Africa people are more likely to be killed by a lion than walking across the street!!

The 3 component which is not required at this point, is if for you and your University or Academic or Training Institution become a regional member of the RMLA.  

This is free, and we ask that you put a Library of Alexandria link/button on your site

WE have given about 7-10 research methods training courses throughout the world which really benefit students.  If we can establish a joint virtual program with the approaches above, we could discuss a regional program.

My colleague Dr Musa Kana and I would be presenting the RMLA at a special panel at this year’s Biovision 2016 Conference in Egypt coming April. BioVision Alexandria , as it is referred to , is an important gathering that brings together distinguished speakers and Nobel Laureates from the four corners of the globe through rich discussions that commemorate science and the finest achievements of the human intellect. We would also be giving a course on research methods at The Society for the Advancement of Science in Africa (SASA) meetings in Nairobi, August 2016.   

You are welcome to be part of the Africa RMLA today.

Contact emails:

Africaglobalhealth@gmail.com ,  Ronaldlaporte@gmail.com

——

Dr. Francis O.Ohanyido

This review concluded that ‘the most effective interventions were those that involve male partner involvement in the decision to initiate contraceptive use… Our findings suggest that when information and contraceptives are provided, contraceptive use improves.’

Below is the citation, abstract and selected extracts. The full text is freely available here: http://www.reproductive-health-journal.com/content/12/1/100#

CITATION: Mwelwa Phiri, R. King, J. N. Newell. Behaviour change techniques and contraceptive use in low and middle income countries: a review

Reproductive Health 2015, 12:100  doi:10.1186/s12978-015-0091-y

Corresponding author: Mwelwa Phiri muleba@gmail.com

ABSTRACT

‘We aimed to identify effective behaviour change techniques to increase modern contraceptive use in low and middle income countries (LMICs). Literature was identified in Global Health, Web of Science, MEDLINE, PsycINFO and Popline, as well as peer reviewed journals. Articles were included if they were written in English, had an outcome evaluation of contraceptive use, modern contraceptive use, contraceptive initiation/uptake, contraceptive adherence or continuation of contraception, were a systematic review or randomised controlled trial, and were conducted in a low or middle income country. We assessed the behaviour change techniques used in each intervention and included a new category of male partner involvement. We identified six studies meeting the inclusion criteria. The most effective interventions were those that involve male partner involvement in the decision to initiate contraceptive use. The findings also suggest that providing access to contraceptives in the community promotes their use. The interventions that had positive effects on contraceptive use used a combination of behaviour change techniques. Performance techniques were not used in any of the interventions. The use of social support techniques, which are meant to improve wider social acceptability, did not appear except in two of the interventions. Our findings suggest that when information and contraceptives are provided, contraceptive use improves. Recommendations include reporting of behaviour change studies to include more details of the intervention and techniques employed. There is also a need for further research to understand which techniques are especially effective.’

EXTRACTS (selected by Neil PW)

‘Information techniques were used in all the interventions and included providing information on the available methods, importance and advantages of methods, ill effects of large families, misconceptions about methods and explanations of methods, including side effects and efficacy [11]–[16]. This information was mostly provided orally and face-to-face. Two interventions used a video to provide information with one adding a description of the methods on the patient consent form. One intervention also used drama, role playing and music to provide information. Peers, authority figures such as healthcare professionals, and community health workers (CHWs) provided this information.’

‘Media techniques consisted of using short videos to provide information, illustrating scenarios using drama and role plays, music and print media such as flip charts, leaflets, booklets and posters. Print media was provided as a supplement to the oral information in two of the interventions. None of the interventions used mass media. One intervention also contained a brief description of the methods on the patient consent form. Media techniques were used by three of the six interventions.’

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

There seems to be an increasing trend to focus systematic reviews on more and more specific questions, as illustrated by this review of features and content quality of mobile apps for bipolar disorder’.

Below is the citation and abstract. The authors identified 571 apps and concluded: ‘In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles.’ The review looked only for English-language apps and did not say anything about the applicability of the apps for different contexts such as low-resource environments and users with low literacy.

I am left feeling concerned that this is part of a larger explosion in poor-quality health apps which could have important adverse consequences on public and individual health. Many if not most of these apps are likely to be commercially driven. It is vital that funders and governments support efforts by international health agencies and rigourous content providers to produce high-quality content that truly meets the health needs of populations, especially in low and middle income countries.

CITATION: Nicholas J, Larsen ME, Proudfoot J, Christensen H. Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality. J Med Internet Res 2015;17(8):e198  DOI: 10.2196/jmir.4581

ABSTRACT

Background: With continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality.

Objective: Our aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content.

Methods: A systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed.

Results: Of the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%).

Conclusions: In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public.

—

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The reliability of information contained on health apps for mobile phones is of increasing concern. Below is a news item from PIF that shows action in Europe. I would be interested to learn what action is being taken in other regions, and whether/how WHO arnd other international agencies are being given the support they need to help coordinate this process globally.

—

‘The European Commission announced earlier this month that it has has set up a working group to develop guidelines for assessing the validity and reliability of the data that health apps collect and process.

Based on their expertise, 20 members representing civil society, research and industry organisations were selected to participate in the working group. The guidelines are expected to be published by the end of this year.

The development of the guidelines is one of the follow-up activities to the Commission’s Green Paper on mobile health (April 2014).  A public consultation on the Green Paper was carried out in 2014 and collected stakeholders’ views on how to tackle the challenges to the mHealth market in Europe. The results of the public consultation were published in January 2015.

Safety and transparency of information were identified by the respondents to the consultation as one of the main issues for mHealth uptake. The large number of lifestyle and wellbeing apps available, combined with no clear evidence on their quality and reliability, is raising concerns about the ability of consumers to assess their usefulness. This could limit the effective uptake of mHealth apps to the benefit of public health.

In order to fully benefit from the mobile health apps that people increasingly use to monitor their lifestyle and health status or to manage their chronic disease, it should be possible in the future to link data from these apps to the electronic health records.

This means that patients would be able to give access to their health professionals to consult the data collected by the apps.

Also, health professionals need the reassurance about the reliability of the apps, in order to be able to recommend apps to their patients and take apps’ data into consideration in a treatment/monitoring process.

The guidelines that the new Working Group will develop are expected to build on existing initiatives and best practices in Europe.

The group will seek to provide common quality criteria and assessment methodologies that could help different stakeholders (users, developers, vendors of electronic health record systems, payers etc.) in assessing the validity and reliability of mobile health applications.

Full details of the Working Group and the development of the guidelines can be found on the European Commission website herehttps://ec.europa.eu/digital-agenda/en/news/new-eu-working-group-aims-draft-guidelines-improve-mhealth-apps-data-quality

—

Best wishes, neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

You might be interested in this TED talk by Nigerian born Dr. Seyi Oyesola, on improving emergency care provision in Nigeria:

http://www.ted.com/talks/dr_seyi_oyesola_tours_a_hospital_in_nigeria

He highlights African solutions to African problems, including right infrastructure and a focus on solutions (and a little local sacrifice?) as opposed to just problems.

What do you think?

Best wishes

Jo

HIFA profile: Jo Vallis is Research Officer at NHS Education for Scotland (http://www.nes.scot.nhs.uk/)

Below are extracts from a news item on the BBC website. The paper in The Lancet Infectious Diseases is freely available here:

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00536-8/abstract

HIV becoming resistant to key drug, study finds

By Dominic Howell

http://www.bbc.co.uk/news/health-35433856

Strains of HIV are becoming resistant to an antiretroviral drug commonly used to prevent and fight the virus, research has suggested.

HIV was resistant to the drug Tenofovir in 60% of selected cases [individuals with treatment failure] in some African countries, according to the study, which covered a 17-year period…

Lead author Dr Ravi Gupta said the results were “extremely concerning”…

The paper, which has been published in The Lancet Infectious Diseases journal, said poor administration of the drug, in terms of regularly taking the right levels of Tenofovir could be explanation for the discrepancy.

“If the right levels of the drug are not taken, as in they are too low or not regularly maintained, the virus can overcome the drug and become resistant,” Dr Gupta told the BBC News website…’

The authors write:

‘Our findings are important in view of the fact that following WHO recommendations, tenofovir is replacing thymidine analogues (zidovudine and stavudine) as part of the NRTI backbone in first-line regimens in resource-limited settings. Every drug in these regimens can be compromised by one aminoacid mutation, and the combination therapy is therefore potentially fragile.’

—

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WONCA News – February 2016

The latest WONCA News is available via the WONCA website, packed with WONCA news, views and events.

From the WONCA President

“I had travelled to Hanoi, the capital city of the Socialist Republic of Vietnam, at the invitation of the Ministry of Health, and the Health Strategy and Policy Institute, to review the work under way to develop the Family Doctor Model across the nation to strengthen primary health care and ensure universal health coverage. Family medicine development is a top priority for the Government of Vietnam and I was asked to advise especially on the lessons that Vietnam could take from experience in family medicine development in other countries with a focus on the education and training of the family medicine workforce…… and on the financial mechanisms needed to ensure high quality, sustainable health care services which will be trusted and utilised by the population”

Read more about Michael Kidd’s fascinating visit to Vietnam, and the reforms taking place.

From the CEO’s Desk

In his column this month Garth Manning outlines details of the forthcoming WONCA Council meeting.  He also highlights the several WONCA awards available, and gives diary dates for key WONCA events throughout 2016.

WHO Call for Contributions to Survey – short notice

An important announcement from WHO. As a joint project between the Patient, Family and Community Engagement initiative and the Universal Health Coverage and Quality Unit of the WHO Service Delivery and Safety department, WHO is conducting a short survey on people’s opinions and perspectives of what universal health coverage means to them.  You can help WHO to better understand people’s needs and values about UHC. Your contribution, by completing this short survey of four questions, will offer new insights into how health systems can be more responsive, accessible and of high-quality in your context.

The deadline for submissions is 15th February.  Further details of the survey and how to complete it are at the WONCA website.

WONCA Europe – Early Bird deadline approaching!

The organizers of the WONCA Europe conference in Copenhagen (15th to 18th June) have reminded us that the deadline for Early Bird registration is 15th February.  

The conference promises to be interesting and dynamic.  The keynote speaker is Professor Martin Marshall of UK, who will be talking on making health care affordable in a future Europe. Can we provide high quality primary care and still have a cost-effective system under increasing economic restraints?  What, in fact, is the core output of general practice in an integrated healthcare system? 

We are not experts but we have read some of the publications and fact sheets on Zika and we have identified what we think are the most important 10 messages on Zika for children to learn and share. We tried to express the messages in a simple way. Can you let us know what you think?

Zika

10 messages for children aged 10-14 to learn and share

1.         Zika is a disease caused by a virus. It passes from one person to another by the bite of a mosquito called the “Aedes Mosquito.”

2.         The Aedes Mosquito bites in the morning and the late afternoon, so people have to be careful all day.

3.         There are people infected with the Zika virus disease in Africa, the Americas, Asia and the Pacific and it is spreading.

4.         In 2016, there has been a large increase of the numbers of people with Zika. Most of these live in South America.

5.         People with the Zika virus disease usually have a mild fever, a rash and red itchy sore eyes, and this can last for 2-7 days.

6.         At the moment there is no medicine or vaccine to prevent or treat Zika. (February 2016)

7.         Prevent mosquitoes biting by using insect repellent; wearing light coloured clothes to cover the body; using insect screens; closing doors and windows; and sleeping under insecticide-treated bed nets.

8.         Zika does not kill, but if a pregnant woman catches Zika her baby can be born with a small head and other problems to the body and brain.

9.         Help stop mosquitoes breeding: empty, clean or cover any containers that you see that hold any water,  however small e.g. pots or tyres.

10.       Help prevent mosquitoes biting young children the sick or elderly.

There is probably a case for another 10 messages on supporting families, babies and children who have disabilities that can be linked to this topic and we would be very happy to link with an expert or expert group on this to review  a further 10 messages.

All our messages are aimed at children aged 10-14 and we believe that most of the time the messages would get to the children via parents, older siblings and educators.

Best wishes

Clare

HIFA profile: Clare Hanbury qualified as a teacher in the UK

The new AIDSFree Guidance Database brings together national HIV testing and treatment guidance from many PEPFAR priority countries around the world. Use this interactive database to prepare guideline revisions for a specific country, conduct research and product development, prepare training materials for health care personnel, write proposals and grants, or learn about guidelines from other countries.

Check out the new interactive tool: http://1.usa.gov/1nN67re

—

JSILogo KATIE COOK

KNOWLEDGE MANAGEMENT STRATEGIST

PHONE: 571.302.7514 | WWW.JSI.COM

“Countries really need to get on a war footing against the mosquito”. These are the concluding words of an excellent 4-minute video statement by Dr Anthony Costello, Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health.

https://www.youtube.com/watch?v=0skonVosTJU&feature=youtu.be

The video is in English. It needs to be available also with Portuguese and Spanish subtitles.

For further information on Zika virus, see http://who.int/emergencies/zika-virus/en/

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

CITATION: Syrowatka A, Krömker D, Meguerditchian AN, Tamblyn R

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses

J Med Internet Res 2016;18(1):e20

DOI: 10.2196/jmir.4982

http://www.jmir.org/2016/1/e20/

ABSTRACT

Background: Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids.

Objective: The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making.

Methods: Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making.

Results: Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support.

Conclusions: Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness.

SELECTED EXTRACTS (selected by Neil PW)

‘Overall, content control improved quality of decision making. All types of content control performed better than other features, with the exception of navigation. Content control is intended to provide patients with control over order, detail, and type of evidence presented.’

‘Tailoring reduced quality of decision making, with all subgroups performing worse than other features. In general, tailoring is intended to translate evidence into patient-specific information to improve engagement.’

‘Patient narratives reduced quality of decision making. Patient narratives are intended to provide insight into patient experiences and bring attention to important evidence to consider throughout the decision-making process. In addition, information presented through patient narratives is processed differently than written information and can improve understanding and retention of evidence. However, narratives can unintentionally present biased or unbalanced information, which may result in lower-quality decision making.’

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CITATION: Why do health workers give anti-malarials to patients with negative rapid test results? A qualitative study at rural health facilities in western Uganda

by Robin Altaras, Anthony Nuwa, Bosco Agaba et al.

Malaria Journal 2016, 15:23 (11 January 2016)

http://www.malariajournal.com/content/pdf/s12936-015-1020-9.pdf

Correspondence: clarestrachan10@gmail.com

ABSTRACT: ‘The large-scale introduction of malaria rapid diagnostic tests (RDTs) promises to improve management of fever patients and the rational use of valuable anti-malarials. However, evidence on the impact of RDT introduction on the overprescription of anti-malarials has been mixed. The study found high provider adherence to RDT results, but that providers believed in certain clinical exceptions and felt they lacked alternative options. Guidance on how the RDT works and testing following partial treatment, better methods for assisting providers in diagnostic decision-making, and a context-appropriate provider behaviour change intervention package are needed.’

SELECTED EXTRACTS (selected by Neil PW)

Analysis of observation data and provider interview transcripts identified a number of factors that appeared to affect provider decision-making to prescribe anti-malarials to patients who tested negative. These were grouped into three intersecting thematic areas: clinical beliefs (what providers believe is the right thing to do), capacity constraints and the ability to make an alternative diagnosis (what providers have the means to do), and perception of patient demand (what providers think the patient wants them to do)…

A few providers did however raise doubts over test accuracy, citing patients who tested negative by RDT and then later positive by blood smear examination, which they sometimes attributed to “other strains of malaria” that could not be detected by the RDT…

“Generally I also have some doubts because one time my child fell sick, had all symptoms of malaria, when I did an RDT test, it turned out to be negative. Then the next day, I repeated the test, it again showed negative. Then I took the baby to hospital and that very night, the baby convulsed, they tested her… and the baby had malaria plus plus. Automatically, we put the baby on quinine IV, and the baby improved. So because of that experience, I have some doubts about the RDT results because that was really scaring and worrying.” [HW02, Nurse-midwife, HCIII]

… in cases where patients had already taken ACT prior to coming to the health facility, some providers seemed to presume treatment failure due to resistance, even when there was no prior confirmation that the patient had malaria. In such cases, providers reported shifting ‘automatically’ to prescribing a second-line antimalarial…

“There are some times when I give quinine injection when the patient has signs like shivering, vomiting, headache, very high temperature, etc. yet the patient had taken [AL], but is still very sick. At that point I can give quinine injection even if the RDT was negative because in most cases if the patient takes any anti-malaria drugs before testing, there is a possibility of the results turning out negative… [HW20, Nurse in charge, HCII]

While providers appeared to value RDTs as a confirmatory diagnostic, in observed practice they demonstrated limited capacity to diagnose non-malarial fevers…

Providers’ limited ability to make an alternative diagnosis for patients with negative RDT results appeared to be associated with three main constraints: a lack of know-how and low level of clinical skills, a lack of other point-of-care diagnostics and insufficient time due to understaffing and high workloads… Most providers tended to conflate symptoms and disease aetiology; cough and headache were frequently referred to as “causes of fever”.

“The most challenging part is communicating the results to the patient because some patients come here with a belief that they have malaria and expect to get treatment, so telling them a negative result is a disappointment on their side”. [HW20, Nurse in charge, HCII]

—

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This report from WHO looks to be very useful as countries seek to achieve universal health coverage in the post-2015 era. The indicators do not specifically include access to healthcare information. One could argue that it should be included among the section on ‘Health systems indicators’, alongside indicators such as ‘Availability of essential medicines and commodities’ and ‘Health worker density and distriution’. Or one could argue that the availability and use of healthcare information is so fundamental to all decision-making, whether by governments, health professionals, or citizens, that current failures in the global health information system need to be addressed with even more urgency than many of the specific 100 indicators. What do you think?

(The question of whether the availability and use of healthcare information can or should be recognised as a key health indcator is complicated by the fact that there is no agreement on how this might be measured. Then again, to paraphrase Seth Godin, “Just because something is difficult to measure doesn’t mean it’s not important.”)

2015 Global Reference List of 100 Core Health Indicators

Interagency Working Group on Indicators and Reporting Burden

World Health Organization, 2015

http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_HSI_2015.3_eng.pdf?ua=1

‘The Global Reference List of 100 Core Health Indicators is a standard set of 100 indicators prioritized by the global community to provide concise information on the health situation and trends, including responses at national and global levels. It will be reviewed and updated periodically as global and country priorities evolve and measurement methods improve.’

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Hesperian’s Zika Prevention & Community Education guide has now been translated into French, Spanish and Portuguese, and will be available in Haitian Kreyol soon. This guide is available online on our HealthWiki and also as a PDF printable handout.

Please share this resource widely with your community:

English: http://en.hesperian.org/hhg/Zika

Spanish: http://es.hesperian.org/hhg/Zika

French: http://fr.hesperian.org/hhg/Zika

Portuguese: http://pt.hesperian.org/hhg/Zika

Best regards,

Rachel Grinstein

—

Rachel Grinstein

Development and Marketing Associate

Hesperian Health Guides

P: 510.845.1447 | F: 510.845.9141

www.hesperian.org

Congratulations to Hesperian for making this guide available in Portuguese. I have informed our HIFA-Portuguese members, who have been lamenting the lack of information available in Portuguese (which is so clearly the language that is most needed). http://www.hifa2015.org/hifa-pt/

Meanwhile, I learn on BBC news today: ‘More than 220,000 soldiers are being deployed across Brazil to warn people about the risks of the Zika virus… Troops will hand out 4 million leaflets advising people about the risks of the virus, carried by mosquitoes.’

http://www.bbc.co.uk/news/world-latin-america-35568461

This is a clear recognition that meeting the information needs of citizens is vitally important. But is this the best way to go about it? As we have discussed on HIFA through the Ebola outbreak in West Africa, there are some key learning points that are as applicable to Zika as they are to Ebola:

1. Communication should be multi-channel. The Brazilian Government, WHO and the mass media should be collaborating to provide clean, clear, non-conflicting information for the general public through all media – an emphasis on one medium such as printed leaflets will be relatively ineffective.

2. Reaching people with low literacy is a priority – this cannot be done with leaflets.

3. Communication should be community-based wherever possible, engaging community leaders (municipal, religious, celebrities, and others)

4. The channel of communication should be one that is trusted by the people, and such communication should be done sensitively (are soldiers likely to be trusted by the communities? will they be able to work sensitively?)

5. Communication should not be one-way – it should include the opportunity for people to express concerns, ask questions, and work together to take effective community action (such as elimination of stagnant water where mosquitos breed).

6. Every country should prepare its capacity for mass health education in a public health emergency. This is important in any country, and especially in low and middle income countries where such emergencies are inevitable.

On the last point, it would be interesting to compare the annual public health education budget of the Brazil Government with the cost of deployment of 220,000 soldiers.

I look forward to hear from other HIFA members, especially those who have experience in public health education.

Best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

http://mobile.reuters.com/article/idUSKCN0VK0FQ?utm_campaign=KFF-2016-Daily-GHP-Report&utm_source=hs_email&utm_medium=email&utm_content=26159936&_hsenc=p2ANqtz-8y40tw3eYZouHgOXkAhFNjGxyeb5MZFOxrjTFzFLDEEakHjYynNpMzYmKHNmw5mUlcaYGU_gifn-w6wiTglGVqzkK62w&_hsmi=26159936

LUANDA (Reuters) – A yellow fever outbreak in Angola has killed 37 people since December with eight new cases reported in the last 24 hours, the country’s national director of health Adelaide de Carvalho said late on Wednesday. The outbreak of yellow fever, which is transmitted by mosquito bites, began in the Luanda suburb of Viana but has spread to other areas of the southern African country with 191 people infected so far. De Carvalho said health officials were monitoring suburbs around the capital of Luanda where infections have been worsened by unsanitary conditions caused by a garbage collection backlog.

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

http://www.who.int/emergencies/zika-virus/response/en/

WHO has launched a global Strategic Response Framework and Joint Operations Plan to guide the international response to the spread of Zika virus infection and the neonatal malformations and neurological conditions associated with it.

The strategy focuses on mobilizing and coordinating partners, experts and resources to help countries enhance surveillance of the Zika virus and disorders that could be linked to it, improve vector control, effectively communicate risks, guidance and protection measures, provide medical care to those affected and fast-track research and development of vaccines, diagnostics and therapeutics.

WHO says $56 million is required to implement the Strategic Response Framework and Joint Operations Plan, of which $25 million would fund the WHO/AMRO/PAHO response and $31 million would fund the work of key partners. In the interim, WHO has tapped a recently established emergency contingency fund to finance its initial operations.

As part of WHO’s new emergency programme, the agency’s headquarters activated an Incident Management System to oversee the global response and leverage expertise from across the organization to address the crisis. WHO is tapping a recently established emergency contingency fund to finance its initial operations.

WHO’s Regional Office for the Americas (AMRO/PAHO) has been working closely with affected countries since May 2015, when the first reports of Zika virus disease emerged from northeastern Brazil. AMRO/PAHO and partner specialists were deployed to help health ministries detect and track the virus, contain its spread, advise on clinical management of Zika and investigate the spikes in microcephaly and Guillain-Barré syndrome in areas where Zika outbreaks have occurred. AMRO/PAHO will continue to work with partners to manage the response in the Americas.

WHO is issuing regular information and guidance on the congenital and neurological conditions associated with Zika virus disease, as well as related health, safety and travel issues.

Working with partners, WHO is also mapping efforts to develop vaccines, therapies, diagnostic tests and new vector control tactics and putting in place mechanisms to expedite data sharing, product development and clinical trials.

On 1 February 2016, based on recommendations of the International Health Regulations Emergency Committee, WHO declared the increasing cases of neonatal and neurological disorders, amid the growing Zika outbreak in the Americas, a Public Health Emergency of International Concern.

All my best regards.

Mrs Isabelle Wachsmuth, Project manager, Health Information & System (HIS)

Service Delivery & Safety, Emerging Issues, Universal Health Coverage & Quality

Moderator of Global Francophone Forum – Health Information For All (HIFA-Fr)

Tel. direct: +41 22 791 3175 / Mail: hugueti@who.int

World Health Organization, 20, avenue Appia, CH-1211 Geneva 27

Tel: +41 22 791 2111 / Fax: +41 22 791 3111 / Visit WHO at: www.who.int

__________________________________________________________

EBSCO has made available free access to a comprehensive summary of the clinical evidence related to Zika virus in DynaMed Plus.

You can view it at https://health.ebsco.com/dynamed-content/zika-virus without logging in, or you can see it inside DynaMed Plus at http://www.dynamed.com/topics/dmp~AN~T909469/Zika-virus-infection — this topic will include evidence and guidelines, and be updated frequently.

Brian S. Alper, MD, MSPH, FAAFP

__________________________________________________________

Founder of DynaMed, Vice President of EBM Research and Development, Quality & Standards / http://www.dynamed.com/

Evidence Aid (www.evidenceaid.org) is developing a resource for Zika containing systematic reviews, randomised controlled trials and guidelines. If you know of any SRs, RCTs or guidelines you think should be considered for this collection, please send them directly to me (callen@evidenceaid.org).

Many thanks,

Claire Allen

Operations Manager, Evidence Aid: Winner of the Unorthodox Prize 2013 ($10,000)

Email: callen@evidenceaid.org, Skype: claireallencochrane, Website: www.evidenceaid.org

Twitter: @evidenceaid, Facebook: Evidence Aid

WONCA E-Update

Friday 19th February 2016

WONCA News – February 2016

The latest WONCA News is available via the WONCA website, packed with WONCA news, views and events.

Policy Bite: Public-Private Partnerships for PHC

“All governments have to decide how to meet the needs of their peoples, and most political elections are based on different beliefs as to how this can best be done. Fundamental issues about how to finance investment for health care and other public sectors require clear thinking and recurrent review of decisions made.”

In this month’s Policy Bite Professor Amanda Howe looks at a number of financing models for PHC delivery and discusses the pros and cons of each.

WONCA Special Interest Group on Health Equity

Professor William Wong, Convener of WONCA’s SIG on Health Equity, reports on the enthusiastic discussions which took place during the Health Equity workshop during WONCA Europe in Istanbul in October 2015.  He also encourages members to visit the newly affiliated journal: International Journal for Equity in Health for up to date health equity research and news from around the world whilst Global Focus looks especially at Bangladesh, Uganda and Taiwan

WONCA conferences

The first WONCA conference of the year – the South Asia Region conference in Colombo, Sri Lanka – took place last weekend, with over 600 delegates enjoying a very interesting and varied programme.  There are still several other WONCA conferences throughout 2016, including Dubai, Costa Rica and Copenhagen before the “big one” – the World Conference in Rio de Janeiro in November.  Full details of all WONCA events can be found on the website.

And don’t forget that if you enroll as a WONCA Direct Member you are entitled to discounted conference registration at all regional and world events.  Rio de Janeiro is offering especially attractive discounts to Direct Members, so why not sign up now?  Details of how to apply are available on the WONCA website

Or contact Arisa, in the WONCA Secretariat on admin@wonca.net.

RCGP publication on managing uncertainty in medical practice

The Royal College of General Practitioners (RCGP) has just published guidance to help clinicians understand uncertainty in medical practice, help them manage it effectively and improve their stress levels and resilience as a result. The book has wide appeal – clinicians in all specialties whether experienced or in training, or wherever in the world they are practising.

• Full details can be found on the RCGP website.

• Read a sample chapter.

• Copies can be purchased online from the RCGP Medical Bookshop.

Web server changeover

Finally we will be changing web server next week, prior to an update of the WONCA website.  There will thus be no e-update next week, and WONCA News will appear on Friday 5th March.  We hope that this will be a seamless changeover, but please bear with us if any glitches occur.

Abe SK, Balogun OO, Ota E, Takahashi K, Mori R. Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD010647. DOI: 10.1002/14651858.CD010647.pub2

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010647.pub2/abstract

The Plain Language Summary states:

“The benefits and risks of multiple-micronutrient supplementation during lactation are not clear from randomised controlled studies. Key vitamins and minerals, particularly iodine, iron and zinc, are required in small amounts to ensure normal body metabolism, physical growth and development. Nutrient deficiency affects nearly one third of the world’s population, especially in low- and middle-income countries. Breastfeeding mothers need higher levels than usual in order to provide sufficient vitamins and minerals for their own health and that of their babies, particularly for normal functioning and the growth and development of the baby.

Previous studies have assessed supplementation of individual micronutrients. This review looked at the use of multiple-micronutrient supplements for breastfeeding women for improving outcomes for the mother and her baby. We searched for studies on 30 September 2015 and identified two small studies (involving 52 women) for inclusion in this review. The studies were carried out in Brazil and the USA and included women who had a low socioeconomic status. The studies were poorly reported and this lack of information made it difficult to determine whether the studies were at risk of bias. Neither of the studies provided data for any of this review’s important outcomes: maternal illness (fever, respiratory infection, diarrhoea), adverse effects of micronutrients within three days of taking them, infant death (defined as a child dying before reaching one year of age).

Similarly, there were no data for any of the other outcomes that we were interested in. For the mother, these outcomes were maternal anaemia, and women’s satisfaction. For the baby, these outcomes were micronutrient deficiency; illness episodes (fever, respiratory infection, diarrhoea, other), adverse effects of micronutrients within three days of the woman receiving the supplement. However, one of the included studies reported that multiple-micronutrient supplementation was effective for lactating women recuperating from anaemia.

There is a need for high-quality studies to assess the effectiveness and safety of multiple-micronutrient supplementation for breastfeeding women for improving outcomes for the mother and her baby. Larger studies with longer-term follow-up would improve the quality of studies and provide stronger evidence. Further research should focus on whether multiple-micronutrient supplementation during lactation (compared with no supplementation, a placebo or supplementation with fewer than two micronutrients) is beneficial to the mother and her baby and any associated adverse effects of the intervention. Further studies should report on important outcomes such as those listed in this review and consider the risks of excess supplementation. Future studies could more precisely assess a variety of multiple-micronutrient combinations and different dosages and look at how these effect outcomes for the mother and her baby.”

Best wishes,

Holly

Holly Millward

Communications and Engagement Officer

Cochrane UK

CITATION: Hum Resour Health. 2016 Feb 12;14(1):5. doi: 10.1186/s12960-016-0100-4.

Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study.

Otu A, Ebenso B, Okuzu O, Osifo-Dawodu E.

Abstract

BACKGROUND: The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa.

METHODS: We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease.

RESULTS: Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P?<?0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola.

CONCLUSIONS: The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa.

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org