A smartphone, a strip of double-sided tape and a simple glass lens could have a significant impact on the diagnosis of helminths, intestinal parasites that affect millions in remote, rural parts of the world. In this proof-of-concept study in rural Tanzania, researchers compared the effectiveness of a lens attached to an iPhone with the effectiveness of a standard light microscope in searching for roundworm and hookworm eggs in 199 children's stool samples. Although not as sensitive as the light microscope, the mobile phone microscope revealed a sensitivity of 69.4% and a specificity of 61.5% for detecting any soil-transmitted helminth infection. The advantages of the mobile phone microscope are that it can be used with any smart phone, a lay health worker can operate it and it’s portable. The standard diagnostic process requires a microscope, a person trained to use one, electricity and a decent light source, which are often not widely available in rural areas.
Monitoring equity and research policy
In this study, researchers aimed to develop and assess inter-rater agreement for an algorithm for systematic review authors to predict whether differences in effect measures are likely for disadvantaged populations relative to advantaged populations. They developed a health equity plausibility algorithm with three items that dealt with the plausibility of differences in relative effects across sex or socioeconomic status (SES) due to: patient characteristics; intervention delivery (i.e. implementation); and comparators. Thirty-five respondents (consisting of clinicians, methodologists and research users) assessed the likelihood of differences across sex and SES for ten systematic reviews with these questions. The proportion agreement was 66% for patient characteristics, 67% for intervention delivery and 55% for the comparator. Users of systematic reviews rated that important differences in relative effects across sex and socioeconomic status were plausible for a range of individual and population-level interventions. However, there was very low inter-rater agreement for these assessments. There is an unmet need for discussion of plausibility of differential effects in systematic reviews. Increased consideration of external validity and applicability to different populations and settings is warranted in systematic reviews to meet this need, the authors conclude.
In this audit of the International Finance Corporation (IFC), the World Bank’s private lending arm, the CAO found that the IFC has processed most of its investments in compliance with the organisation’s own environmental and social policy requirements, but it was difficult to make an accurate assessment of the actual impact of the projects it invested in. Despite outward appearances, the CAO argues that many Social and Environmental Management Systems (SEMSs) for development projects have become mere window dressing, rather than a genuine means to improved environmental and social (E&S) outcomes on the ground. At the same time, the IFC’s E&S procedures and impact assessment measurements are not optimally designed to support broader environmental and social outcomes. To achieve those broader objectives, the IFC would need to focus on facilitating a self-sustaining cultural change within client organisations, raising their level of understanding and management of environmental and social risk. This implies a more sophisticated approach to the analysis of client commitment, and interventions that align E&S issues with relevant business and socioeconomic drivers of change, rather than focusing on systems compliance. It would also require a systematic methodology for measuring impact at the subclient level.
The Orphaned and Separated Children's Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. To date the study has enrolled 3,130 orphaned and separated children. In this paper, the authors use this project to describe how community-based participatory research (CBPR) approaches and principles can be incorporated and adapted into study design and methods. Preliminary results suggest that community engagement and participation was integral in refining the study design and identifying research questions that were impacting the community. Through the participation of village chiefs and elders, researchers were able to successfully identify eligible households and randomise the selection of participants. The on-going contribution of the community in the research process was also vital to participant retention and data validation while ensuring cultural and community relevance and equity in the research agenda. In conclusion, the authors argue that CBPR methods can strengthen epidemiological and public health research in sub-Saharan Africa within the social, political, economic and cultural contexts of the diverse communities on the continent, provided that the methods are adapted to the local context.
Qualitative and quantitative indicators are useful tools for promoting and monitoring the implementation of human rights. International human rights treaties and jurisprudence of the human rights treaty bodies call for the development of statistical indicators in compliance with international human rights norms and principles. The Office of the High Commissioner for Human Rights (OHCHR) has published this guide to assist in developing quantitative and qualitative indicators to measure progress in the implementation of international human rights norms and principles. The Guide describes the conceptual and methodological framework for human rights indicators recommended by international and national human rights mechanisms and used by a growing number of governmental and non-governmental actors. It provides concrete examples of indicators identified for a number of human rights - all originating from the Universal Declaration of Human Rights - and other practical tools and illustrations, to support the realization of human rights at all levels. It will be of interest to human rights advocates as well as policymakers, development practitioners, statisticians and others who are working to make human rights a reality for all.
Following a literature review and an analysis of health research priority-setting exercises that have been organised or coordinated by the World Health Organization since 2005, this article proposes a checklist for health research priority-setting that allows for informed choices on different approaches and ensures good practice. The list is intended to provide generic assistance for planning health research prioritisation processes. The nine themes in the checklist are: identifying contextual factors; using a comprehensive approach; ensuring inclusiveness in decision-making processes; identifying and gathering relevant information; planning for implementation; selecting criteria for setting priorities; choosing methods for selecting priorities; evaluating priorities; and writing a report that will make the process that was followed transparent.
This paper describes how the SUPPORT collaboration developed a short summary format for presenting the results of systematic reviews to policy-makers in low- and middle-income countries (LMICs). SUPPORT carried out 21 user tests in six countries – including South Africa and Uganda – to explore users’ experiences with the summary format. They found that policy makers liked a graded entry format (i.e. short summary with key messages up front). Policy makers particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally relevant detail in the original review. The authors conclude that presenting evidence from systematic reviews to policy makers in LMICs in the form of short summaries can render the information easier to assimilate and more useful, but summaries must be clear and easy to read or scan quickly. Policy makers should also be sensitised to the nature of the information provided by systematic reviews and its relevance for policy decisions.
Evaluation of large-scale programmes and initiatives aimed at improvement of health in countries of low- and middle-income needs a new approach, according to this article. Traditional designs, which compare areas with and without a given programme, are no longer relevant at a time when many programmes are being scaled up in virtually every district in the world. The authors propose an evolution in evaluation design: a national platform approach that uses the district as the unit of design and analysis, is based on continuous monitoring of different levels of indicators and gathers additional data before, during, and after the period to be assessed by multiple methods. The approach uses several analytical techniques to deal with various data gaps and biases and includes interim and summative evaluation analyses. It is intended to promote country ownership, transparency and coordination of external funding, while providing a rigorous comparison of the cost-effectiveness of different scale-up approaches.
Collaboration between policy, practice and research is imperative to obtaining more solid evidence in public health. However, the three domains do not easily work together because they emanate from three more-or-less independent 'niches', the authors of this study argue. They conducted a literature review of qualitative descriptive research published in English and Dutch between 1980 and 2006, and analysed literature according to the four steps of the policy, practice and research work cycles: problem recognition, approach formulation, implementation and evaluation. They found conspicuous differences in approach formulation and implementation that strengthen the niche character of each domain and hamper integration and collaboration. Disconnections ranged from formulating priorities in problem statements to power roles, appraisal of evidence, work attitudes, work pace, transparency of goals, evaluation and continuation strategies and public accountability. Creating awareness of these disconnections may result in more compatibility between researchers, policy makers and practitioners. This analysis can be used by public health services-related researchers, practitioners and policy makers to take into account the risk for disconnections. The authors recommend practice- and policy-based research networks to establish strong links between researchers, policy makers and practitioners to improve public health.
The authors of this study reviewed social science and interdisciplinary research in neglected tropical diseases (NTDs). They conducted a bibliographic analysis of neglected NTD-related research papers published over the past 10 years in biomedical and social sciences, focusing on specific NTDs, namely chikungunya, dengue, visceral leishmaniasis and onchocerciasis. According to the review, there is substantial variation in the number of publications associated with each disease. The proportion of the research that is social science based appears remarkably consistent. A textual analysis, however, revealed a degree of misclassification by the abstracting service, where a surprising proportion of the ‘social sciences’ research was actually pure clinical research. Much of the social sciences research also tends to be ‘hand maiden’ research focused on the implementation of biomedical solutions. The authors conclude there is little evidence that scientists pay any attention to the complex social, cultural, biological and environmental dynamic involved in human pathogenesis. They found little investigator-driven social science research and a poor presence of interdisciplinary science. NTD research needs more sophisticated funders and priority setters who are not beguiled by uncritical biomedical promises, they argue.