Journal Article > CommentaryFull Text
Public Health Action. 21 September 2014; Volume 4 (Issue 3); DOI:10.5588/pha.14.0028
Zachariah R, Kumar AMV, Reid A, Van der Bergh R, Isaakidis P, et al.
Public Health Action. 21 September 2014; Volume 4 (Issue 3); DOI:10.5588/pha.14.0028
Journal Article > ResearchFull Text
Public Health Action. 21 June 2017; Volume 7 (Issue 1); DOI:10.5588/pha.16.0085
Moses FL, Tamang D, Denisiuk O, Dumbuya U, Hann K, et al.
Public Health Action. 21 June 2017; Volume 7 (Issue 1); DOI:10.5588/pha.16.0085
Setting: Sixty-eight primary health facilities, Koinadugu District, rural Sierra Leone. Objectives: Sierra Leone, a country with one of the highest burdens of malaria, was severely affected by the 2014-2015 Ebola virus disease outbreak. In under-five children, we compared trends in the completeness of malaria reports sent to the district office during the pre-Ebola, Ebola and post-Ebola periods, including the number of children with reported fever, malaria diagnostic testing performed and treatment for malaria initiated with artemisinin-based combination therapy (ACT). Design: A cross-sectional study. Results: Of 1904 expected malaria reports, 1289 (68%) were received. Completeness of reporting was 61% pre-Ebola, increased to 88% during the outbreak and dropped to 44% post-Ebola (P = 0.003). Total malaria testing (n = 105 558) exceeded the number of fever cases (n = 105 320). Pre-Ebola, 75% (n = 43 245) of all reported fever cases received malaria treatment, dropping to 34% (n = 50 453) during the Ebola outbreak. Of 36 804 confirmed malaria cases during Ebola, 17 438 (47%) were treated, significantly fewer than in the pre-Ebola period (96%, P < 0.001). Of the fever cases, 95% in both the pre- and post-Ebola periods received ACT, a rate that increased to 99% during the Ebola outbreak. Conclusion: Pre-existing gaps in malaria reporting worsened after the Ebola outbreak. Reassuringly, malaria testing matched fever cases, although only half of all confirmed cases received treatment during the outbreak, possibly explained by outbreak-related operational difficulties. These findings could be useful to guide health systems strengthening and recovery.
Journal Article > ResearchFull Text
Public Health Action. 21 June 2017; Volume 7 (Issue 1); DOI:10.5588/pha.16.0089
Sylvester Squire J, Hann K, Denisiuk O, Kamara M, Tamang D, et al.
Public Health Action. 21 June 2017; Volume 7 (Issue 1); DOI:10.5588/pha.16.0089
Setting: The 82 public health facilities of rural Kailahun District, Sierra Leone. Objective: The 2014-2015 Ebola virus disease outbreak in Sierra Leone led the Ministry of Health and Sanitation and stakeholders to set minimum standards of staffing (medical/non-medical) for a basic package of essential health services (BPEHS). No district-level information exists on staffing levels in relation to the Ebola outbreak. We examined the staffing levels before the Ebola outbreak, during the last month of the outbreak and 4 months after the outbreak, as well as Ebola-related deaths among health care workers (HCWs). Design: This was a retrospective cross-sectional study. Results: Of 805 recommended medical staff (the minimum requirement for 82 health facilities), there were deficits of 539 (67%) pre-Ebola, 528 (65%) during the Ebola outbreak and 501 (62%) post-Ebola, hovering at staff shortages of >50% at all levels of health facilities. Of the 569 requisite non-medical staff, the gap remained consistent, at 92%, in the three time periods. Of the 1374 overall HCWs recommended by the BPEHS, the current staff shortage is 1026 (75%). Of 321 facility-based HCWs present during Ebola, there were 15 (14 medical and one non-medical staff) Ebola-related and three non-Ebola related deaths among HCWs. Conclusion: The post-Ebola health-related human resource deficit is alarmingly high, with very few staff available to work. We call for urgent political will, resources and international collaboration to address this situation.
Journal Article > ResearchFull Text
Public Health Action. 21 October 2014; Volume 4 (Issue 2); S13-6.; DOI:10.5588/pha.14.0038
Davtyan K, Zachariah R, Davtyan H, Ramsay AR, Denisiuk O, et al.
Public Health Action. 21 October 2014; Volume 4 (Issue 2); S13-6.; DOI:10.5588/pha.14.0038
We assessed the performance of decentralised tuberculosis (TB) out-patient centres in tuberculosis (TB) case notification and treatment success in Armenia. An average threshold case notification of ⩾37/100 000 was seen in centres that had higher numbers of presumptive TB patients, where more TB was diagnosed by in-patient facilities and where TB contacts were examined. The number of doctors and/or TB specialists at centres did not influence case notification. Onsite smear microscopy was significantly associated with a treatment success rate of ⩾85% for new TB patients. Addressing specific characteristics of TB centres associated with lower case notification and treatment success and optimising their location may improve performance.
Journal Article > ResearchFull Text
Public Health Action. 1 September 2017; Volume 7 (Issue 3); DOI:10.5588/pha.17.0002
Goncharova O, Denisiuk O, Zachariah R, Davtyan K, Nabirova D, et al.
Public Health Action. 1 September 2017; Volume 7 (Issue 3); DOI:10.5588/pha.17.0002
Setting: Twenty-two first-line, two second-line and one tertiary health facility in Bishkek, the capital of Kyrgyzstan. Objectives: Among migrants, a marginalised population at risk for acquiring and transmitting tuberculosis (TB), we determined the proportion with TB among all registered TB cases. For those registered at primary-level facilities, we then reported on their demographic and clinical profiles and TB treatment outcomes. Design: This was a retrospective cohort analysis of 2012-2013 programme data. Results: Of 2153 TB patients registered in all health facilities, 969 (45%) were migrants, of whom 454 were registered in first-line facilities. Of these, 27% were cross-border migrants, 50% had infectious TB and 12% had drug-resistant TB. Treatment success was 74% for new cases and 44% for retreatment TB (the World Health Organization target is ⩾85%). Failure in new and retreatment TB patients was respectively 8% and 25%. Twenty-six individuals started on a first-line anti-tuberculosis regimen failed due to multidrug-resistant TB. Eight (25%) of 32 individuals on a retreatment TB regimen also failed. Loss to follow-up was 10% for new and 19% for retreatment TB. Conclusion: Migrants constituted almost half of all TB patients, drug resistance is prevalent and treatment outcomes unsatisfactory. Fostering inter-country collaboration and prioritising rapid TB diagnostics (Xpert® MTB/RIF) and innovative ways forward for improving treatment outcomes is urgent.
Journal Article > ResearchFull Text
Public Health Action. 21 October 2014; Volume 4 (Issue 2); S64-6.; DOI:10.5588/pha.14.0043
Dolgusev O, Obevzenco N, Padalco O, Pankrushev S, Ramsay AR, et al.
Public Health Action. 21 October 2014; Volume 4 (Issue 2); S64-6.; DOI:10.5588/pha.14.0043
This cohort study assessed drug susceptibility testing (DST) patterns and associated treatment outcomes from Transnistria, Moldova, from 2009 to 2012. Of 1089 newly registered tuberculosis (TB) patients with available DST results, 556 (51%) had some form of drug resistance, while 369 (34%) had multidrug-resistant TB (MDR-TB). There were four cases of extensively drug-resistant TB. MDR-TB patients had poor treatment success (45%); human immunodeficiency virus positivity and a history of incarceration were associated with an unfavourable treatment outcome. This first study from Trans-nistria shows a high level of drug-resistant TB, which constitutes a major public health problem requiring urgent attention.
Journal Article > ResearchFull Text
Public Health Action. 21 June 2017; Volume 7 (Issue 1); DOI:10.5588/pha.16.0088
Sesay T, Denisiuk O, Shringarpure KS, Wurie BS, George P, et al.
Public Health Action. 21 June 2017; Volume 7 (Issue 1); DOI:10.5588/pha.16.0088
Setting: All peripheral health units countrywide in Sierra Leone and one hospital in Port Loko. Objectives: Sierra Leone was severely affected by the 2014-2015 Ebola outbreak, whose impact on paediatric care and mortality reports merits assessment. We sought to compare the periods before, during and after the Ebola outbreak, the countrywide trend in morbidities in children aged < 5 years and exit outcomes in one district hospital (Port Loko). During the Ebola outbreak period, gaps in district death reporting within the routine Health Management Information System (HMIS) were compared with the Safe and Dignified Burials (SDB) database in Port Loko. Design: This was a retrospective records analysis. Results: The average number of monthly consultations during the Ebola outbreak period declined by 27% for malaria and acute respiratory infections and 38% for watery diarrhoea, and did not recover to the pre-Ebola levels. For measles, there was an 80% increase during Ebola, which multiplied by 6.5-fold post-Ebola. The number of unfavourable hospital exit outcomes was 52/397 (13%) during Ebola, which was higher than pre-Ebola (47/496, 9%, P = 0.04). Of 6565 deaths reported in the Port Loko SDB database, only 2219 (34%) appeared in the HMIS, a reporting deficit of 66%. Conclusion: The Ebola disease outbreak was associated with reduced utilisation of health services, and appears to have triggered a measles epidemic. Almost 70% of deaths were missed by the HMIS during the Ebola outbreak period. These findings could guide health system responses in future outbreaks.
Journal Article > ResearchFull Text
Public Health Panor. 1 March 2016; Volume 2 (Issue 1); 104-109.
Kulzhabaeva A, Nabirova D, Usenbaev N, Denisiuk O, Zachariah R
Public Health Panor. 1 March 2016; Volume 2 (Issue 1); 104-109.
The performance of the tuberculosis (TB) programme should be judged on the basis of detected TB cases recorded in the laboratory register and not just those placed on treatment and recorded in the TB treatment register. We examined the performance of the TB programme in this regard in Kyrgyzstan in 2012. This retrospective cohort study included all sputum smear-positive pulmonary TB cases registered in the TB laboratory register (584 persons). Data variables on geographical region, TB diagnosis, TB treatment and outcomes were sourced from various registers. We analysed (1) initial lost to follow-up (LTfu) between urban and rural areas; (2) time of starting treatment after diagnosis; (3) treat-
ment outcomes of laboratory-registered and treatment-registered patients. Of 584 patients diagnosed with new smear-positive pulmonary TB in two cities and eight rural districts, 59 (10%) were not traced in the patient TB treatment register and considered as initial LTfu. rural areas had significantly higher initial LTfu (13%) compared with urban areas (8%). The mean time to initiating treatment among those who were entered
in the TB register was 14 days (range 8–28 days). When all TB cases included in the laboratory register were used as the denominator, the overall treatment success rate reduced from 75% to 67% (a drop of 8%). Reporting on TB programme outcomes without including initial LTfu tends to exaggerate TB programme performance. Concerted efforts are needed to limit initial LTfu and accelerate progress towards ending TB as a
public health problem.
ment outcomes of laboratory-registered and treatment-registered patients. Of 584 patients diagnosed with new smear-positive pulmonary TB in two cities and eight rural districts, 59 (10%) were not traced in the patient TB treatment register and considered as initial LTfu. rural areas had significantly higher initial LTfu (13%) compared with urban areas (8%). The mean time to initiating treatment among those who were entered
in the TB register was 14 days (range 8–28 days). When all TB cases included in the laboratory register were used as the denominator, the overall treatment success rate reduced from 75% to 67% (a drop of 8%). Reporting on TB programme outcomes without including initial LTfu tends to exaggerate TB programme performance. Concerted efforts are needed to limit initial LTfu and accelerate progress towards ending TB as a
public health problem.
Journal Article > ResearchFull Text
Trop Med Infect Dis. 6 November 2020; Volume 5 (Issue 4); 167.; DOI:10.3390/tropicalmed5040167
Zachariah R, Rust S, Thekkur P, Khogali A, Kumar AMV, et al.
Trop Med Infect Dis. 6 November 2020; Volume 5 (Issue 4); 167.; DOI:10.3390/tropicalmed5040167
INTRODUCTION
Observational studies are often inadequately reported, making it difficult to assess their validity and generalizability and judge whether they can be included in systematic reviews. We assessed the publication characteristics and quality of reporting of observational studies generated by the Structured Operational Research and Training Initiative (SORT IT).
METHODS
A cross-sectional analysis of original publications from SORT IT courses. SORT IT is a global partnership-based initiative aimed at building sustainable capacity for conducting operational research according to country priorities and using the generated evidence for informed decision-making to improve public health. Reporting quality was independently assessed using an adapted version of ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) checklist.
RESULTS
In 392 publications, involving 72 countries, 50 journals, 28 publishers and 24 disease domains, low- and middle-income countries (LMICs) first authorship was seen in 370 (94%) and LMIC last authorship in 214 (55%). Publications involved LMIC-LMIC collaboration in 90% and high-income-country-LMIC collaboration in 87%. The majority (89%) of publications were in immediate open access journals. A total of 346 (88.3%) publications achieved a STROBE reporting quality score of >85% (excellent), 41 (10.4%) achieved a score of 76–85% (good) and 5 (1.3%) a score of 65–75% (fair).
CONCLUSION
The majority of publications from SORT IT adhere to STROBE guidelines, while also ensuring LMIC equity and collaborative partnerships. SORT IT is, thus, playing an important role in ensuring high-quality reporting of evidence for informed decision-making in public health.
Observational studies are often inadequately reported, making it difficult to assess their validity and generalizability and judge whether they can be included in systematic reviews. We assessed the publication characteristics and quality of reporting of observational studies generated by the Structured Operational Research and Training Initiative (SORT IT).
METHODS
A cross-sectional analysis of original publications from SORT IT courses. SORT IT is a global partnership-based initiative aimed at building sustainable capacity for conducting operational research according to country priorities and using the generated evidence for informed decision-making to improve public health. Reporting quality was independently assessed using an adapted version of ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) checklist.
RESULTS
In 392 publications, involving 72 countries, 50 journals, 28 publishers and 24 disease domains, low- and middle-income countries (LMICs) first authorship was seen in 370 (94%) and LMIC last authorship in 214 (55%). Publications involved LMIC-LMIC collaboration in 90% and high-income-country-LMIC collaboration in 87%. The majority (89%) of publications were in immediate open access journals. A total of 346 (88.3%) publications achieved a STROBE reporting quality score of >85% (excellent), 41 (10.4%) achieved a score of 76–85% (good) and 5 (1.3%) a score of 65–75% (fair).
CONCLUSION
The majority of publications from SORT IT adhere to STROBE guidelines, while also ensuring LMIC equity and collaborative partnerships. SORT IT is, thus, playing an important role in ensuring high-quality reporting of evidence for informed decision-making in public health.
Journal Article > ResearchFull Text
F1000Research. 10 March 2021; Volume 10; 198.; DOI:10.12688/f1000research.27349.1
Khogali MA, Tayler-Smith K, Harries AD, Zachariah R, Kumar AMV, et al.
F1000Research. 10 March 2021; Volume 10; 198.; DOI:10.12688/f1000research.27349.1
BACKGROUND
The Structured Operational Research and Training Initiative (SORT IT) teaches the practical skills of conducting and publishing operational research (OR) to influence health policy and/or practice. In addition to original research articles, viewpoint articles are also produced and published as secondary outputs of SORT IT courses. We assessed the characteristics, use and influence of viewpoint articles derived from all SORT IT courses.
METHODS
This was a cross-sectional study involving all published viewpoint articles derived from the SORT IT courses held from August 2009 - March 2020. Characteristics of these papers were sourced from the papers themselves and from SORT-IT members involved in writing the papers. Data on use were sourced from the metrics provided on the online publishing platforms and from Google Scholar. Influence on policy and practice was self-assessed by the authors of the papers and was performed only for papers deemed to be 'calls for action'.
RESULTS
A total of 41 viewpoint papers were published. Of these, 15 (37%) were 'calls for action'. In total, 31 (76%) were published in open-access journals and the remaining 10 in delayed access journals. In 12 (29%) of the papers, first authors were from low and middle-income countries (LMICs). Female authors (54%) were included in 22, but only four (10%) and two (5%) of first and last authors respectively, were female. Only seven (17%) papers had available data regarding online views and downloads. The median citation score for the papers was four (IQR 1-9). Of the 15 'call for action' papers, six influenced OR capacity building, two influenced policy and practice, and three influenced both OR capacity building within SORT IT and policy and practice.
CONCLUSION
Viewpoint articles generated during SORT IT courses appear to complement original OR studies and are valued contributors to the dissemination of OR practices in LMICs.
The Structured Operational Research and Training Initiative (SORT IT) teaches the practical skills of conducting and publishing operational research (OR) to influence health policy and/or practice. In addition to original research articles, viewpoint articles are also produced and published as secondary outputs of SORT IT courses. We assessed the characteristics, use and influence of viewpoint articles derived from all SORT IT courses.
METHODS
This was a cross-sectional study involving all published viewpoint articles derived from the SORT IT courses held from August 2009 - March 2020. Characteristics of these papers were sourced from the papers themselves and from SORT-IT members involved in writing the papers. Data on use were sourced from the metrics provided on the online publishing platforms and from Google Scholar. Influence on policy and practice was self-assessed by the authors of the papers and was performed only for papers deemed to be 'calls for action'.
RESULTS
A total of 41 viewpoint papers were published. Of these, 15 (37%) were 'calls for action'. In total, 31 (76%) were published in open-access journals and the remaining 10 in delayed access journals. In 12 (29%) of the papers, first authors were from low and middle-income countries (LMICs). Female authors (54%) were included in 22, but only four (10%) and two (5%) of first and last authors respectively, were female. Only seven (17%) papers had available data regarding online views and downloads. The median citation score for the papers was four (IQR 1-9). Of the 15 'call for action' papers, six influenced OR capacity building, two influenced policy and practice, and three influenced both OR capacity building within SORT IT and policy and practice.
CONCLUSION
Viewpoint articles generated during SORT IT courses appear to complement original OR studies and are valued contributors to the dissemination of OR practices in LMICs.