Influencing policy change: the experience of health think tanks in low- and middle-income countries

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties

Uganda's experience in Ebola virus disease outbreak preparedness, 2018-2019.

BACKGROUND: Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda's experience in EVD preparedness. RESULTS: On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. CONCLUSION: As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a "fire-fighting" approach during public health emergencies

Reproducibility of pain manikins : a comparison of paper versus online questionnaires

Background: In epidemiological studies, pain location is often collected by paper questionnaire using blank body manikins, onto which participants shade the location of their pain(s). However, it is unknown how reliable these will transfer to online questionnaires. The aim of the current study was to determine agreement between online- and paper-based completion of pain manikins. Methods: A total of 264 children, aged 15–18 years, completed both an online and a paper questionnaire. Participants were asked to identify the location of their pain by highlighting predefined body areas on a manikin (online) or by shading a blank version of the manikin (paper). The difference in the prevalence of 12 regional/widespread pain conditions was determined, and agreement between online and paper questionnaires was assessed using prevalence- and bias-adjusted kappa (PABAK). Results: For the majority of pain conditions, prevalence was higher when ascertained by paper questionnaire. However, for the most part, the difference in prevalence was modest (range: −1.1 to 5.7%) the exceptions being hip/thigh pain (difference: 10.6%) and upper back pain (difference: 14.8%). For most pain locations, there was good or very good agreement between paper and online manikins (PABAK range: 0.61 to 0.88). However, identification of pain in the hip/thigh and in the upper back had poorer agreement (PABAK: 0.49 and 0.29, respectively). Conclusions: This is the first study to examine the reproducibility of body manikins on different media, in a population-based survey. We have shown that online manikins can be used to capture data on pain location in a manner satisfactorily comparable to paper questionnaires

Design and analysis of compact MMIC switches utilising GaAs pHEMTs in 3D multilayer technology

In this paper, we demonstrate for the first time the implementation of three-dimensional multilayer technology on GaAs-based pseudomorphic high electron mobility transistor (pHEMT) switches. Two types of pHEMT switches are considered, namely single-pole single-throw (SPST) and single-pole double-throw (SPDT). The design and analysis of the devices are demonstrated first through a simulation of the industry-recognised standard model, TriQuint's Own Model - Level 3, developed by TriQuint Semiconductor, Inc. From the simulation analysis, three optimised SPST and SPDT pHEMT switches which can address applications ranging from L to X bands, are fabricated and tested. The performance of the pHEMT switches using multilayer technology are comparable to those of the current state-of-the-art pHEMT switches, while simultaneously offering compact circuits with the advantages of integration with other MMIC components.</p

Quality Monitoring of HIV-1-Infected and Uninfected Peripheral Blood Mononuclear Cell Samples in a Resource-Limited Setting▿

Human immunodeficiency virus type 1 (HIV-1) vaccine and natural history studies are critically dependent on the ability to isolate, cryopreserve, and thaw peripheral blood mononuclear cell (PBMC) samples with a high level of quality and reproducibility. Here we characterize the yield, viability, phenotype, and function of PBMC from HIV-1-infected and uninfected Ugandans and describe measures to ascertain reproducibility and sample quality at the sites that perform cryopreservation. We have developed a comprehensive internal quality control program to monitor processing, including components of method validation. Quality indicators for real-time performance assessment included the time from venipuncture to cryopreservation, time for PBMC processing, yield of PBMC from whole blood, and viability of the PBMC before cryopreservation. Immune phenotype analysis indicated lowered B-cell frequencies following processing and cryopreservation for both HIV-1-infected and uninfected subjects (P < 0.007), but all other major lymphocyte subsets were unchanged. Long-term cryopreservation did not impact function, as unstimulated specimens exhibited low background and all specimens responded to staphylococcal enterotoxin B (SEB) by gamma interferon and interleukin-2 production, as measured by intracellular cytokine staining. Samples stored for more than 3 years did not decay with regard to yield or viability, regardless of HIV-1 infection status. These results demonstrate that it is possible to achieve the high level of quality necessary for vaccine trials and natural history studies in a resource-limited setting and provide strategies for laboratories to monitor PBMC processing performance

Sex and Urbanicity Contribute to Variation in Lymphocyte Distribution across Ugandan Populations.

Management of patient care and interpretation of research data require evaluation of laboratory results in the context of reference data from populations with known health status to adequately diagnose disease or make a physiological assessment. Few studies have addressed the diversity of lymphocyte subsets in rural and urban Ugandan populations. Here, 663 healthy blood bank donors from semi-urban centers of Kampala consented to participate in a study to define lymphocyte reference ranges. Whole blood immunophenotyping was performed to determine the frequency and absolute counts of T, B, and NK cells using clinical flow cytometry. Results from blood bank donors were compared to a rural cohort from the district of Kayunga and more urban clinical trial participants from the capital city, Kampala. Relationships between hematological and lymphocyte parameters were also explored. In the semi-urban blood donors, females were significantly different from males in all parameters except the frequency of CD8 T and B cells. Females had higher absolute counts of CD4 T, CD8 T and B cells, whereas males had higher NK cell counts. NK cell frequency and counts were significantly higher in semi-urban blood donors, regardless of sex, compared to more urban study participants. CD8 T cell frequency and counts were significantly higher in the blood donors compared to the rural participants, irrespective of sex. Interestingly, basophil counts were positively associated with overall T cell counts. These findings suggest that both sex and level of cohort urbanicity may influence lymphocyte subset distributions in Ugandans

Modern technologies in education of hearing impaired pupils

<p>Box and whisker plots showing median and 2.5–97.5 percentiles of (A) neutrophils in semi-urban blood bank donors [SU] and vaccine trial [U]; (B) eosinophils; (C) lymphocytes; (D) basophils; (E) B monocytes; and (F) hemoglobin levels and RBC counts. The non-parametric Mann Whitney U test was used to determine any statistically significant differences between cohorts; *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001.</p