Burden of severe maternal morbidity and association with adverse birth outcomes in sub–Saharan Africa and south Asia: protocol for a prospective cohort study

Background Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in children and young adults worldwide. The disease burden associated with N. meningitidis infections has not been systematically assessed in China. Therefore, we undertook this study to determine the burden of meningococcal disease in China. Method We performed a systematic review and meta–analysis of articles on N. meningitidis incidence, carriage, seroprevalence and mortality rates in China by searching the Chinese BioMedical Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang database and PubMed for publications from January 2005 to Aug 2015. Results In total, 50 articles were included in our analysis. The overall incidence of meningococcal disease and associated mortality were estimated to be 1.84 (95% confidence interval (CI) 0.91–3.37) per 100 000 persons per year and 0.33 (95% CI 0.12–0.86) per 100 000 persons per year, respectively. N. meningitidis carriage rate among the healthy population was estimated to be 2.7% (95% CI 2.0–3.5%). Prevalence of antibodies against N. meningitidis serogroup A and C were estimated to be 77.3% (95% CI 72.4%–81.6%) and 33.5% (95% CI 27.0%–40.8%), respectively. No studies were found for serogroup specific disease burden. Conclusions The overall incidence of meningococcal disease in China is low. The lower seroprevalence of serogroup C within the population suggests that it may pose a greater risk for meningococcal disease outbreak than serogroup A. The lack of data on serogroup disease burden by age groups suggests the implementation of laboratory based meningococcal surveillance systems are urgently needed in China

An independent evaluation of The Filter

Existing Research In 2009, a comprehensive review of evidence relating to young people and smoking was published. Few studies were identified which focused specifically on smoking prevention or cessation interventions for young people, and the majority of the existing evidence focused on school-based programmes. We searched for Cochrane reviews and peer reviewed literature from 2009-2015. There was little research on the acceptability and effectiveness of training professionals who work with young people to deliver smoking prevention and cessation messages. There was also a dearth of evidence regarding the effectiveness of direct youth involvement in smoking prevention and cessation programmes. Evidence relating to online health promotion and young people focused primarily on educational programmes involving highly structured content, with very little evidence regarding a less formal approach. Research design A multi-faceted process evaluation of The Filter was undertaken. First, tweets sent to or from The Filter Twitter account were subjected to thematic analysis. Second, semi-structured interviews were undertaken with The Filter staff, professionals who had undergone training from The Filter and young people who had either interacted with The Filter online or as part of face-to-face workshops. Finally, surveys were developed based on the findings of the interview study, which asked professionals and young people about their experiences of all elements of The Filter programme. Results: Training for professionals working with young people The Filter training team reported that initially they designed and delivered training based on the key tobacco topics identified in Wales. This was later amended, to include smoking cessation training, and bespoke training packages. Professionals who took part in interviews reported that they valued this flexible approach to training courses and had put some of the techniques they had learnt into practice in their work with young people. This was found to be the case by professionals who took part in the online survey. Professionals also reported that the training was relevant, enjoyable and gave them new knowledge about smoking. 5 Results: Youth development, education and smoking cessation support The Filter developed a workshop-based approach to transmitting tobacco control and smoking cessation messages, which was delivered to small groups of young people in their own communities. The Filter staff reported that delivering these sessions was unproblematic, and all respondents identified a very strong rapport between The Filter staff and young people. The range of activities included in workshops was also identified as a key way of sustaining interest from young people, and visual aids were identified as particularly engaging. Some young people suggested that their interaction with The Filter had changed their planned behaviour in relation to smoking, or encouraged them to cut down or quit if they were existing smokers. Results: Online health promotion The Filter team shared tobacco control messages via a wide range of online platforms. They have achieved some level of success in terms of reach on The Filter website and potential reach on Twitter and Facebook. However, it was not possible within the confines of this research to understand if these users fit within the target demographic for the intervention, and how much overlap there was between The Filter face-to-face services and online services. The Filter staff reported that the intervention was deliverable by using a flexible approach, including the use of multiple and changing online platforms. It was not possible to understand how acceptable this intervention was to young people, as only one of The Filter’s followers agreed to take part in an online interview, and only 11 respondents to the online survey had interacted with the online resources. The evaluation of social media based interventions has been acknowledged to be a challenging area (Bailey et al., 2015) and this low response does not mean that the intervention is not reaching the targeted individuals, but that the individuals were not willing to take part in a brief evaluation. Conclusion To carry out this evaluation, we were given full access to The Filter team and their contacts in order to gather samples for the interviews and surveys. The Filter team were adaptable in their approaches to training and the use of social media over the course of the project, ensuring smoking cessation and prevention information was maintained as up to date and relevant. Professionals noted the rapport the Filter Team developed with young people was excellent. Training was high quality and professionals were able to use what they had learned from The Filter when working directly with young people. Young people liked the visual aspects of The Filter and they preferred the informal youth work approach to school based sessions on smoking. The use of The Filter social media platforms and online resources was encouraging, showing maintained growth over the course of evaluation period. Online resources were reported to be used by the majority of professionals taking part in the evaluation, however, engaging young people in the evaluation of The Filter via social media proved challenging. The data in this evaluation suggests that The Filter is a service which is feasible to deliver. The methodology of this evaluation did not allow us to examine the effectiveness of The Filter in terms of smoking prevention or cessation

Burden of severe maternal morbidity and association with adverse birth outcomes in sub–Saharan Africa and south Asia: protocol for a prospective cohort study

Background Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in children and young adults worldwide. The disease burden associated with N. meningitidis infections has not been systematically assessed in China. Therefore, we undertook this study to determine the burden of meningococcal disease in China. Method We performed a systematic review and meta–analysis of articles on N. meningitidis incidence, carriage, seroprevalence and mortality rates in China by searching the Chinese BioMedical Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang database and PubMed for publications from January 2005 to Aug 2015. Results In total, 50 articles were included in our analysis. The overall incidence of meningococcal disease and associated mortality were estimated to be 1.84 (95% confidence interval (CI) 0.91–3.37) per 100 000 persons per year and 0.33 (95% CI 0.12–0.86) per 100 000 persons per year, respectively. N. meningitidis carriage rate among the healthy population was estimated to be 2.7% (95% CI 2.0–3.5%). Prevalence of antibodies against N. meningitidis serogroup A and C were estimated to be 77.3% (95% CI 72.4%–81.6%) and 33.5% (95% CI 27.0%–40.8%), respectively. No studies were found for serogroup specific disease burden. Conclusions The overall incidence of meningococcal disease in China is low. The lower seroprevalence of serogroup C within the population suggests that it may pose a greater risk for meningococcal disease outbreak than serogroup A. The lack of data on serogroup disease burden by age groups suggests the implementation of laboratory based meningococcal surveillance systems are urgently needed in China

Population-based rates, risk factors and consequences of preterm births in South-Asia and sub-Saharan Africa: A multi-country prospective cohort study

Background Preterm birth is the leading cause of neonatal deaths in low middle-income countries (LMICs), yet there exists a paucity of high-quality data from these countries. Most modelling estimates are based on studies using inaccurate methods of gestational age assessment. We aimed to fill this gap by measuring the population-based burden of preterm birth using early ultrasound dating in five countries in South-Asian and sub-Saharan Africa. Methods We identified women early in pregnancy (<20 weeks based on last menstrual period) by home visits every 2-3 months (except in Zambia where they were identified at antenatal care clinics) in 5 research sites in South-Asia and sub-Saharan Africa between July 2012 and September 2016. Trained sonographers performed an ultrasound scan for gestational age dating. Women were enrolled if they were 8-19 weeks pregnant on ultrasound. Women <8 weeks were rescheduled for repeat scans after 4 weeks, and identified women were followed through pregnancy until 6 weeks postpartum. Site-specific rates and proportions were calculated and a logistic regression model was used to predict the risk factors of preterm birth. Results Preterm birth rates ranged from 3.2% in Ghana to 15.7% in Pakistan. About 46% of all neonatal deaths occurred among preterm infants, 49% in South Asia and 40% in sub-Saharan Africa. Fourteen percent of all preterm infants died during the neonatal period. The mortality was 37.6% for early preterm babies (<34 weeks), 5.9% for late preterm babies (34 to <37 weeks), and 1.7% for term babies (37 to <42 weeks). Factors associated lower gestation at birth included South-Asian region (adjusted mean difference (Adj MD)=-6.2 days, 95% confidence interval (CI)=-5.5, -6.9), maternal morbidities (Adj MD=-3.4 days, 95% CI=-4.6, -2.2), multiple pregnancies (Adj MD=-17.8 days, 95% CI=-19.9, -15.8), adolescent pregnancy (Adj MD=–2.7 days, 95% CI=-3.7, -1.6) and lowest wealth quintile (Adj MD=1.3 days, 95% CI=-2.4, -0.3). Conclusions Preterm birth rates are higher in South Asia than in sub-Saharan Africa and contribute to 49% and 40% of all neonatal deaths in the two regions, respectively. Adolescent pregnancy and maternal morbidities are modifiable risk factors associated with preterm birth

The causal web of foetal alcohol spectrum disorders : a review and causal diagram

Peer reviewedPublisher PD

Developing and evaluating a model of public involvement and engagement embedded in a national longitudinal study : HealthWise Wales

Acknowledgements: We acknowledge and thank the contribution of all the HWW Champion and Supporters who provided input to the protocol, collaborated with the research team and attended the events. We also thank Ameeta Richardson who helped facilitate the HWW Champion model. Funding HWW is funded by Health and Care Research Wales.Peer reviewedPublisher PD

Hospital admissions in infants with Down syndrome : a record-linked population-based cohort study in Wales

Acknowlegements This research was supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration Public Health Research Centre of Excellence, and The Centre for the Improvement of Population Health through E-records Research (CIPHER). CIPHER was funded by: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government), and the Wellcome Trust (Grant reference: MR/K006525/1). The development of the Wales Electronic Cohort for Children (WECC) was supported by a Translational Health Research Platform Award from the National Institute for Social Care and Health Research (grant reference: TPR08-006).Peer reviewedPublisher PD

Objective measures of prenatal alcohol exposure: a systematic review

CONTEXT: Objective measurement of prenatal alcohol exposure (PAE) is essential for identifying children at risk for adverse outcomes, including fetal alcohol spectrum disorders. Biomarkers have been advocated for use in universal screening programs, but their validity has not been comprehensively evaluated. OBJECTIVE: To systematically review the validity of objective measures of PAE. DATA SOURCES: Thirteen electronic databases and supplementary sources were searched for studies published between January 1990 and October 2015. STUDY SELECTION: Eligible studies were those that evaluated the diagnostic accuracy of objective measures of PAE. DATA EXTRACTION: Three reviewers independently verified study inclusion, quality assessments, and extracted data. RESULTS: Twelve studies met inclusion criteria. Test performance varied widely across studies of maternal blood (4 studies; sensitivity 0%–100%, specificity 79%–100%), maternal hair (2 studies; sensitivity 19%–87%, specificity 56%–86%) maternal urine (2 studies; sensitivity 5%–15%, specificity 97%–100%), and biomarker test batteries (3 studies; sensitivity 22%–50%, specificity 56%–97%). Tests of the total concentration of 4 fatty acid ethyl esters (in meconium: 2 studies; in placenta: 1 study) demonstrated high sensitivity (82%–100%); however, specificity was variable (13%–98%). LIMITATIONS: Risk of bias was high due to self-report reference standards and selective outcome reporting. CONCLUSIONS: Current evidence is insufficient to support the use of objective measures of prenatal alcohol exposure in practice. Biomarkers in meconium and placenta tissue may be the most promising candidates for further large-scale population-based research

Economic evaluation of interventions delivered by primary care providers to improve neurodevelopment in children aged under 5 years: protocol for a scoping review

Background: Frequently cited benefit-cost ratios suggest that interventions to improve neurodevelopment have high economic returns when implemented during pregnancy and early childhood. However, there are many challenges when primary care providers implement these interventions at scale, and it is unclear how many research studies or programmes have examined cost-effectiveness and which methods were used. There are no current scoping or systematic reviews which have assessed economic evaluations of interventions delivered by primary care providers to improve child neurodevelopment. Methods/design: The aim of this review is to describe the economic evaluations of interventions delivered by primary care providers to improve neurodevelopment in children aged 0–4 years. Specific subgroup analyses will include income level of country (high, middle and low); population type (universal vs targeted); time period when intervention was implemented (antenatal vs infancy [0–11 months] vs early childhood [12–59 months]); and setting (research study vs programmes evaluation at scale). All study designs will be included. The primary outcomes of interest are cost per neurodevelopmental or cognitive health gain in children aged 0–4 years. All measures of cost, neurodevelopment or cognitive function that have been previously validated as an appropriate test in this domain will be included. Databases such as MEDLINE (OVID), PsycINFO (OVID), EMBASE (OVID), CINAHL, Cochrane Library (including CENTRAL, DARE, HTA and NHS EED), Paediatric Economic Database Evaluation (PEDE) and WHO databases and reference lists of papers will be searched for relevant articles. Five phases will be followed: identifying the research question, identifying relevant studies, study selection, charting data and collating, summarising and reporting results. We will present cost and effectiveness data descriptively. Discussion: This review appears to be the first to be conducted in this area. The findings will be an important resource for future systematic reviews on interventions that have a cost component. This information will be valuable for policy makers and programmers who work in public health or primary care settings

An independent evaluation of The Filter

Existing Research In 2009, a comprehensive review of evidence relating to young people and smoking was published. Few studies were identified which focused specifically on smoking prevention or cessation interventions for young people, and the majority of the existing evidence focused on school-based programmes. We searched for Cochrane reviews and peer reviewed literature from 2009-2015. There was little research on the acceptability and effectiveness of training professionals who work with young people to deliver smoking prevention and cessation messages. There was also a dearth of evidence regarding the effectiveness of direct youth involvement in smoking prevention and cessation programmes. Evidence relating to online health promotion and young people focused primarily on educational programmes involving highly structured content, with very little evidence regarding a less formal approach. Research design A multi-faceted process evaluation of The Filter was undertaken. First, tweets sent to or from The Filter Twitter account were subjected to thematic analysis. Second, semi-structured interviews were undertaken with The Filter staff, professionals who had undergone training from The Filter and young people who had either interacted with The Filter online or as part of face-to-face workshops. Finally, surveys were developed based on the findings of the interview study, which asked professionals and young people about their experiences of all elements of The Filter programme. Results: Training for professionals working with young people The Filter training team reported that initially they designed and delivered training based on the key tobacco topics identified in Wales. This was later amended, to include smoking cessation training, and bespoke training packages. Professionals who took part in interviews reported that they valued this flexible approach to training courses and had put some of the techniques they had learnt into practice in their work with young people. This was found to be the case by professionals who took part in the online survey. Professionals also reported that the training was relevant, enjoyable and gave them new knowledge about smoking. 5 Results: Youth development, education and smoking cessation support The Filter developed a workshop-based approach to transmitting tobacco control and smoking cessation messages, which was delivered to small groups of young people in their own communities. The Filter staff reported that delivering these sessions was unproblematic, and all respondents identified a very strong rapport between The Filter staff and young people. The range of activities included in workshops was also identified as a key way of sustaining interest from young people, and visual aids were identified as particularly engaging. Some young people suggested that their interaction with The Filter had changed their planned behaviour in relation to smoking, or encouraged them to cut down or quit if they were existing smokers. Results: Online health promotion The Filter team shared tobacco control messages via a wide range of online platforms. They have achieved some level of success in terms of reach on The Filter website and potential reach on Twitter and Facebook. However, it was not possible within the confines of this research to understand if these users fit within the target demographic for the intervention, and how much overlap there was between The Filter face-to-face services and online services. The Filter staff reported that the intervention was deliverable by using a flexible approach, including the use of multiple and changing online platforms. It was not possible to understand how acceptable this intervention was to young people, as only one of The Filter’s followers agreed to take part in an online interview, and only 11 respondents to the online survey had interacted with the online resources. The evaluation of social media based interventions has been acknowledged to be a challenging area (Bailey et al., 2015) and this low response does not mean that the intervention is not reaching the targeted individuals, but that the individuals were not willing to take part in a brief evaluation. Conclusion To carry out this evaluation, we were given full access to The Filter team and their contacts in order to gather samples for the interviews and surveys. The Filter team were adaptable in their approaches to training and the use of social media over the course of the project, ensuring smoking cessation and prevention information was maintained as up to date and relevant. Professionals noted the rapport the Filter Team developed with young people was excellent. Training was high quality and professionals were able to use what they had learned from The Filter when working directly with young people. Young people liked the visual aspects of The Filter and they preferred the informal youth work approach to school based sessions on smoking. The use of The Filter social media platforms and online resources was encouraging, showing maintained growth over the course of evaluation period. Online resources were reported to be used by the majority of professionals taking part in the evaluation, however, engaging young people in the evaluation of The Filter via social media proved challenging. The data in this evaluation suggests that The Filter is a service which is feasible to deliver. The methodology of this evaluation did not allow us to examine the effectiveness of The Filter in terms of smoking prevention or cessation