Factors that affect the uptake of community-based health insurance in low-income and middle-income countries : a systematic protocol

Many people residing in low-income and middle-income countries (LMICs) are regularly exposed to catastrophic healthcare expenditure. It is therefore pertinent that LMICs should finance their health systems in ways that ensure that their citizens can use needed healthcare services and are protected from potential impoverishment arising from having to pay for services. Ways of financing health systems include government funding, health insurance schemes and out-of-pocket payment. A health insurance scheme refers to pooling of prepaid funds in a way that allows for risks to be shared. The health insurance scheme particularly suitable for the rural poor and the informal sector in LMICs is community-based health insurance (CBHI), that is, insurance schemes operated by organisations other than governments or private for-profit companies. We plan to search for and summarise currently available evidence on factors associated with the uptake of CBHI, as we are not aware of previous systematic reviews that have looked at this important topic

Who will use pre-exposure prophylaxis (PrEP) and why?: Understanding PrEP awareness and acceptability amongst men who have sex with men in the UK – a mixed methods study

Background: Recent clinical trials suggest that pre-exposure prophylaxis (PrEP) may reduce HIV transmission by up to 86% for men who have sex with men (MSM), whilst relatively high levels of PrEP acceptability have been reported to date. This study examines PrEP awareness amongst sub-groups of MSM communities and acceptability amongst MSM in a low prevalence region (Scotland, UK), using a mixed methods design. Methods: Quantitative surveys of n = 690 MSM recruited online via social and sociosexual media were analysed using descriptive statistics and multivariate logistic regression. In addition, n = 10 in-depth qualitative interviews with MSM were analysed thematically. Results: Under one third (29.7%) of MSM had heard of PrEP, with awareness related to living in large cities, degree level education, commercial gay scene use and reporting an HIV test in the last year. Just under half of participants (47.8%) were likely to use PrEP if it were available but there was no relationship between PrEP acceptability and previous PrEP awareness. Younger men (18–25 years) and those who report higher risk UAI were significantly more likely to say they would use PrEP. Qualitative data described specific PrEP scenarios, illustrating how risk, patterns of sexual practice and social relationships could affect motivation for and nature of PrEP use. Conclusion: These findings suggest substantial interest PrEP amongst MSM reporting HIV risk behaviours in Scotland. Given the Proud results, there is a strong case to investigate PrEP implementation within the UK. However, it appears that disparities in awareness have already emerged along traditional indicators of inequality. Our research identifies the need for comprehensive support when PrEP is introduced, including a key online component, to ensure equity of awareness across diverse MSM communities (e.g. by geography, education, gay scene use and HIV proximity), as well as to responding to the diverse informational and sexual health needs of all MSM communities

Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns

CITATION: Okwundu, C. I., et al. 2017. Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns. Cochrane Database of Systematic Reviews, 5:1-12, Art. CD012660, doi:10.1002/14651858.CD012660.The original publication is available at https://www.cochranelibrary.comThis is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: - To determine the diagnostic accuracy of TcB as: i) a diagnostic test for hyperbilirubinaemia in newborns suspected to have hyperbilirubinaemia on visual inspection; ii) a diagnostic test for monitoring bilirubin levels in newborns receiving treatment (e.g. phototherapy) for hyperbilirubinaemia. - To determine whether the gestational age, postnatal age, body weight, race and site of TcB measurement have any influence on the accuracy of TcB measurement for hyperbilirubinaemia in newborns.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012660/fullPublisher's versio

A process for developing a sustainable and scalable approach to community engagement : community dialogue approach for addressing the drivers of antibiotic resistance in Bangladesh

BACKGROUND: Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explores the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example. METHODS: The intervention was developed using a sequential mixed methods study design. This consisted of: exploring the evidence base through an umbrella review, and identifying key international standards on the appropriate use of antibiotics; undertaking detailed formative research through a) a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and to understand patterns of knowledge, attitudes and practice regarding antibiotics and antibiotic resistance; and b) a household survey - which drew on the qualitative findings - to quantify knowledge, and reported attitudes and practice regarding antibiotics and antibiotic resistance within the target population; and c) drawing on appropriate theories regarding change mechanisms and experience of implementing community engagement interventions to co-produce the intervention processes and materials with key stakeholders at policy, health system and community level. RESULTS: A community engagement intervention was co-produced and was explicitly designed to link into existing health system and community structures and be appropriate for the cultural context, and therefore have the potential to be implemented at scale. We anticipate that taking this approach increases local ownership, as well as the likelihood that the intervention will be sustainable and scalable. CONCLUSIONS: This study demonstrates the value of ensuring that a range of stakeholders co-produce the intervention, and ensuring that the intervention is designed to be appropriate for the health system, community and cultural context

Transcutaneous screening for hyperbilirubinemia in neonates

CITATION: Okwundu, C. I., Uthman, O. A. & Smith, J. 2014. Transcutaneous screening for hyperbilirubinemia in neonates. Cochrane Database of Systematic Reviews, 4: CD011060, doi:10.1002/14651858.CD011060.The original publication is available at https://www.cochranelibrary.comThis is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate to the effects of transcutaneous screening for hyperbilirubinemia to prevent the readmission of neonates for phototherapy.Publisher's versio

Zinc supplementation for the treatment ofmeasles in children (Review)

Background: Measles is an important cause of childhoodmorbidity andmortality globally, despite increasing vaccine coverage. Zinc plays a significant role in the maintenance of normal immunological functions, therefore supplements given to zinc-deficient children will increase the availability of zinc and could reduce measles-related morbidity and mortality. This is an update of a review first published in 2015. Objectives: To assess the effects of zinc supplementation in reducing morbidity and mortality in children with measles

Treatment of severe or progressive Kaposi's sarcoma in HIV-infected adults

CITATION: Gbabe, O. F. et al. 2014. Treatment of severe or progressive Kaposi's sarcoma in HIV-infected adults. Cochrane Database of Systematic Reviews, 9: CD003256, doi:10.1002/14651858.CD003256.pub2.The original publication is available at https://www.cochranelibrary.comBackground: Kaposi’s sarcoma remains the most common cancer in Sub-Saharan Africa and the second most common cancer in HIV-infected patients worldwide. Since the introduction of highly active antiretroviral therapy (HAART), there has been a decline in its incidence. However, Kaposi’s sarcoma continues to be diagnosed in HIV-infected patients. Objectives: To assess the added advantage of chemotherapy plusHAART compared toHAART alone; and the advantages of different chemotherapy regimens in HAART and HAART naive HIV infected adults with severe or progressive Kaposi’s sarcoma.Publisher's versio