Eco-epidemiological assessment of the COVID-19 epidemic in China, January–February 2020

Ethics and consent No ethical approval was required for this study, which relied solely on open-access public data. Funding There was no specific funding for this study.Peer reviewedPublisher PD

Microcomputer support for health care delivery in the Gambia

Microcomputer support for health care delivery is a relatively new concept in developing countries, despite serious shortages of human expertise. In this light, the concept of microcomputer-based decision support for patient management at the rural health centre level in The Gambia is discussed and developed. Possible methodologies are devised and evaluated, taking into account constraints imposed both by feasibility of hardware for the rural African setting and by appropriate software techniques. Clinical data were collected for a pilot system, which was implemented using a Bayesian methodology, and assessed, with encouraging results. Further sources of data were then considered in order to generalise the pilot system into a prototype, which was implemented on a portable solar-powered microcomputer. The evaluation of this prototype system, and the difficulties involved in undertaking rigorous evaluations of this type of decision aid, are described and discussed. Whilst it is not proven that major health benefits would arise from the widespread introduction of such systems, the results of this preliminary study suggest that this type of approach merits further consideration and development

Microcomputer support for health care delivery in the Gambia

Microcomputer support for health care delivery is a relatively new concept in developing countries, despite serious shortages of human expertise. In this light, the concept of microcomputer-based decision support for patient management at the rural health centre level in The Gambia is discussed and developed. Possible methodologies are devised and evaluated, taking into account constraints imposed both by feasibility of hardware for the rural African setting and by appropriate software techniques. Clinical data were collected for a pilot system, which was implemented using a Bayesian methodology, and assessed, with encouraging results. Further sources of data were then considered in order to generalise the pilot system into a prototype, which was implemented on a portable solar-powered microcomputer. The evaluation of this prototype system, and the difficulties involved in undertaking rigorous evaluations of this type of decision aid, are described and discussed. Whilst it is not proven that major health benefits would arise from the widespread introduction of such systems, the results of this preliminary study suggest that this type of approach merits further consideration and development

Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa

The authors would also like to acknowledge the field staff at the MRC/Wits Agincourt unit, particularly Ms Rirhandzu Debs and Dr Kerstin Edin from the Umeå Centre for Global Health Research, Umeå University, who facilitated data collection and made important contributions to the fieldwork.Peer reviewedPublisher PD

Avant-propos

Ce numéro des Quaderni tente de croiser plusieurs approches et niveaux d'analyse pour appréhender le concept de risque technologique, mais également pour comprendre comment la définition des dangers rattachés à cette mise en risque se trouve spontanément intégrée au dialogue constitutionnel, donc au politique. Mary Douglas a bien montré l'usage politique des dangers naturels dans les sociétés traditionnelles, elle présuppose fortement un lien entre ces dangers et leur rôle dans la consolidation des valeurs communautaires de nos sociétés actuelles. [Premières lignes de l'article

Undertaking cause-specific mortality measurement in an unregistered population: an example from Tigray Region, Ethiopia

Background: The lack of adequate documentation of deaths, and particularly their cause, is often noted in African and Asian settings, but practical solutions for addressing the problem are not always clear. Verbal autopsy methods (interviewing witnesses after a death) have developed rapidly, but there remains a lack of clarity as to how these methods can be effectively applied to large unregistered populations. This paper sets out practical details for undertaking a representative survey of cause-specific mortality in a population of several million, taking Tigray Region in Ethiopia as a prototype. Sampling: Sampling was designed around an expected level of maternal mortality ratio of 400 per 100,000 live births, which needed measuring within a 95% confidence interval of approximately ±100. Taking a stratified cluster sample within the region at the district level for logistic reasons, and allowing for a design effect of 2, this required a population of around 900,000 people, equating to six typical districts. Since the region is administered in six geographic zones, one district per zone was randomly selected. Implementation: The survey was implemented as a two-stage process: first, to trace deaths that occurred in the sampled districts within the preceding year, and second to follow them up with verbal autopsy interviews. The field work for both stages was undertaken by health extension workers, working in their normally assigned areas. Most of the work was associated with tracing the deaths, rather than undertaking the verbal autopsy interviews. Discussion: This approach to measuring cause-specific mortality in an unregistered Ethiopian population proved to be feasible and effective. Although it falls short of the ideal situation of continuous civil registration and vital statistics, a survey-based strategy of this kind may prove to be a useful intermediate step on the road towards full civil registration and vital statistics implementation

Moving from medical to health systems classifications of deaths : extending verbal autopsy to collect information on the circumstances of mortality

Acknowledgements The authors would also like to acknowledge the field staff at the MRC, SA/Wits Agincourt Unit, particularly Sizzy Ngobeni. The authors also acknowledge Drs Malin Eriksson and Edward Fottrell at Umeå Centre for Global Health Research *UCGHR) who contributed to the development of the SF-VA indicators, Dr Nawi Ng at UCGHR who advised on the cause of death categories, and Dr Kerstin Edin at UCGHR who provided comments on the manuscript categories, and Dr Kerstin Edin who provided comments on the manuscript. Funding A Health Systems Research Initiative Development Grant from the UK Department for International Development (DFID), Economic and Social Research Council (ESRC), Medical Research Council (MRC (and the Wellcome Trust (MR/N005597/1) funds the research presented in this paper. Support for the Agincourt HDSS including verbal autopsies was provided by The Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z), and the University of the Witwatersrand and Medical Research Council, South Africa.Peer reviewedPublisher PD

Initiating a participatory action research process in the Agincourt health and socio–demographic surveillance site

Financial disclosure Funding: The research presented in this paper is funded by a Development Grant as part of the Health Systems Research Initiative from Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/N005597/1). The fieldwork was completed with the Umeå Centre for Global Health Research, with support from FORTE: Swedish Council for Health, Working Life and Welfare (grant No. 2006–1512). The School of Public Health at the University of the Witwatersrand, the South African Medical Research Council, and the Wellcome Trust, UK support the MRC/Wits Rural Public Health and Health Transitions Research Unit and Agincourt HDSS (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z). OW is a recipient of an MSc Chevening Scholarship, the UK government's global scholarship programme, funded by the Foreign and Commonwealth Office (FCO) and partner organizations (Chevening Ref.: NGCV–2015–1194).Peer reviewedPublisher PD

The case for verbal autopsy in health systems strengthening

This Comment is based on a round-table discussion held at University College London on Oct 17, 2016, funded by a Health Systems Research Initiative grant from the UK Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/N005597/1). We declare no competing interests.Peer reviewedPublisher PD