Quality assurance of health management information system in Kayunga district, Uganda

Background: An efficient health management information system (HMIS) improves health care delivery and outcomes. However, in most rural settings in Uganda, paper-based HMIS are widely used to monitor public health care services. Moreover, there are limited capabilities and capacity for quality HMIS in remote settings such as Kayunga district. Objectives: The quality assurance practices of HMIS in health centres (HCs) in Kayunga district were evaluated. Method: A cross-sectional descriptive study design was used to assess the quality of HMIS at 21 HCs in Kayunga district. Data were collected through in-depth interviews of HMIS focal persons as well as document analysis of HMIS records and guidelines between 15 June 2010 and 15 July 2010. The main outcomes were quality assurance practices, the HMIS programmatic challenges and opportunities. The practice of HMIS was assessed against a scale for good quality assurance practices. Qualitative data were coded and thematically analysed, whereas quantitative data were analysed by descriptive statistics using SPSS v22 software. Results: All the 21 HCs had manual paper-based HMIS. Less than 25% of HCs practised quality assurance measures during collection, compilation, analysis and dissemination of HMIS data. More than 50% of HCs were not practising any type of quality assurance during analysis and dissemination of data. The main challenges of the HMIS were the laborious and tedious manual system, the difficulty to archive and retrieve records, insufficient HMIS forms and difficulty in delivering hard copies of reports to relevant stakeholders influenced quality of data. Human resource challenges included understaffing where 43% of participating HCs did not have a designated HMIS staff. Conclusion: The HMIS quality assurance practices in Kayunga were suboptimal. Training and support supervision of HMIS focal persons is required to strengthen quality assurance of HMIS. Implementation of electronic HMIS dashboards with data quality checks should be integrated alongside the manual system

Metabolic Syndrome and Cardiovascular Disease after Hematopoietic Cell Transplantation: Screening and Preventive Practice Recommendations from the CIBMTR and EBMT

Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that increases the risk of cardiovascular disease, diabetes mellitus, and all-cause mortality. Long-term survivors of hematopoietic cell transplantation (HCT) have a substantial risk of developing MetS and cardiovascular disease, with an estimated prevalence of MetS of 31% to 49% among HCT recipients. Although MetS has not yet been proven to impact cardiovascular risk after HCT, an understanding of the incidence and risk factors for MetS in HCT recipients can provide the foundation to evaluate screening guidelines and develop interventions that may mitigate cardiovascular-related mortality. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to review literature and recommend practices appropriate to HCT recipients. Here we deliver consensus recommendations to help clinicians provide screening and preventive care for MetS and cardiovascular disease among HCT recipients. All HCT survivors should be advised of the risks of MetS and encouraged to undergo recommended screening based on their predisposition and ongoing risk factors

A cost-effective model for monitoring medicine use in Namibia: Outcomes and implications

Background: Routine monitoring of medicine use is costly. Medicine use monitoring in most low- and middle-income countries is heavily reliant on donor support, which is not sustainable. Innovative models to close gaps in monitoring of medicine use are critical towards strengthening pharmaceutical services. Objective: To pilot an inter-institutional collaborative model for monitoring medicine use in Namibia over a three-year period, 2013–2015. Methods: An interventional analytical design that piloted an inter-institutional collaborative model for monitoring medicine use in public health facilities in Namibia was followed. Three key stakeholders – the Ministry of Health and Social Services (MoHSS) division of pharmaceutical services, University of Namibia School of Pharmacy and United States Agency for International Development–funded Systems for Improved Access to Pharmaceutical Services (SIAPS) project – collaboratively designed and implemented a concept model, tools and guidelines for routine medicine use assessment. The model integrated medicine use monitoring as a component of the annual rural placements of Bachelor of Pharmacy students at public hospitals. The pharmacists at the hospitals and MoHSS provided support and supervised the students prior to, during and after the placement. Each student undertook a mini-project on medicine use at the facilities which included data collection, analysis as well as reporting using the World Health Organization or International Network of Rational Use of Drugs indicators. These were subsequently aggregated by the university with technical assistance from SIAPS and findings reported to the Ministry. Data collected by the students on hospital placements were entered in Microsoft Excel® template for descriptive analysis for patient care indicators. All students discussed their findings with health facility supervisors. Results: The collaborative efforts enhanced local institutional and students’ capacity on analysing, reporting and presentation of data on medicine use. A total of three medicine use surveys (MUS) involving over 1938 patients were conducted from 2013 to 2015. The local capacity to conduct medicine use evaluation (MUE) was increased among 74 pharmacy students. At least 15 public hospitals in 12–14 regions participated in the MUS. Findings reveal 83% of prescribed medicines were dispensed; 53%–57% patients were satisfied with medicine information; 50%–59% of patients felt they waited too long (consultation time of more than 3 h) before getting their medicines; over 80% patients did not know how to take their medicines correctly; 56%–80% of dispensed medicines were labelled correctly. Conclusions: A multisectoral collaborative model is cost-effective in medicine surveys, if there are mutual benefits. Student placements provide an opportunity to build local capacity for routine MUE. Ministries of Health should utilise this innovative approach to assess service delivery

Validity of World Health Organisation prescribing indicators in Namibia's primary healthcare:Findings and implications

Objective: World Health Organization/ International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia’s primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. Design, setting, participants and interventions: An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in outpatient units of two PHC facilities and one hospital from 1st February 2015 to 31st July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. Main outcomes and results: Out of 1243 prescriptions; compliance to NSTG prescribing in PHCs was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. Conclusion: WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in PHCs in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in PHCs in the futur

Response of fish stocks in Lake Victoria to enforcement of the ban on illegal fishing:are there lessons for management?

Most small-scale inland fisheries in the Global South prohibit fishing gear with smaller meshes than is legally permitted. Nonetheless, in most instances, this is not strictly enforced. But starting in 2017, Uganda and Tanzania ramped up enforcement on Lake Victoria. We used time series hydro-acoustic data to determine whether the strict enforcement achieved the management goal of increased biomass (t) of commercial species and an increase in the biomass of big Nile perch (>50 cm). The biomass for 2018–2021 (under strict enforcement) was expected to be greater than in 2007–2017 (prior to strict enforcement). The biomass of key species fluctuated annually, but no spatial or temporal differences in biomass associated with strict enforcement were evident. Similarly, the biomass of big Nile perch did not increase. Our findings suggest that mesh sizes may have limited influence on fish biomass dynamics in Lake Victoria, and that high primary productivity of the lake, high turnover rates of fish species, and limited compliance by fishers likely counteract the effects of high fishing effort on biomass and size structure of fish. Therefore, the high cost of strict top-down enforcement and the societal cost of lost lives, jobs, and livelihoods may not be justified

A Case of Primary Bone Marrow B-Cell Non Hodgkin’s Lymphoma with Severe Thrombocytopenia: Case Report and A Review of the Literature

A 78-year-old man presented with persistent gingival bleeding. He had low platelet count of 1.0 × 109/L without any lymphadenopathy. Bone marrow specimen showed diffusely distributed small-sized lymphocytes. Combined with immunophenotypic analysis, a diagnosis of primary bone marrow B-cell non-Hodgkin’s lymphoma was made. Thrombocytopenia was considered to be caused by autoimmune destruction of platelets

Economic evaluation of implementation science outcomes in low- and middle-income countries: a scoping review

Background Historically, the focus of cost-effectiveness analyses has been on the costs to operate and deliver interventions after their initial design and launch. The costs related to design and implementation of interventions have often been omitted. Ignoring these costs leads to an underestimation of the true price of interventions and biases economic analyses toward favoring new interventions. This is especially true in low- and middle-income countries (LMICs), where implementation may require substantial up-front investment. This scoping review was conducted to explore the topics, depth, and availability of scientific literature on integrating implementation science into economic evaluations of health interventions in LMICs. Methods We searched Web of Science and PubMed for papers published between January 1, 2010, and December 31, 2021, that included components of both implementation science and economic evaluation. Studies from LMICs were prioritized for review, but papers from high-income countries were included if their methodology/findings were relevant to LMIC settings. Results Six thousand nine hundred eighty-six studies were screened, of which 55 were included in full-text review and 23 selected for inclusion and data extraction. Most papers were theoretical, though some focused on a single disease or disease subset, including: mental health (n = 5), HIV (n = 3), tuberculosis (n = 3), and diabetes (n = 2). Manuscripts included a mix of methodology papers, empirical studies, and other (e.g., narrative) reviews. Authorship of the included literature was skewed toward high-income settings, with 22 of the 23 papers featuring first and senior authors from high-income countries. Of nine empirical studies included, no consistent implementation cost outcomes were measured, and only four could be mapped to an existing costing or implementation framework. There was also substantial heterogeneity across studies in how implementation costs were defined, and the methods used to collect them. Conclusion A sparse but growing literature explores the intersection of implementation science and economic evaluation. Key needs include more research in LMICs, greater consensus on the definition of implementation costs, standardized methods to collect such costs, and identifying outcomes of greatest relevance. Addressing these gaps will result in stronger links between implementation science and economic evaluation and will create more robust and accurate estimates of intervention costs. Trial registration The protocol for this manuscript was published on the Open Science Framework. It is available at: https://osf.io/ms5fa/ (DOI: 10.17605/OSF.IO/32EPJ).Implementation Research Strategies for Heart, Lung, and Blood Co-morbidities in People Living with HIV-Research Coordinating Center-1U24HL154426-01. Integrating Hypertension and Cardiovascular Disease Care into Existing HIV Service Package in Botswana (InterCARE)-1UG3HL154499-01. Scaling Out and Scaling Up the Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SCALE SAIA HTN)-1UG3HL156390-01. Integrating HIV and hEART health in South Africa (iHeart-SA)-1UG3HL156388-01. PULESA-UGANDA-Strengthening the Blood Pressure Care and Treatment cascade for Ugandans living with HIV-ImpLEmentation Strategies to SAve lives-1UG3HL154501-01. Application of Implementation Science approaches to assess the efectiveness of Task-shifted WHO-PEN to address cardio Metabolic complications in people living with HIV in Zambia-1UG3HL156389-01. The funders had no role in the design of the study, the collection, analysis, and interpretation of data, or in the writing of the manuscript