Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children

Background: Almost half of global child deaths due to acute lower respiratory infections (ALRIs) occur in sub-Saharan Africa, where three-quarters of the population cook with solid fuels. This study aims to quantify the impact of fuel type and cooking practices on childhood ALRI mortality in Africa, and to explore implications for public health interventions. Methods: Early-release World Health Survey data for the year 2003 were pooled for 16 African countries. Among 32 620 children born during the last 10 years, 1455 (4.46%) were reported to have died prior to their fifth birthday. Survival analysis was used to examine the impact of different cooking-related parameters on ALRI mortality, defined as cough accompanied by rapid breathing or chest indrawing based on maternal recall of symptoms prior to death. Results: Solid fuel use increases the risk of ALRI mortality with an adjusted hazard ratio of 2.35 (95% CI 1.22 to 4.52); this association grows stronger with increasing outcome specificity. Differences between households burning solid fuels on a well-ventilated stove and households relying on cleaner fuels are limited. In contrast, cooking with solid fuels in the absence of a chimney or hood is associated with an adjusted hazard ratio of 2.68 (1.38 to 5.23). Outdoor cooking is less harmful than indoor cooking but, overall, stove ventilation emerges as a more significant determinant of ALRI mortality. Conclusions: This study shows substantial differences in ALRI mortality risk among African children in relation to cooking practices, and suggests that stove ventilation may be an important means of reducing indoor air pollution

Mehr Evidenzbasierung in Prävention und Gesundheitsförderung: Kriterien für evidenzbasierte Maßnahmen und notwendige organisationale Rahmenbedingungen und Kapazitäten

The German Prevention Act underlines the need for an evidence-based approach to prevention and health promotion. It is unclear which steps and processes are necessary for the evolving system of prevention and health promotion in Germany to meet this requirement. This overview article aims to define and operationalize evidence-based interventions in prevention and health promotion and describes the necessary organizational support and capacity building to foster evidence-based action in practice.Based on the international scientific literature and the Federal Centre for Health Education's Memorandum on Evidence-based Prevention and Health Promotion, the term evidence-based intervention is defined and operationalized, and implementation requirements in terms of organizational processes and capacity building are described and discussed.To foster implementation of evidence-based action in practice, decision makers in policy and practice should draw on a~shared understanding of the concept of evidence-based interventions and of the need for evaluations that assure generating evidence while implementing interventions. Moreover, organizational support is necessary, such as emphasizing the value of evidence-based action within organizations, ensuring access to existing evidence databases with a~transparent and relevant presentation of evidence, advancing competencies of the workforce in searching for and interpreting evidence syntheses, as well as promoting a~systematic cooperation between practitioners and researchers.Implementing the above-described elements for more evidence-based action is an important step towards strengthening the evolving system of prevention and health promotion as a~fifth pillar of the German health system. ZUSAMMENFASSUNG Für die Umsetzung des Präventionsgesetzes in einem sich entwickelnden System Prävention und Gesundheitsförderung (PGF) ist die Anforderung der Evidenzbasierung formuliert. Vor diesem Hintergrund stellt sich die Frage, welche Schritte, Prozesse und Vorgehensweisen in diesem System benötigt werden, um der Anforderung zunehmend gerecht zu werden. Dieser Übersichtsartikel diskutiert für Deutschland, wie evidenzbasierte Maßnahmen in der Praxis operationalisiert werden können und welche organisationalen Rahmenbedingungen und Kapazitäten für ein evidenzbasiertes Handeln von AkteurInnen notwendig sind.Aufbauend auf internationalen wissenschaftlichen Erkenntnissen und dem Memorandum Evidenzbasierte Prävention und Gesundheitsförderung der Bundeszentrale für gesundheitliche Aufklärung (BZgA) wird zunächst das Verständnis von evidenzbasierten Maßnahmen erläutert und im Weiteren werden Elemente zur Umsetzung von mehr Evidenzbasierung skizziert.Neben der transparenten und einheitlichen Darstellung in Datenbanken und Empfehlungen ist es notwendig, bei EntscheidungsträgerInnen in Praxis und Politik ein gemeinsames Verständnis von evidenzbasierten Interventionen und von Anforderungen für eine Evaluation, die Evidenzbasierung sichert, zu schaffen. Darüber hinaus kann evidenzbasiertes Handeln von EntscheidungsträgerInnen gefördert werden durch Wertschätzung gegenüber Evidenzbasierung in ihren Organisationen, durch Gewährleistung eines regelhaften Zugangs zu Evidenzdatenbanken, durch verbesserte Kompetenzen in Bezug auf Interpretation von Evidenz und durch eine systematische Zusammenarbeit mit der Wissenschaft.Mehr Evidenzbasierung ist eine Voraussetzung für die nachhaltige Verankerung von PGF als fünfte Säule des Gesundheitssystems

A protocol for a systematic review of the effectiveness of interventions to reduce exposure to lead through consumer products and drinking water.

The toxic heavy metal lead continues to be a leading environmental risk factor, with the number of attributable deaths having doubled between 1990 and 2010. Although major sources of lead exposure, in particular lead in petrol, have been significantly reduced in recent decades, lead is still used in a wide range of processes and objects, with developing countries disproportionally affected. The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels and associated health outcomes in children, pregnant women and the general population

Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making

Background Decision-making in public health and health policy is complex and requires careful deliberation of many and sometimes conflicting normative and technical criteria. Several approaches and tools, such as multi-criteria decision analysis, health technology assessments and evidence-to-decision (EtD) frameworks, have been proposed to guide decision-makers in selecting the criteria most relevant and appropriate for a transparent decision-making process. This study forms part of the development of the WHO-INTEGRATE EtD framework, a framework rooted in global health norms and values as reflected in key documents of the World Health Organization and the United Nations system. The objective of this study was to provide a comprehensive overview of criteria used in or proposed for real-world decision-making processes, including guideline development, health technology assessment, resource allocation and others. Methods We conducted an overview of systematic reviews through a combination of systematic literature searches and extensive reference searches. Systematic reviews reporting criteria used for real-world health decision-making by governmental or non-governmental organization on a supranational, national, or programme level were included and their quality assessed through a bespoke critical appraisal tool. The criteria reported in the reviews were extracted, de-duplicated and sorted into first-level (i.e. criteria), second-level (i.e. sub-criteria) and third-level (i.e. decision aspects) categories. First-level categories were developed a priori using a normative approach; second- and third-level categories were developed inductively. Results We included 36 systematic reviews providing criteria, of which one met all and another eleven met at least five of the items of our critical appraisal tool. The criteria were subsumed into 8 criteria, 45 sub-criteria and 200 decision aspects. The first-level of the category system comprised the following seven substantive criteria: \textquotedblHealth-related balance of benefits and harms\textquotedbl; \textquotedblHuman and individual rights\textquotedbl; \textquotedblAcceptability considerations\textquotedbl; \textquotedblSocietal considerations\textquotedbl; \textquotedblConsiderations of equity, equality and fairness\textquotedbl; \textquotedblCost and financial considerations\textquotedbl; and \textquotedblFeasibility and health system considerations\textquotedbl. In addition, we identified an eight criterion \textquotedblEvidence\textquotedbl. Conclusion This overview of systematic reviews provides a comprehensive overview of criteria used or suggested for real-world health decision-making. It also discusses key challenges in the selection of the most appropriate criteria and in seeking to implement a fair decision-making process

Assessing Household Solid Fuel Use: Multiple Implications for the Millennium Development Goals

OBJECTIVE: The World Health Organization is the agency responsible for reporting the Millennium Development Goal (MDG) indicator “percentage of population using solid fuels.” In this article, we present the results of a comprehensive assessment of solid fuel use, conducted in 2005, and discuss the implications of our findings in the context of achieving the MDGs. METHODS: For 93 countries, solid fuel use data were compiled from recent national censuses or household surveys. For the 36 countries where no data were available, the indicator was modeled. For 52 upper-middle or high-income countries, the indicator was assumed to be < 5%. RESULTS: According to our assessment, 52% of the world’s population uses solid fuels. This percentage varies widely between countries and regions, ranging from 77%, 74%, and 74% in Sub-Saharan Africa, Southeast Asia, and the Western Pacific Region, respectively, to 36% in the Eastern Mediterranean Region, 16% in Latin America and the Caribbean and in Central and Eastern Europe. In most industrialized countries, solid fuel use falls to the < 5% mark. DISCUSSION: Although the “percentage of population using solid fuels” is classified as an indicator to measure progress towards MDG 7, reliance on traditional household energy practices has distinct implications for most of the MDGs, notably MDGs 4 and 5. There is an urgent need for development agendas to recognize the fundamental role that household energy plays in improving child and maternal health and fostering economic and social development

The role of energy in health facilities: A conceptual framework and complementary data assessment in Malawi

BACKGROUND Modern energy enables health service delivery. Access to electricity is, however, unreliable in many health facilities in developing countries. Little research has explored the relationships between energy and service delivery. METHODS Based on extensive literature searches and iterative discussions within the research team, we first develop a conceptual framework of the role of energy in health facilities. We then use this framework to explore how characteristics of electricity supply affect distinct energy uses in health facilities (e.g. lighting), and how functional or non-functional lighting affects the provision of night-time care services in Malawi. To do so we apply descriptive statistics and conduct logistic and multinomial regressions using data from the Service Provision Assessment (SPA) of the Demographic and Health Surveys (DHS) for all health facilities in Malawi in 2013/2014. RESULTS The conceptual framework depicts the pathways from different energy types and their characteristics, through to distinct energy uses in health facilities (e.g. medical devices) and health-relevant service outputs (e.g. safe medical equipment). These outputs can improve outcomes for patients (e.g. infection control), facilities (e.g. efficiency) and staff (e.g. working conditions) at facilities level and, ultimately, contribute to better population health outcomes. Our exploratory analysis suggests that energy uses were less likely to be functional in facilities with lower-quality electricity supply. Descriptive statistics revealed a critical lack of functional lighting in facilities offering child delivery and night-time care; surprisingly, the provision of night-time care was not associated with whether facilities had functional lighting. Overall, the DHS SPA dataset is not well-suited for assessing the relationships depicted within the framework. CONCLUSION The framework conceptualizes the role of energy in health facilities in a comprehensive manner. Over time, it should be empirically validated through a combination of different research approaches, including tracking of indicators, detailed energy audits, qualitative and intervention studies

Impact of the community-based newborn care package in Nepal: a quasi-experimental evaluation

OBJECTIVE To evaluate the impact of the community-based newborn care package (CBNCP) on six essential practices to improve neonatal health. METHODS CBNCP pilot districts were matched to comparison districts using propensity scores. Impact on birth preparedness, antenatal care seeking, antenatal care quality, delivery by skilled birth attendant, immediate newborn care and postnatal care within 48 hours were assessed using Demographic and Health Survey (DHS) and Health Management Information System (HMIS) data through difference-in-differences and multivariate logistic regression analyses. FINDINGS Changes over time in intervention and comparison areas were similar in difference-in-differences analysis of DHS and HMIS data. Logistic regression of DHS data also did not reveal any significant improvement in combined outcomes: birth preparedness, adjusted OR (aOR)=0.8 (95% CI 0.4 to 1.7); antenatal care seeking, aOR=1.0 (0.6 to 1.5); antenatal care quality, aOR=1.4 (0.9 to 2.1); delivery by skilled birth attendant, aOR=1.5 (1.0 to 2.3); immediate newborn care, aOR=1.1 (0.7 to 1.9); postnatal care, aOR=1.3 (0.9 to 1.9). Health providers' knowledge and skills in intervention districts were fair but showed much variation between different providers and districts. CONCLUSIONS This study, while representing an early assessment of impact, did not identify significant improvements in newborn care practices and raises concerns regarding CBNCP implementation. It has contributed to revisions of the package and it being merged with the Integrated Management of Neonatal and Childhood Illness programme. This is now being implemented in 35 districts and carefully monitored for quality and impact. The study also highlights general challenges in evaluating the impacts of a complex health intervention under 'real life' conditions

Interventions to Ameliorate the Psychosocial Effects of the COVID-19 Pandemic on Children-A Systematic Review

The aim of this study was to identify interventions targeting children and their caregivers to reduce psychosocial problems in the course of the COVID-19 pandemic and comparable outbreaks. The review was performed using systematic literature searches in MEDLINE, Embase, PsycINFO and COVID-19-specific databases, including the CDC COVID-19 Research Database, the World Health Organisation (WHO) Global Database on COVID-19 Research and the Cochrane COVID-19 Study Register, ClinicalTrials.gov, the EU Clinical Trials Register and the German Clinical Trials Register (DRKS) up to 25th September 2020. The search yielded 6657 unique citations. After title/abstract and full text screening, 11 study protocols reporting on trials planned in China, the US, Canada, the UK, and Hungary during the COVID-19 pandemic were included. Four interventions targeted children \geq10 years directly, seven system-based interventions targeted the parents and caregivers of younger children and adolescents. Outcome measures encompassed mainly anxiety and depressive symptoms, different dimensions of stress or psychosocial well-being, and quality of supportive relationships. In conclusion, this systematic review revealed a paucity of studies on psychosocial interventions for children during the COVID-19 pandemic. Further research should be encouraged in light of the expected demand for child mental health management