Set Of Countries Research Articles

Revitalizing accountability: exploring the impact of performance audits in Indonesia’s public sector

PurposeThis study examines the perceptions of auditees from ministries/agencies and local governments in Indonesia of the quality and impact of performance audits. Additionally, it investigates the extent of improvements and changes implemented by auditees in response to audit findings and recommendations.Design/methodology/approachThe research employed an online survey to collect data from auditees in ministries/agencies and local governments (at provincial, city and district levels) that underwent performance audits between 2018 and 2022. A total of 180 valid responses were analyzed using descriptive statistical techniques, including mean score ranking and frequency distribution.FindingsThe findings reveal that the auditees perceive that performance audits have a high level of quality and provide significant benefits. The respondents noted that such audits play a critical role in enhancing performance, serving as effective accountability tools and improving operational efficiency. Five key areas of significant impact were identified: (1) strategic shifts in planning and management by objectives, (2) enhancements in standard operating procedures, (3) improvements in internal control and risk management systems, (4) updates to laws and regulations and (5) institutionalization of improved governance practices. However, increased documentation and reporting pressures emerged as notable challenges.Research limitations/implicationsThe study is limited by its reliance on descriptive and correlation analysis. This restricts the depth of insights into the causal relationships between variables and limits the robustness of the findings. Future research should consider incorporating experimental designs or hypothesis testing with regression analysis to provide a deeper understanding of the causal impact of performance audits. This approach could enhance the generalizability and applicability of the findings, particularly in the framing of performance audits as a policy recommendation for mandatory implementation.Practical implicationsThe study contributes to the literature by addressing the underexplored area of performance audit impacts in developing countries, particularly Indonesia. It highlights the role of such audits as drivers of governance reform and operational efficiency, filling a critical gap in public sector auditing research. Unlike previous studies that have focused on audit processes or developed country contexts, this paper underscores the unique challenges and opportunities in a developing country setting. It is recommended that performance audits be made mandatory to enhance their effectiveness in fostering governance improvements.Originality/valueThe novelty of the work lies in its context-specific insights and focus on the broader implications of performance audits for public sector accountability and operational improvement in a developing country, with practical recommendations for policymakers and audit practitioners made.

DRIVERS INFLUENCING THE USAGE INTENTION TOWARDS ONLINE ZAKAT PAYMENT SYSTEM: EVIDENCE FROM MALAYSIA

A digital zakat system significantly enhances zakat collection by streamlining the process, making it more accessible, transparent, and efficient for both zakat payers and zakat institutions. Through digital platforms, individuals can easily calculate, pay, and track their zakat contributions in real time. However, it faces challenges as some zakat payers remain reluctant to use online platforms due to concerns about security and the traditional nature of their giving. Thus, this study investigates how socio-economic determinants, perceived risk, trust in zakat institutions, zakat literacy, and prior experience affect zakat payers' intention to use online zakat payment systems. Data were gathered via an online survey of 288 zakat payers in Malaysia, with cluster sampling used to select participants from government and private sectors across Perak, Selangor, and Kelantan. SmartPLS was used for the analysis. The results indicate that perceived risk has a significant and negative impact on the intention to use online zakat payment services, highlighting the importance of addressing concerns related to risk perception in promoting their adoption. On the other hand, trust in zakat institutions, zakat literacy, and prior experience exhibited positive and significant relationships with zakat payers' intention to utilize online zakat payment services. The findings suggest that institutions mitigate perceived risk, strengthen institutional trust, increase zakat literacy, and leverage users' prior experience to enhance online zakat system adoption. This study contributes significantly to understanding the factors influencing the adoption of online zakat payment services to inform strategies to boost the utilization of online zakat payment services in similar developing country settings.

A conceptual framework to assess the health, socioeconomic and environmental burden of chronic kidney disease.

Chronic kidney disease (CKD) is a global health challenge that affects patients, caregivers, healthcare systems, the environment and national economies. Despite its far-reaching impact, there is no framework to systematically evaluate national CKD prevention and management programmes or evaluate the societal burden of disease. This paper has two objectives: first, to introduce a comprehensive framework to assess national programmes, which recognises gaps and weaknesses and identifies feasible policy interventions to reduce overall CKD burden; second, to present some key challenges and success stories in delivering CKD services delivered in eight different country settings. A literature review informed an initial version of the framework, which was further developed and refined via collaboration with a panel of UK experts across relevant disciplines. This framework was then presented to seven other country expert panels (Australia, Brazil, China, Germany, the Netherlands, Spain and the USA) that made further refinements based on their country perspective. The resultant framework covers all health system levels, from preventive public health measures to primary, secondary and tertiary care, including dialysis, transplantation and palliative care. Furthermore, it evaluates the disease burden from economic, social and environmental perspectives. Each panel also discussed challenges regarding providing CKD services in their country and provided success stories, generating valuable insights into areas where policy initiatives could have positive impact on the various components of burden of disease.

P-358. Infection Prevention and Control Practice in Tertiary Care Military Hospitals in Bangladesh during COVID-19 Pandemic: Results from WHO IPCAF Assessment Tools

Abstract Background WHO estimates a high burden of the MDR organism in hospital settings in South Asian countries, especially in Bangladesh. Infection prevention and control (IPC) in healthcare settings is critical to limit the healthcare-associated infections, especially during pandemics like COVID-19. Military hospitals in Bangladesh are known for better compliance of health system practice. To measure current IPC level, activities, resources, and gaps, WHO developed the IPC Assessment Framework (IPCAF) assessment tools. We aimed to assess the IPC practices level in Military hospitals of Bangladesh to reduce the gaps.Table of WHO IPCAF score of Dhaka and Jashore CMH Methods From Oct to Dec 2019, using IPCAF tools, we conducted a cross-sectional survey at two tertiary level Combined Military hospitals (CMH) in Bangladesh to collect the information. The hospital administrator, IPC focal person, or relevant person who had better knowledge about the overall IPC situation was interviewed. The tool comprises eight sections assessing the eight IPC core components. Based on the scores ranging from 0 to 100, the hospital was categorized into four distinct IPC levels - Advanced, Intermediate, Basic and Inadequate. Descriptive statistics were used to summarize and describe the key findings. Results The mean IPCAF score was 421.75 out of 800.The Dhaka CMH (1100 bedded) was categorized as ‘intermediate’ with the score of 497.5 and Jashore CMH (500 bedded) scored 346 which was characterized ‘basic’ level. Both the hospitals scored very high in adherence of IPC guideline 87.5 and 77.5 respectively. Scoring of Dhaka CMH in IPC program (77.5), Workload, staffing & bed occupancy (75) and Built environment, materials and equipment (82.5) is higher than the same components of Jashore CMH. IPC education & training score of both hospitals (50 and 25 respectively) was not satisfactory. None of the hospitals had an IPC surveillance system with standard surveillance case definitions to track HAIs. Conclusion Military hospitals needs to attain advanced level IPC practice. To achieve that organized quality improvement programs and feedback mechanisms is required. To strengthen all IPC core components, particularly IPC surveillance, monitoring, education & training is needed to improve for healthcare safety and resilience. Disclosures All Authors: No reported disclosures

P-2357. Respiratory Syncytial Virus (RSV) Disease Burden among Adults in Primary Care Settings in High-income Countries: a Systematic Review and Modelling Study

Abstract Background Data on RSV disease burden in adults remain scarce and mostly focus on hospitalisation. We aimed to estimate RSV disease burden in primary-care settings among adults in high-income countries.Figure 1.PRISMA flowchart Methods We conducted a systematic review to include studies that reported RSV disease burden in primary-care settings; studies of emergency department (ED) visits were also included but analysed separately. We searched MEDLINE, Embase, Global Health, CINAHL, Web of Science, and Global Index Medicus for eligible studies published between 1 Jan 1996 and 30 Nov 2022 and conducted citation searching of identified studies. Using a random-effects meta-analysis, we synthesised RSV incidence rate, positive proportion, and incidence-to-hospitalisation ratio. When estimating RSV incidence rate and positive proportion, we adjusted for RSV under-ascertainment related to clinical specimens and diagnostic tests used in individual studies by a previously published two-stage statistical framework. We used the Joanna Briggs Institute critical appraisal checklist for assessing study quality. Results We included 14 studies (Figure 1), with 13 studies rated as high-quality. RSV incidence rate increased with increasing age in primary-care settings and in ED; the adjusted annual incidence rate in primary-care settings ranged from 2,350 (95% CI: 1,254–4,405) per 100,000 in 18–49 year-olds to 4,339 (3,267–5,763) in adults ≥65 years (Table 1). The RSV positive proportion in acute respiratory infection episodes in primary-care settings was higher among those aged ≥65 years than 18–49 years (Table 2). In adults ≥65 years, 6.2% (1.4–23.8) of RSV episodes in primary-care settings led to hospitalisation, equivalent to one patient progressing to hospitalisation for every 16 outpatient visits. According to five studies (total N=413; age: >60 or >65 years), no RSV-associated deaths occurred in primary-care settings. Conclusion RSV disease burden in primary-care settings is substantial among adults in high-income countries, particularly for older adults. Further larger studies are needed to assess mortality risk following RSV-related outpatient visits. This study’s estimates have important implications for evaluating RSV prevention programmes’ impact. Disclosures You Li, Pfizer: Advisor/Consultant Elizabeth Begier, MD, M.P.H., Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds (Private Company) Caihua Liang, MD, PhD, Pfizer: Stocks/Bonds (Private Company) Reiko Sato, PhD, Pfizer Inc: employee|Pfizer Inc: Stocks/Bonds (Private Company) Bradford D. Gessner, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Harish Nair, n/a, Pfizer: Advisor/Consultant

Investigating students’ awareness of online privacy and cybersecurity: an empirical study with effective cybersecurity training framework

Purpose The main purpose of this study is to assess the level of cybersecurity and social media privacy awareness among college students in Bangladesh and propose a scalable cybersecurity training framework to promote safe online practices. Design/methodology/approach This study used a structured, printed questionnaire survey to collect data from the students of five renowned colleges from the southern part of Bangladesh. Stratified sampling technique was followed and a total of 353 data were collected. Collected data were analyzed using SPSS and Python programming languages. Findings The findings uncovered that most of the students possessed limited knowledge regarding fundamental cybersecurity concepts, though they were using different social media platforms and posting personal information frequently. The study found a significant positive relationship between students’ sharing of personal information on social media and becoming a victim of cybersecurity attacks. Contrarily, becoming a victim of a cybersecurity attack was negatively correlated with their ability to respond in case of cyberattacks. However, most of the students were interested in acquiring knowledge of cybersecurity. Based on these findings, the study proposed a game-based cybersecurity training framework for students named “CyberSAFE”. Originality/value Though several studies have proposed different cybersecurity frameworks in different contexts, this study, to the best of the authors’ knowledge, is the first attempt to explore college students’ cybersecurity knowledge and propose a game-based framework in a developing country setting.

ULACNet-301, OPTIMO protocol: optimizing HPV vaccination regimen for cancer prevention in children and adolescents living with HIV

BackgroundPersistent infection with human papillomavirus (HPV) is associated with most cervical and anal cancer cases and a large fraction of other anogenital and oropharyngeal cancers. The prophylactic HPV vaccines are known to prevent HPV infections and HPV-associated disease, although there is evidence of reduced response to the HPV vaccination among individuals living with HIV. Prior studies among individuals without HIV suggest that a single HPV vaccine dose induces humoral immune responses that, while lower than those induced by two or three doses, still confer protection against HPV infection. Current recommendations for HPV vaccine include a single-dose schedule for children 9–14-years-olds without HIV. Although two to three doses are recommended for children living with HIV (CLWH), there is very limited data comparing responses to one vs. 2–3 doses in CLWH.MethodsThe OPTIMO study will compare immune responses to HPV vaccination in CLWH by measuring antibody and memory B cell (Bmem) responses after 1, 2, or 3 doses of the 9-valent HPV (9vHPV) vaccine, Gardasil-9. A comparison group of children without HIV will receive one dose of the vaccine. The durability of the response will be assessed at 24 months after the last dose of a given regimen. The OPTIMO trial will take place among CLWH from low and middle-income country (LMIC) settings in Peru, Brazil, and Haiti.DiscussionPrevious studies of single-dose regimens in individuals without HIV raise questions about whether one dose would suffice for CLWH and, if not, whether two or three doses are needed to provide protection against HPV-related cancers. These questions have operational consequences in LMICs given the barriers to delivering multiple doses, uneven availability, and intermittent shortages of HPV vaccines. In addition, information on HIV status for children and adolescents is rarely available during vaccination campaigns based in schools or public health clinics, so CLWH may receive a single dose despite policy recommendations that they receive two or three. This study will provide evidence on the optimal number of doses needed for CLWH that can inform HPV vaccination campaigns in LMICs, especially those with a higher burden of HIV infection and higher incidence of HPV-related cancers.Trial registrationClinicalTrials.gov NCT04265950.

Correction to “The Impact of Sustainability Governance Attributes on Comprehensive CSR Reporting: A Developing Country Setting”

Correction to “The Impact of Sustainability Governance Attributes on Comprehensive <scp>CSR</scp> Reporting: A Developing Country Setting”

Whole-genome evaluation and prophages characterization associated with genome of carbapenem-resistant Acinetobacter baumannii UOL-KIMZ-24-2.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is an emerging threat to healthcare settings in many countries, principally in South Asia. The current study was aimed to identify, evaluate whole-genome and characterize the prophages in genome of CRAB strain, recovered from patients of Lahore General Hospital, Lahore. More than 200 samples were collected and identified by morphological and biochemical tests. These strains were also subjected to a comprehensive antimicrobial susceptibility evaluation using Kirby-Bauer method and further confirmed as CRAB strains by exploring blaOXA-51. In addition, the whole-genome evaluation of a Acinetobacter baumannii UOL-KIMZ-24-2 was carried out using various Bioinformatics tools. A total of 150 strains of A. baumannii were recovered and identified in the current study. Among them, 49% strains were found resistant to carbapenem. The blaOXA-51 was found prevalent in the genome of A. baumannii recovered from medical ICU (38%). In addition, the UOL-KIMZ-24-2 genome analysis based on multilocus sequence typing (MLST) highlighted that UOL-KIMZ-24-2 belonged to ST2 (Pasteur scheme) sequence type. A total of 29 antimicrobial resistance (AMR) genes were present, importantly, blaOXA-66, blaOXA-23 and blaOXA-25. The mobile genetic elements (MGEs) were identified as transposases and belonged to four classes e.g. IS15d1, ISAba24, ISEc29, and ISEc35. A total of 14 virulence factors encoded by 58 different genes were detected in UOL-KIMZ-24-2. In addition, the phage sequences were identified in genome of UOL-KIMZ-24-2, divided into 3 regions. In conclusion, UOL-KIMZ-24-2 contained a mixture of AMR genes, MGEs. prophages sequences and virulence genes.

Outcomes of Specialist Palliative Care Consultation for Patients with Advanced Cancer in an Oncological Emergency Department: A Retrospective Analysis

Objectives: Research on palliative care (PC) consultation and its outcomes in the emergency department (ED) within a low-and middle-income country (LMIC) setting is limited. This study aimed to evaluate PC consultation outcomes, symptom burden and management, and referral patterns in patients with advanced cancer referred for specialist PC (SPC) in the ED of an urban tertiary care cancer centre in India. Materials and Methods: Data of adult advanced cancer patients referred for SPC services in the ED between August 2017 and June 2019 were retrospectively screened. Patients’ sociodemographic features, clinical characteristics, ED visit-related data, and treatment-related data were documented. Multinomial logistic regression, incorporating significant univariate factors, was performed to analyse the independent predictive factors of consultation outcomes in the ED. Results: Of the 644 consultations, 366 (56.8%) were discharged home, 166 (25.8%) were admitted to various settings (hospital/respite care/hospice), 74 (11.5%) died in the ED, and 38 (5.9%) were unresponsive upon arrival. Sex, performance status (PS), gastrointestinal and cardiovascular events, pain, cancer progression, and receipt of pharmacological treatment were predictive of consultation outcomes. Male patients and those with poor PS were more likely to be admitted to the ED, whereas patients with poor PS and cancer progression were more likely to die. Discharge rates were higher among females, those with gastrointestinal symptoms and pain, and those receiving pharmacological treatment. Conclusion: More than 50% of the patients referred for SPC consultations were discharged. In addition, we also identified predictors for each consultation outcome in the LMIC-ED setting. Future research should investigate advanced care planning and survival analyses in comparable ED settings.

Nuances in the Treatment of Ewing Sarcoma of the Head and Neck in a Low-Middle-Income Country Setting: A Multi-Disciplinary Approach.

Ewing sarcoma of the head and neck (ES-HN) is a rare subsite of ES, where therapeutic outcomes need to be explored further. This retrospective study includes ES-HN patients registered at our center between 2003 and 2019. Demographic details and treatment outcomes were recorded from the hospital database. Prognostic factors for survival were identified by Cox regression. Eighty-five patients were included. Metastatic disease was seen in nine patients (10.59%). Local therapy included radiotherapy alone (n = 38; 44.7%), surgery plus radiotherapy (n = 15; 17.6%), or surgery alone (n = 8; 9.4%). The median overall survival (OS) was 37.4 months. On multivariable analysis, osseous primary (HR 0.40; p = 0.009) and male sex (HR 0.43; p = 0.023) were associated with superior OS. Leucocytosis (HR 3.46; p = 0.001) was associated with inferior OS. ES-HN has favorable biology with metastases being rare at baseline. However, leucocytosis, extra-osseous disease, and female sex are poor prognostic factors. In resource-challenged settings, difficulties in administering local therapy may contribute to inferior outcomes.

Factors affecting decisions to use antibiotic-sparing treatment approaches in women with uncomplicated urinary tract infections: a scoping review protocol.

This scoping review will explore the evidence on factors influencing the decisions to use antibiotic-sparing treatments in women with uncomplicated urinary tract infection. Overuse and misuse of antibiotics are the main drivers of antimicrobial resistance. Antibiotic-sparing treatments, such as symptomatic treatment with analgesics and delayed prescriptions, have considerable potential to reduce antibiotic consumption, but the majority of patients still receive antibiotics without delay. The reasons for the poor implementation of these alternative approaches are unknown. A better understanding of the factors influencing treatment decisions is needed. This review will consider the experiences and attitudes of health care professionals and women, in outpatient settings in high-income countries, regarding the use of antibiotic-sparing treatments for the diagnosis or suspected diagnosis of uncomplicated urinary tract infections (ie, healthy women aged 18-64years who are not pregnant, immunosuppressed, and have no functional or structural urinary tract abnormalities). This review will follow the JBI methodology for scoping reviews. MEDLINE (Ovid), Embase, and the Cochrane Library will be searched to identify peer-reviewed articles: original research (quantitative or qualitative studies, experimental or observational), reviews, case reports, and case series. Gray literature will also be searched for. Sources in any language from 2000 to 2024 will be included. Three reviewers will screen the sources and extract data using a tool developed by the reviewers. The analysis will use counts and descriptive qualitative content analysis. The results will be presented in visual, tabular, and narrative formats. https://osf.io/t8y5e/.

Exploring Dietary Assessment Methods Used to Measure Individual Dietary Intakes in Low- and Middle-Income Countries and Under-Served Populations in High-Income Countries.

For low- and middle- income country (LMIC) settings, a global nutrition transition is rapidly emerging as diets shift, resulting in a dual burden of malnutrition. High quality dietary intake data for these populations is essential to understand dietary patterns contributing to these nutrition issues. New technology is emerging to address dietary assessment challenges; however, it is unknown how researchers conducting studies with LMIC populations or under-served groups in high-income countries adopt technology-assisted methods. This study aimed to describe the features of the dietary assessment methods used in these settings. A cross-sectional survey of members of an online international nutrition network was conducted. Participants completed an online questionnaire collecting data on dietary assessment method use, populations studied, and factors influencing method selection. Of 45 participants (ranging from 27 to 60 years) who completed the questionnaire, 67% conducted dietary assessments in children aged 1-5 years, 60% in pregnant women and 60% in female adults. Dietary assessment was conducted predominantly in countries classified as LMIC (n = 50), compared to the assessment of vulnerable groups in high-income countries (n = 3). All participants reported using 24-h recalls, 80% used food frequency questionnaires, while 22% used image-based and 22% used image-assisted methods. Predominant modes were interviewer-administered, paper questionnaires and manual analysis; however, digital survey platforms were used by nearly half of participants. Although traditional dietary assessment methods continue to dominate in LMICs, evidence of technological-assisted method use is emerging. Technology-assisted methods, tailored to address challenges in collecting quality dietary intake data in LMICs, are becoming more accessible.

Is There a Role for Daratumumab Retreatment in Patients with Relapsed/Refractory Multiple Myeloma?

Multiple myeloma (MM) is a hematologic disease characterized by the clonal expansion of malignant plasma cells that accumulate in the bone marrow, leading to osteolytic bone disease, hypercalcemia, anemia, and renal dysfunction. Daratumumab was the first monoclonal anti-CD38 antibody approved for the treatment of MM, initially in relapse/refractory settings and, more recently, for newly diagnosed patients. Increased first-line usage of daratumumab will also substantially change treatment approaches for patients with relapsed/refractory disease. Due to the cost and availability of bispecific T cell redirecting antibodies (BsAbs) and chimeric antigen receptor T cell therapy (CAR-T) in real-life settings in many countries, retreatment with daratumumab in subsequent lines of therapy might be a reasonable choice. Data regarding efficacy and optimal combinations of daratumumab retreatment are lacking, and here we provide a short literature review of available data. We identified only a small number of articles based on retrospective analysis of medical records in real-life settings. A strong consistency in results regarding response rates and treatment duration was noticed among mainly heavily pre-treated MM patients, with approximately half of patients achieving at least partial remission (PR) after retreatment with daratumumab-based protocol. The duration of treatment and time to the next treatment for retreatment episodes were considerable and consistent with clinical expectations for later lines of therapy. The analysis of data in this literature review indicates that daratumumab retreatment may provide meaningful clinical benefit to some patients with relapsed/refractory MM despite having prior exposure. However, further research is needed to identify clinical and biological parameters that may predict favorable responses to daratumumab retreatment.

Cross-country Variations in Infrastructure Development, Inflow of FDI and Quality of Institutions

This study tries to investigate the cross-country variations in infrastructure development among different sets of countries with varying institutional rankings, over time, by building five infrastructure indices. Along with building the total/composite infrastructure index, four other (energy, ICT, finance and transport) sub-indices are also built in this study. The strength of our study lies in the fact that we not only find variations in the total infrastructure development but also within the sub-indices. We have introduced the role of country-specific Institutional quality and inflow of FDI empirically in this regard to determine the cross-country variance in infrastructure development. The core hypothesis of our study is that countries that receive a good amount of FDI inflows will have impressive infrastructure development provided the country-specific institutional quality is high. On the contrary, countries with low institutional indexes may not have a positive association between FDI inflows and infrastructure development. However, there are exceptions. For example, institutionally strong countries like Ireland and Belgium should invest more funds to boost their financial infrastructure sector. On the other hand, another institutionally strong country like Norway should develop its transport infrastructure. In this study, we are mainly interested in the joint impact of FDI inflows with the institutional variable on infrastructure development that has been largely neglected in the empirical literature. Using two-dimensional panel data for FDI inflows for 39 countries over the period 2000–20, we find that the conditional effects are positive and significant. From the policy point of view, we identify the possible areas of the infrastructure of a country that needs capital to be invested and at the same time identify some of the countries that need to improve their institutional quality that will eventually lead to improvement in the infrastructure development. The results of our study are robust to different institutional measures and infrastructure indices.

Geographic disparities impacting oral vaccine performance: Observations and future directions.

Oral vaccines have several advantages compared with parenteral administration: they can be relatively cheap to produce in high quantities, easier to administer, and induce intestinal mucosal immunity that can protect against infection. These characteristics have led to successful use of oral vaccines against rotavirus, polio, and cholera. Unfortunately, oral vaccines for all three diseases have demonstrated lower performance in the highest-burden settings where they are most needed. Rotavirus vaccines are estimated to have >85% effectiveness against hospitalization in children <12 months in countries with low child mortality, but only ~65% effectiveness in countries with high child mortality. Similarly, oral polio vaccines have lower immunogenicity in developing country settings compared with high-resource settings. Data are more limited for oral cholera vaccines, but suggest lower titers among children compared with adults, and, for some vaccines, lower efficacy in endemic settings compared with non-endemic settings. These disparities are likely multifactorial, and available evidence suggests a role for maternal factors (e.g., transplacental antibodies, breastmilk), host factors (e.g., genetic polymorphisms-with the best evidence for rotavirus-or previous infection), and environmental factors (e.g., gut microbiome, coinfections). Overall, these data highlight the rather ambiguous and often contradictory nature of evidence on factors affecting oral vaccine response, cautioning against broad extrapolation of outcomes based on one population or one vaccine type. Meaningful impact on performance of oral vaccines will likely only be possible with a suite of interventions, given the complex and multifactorial nature of the problem and the degree to which contributing factors are intertwined.

Policy analysis of self-care program: a qualitative study protocol

BackgroundOver the recent years, the self-care program has been a significant policy in the field of health. The WHO recommended self-care for every country and economic setting for reaching universal health coverage, promoting health, keeping the world safe and serving the vulnerable. Conducting a policy analysis study can be useful in closely examining the self-care program’s content, process, context and actors.MethodsA qualitative policy analysis will be conducted in four phases to analyse the self-care program, focussing in Iran. The first phase will involve a scoping review to identify policies related to self-care worldwide. In the second phase, a qualitative study will be conducted to determine the status of the self-care program in Iran. The third phase will involve analysing the self-care program in Iran using the policy triangle framework of Walt and Gilson (1994). In the final phase, initial policy recommendations related to the self-care program will be formulated, and validation and finalization of the initial recommendations will be carried out in a panel of experts.DiscussionTo thoroughly examine the self-care program’s content, process, context and actors, a policy analysis study can be helpful. Therefore, this study will aim to analyse the self-care program using policy analysis approach. By identifying the challenges of the program’s content, process, context and actors, corrective solutions to improve the program’s current status, as well as policy recommendations appropriate to the country’s context, will be provided. In addition, policy-makers in various authorities at the national, regional and provincial levels would benefit from the results of this study.

Amikacin therapeutic drug monitoring: Evaluation of therapy performance and analytical techniques in a developing country setting.

Healthcare systems face several challenges, with microbial infections being one of the main concerns. Therapeutic drug monitoring (TDM) is a strategy that has been encouraged to optimize antimicrobial regimens, particularly those with significant toxicity and narrow therapeutic indices, such as amikacin (AMK). We aimed to evaluate AMK concentrations of patients in a non-routine TDM setting and compare the performance of immunoassay and chromatography methods for routine clinical use. In this prospective study, peak (Cmax) and trough (Cmin) plasma samples were collected from 39 adult patients and quantified by ultra-performance liquid chromatography coupled with mass spectrometry (UPLC-MS/MS). Relevant clinical information was collected from medical records. AMK concentrations and clinical data were analyzed to evaluate therapy performance and influencing factors. In addition, fluorescence polarized immunoassay (FPIA) and UPLC-MS/MS were compared with Passing-Bablok regression and Bland-Altman plot analysis. AMK concentrations varied widely, with a median Cmax of 41.40µg/mL (interquartile range [IQR] 27.60 - 56.75µg/mL) and a median Cmin of 1.87µg/mL (IQR 0.7 - 6.19µg/mL). A high proportion of patients (83.1%) failed to achieve the Cmax therapeutic target, while 31.7% failed to achieve the Cmin therapeutic target. Overall, elderly patients and those with reduced renal function had higher Cmax target attainment, while the same groups had lower Cmin target attainment. The method comparison showed a mean difference of 1.54% (limits of agreement -42.46% to 45.54%) in measured concentrations, with good correlation and no constant or proportional differences. Many patients failed to reach the Cmax target and were at risk of treatment failure, although adequate Cmin was achieved more often. TDM with dose adjustments could improve AMK therapy, but further research is needed.

Harm reduction associated with heated tobacco products: A systematic review and meta-analysis.

We conducted a systematic review and meta-analysis of randomised studies in humans comparing the outcomes of switching to heated tobacco products (HTPs) versus continuing conventional tobacco smoking by burning. We searched the electronic databases which included PubMed, Web of Science, Cochrane Controlled Trials Register, and Google Scholar from inception to May 2023. Randomised Controlled Trials (RCTs) in humans comparing HTPs with conventional burnt tobacco products were selected. Our search yielded 4817 search results, of which six RCTs (number of participants 1362, all from high-income countries) were selected. Five of the six included RCTs had low risk in four of five domains of bias; only one study had a high risk of bias in one domain. PRISMA guidelines were followed. There were 40 biomarkers of harm reduction reported categorised into six categories. One cancer biomarker (nitrosamine) and two cardiovascular biomarkers (eosinophils and total bilirubin) showed statistically significant harm reduction (total NNAL SMD=0·82, 95% CI 0·67-0·98, eosinophils SMD=0·38, 95% CI 0·12-0·65, total bilirubin SMD=0·71, 95% CI 0·28-1·31). The remaining biomarkers of harm in cardiovascular, inflammatory, metabolic, pulmonary, and renal categories showed imprecise findings. In RCTs of moderate quality, some biomarkers show harm reduction associated with switching from burnt tobacco smoking to HTPs. The majority of the findings are imprecise due to the small sample sizes of the included studies. Sufficiently powered, robust RCTs targeting key harm reduction biomarkers within both upper and low-middle income country settings are required in the future.

Optimizing data collection for obstetrical ultrasound research at the primary health care level in rural Uganda

ABSTRACT Background Neonatal and maternal mortality remains high in low- and middle-income countries (LMIC), especially in sub-Saharan Africa. Quality data collection is crucial to understand the magnitude of these problems and to measure the impact of interventions aimed at improving neonatal and maternal mortality. However, data collection in the low-income country setting, especially in rural areas, has been a challenge for researchers, policy makers, and public health officials. Here, we describe the methodology, experience and lessons learned while collecting data at lower-level primary health care facilities in rural Uganda. Methods Data collection was performed at Health Center III sites in rural Uganda, in partnership with Imaging the World and its affiliate Imaging the World Africa. The primary purpose of the data collection was to study the efficacy and clinical effect of introducing prenatal ultrasound services at these sites. Local data clerks were hired to perform the data collection through a combination of intensive training and on-the-ground support. Frequent oversight was used to support data collection. Results Of 2,397 enrolled pregnant women, 1,977 (82.5%) had complete outcome data. Upon independent expert audit, the data were >80% accurate for 10/11 variables and >90% accurate for 6/11 variables. Overall, the data collected at the rural HCs were 90% accurate. Discussion Accurate and complete data collection is possible in an LMIC setting if appropriate training and oversight are employed.