Capacity Building Efforts Research Articles

Understanding Health Equity in Public Health Practice in the United States.

Understanding the extent to which equity-focused work is occurring in public health departments (eg, in chronic disease programs) can identify areas of success and what is needed to move the needle on health equity. The study objective was to characterize the patterns and correlates of equity-related practices in US state and territorial public health practice. The design was a multimethod (quantitative and qualitative), cross-sectional study. The setting included US state and territorial public health departments. Chronic disease prevention practitioners (N = 600) completed self-report surveys in July 2022 through August 2022 (analyzed in September 2022 through December 2022). Health equity data were obtained across 4 domains: (1) staff skills, (2) work unit practices, (3) organizational priorities and values, and (4) partnerships and networks. There was a wide range in self-reported performance across the health equity variables. The highest values (those agreeing and strongly agreeing) were related to staff skills (eg, the ability to describe the causes of inequities [82%]). Low agreement was reported for multiple items, indicating the lack of systems for tracking progress on health equity (32%), the lack of hiring of staff members who represent disadvantaged communities (33%), and limited use of principles for community engagement (eg, sharing decision-making authority with partners [34%]). Qualitative data provided tangible examples showing how practitioners and their agencies are turning an array of health equity concepts into actions. There is urgency in addressing health equity and our data suggest considerable room for enhancing health equity practices in state and territorial public health. To support these activities, our findings provide some of the first information on areas of progress, gaps in practice, and where to target technical assistance, capacity building efforts, and accreditation planning.

The identification and classification of energy waste for efficient energy supervision in manufacturing factories

To respond to global climate change, “Net-Zero” targets have been set up by different governments, organizations, companies, etc. In this regard, manufacturing companies are urged to improve energy efficiency of their production systems. Reducing unnecessary energy consumption, namely energy waste, is therefore becoming critical. Unfortunately, the concept of energy waste has not been clearly defined and classified in both academia and industry. This study aims to uncover the key characteristics of energy waste through an interview-based case study. In total, twenty-five practitioners in different manufacturing factories from China, the UK, Japan, Germany, Austria, and Kenya were interviewed. These interviewees believe that on average energy performance can be improved by 10–20% through energy waste management. Besides, less energy waste results in more stable energy consumption, which can facilitate firms to conduct energy supervision more easily and accurately. Based on the analysis of these cases, an energy waste analytic framework was developed. Thirteen types of energy waste were identified and classified into four categories: 1) management-related behavioural energy waste (Mb-EW); 2) management-related technical energy waste (Mt-EW); 3) technology-related energy waste (T-EW); and 4) design-related energy waste (D-EW). A “step-by-step” strategy is then proposed for reducing energy waste. Both research and development (R&D) efforts and capacity-building efforts should be made to further reduce energy waste. Finally, future research directions are raised, including tools development for reducing energy waste and preparing assessment indicators on energy waste.

Health Services Needs Assessment for Retinoblastoma in Ethiopia.

The aim of this study was to document the available resources and needs for the detection, diagnosis, and treatment of retinoblastoma (RB) in Ethiopia. A health services needs assessment focused on RB care in Ethiopia was conducted. Information was obtained through a web-based survey and field visits. Facilities offering RB service delivery were categorized into three tiers, on the basis of the ability to detect (tier 1) and manage simple (tier 2) or complex (tier 3) patients with RB. Descriptive statistics were performed to quantify human and material resources available at each facility. The web survey received 29 responses from ophthalmologists at 19 health care facilities. Of the 19 units surveyed, seven (36.8%) had an ophthalmologist dedicated to RB treatment, classifying them as either a tier 2 or 3 facility. All tier 3 facilities had an affiliated health facility offering access to off-site pediatric oncology and pathology services. Of the focal therapies offered at tier 3 facilities, none included local chemotherapy or brachytherapy. Enucleation was offered at all tier 2 facilities, but availability of orbital implants and ocular prostheses was variable. None of the health facilities offered genetics services. This study demonstrated that the human and material resources needed for RB care in Ethiopia are constrained. Tier 3 RB facilities are rare and concentrated in urban areas, which could make it difficult for many patients to access. With focused capacity-building efforts, it is possible to increase the efficiency of RB therapy.

Authorship diversity in global evidence synthesis in genitourinary oncology: A 1998-2022 analysis of cochrane reviews.

e23006 Background: Women and individuals from low- and lower-middle-income countries (LMICs) are under-represented in oncology literature, particularly in high-impact publications. LMIC clinicians face multipronged barriers to impactful research. Unlike practice guidelines of oncology societies like ASCO, authors worldwide can potentially contribute to genitourinary (GU) oncology-related Cochrane Reviews, a potentially representative sample of global evidence synthesis efforts in the field. However, the state of authorship diversity here is unknown, which this study sought to determine. Methods: We retrospectively searched the Cochrane Database, using the filter “Topic: Urology”, and extracted authorship data for all reviews related to genitourinary cancers, published until 25 July 2022. We divided authors’ national affiliation into either low- and lower-middle-income countries (LMICs) or non-LMICs based on World Bank 2022 classification. For reviews having collaboratives listed as group authors, we treated the collaborative belonging to one country as a single author, instead of analyzing all collaborators separately to prevent data skew from several included individuals. Given the higher accuracy of manual web-searches for ascertaining gender over algorithmic estimation, we utilized the former to achieve ≥90% ascertainment. We endeavored to capture at least one webpage that demonstrated their gender or pronouns, like institutional profile, and used historical gender conventions. Results: A total of 54 GU oncology-related reviews, co-authored by a total of 324 authors, were included. 53 reviews were published by the Cochrane Urology Group, while one review was published by the Cochrane Incontinence Group. Countries with the highest representation of co-authors were the US (24.1%), UK (25.3%), Germany (23.5%), South Korea (6.8%), Australia (6.2%), Netherlands (3.7%), China (2.8%), Canada (2.5%), Brazil (1.5%). No authors were from LMICs. Gender could be ascertained for 94.14% (N = 305/324) of co-authors. Women made up 27.5% (N = 84/305) of co-authors, 16.0% (N = 8/50) of first authors, and 16.89% (N = 9/53) of corresponding authors. Conclusions: Women authors are better-represented in Cochrane Reviews related to genitourinary cancers compared to urology-specific journals, while LMICs were noted to have no representation. Global capacity-building efforts are warranted for enhancing the involvement of LMIC urologists with evidence synthesis. Equitable authorship representation may help expand both the focus and the utilization of high-impact evidence synthesis literature.

Uncovering the interplay between political will, public management reforms, and outcomes: a study of the United Arab Emirates

The aim of the study is to fill the gap in the existing literature by presenting a comprehensive and theoretically sound framework that examines the interplay between the attributes of political will, public management reform design and implementation, the results they yield and the impact of external factors on these variables. Drawing upon the systematic literature review, the research develops a conceptual framework of political will and applies it to the context of public management reforms in the United Arab Emirates (UAE). A wide range of databases are used from secondary sources including Worldwide Governance Indicators, Failed State Index, Global Innovation Index, and Transparency International. The results show that the UAE government's strong commitment to reforms, as well as its ability to implement those reforms effectively, has contributed to positive outcomes in areas such as economic development and public service delivery. UAE has liberalized its economy and institutionalized innovative practices. All actors are involved in reform initiatives. Given the developmental clientelist regime in the UAE, political leadership has played an instrumental role in successfully implementing public management reforms. The UAE Government has ensured capacity-building efforts and proper incentives such as Government Excellence Awards are in place for the continuity of reform initiatives. Other government regimes could potentially benefit from the approaches employed by the UAE government in undertaking public management reform initiatives. The results challenge the common assumption that monarchical regimes are unable to drive such changes and instead demonstrate that a development-focused clientelist state can effectively implement incremental reforms in public management. The proposed conceptual model will also potentially guide future empirical research in the field.

Genetic and Genomic Researchers' Perspectives on Biological Sample Sharing in Collaborative Research in Uganda: A Qualitative Study.

Numerous ethical, legal, and social issues arise with biological sample sharing. The study explored the perspectives of genetic and genomic researchers on the sharing of biological samples in international collaborative research. Qualitative in-depth interviews were conducted with 15 researchers. Participants expressed positive attitudes towards biobanking and appreciated the benefits of cross-border sharing of biological samples but noted that this practice had adversely affected local capacity building efforts. There was limited understanding of the ethical and regulatory frameworks governing sample sharing. Researchers emphasized the importance of respecting cultural values in biobanking research. Issues concerning poor governance and inequitable benefit sharing were also raised. There is a need for fair and equitable international collaborations where all researchers are treated with respect and as equal partners.

Health and Social Implications of Potential Indo-Pacific Chemical, Biological, Radiological, and Nuclear (CBRN) Proliferation Driven by Adaptation to Population, Climate Change and Geopolitical Upheaval

Introduction:Future strategic pressures in the Indo-Pacific region will present major policy and strategic challenges driven by rapidly increasing populations, resource depletion and contests, and forced adaptation to a changing climate. While regional countries remain likely to continue on a high growth trajectory, there is growing concern that nations will face difficulty to sustain economic gains in the face of strategic resource depletion and availability, population growth, and increasingly frequent extreme weather events. This mismatch could result in strategic miscalculation and reformulation, driving CBRN proliferation choices that fall outside of historical norms or standards. Such societal stressors are already occurring in the region and themselves may suddenly impact on health and social systems in unpredictable and complex ways.Method:Three tabletop exercises called the Boxwood Scenarios were conducted utilizing the Avalanche TTX system, including participants from key intelligence, military, and academic experts. Participants were invited to a Delphi study examining positive and negative drivers, shaping factors, motivators, and consequences of CBRNE proliferation in the Indo-Pacific region. Two rounds of result review were conducted by the group. These results underwent a systematic mixed methods analysis (quantitative and qualitative methods) and interpretation.Results:Climate change, demographic and geopolitical pressures were highlighted as key to future potential CBRN proliferation risks, with this nexus resulting in major proliferation concerns as early as 2040. Proliferation decisions driven by, and occurring in parallel to, climate and demographic pressures were identified as of major concern. Such decisions would have profound multi-layered social, health and broader implications for Indo-Pacific countries with declining determinants of national power.Conclusion:Climate change and demographic and geopolitical pressures could drive future Indo-Pacific CBRN proliferation. The consequences to human populations, the viability of ongoing international disaster risk reduction and capacity-building efforts, and the increased future risk of major CBRN events cannot be overstated.

Exploring the Ripple Effect and Consequences of Correspondent Banking De-Risking on Global Financial Inclusion and Stability: Evidence from Europe

This study explored the ripple effect and consequences of correspondent banking de-risking on global financial inclusion and stability, with a specific focus on evidence from Europe. Driven primarily by increased compliance requirements and the need to mitigate risks associated with anti-money laundering and combating the financing of terrorism regulations, de-risking led to the termination of correspondent banking relationships with various countries and financial institutions. The research aimed to understand the implications of this phenomenon on financial integration, access to essential financial services, and the exacerbation of economic disparities among different regions and demographic groups in Europe. A descriptive research design approach was employed, mainly quantitative analysis of CBR data and regulatory changes. The findings demonstrated that de-risking had a significant negative impact on financial inclusion and stability, particularly for small and medium-sized enterprises, non-profit organizations, and marginalized communities. Moreover, the termination of CBRs disrupted the flow of remittances, trade finance, and development aid, and led to an increased reliance on less-regulated, informal channels, which in turn undermined the global AML/CFT regime and exacerbated financial crime and systemic risks. Based on these findings, the study recommended enhancing collaboration and coordination among regulatory authorities, financial institutions, and affected stakeholders to develop a harmonized regulatory framework across European countries, implement a risk-based approach, and establish a centralized information-sharing platform. Additionally, targeted capacity-building efforts, exploration of innovative financial solutions, and the development of financial inclusion strategies prioritizing the needs of the most vulnerable segments of the population were recommended to counteract the negative effects of de-risking and promote financial inclusion and stability in Europe. Keywords: Correspondent banking de-risking, financial inclusion, global financial stability, anti-money laundering, combating the financing of terrorism

Developing a framework for using local knowledge systems to enhance capacity building in agricultural development

Building human capacity through education and training programs is a key component of agricultural development. This article lays out a framework for educators working in agricultural development to use local knowledges to enhance capacity building efforts. Local knowledge systems are complex social phenomena consisting of unique combinations of ontologies/epistemologies, worldviews, and cultures of the people in a particular social/ecological context. To embrace local knowledge systems, educators should: (a) understand power, positionality, and privilege; (b) understand your learners and yourselves; (c) use participatory approaches; and (d) embrace new knowledges. The framework presented provides guidance for agricultural development practitioners; agricultural development organizations; educational institutions and others who train agricultural development practitioners; and researchers and evaluators.

Improving Environmental Health in Schools

School environmental conditions have immediate and long-term effects on student health and learning. Relying on disconnected, inconsistent, voluntary, or unenforced environmental standards has not resulted in sufficient protection of students from toxic insults. Furthermore, the United States public school system was not prepared to navigate a potentially deadly infectious disease like COVID-19. Although Department of Education agencies have policies to establish clean and safe learning spaces, deficiencies are evident. This article highlights common environmental challenges in schools and opportunities for improvement. Voluntary adoption of rigorous environmental policies by grassroots efforts alone is unlikely to occur in all school systems. In the absence of a legally enforced requirement, the dedication of sufficient resources to update infrastructure and build the environmental health workforce capacity is equally unlikely to occur. Environmental health standards in schools should not be voluntary. Science-based standards should be comprehensive, and part of an actionable, integrated strategy that includes preventive measures and addresses environmental health issues sustainably. Establishing an Integrated Environmental Management approach for schools will require a coordinated capacity-building effort, community-based implementation efforts, and enforcement of minimal standards. Schools will need ongoing technical support and training for staff, faculty, and teachers sufficient to enable them to assume greater oversight and responsibility for environmental management of their schools. Ideally, a holistic approach will include all environmental health components, including IAQ, IPM, green cleaning, pesticide and chemical safety, food safety, fire prevention, building legacy pollutant management, and drinking water quality. Thus, creating a comprehensive management system with continuous monitoring and maintenance. Clinicians who care for children can serve as advocates for children's health beyond their clinic walls by advising parents and guardians to be aware of school conditions and management practices. Medical professionals have always been valued and influential members of communities and school boards. In these roles they can greatly assist in identifying and providing solutions to reduce environmental hazards in schools.

Connecting technical assistance to implementation progress in child welfare capacity building efforts

ABSTRACT Child welfare jurisdictions implement practices designed to improve child outcomes. Three federally funded Child Welfare Capacity Building Centers provide technical assistance (TA) to jurisdictions to support implementation of practice improvements. The aim of this study was to understand implementation progress among jurisdictions served by the Centers. Analyses indicate (1) amount of TA was positively associated with achievement of implementation milestones; (2) jurisdictions with higher levels of foundational capacity were more likely to achieve milestones; and (3) coaching was associated with faster milestone achievement. Methodological limitations and implications for future evaluations of TA in child welfare are discussed.

Capacity Building Empowerment of Weaver Groups Through Weaving Business Innovation at the Ikat Jata Kapa Weaving Center in Sikka Regency, East Nusa Tenggara Province, Indonesia, Indonesia

This study aims to identify and explain the potential of the Weaver Group's human resources, capacity building efforts to empower Weaver Groups, the changes that have occurred as well as the supporting and inhibiting factors. This study used a qualitative descriptive method with data collection techniques through observation and in-depth interviews and documentation with Sikka Regency Cooperative and UKM Trade Office officials who were administrators and field assistants of the Jata Kapa Ikat Weaving Center and Groups of Weavers in the small, medium and large categories. The findings show that capacity building efforts to empower Weaver Groups are carried out by the Sikka Regency Cooperative and UKM Trade Service through the Jata Kapa Ikat Weaving Center by carrying out several programs, namely human development, business development, environmental development and institutional development. The program's efforts have been carried out well facilitated by supporting factors in it, but there are still several dimensions that have not worked properly due to several inhibiting factors in the capacity building process of empowering the Weaver Group.

Sustainable natural resource management must recognise community diversity

ABSTRACT Deforestation and overexploitation of mangrove forests are affecting the livelihoods of millions of families that rely on their ecosystem services. Understanding local perceptions about the status and threats to mangroves is therefore crucial in addressing this issue. This research aims to enhance understanding of how sociodemographic factors influence resource use and perceptions of environmental changes through a questionnaire survey (n = 592 households) in five locations in Lamu County, home to 62% of Kenya’s mangroves. The results highlight the variability of mangrove use, ecosystem service recognition, and perceptions and drivers of change across locations, which are influenced by sociodemographic factors such as gender, education, and occupation. Although 89% of respondents reported using mangrove products, only 56% were able to identify mangrove ecosystem services, with those without formal education being less likely to recognize them. Interestingly, 50% of respondents perceived an increase in mangrove cover, contrary to research showing mangrove loss in the area over the last decade. Results show that communities are diverse and perceptions vary between groups, suggesting that implementing uniform management measures may be incomplete or ineffective. Awareness campaigns and capacity-building efforts must be tailored to reduce misperceptions about the state of local resources and to address the specific needs and challenges faced by different groups. Recommendations made here are widely applicable to promote more inclusive and sustainable community engagement in the management of natural resources in developing countries worldwide.

Exploring the Reported Strengths and Limitations of Aboriginal and Torres Strait Islander Health Research: A Narrative Review of Intervention Studies

High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008-2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.

A Competency Framework for Participatory Modeling

Participatory modeling (PM) is a craft that is often learned by training ‘on the job’ and mastered through years of practice. There is little explicit knowledge available on identifying and documenting the skills needed to perform PM. In the modeling literature, existing attempts to identify relevant competencies have focused on the specific technical skills required for specific technical model development. The other skills required to organize and conduct the stakeholder process seem to be more vaguely and poorly defined in this context. The situation is complicated by PM being an essentially transdisciplinary craft, with no single discipline or skill set to borrow ideas and recommendations from. In this paper, we aim to set the foundation for both the practice and capacity-building efforts for PM by identifying the relevant core competencies. Our inquiry into this topic starts with reviewing and compiling literature on competencies in problem-solving research areas related to PM (e.g., systems thinking, facilitated model building, operations research, and so forth). We augment our inquiry with results from a PM practitioners’ survey to learn how they perceive the importance of different competencies and how the scope of these competencies may vary across the various roles that participatory modellers play. As a result, we identified five core competency areas essential for PM: systems thinking, modeling, group facilitation, project management and leadership, and, more recently, designing and running virtual workshops and events.

Capacity-building and continuing professional development in healthcare and rehabilitation in low- and middle-income countries—a scoping review protocol

BackgroundA recent world health report suggests that there is a growing rehabilitation human resource crisis. This review focuses on the capacity-building needed to meet present and future rehabilitation challenges in low- and middle-income countries (LMICs). Capacity-building is the process by which individuals and organizations obtain, improve, and retain the skills, knowledge, tools, equipment, and other resources needed to do their jobs competently. The objectives of this review are (1) to determine how capacity-building has been defined, implemented, and evaluated in LMICs and (2) to provide an overview of the effectiveness of capacity-building initiatives.MethodsIn the first of seven stages, we will refine and delimit the research. Then, we will identify relevant studies by searching five biomedical databases, two rehabilitation databases, three regional databases, and three databases of gray literature. Two independent reviewers will then select the studies using a priori selection criteria. We will exclude incomplete records, records published prior to 2000 for databases and 2010 for gray literature, and records written in languages other than English or Spanish. We will also exclude records focusing on entry-to-practice programs in academic settings. For Objective 1, using qualitative analysis software, we will extract and analyze text from included records that define or explains capacity building. For Objective 2, using an online file-sharing platform, one reviewer will extract data describing the effectiveness of capacity-building interventions and a second reviewer will verify the accuracy, with disagreements resolved by consensus. The results will be collated using tables and charts. After synthesizing the results, we will discuss the practicality and applicability of the findings with partners from Honduras and Colombia. We will use several formats and venues including presentations and publications in English and Spanish to present our results.DiscussionTo our knowledge, this will be the first attempt to systematically identify knowledge of capacity-building and rehabilitation in LMICs. This scoping review results will offer unique insights concerning the breadth and depth of literature in the area. It is anticipated that results from this scoping review will guide efforts in future capacity-building efforts in rehabilitation in LMICs.Review registrationBusch AJ, Deprez D, Bidonde J, Ramírez PA, Araque EP. Capacity building and continuing professional development in healthcare and rehabilitation in low- and middle-income countries—a scoping review. 2021. https://doi.org/10.17605/OSF.IO/7VGXU.

A comparative assessment of the community frontline health workers for their knowledge and practices of malaria diagnosis and treatment in three contiguous districts Mandla, Balaghat, and Dindori of Madhya Pradesh, India

BackgroundGlobal malaria cases rose by 14 million, and deaths by 69,000, in 2020. In India, a 46% decline has been reported between 2020 and 2019. In 2017, the Malaria Elimination Demonstration Project conducted a needs-assessment of the Accredited Social Health Activists (ASHAs) of Mandla district. This survey revealed the inadequate level of knowledge in malaria diagnosis and treatment. Subsequently, a training programme was launched for enhancing malaria-related knowledge of ASHAs. The present study was conducted in 2021 to evaluate the impact of training on malaria-related knowledge and practices of ASHAs in Mandla. This assessment was also done in two adjoining districts: Balaghat and Dindori.MethodsA cross-sectional survey using a structured questionnaire was administered to ASHAs to measure their knowledge and practices related to malaria etiology, prevention, diagnosis, and treatment. A comparison of information collected from these three districts was performed using simple descriptive statistics, comparison of means and multivariate logistic regression analysis.ResultsSignificant improvement was noted amongst ASHAs of district Mandla between 2017 (baseline) and 2021 (endline) in knowledge related to malaria transmission, preventive measures, adherence to the national drug policy, diagnosis using rapid diagnostic tests, and identification of age group-specific, colour-coded artemisinin combination therapy blister packs (p < 0.05). The multivariate logistic regression analysis revealed that odds of Mandla baseline was 0.39, 0.48, 0.34, and 0.07 times lower for malaria-related knowledge on disease etiology, prevention, diagnosis, and treatment, respectively (p < 0.001). Further, participants in districts Balaghat and Dindori showed significantly lower odds for knowledge (p < 0.001) and treatment practices (p < 0.01) compared to Mandla endline. Education, attended training, having a malaria learner’s guide, and minimum 10 years’ work experience were potential predictors for good treatment practices.ConclusionThe findings of the study unequivocally establishes significant improvement in overall malaria-related knowledge and practices of ASHAs in Mandla as a result of periodic training and capacity building efforts. The study suggests that learnings from Mandla district could be helpful in improving level of knowledge and practices among frontline health workers.

Who coauthors Cochrane Reviews related to genitourinary cancers? A 1998-2022 analysis of country and gender diversity.

436 Background: Women and individuals from low- and lower-middle-income countries (LMICs) are under-represented in urology literature, particularly in high-impact publications. Cochrane, a non-profit collaboration, publishes high‐quality systematic reviews that frequently impact policy and clinical practice worldwide. However, the state of the country and gender diversity amongst authors of urology-related Cochrane Reviews is unknown, which this work sought to determine. Methods: We searched the Cochrane Database, under the filter “Topic: Urology”, for all reviews related to genitourinary cancers, published until 25 July 2022, including both active reviews and those withdrawn for updation. We extracted authorship data and classified the national affiliation of authors into either high- and upper-middle-income countries (HICs) or LMICs based on the World Bank income classification. We treated a collaborative author group belonging to one country as a single-country affiliation. Given the higher accuracy of manual web searches for ascertaining gender over algorithmic estimation, we utilized the former to achieve ≥90% ascertainment. We endeavored to capture at least one webpage that demonstrated their gender, e.g. institutional profile, Google Scholar, ResearchGate, etc. Results: A total of 54 urology-related reviews, co-authored by a total of 324 authors, were included. 53 reviews were published by the Cochrane Urology Group, while one review was by the Incontinence Group. Zero authors were from LMICs. Countries with the highest representation of co-authors were the US (24.1%), UK (25.3%), Germany (23.5%), South Korea (6.8%), Australia (6.2%), Netherlands (3.7%), China (2.8%), Canada (2.5%), Brazil (1.5%). Gender could be ascertained for 94.14% (N=305/324) of co-authors. Women made up 27.5% (N=84/305) of co-authors, 16.0% (N=8/50) of first authors, and 16.89% (N=9/53) of corresponding authors. Conclusions: Women are well-represented in Cochrane Reviews related to genitourinary cancers compared to urology-specific journals and their representation in urology. However, LMICs contributed zero authors, while those from the US, UK, and Germany constitute &gt;70% of authors for one of the highest-quality evidence sources in urology. Equitable authorship representation may help expand both the utilization and the global relevance of recommendations of such high-impact urology literature. Global capacity-building efforts are warranted, particularly in Africa, for enhancing the involvement of LMIC urologists with evidence synthesis.

Stocking Practices of Anti-Tuberculosis Medications among Community Pharmacists and Patent Proprietary Medicine Vendors in Two States in Nigeria.

Evidence has shown that non-fixed-dose combination (non-FDC) anti-TB drugs could promote the spread of drug-resistant tuberculosis (DR-TB). We aimed to determine anti-TB medication stocking and dispensing practices among patent medicine vendors (PMVs) and community pharmacists (CPs) and their determinants. This was a cross-sectional study using a structured, self-administered questionnaire among 405 retail outlets (322 PMVs and 83 CPs) across 16 Lagos and Kebbi local government areas (LGAs) between June 2020 and December 2020. Data were analyzed with Statistical Program for Social Sciences (SPSS) for Windows version 17 (IBM Corp., Armonk, NY, USA). Chi-square test and binary logistic regression were used to assess the determinants of anti-TB medication stocking practices at a p-value of 0.05 or less for statistical significance. Overall, 91%, 71%, 49%, 43% and 35% of the respondents reported stocking loose rifampicin, streptomycin, pyrazinamide, isoniazid and ethambutol tablets, respectively. From bivariate analysis, it was observed that being aware of directly observed therapy short course (DOTS) facilities (OR 0.48, CI 0.25-0.89, p < 0.019) and having previous training on TB (OR 0.32, CI 0.14-0.73, p < 0.005) reduced the odds of stocking anti-TB medication, while operating more than 1 shop (OR 3.32, CI 1.44-7.57, p = 0.004), having 3 or more apprentices (OR 5.31, CI 2.74-10.29, p < 0.001) and seeing over 20 clients/day (OR 3.02, CI 1.18-7.71, p = 0.017) increased the odds of stocking loose anti-TB medications. From multivariate analysis, it was observed that only the variable having three or more apprentices (OR 10.23, CI 0.10-0.49, p = 0.001) significantly increased the odds of stocking anti-TB medications. The stocking of non-FDC anti-TB medications was high and largely determined by the number of apprentices among PMVs and CPs in Nigeria, and this may have serious implications for drug resistance development. However, the results linking the stocking of anti-TB to the number of apprentices should be interpreted cautiously as this study did not control for the level of sales in the pharmacies. We recommend that all capacity-building and regulatory efforts for PMVs and CPs in Nigeria should include not just the owners of retail premises but also their apprentices.

Scale-Up of a Newborn Resuscitation Capacity-Building and Skill Retention Program Associated With Improved Neonatal Outcomes in Gandaki Province, Nepal.

Intrapartum events leading to asphyxia at birth are a leading cause of neonatal morbidity and mortality in Nepal. In response, the Nepal Ministry of Health and Population adopted the Helping Babies Breathe (HBB) training curriculum in 2015 as a tool to improve neonatal resuscitation and outcomes. Although the effectiveness of HBB training has been well documented, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN) designed an evidence-based intervention for scaling up newborn resuscitation training and skill retention. We report on its implementation and the changes in newborn outcomes during the program period. The program empowered facility-based trainers in newborn resuscitation and skill retention at 12 facilities in Gandaki Province. Seven of 14 level I hospitals and 5 of 6 level II hospitals were selected. A single external mentor coached the facility-based trainers, provided general support, and monitored progress. Program evaluation tracked changes in newborn metrics over 21 Nepali months (March 2018-November 2019). All deliveries occurring in the health facilities during the program period were included in the evaluation. We assessed program effectiveness by analyzing time trends of neonatal mortality, morbidity, and stillbirths. We gathered data on neonatal health outcomes of 33,417 deliveries, including 23,820 vaginal deliveries and 9,597 cesarean deliveries. During the program, 43 facility-based trainers taught resuscitation skills to 425 medical personnel and supported skill retention. Neonatal deaths within 24 hours of birth (incidence rate ratio [IRR]=0.993, P=.044) and newborn morbidities (IRR=0.996, P<.001) showed a significantly declining trend. Our findings suggest that the SSN program had a substantial influence on critical neonatal outcomes. Future neonatal resuscitation capacity-building and skill retention efforts may benefit from incorporating elements of the program.