Large-scale Programs Research Articles

Development method in a large-scale public sector IT programme

The Norwegian parental benefit programme started as a large-scale information technology operation to automate and provide self-service solutions for parental benefit applications. This benefit replaces lost salaries for about 100,000 parents every year while parents are home with new-born children. A previous programme to modernize IT solutions was stopped. The new programme replacing legacy solutions from the 1970s was seen as a large, complicated, and risky undertaking with a cost limit of USD 130 million. Initially, this programme had three main releases based on an internal development method combining project management and agile methods. During the second release, the programme experienced challenges with coordinating work across the business and development projects. The programme manager established a task force to propose changes in the development method for the last release. We then ask the question: If you were part of this task force, what should the programme manager do to remedy the coordination challenges for the last release? This teaching case is based on a longitudinal case study and is relevant for graduate or continuing education courses in information systems development or IT project management during which students learn how to organize efficient software development at scale.

A modeling approach to forecast local demographic trends in metapopulations.

Predicting animal population trajectories into the future has become a central exercise in both applied and fundamental ecology. Because demographic models classically assume population closure, they tend to provide inaccurate predictions when applied locally to interconnected subpopulations that are part of a larger metapopulation. Ideally, one should explicitly model dispersal among subpopulations, but in practice this is prevented by the difficulty of estimating dispersal rates in the wild. To forecast the local demography of connected subpopulations, we developed a new demographic model (hereafter, the two-scale model) that disentangles two processes occurring at different spatial scales. First, at the larger scale, a closed population model describes changes in metapopulation size over time. Second, total metapopulation size is redistributed among subpopulations, using time-varying proportionality parameters. This two-step approach ensures that the long-term growth of every subpopulation is constrained by the overall metapopulation growth rate. It implicitly accounts for the interconnectedness among subpopulations and avoids unrealistic trajectories. Using realistic simulations, we compared the performance of this new model with that of a classical closed population model at predicting subpopulations' trajectories over 30 years. While the classical model predicted future subpopulation sizes with an average bias of 30% and produced predictive errors sometimes >500%, the two-scale model showed very little bias (<3%) and never produced predictive errors >20%. We also applied both models to a real dataset on European shags (Gulosus aristotelis) breeding along the Atlantic coast of France. Again, the classical model predicted highly unrealistic growths, as large as a 200-fold increase over 30 years for some subpopulations. The two-scale model predicted very sensible growths, never larger than a threefold increase over the 30-year time horizon, which is more in accordance with this species' life history. This two-scale model provides an effective solution to forecast the local demography of connected subpopulations in the absence of data on dispersal rates. In this context, it is a better alternative than closed population models and a more parsimonious option than full-dispersal models. Because the only data required are simple counts, this model could be useful to many large-scale wildlife monitoring programs.

Multidimensional patterns of bird diversity and its driving forces in the Yangtze river basin of China

Biodiversity is fundamental to human well-being and economic development. The Yangtze River, the largest river in China, faces biodiversity loss due to habitat degradation, climate change, and other anthropogenic threats. However, the long-term changes in the region's biodiversity remain poorly understood. Here, we constructed an optimized living planet index (LPIO) by combining Partial Least Squares Structural Equation Modeling and Random Forest Modeling. Using data from a monitoring network of 536 sites, we observed an increasing trend in terrestrial bird diversity and functional complexity across the entire watershed from 2011 to 2020. Our findings indicate that a large-scale ecological restoration program has contributed to increases in terrestrial and aquatic bird diversity in the Yangtze River Basin. In contrast, bird diversity in the downstream area has decreased by 2.83 ​%, largely due to a rapid decline in wetland birds. The degradation of wetland habitats and insufficient conservation measures have negatively impacted bird diversity in the downstream region. This suggests that although there have been significant improvements in terrestrial bird diversity, more effective wetland restoration is necessary for biodiversity conservation. We recommend optimizing the national large-scale biodiversity monitoring network and increasing the number of upstream monitoring sites.

Rapid reagent-free anaemia screening using plant-derived “HemoQR” paper-strips and smartphone: A study on 200 human subjects

Detecting anaemia in resource-limited settings is challenging due to limited access to diagnostic tools, healthcare infrastructure, and trained personnel, often resulting in underdiagnosis and delayed treatment. This study aims to evaluate HemoQR, a novel point-of-care (POC) diagnostic method for haemoglobin (Hb) level detection using a smartphone-based system integrated with a paper strip without needing any reagent or additional auxiliary device. The goal is to assess the efficacy of this portable, user-friendly, rapid and accurate alternative for Hb measurement in large-scale intervention programmes such as Anaemia-mukt Bharat (AMB), which is crucial for diagnosing anaemia and monitoring various health conditions. The method involves the transfer of one drop of the blood sample to a paper strip that is made indigenously using plant based cellulosic sources for optimal functionality. The colour signal around the test spot is quantitatively analysed using a smartphone camera equipped with a custom application. The application processes the images through a machine learning algorithm to determine the Hb concentration. The system was evaluated in a clinical trial involving 200 participants, comparing its performance with the gold-standard laboratory Hb assay using automated haematology analyser. The smartphone-based method demonstrated high sensitivity (87.09 %) and specificity (96.11 %) for anaemia screening, as compared with laboratory results. The average detection time was significantly reduced to under q minute, and the system showed excellent user-friendliness and portability with no auxiliary device needed beyond the smartphone. Clinical trial results indicated that the device was accurate and reliable across different Hb levels. Summarily, HemoQR evidenced to be a promising tool for POC diagnostics. Its high accuracy, rapid results, and ease of use make it suitable for both clinical settings and remote areas with limited access to laboratory facilities. Future research will prioritize further validation and integration of the anaemia screening outcome with electronic health records from a large population cohort. This will help identify early indicators and signals of numerous emerging disease burdens that could escalate into secondary and tertiary health crises if not addressed in time.

Process evaluation of an urban piped water supply infrastructure improvement programme in Uvira, Democratic Republic of the Congo

Major investments in water supply infrastructure will be required to achieve Sustainable Development Goal (SDG) 6. Safely managed water services are also central to global cholera and diarrhoeal diseases prevention strategies. However, evidence remains scarce on how to efficiently improve piped water services in complex settings where infrastructure investments are most needed. We conducted a process evaluation of a large-scale water supply infrastructure improvement programme in Uvira, Democratic Republic of the Congo, in parallel to a pragmatic trial. Considering three evaluation domains–context, implementation, and population response–, we assessed the validity of the programme’s theory of change and underlying assumptions. Information sources included construction works documentation, operational and billing records from the water utility, and household surveys. The evaluation covers the period 2014–2021. Trial results are not within the scope of this manuscript. The programme did not achieve expected improvements in the water supply service during the evaluation period. Out of 16 assumptions underlying the theory of change, six remained valid, seven partially valid, and three turned out to be invalid. Contextual challenges included extreme flooding in 2020 and the Covid-19 pandemic, which disrupted construction works. Issues related to electricity supply and the rise of Lake Tanganyika emphasise the need for cross-sectoral approaches and consideration of climate change in the planning of water supply infrastructure. Implementation challenges underlined the importance of capacity strengthening alongside infrastructure improvements. Population response elements suggest that affordability and informal practices such as tap sharing should be taken into account. The programme was a good example of early engagement with researchers and provides unique insights into the implementation of large-scale infrastructure improvements in a complex, low-income setting. Pragmatic evaluation approaches should be adopted for the generation of scientific evidence from complex programmes in order to optimise future infrastructure investments contributing to progress towards SDG6.

A Cross-Sectional Survey to Measure Attitude, Self-Reported Practice, Levels, Typology, and Determinants of Lifetime Gambling Behaviors Among Undergraduate Students in Higher Training Institutions, Tanzania.

Lifetime gambling activities and behaviors are considered as potentially addictive behaviors that may impact a student's performance. According to a survey conducted in Tanzanian's higher training institutions, for example, 37.2% of sports gamblers were students. This study employed an institutional-based cross-sectional survey in a quantitative research approach to study 374 randomly sampled undergraduate students in higher training institutions in Dodoma region, Tanzania from June to July 2023. Students reported their attitudes, practices, and drivers of gambling activities through interviewer-administered structured questionnaires adopted from previous studies. Results indicate that 374 of 583 potential participants were eligible and surveyed for the study with 100% response rate. Participants' mean age was 24 years ± 2.79 of which, few of them (34%) had age ranging between 25 and 42years. Male participants accounted for 69.8% (n = 261). 59.1% of the study participants believed that gambling activities were okay to them of which 47.3% of them were lifetime gamblers; 19.2% moderate-risk lifetime gamblers and 2.5% low-risk lifetime gamblers respectively. Online sports betting (44.5%), coin pusher (29.4%), poll tables (8.0%), and slot machines (6.9%) were the most preferred types of gambling games among students. Age between 17 and 24years; levels three and four classes, being male; living off-campus; drug abuse; mobile smartphone ownership; exposure to social media platforms and high attitude towards gambling activities were associated significantly with undergraduate students' gambling practices (p < 0.05). Large-scale institutional-based educational programs about the financial and academic ramifications of gambling among students during their studies may be able to moderate their gambling behaviors.

A comprehensive evaluation of an artificial intelligence based digital pathology to monitor large-scale deworming programs against soil-transmitted helminths: A study protocol.

Manual screening of a Kato-Katz (KK) thick stool smear remains the current standard to monitor the impact of large-scale deworming programs against soil-transmitted helminths (STHs). To improve this diagnostic standard, we recently designed an artificial intelligence based digital pathology system (AI-DP) for digital image capture and analysis of KK thick smears. Preliminary results of its diagnostic performance are encouraging, and a comprehensive evaluation of this technology as a cost-efficient end-to-end diagnostic to inform STH control programs against the target product profiles (TPP) of the World Health Organisation (WHO) is the next step for validation. Here, we describe the study protocol for a comprehensive evaluation of the AI-DP based on its (i) diagnostic performance, (ii) repeatability/reproducibility, (iii) time-to-result, (iv) cost-efficiency to inform large-scale deworming programs, and (v) usability in both laboratory and field settings. For each of these five attributes, we designed separate experiments with sufficient power to verify the non-inferiority of the AI-DP (KK2.0) over the manual screening of the KK stool thick smears (KK1.0). These experiments will be conducted in two STH endemic countries with national deworming programs (Ethiopia and Uganda), focussing on school-age children only. This comprehensive study will provide the necessary data to make an evidence-based decision on whether the technology is indeed performant and a cost-efficient end-to-end diagnostic to inform large-scale deworming programs against STHs. Following the protocolized collection of high-quality data we will seek approval by WHO. Through the dissemination of our methodology and statistics, we hope to support additional developments in AI-DP technologies for other neglected tropical diseases in resource-limited settings. The trial was registered on September 29, 2023 Clinicaltrials.gov (ID: NCT06055530).

Preferences of parents from diverse backgrounds on genomic screening of apparently healthy newborns.

Genomic sequencing has been proposed as a strategy to expand newborn screening. Perspectives on genomic newborn screening from parents of diverse racial, ethnic, and socioeconomic backgrounds are needed to shape equitable implementation of this modality. We conducted 20 semi-structured interviews (15 English, 5 Spanish) and seven focus groups (4 English, 3 Spanish) with parents from diverse backgrounds to assess their perspectives regarding which disorders and variants might be screened, data privacy, and barriers to pursuing specialized care. Parents felt that genomic newborn screening would provide them with improved understanding of their children's health and had the potential to yield health and personal benefits. Themes that became evident included: interest in childhood and family health risks, the value of emotional preparation and personal planning, understanding of uncertain and low-risk results, concerns regarding data privacy, and concerns about support following the receipt of a positive newborn screening result. The expected benefits and concerns expressed by parents of diverse backgrounds regarding genomic newborn screening should guide future policy decisions. Their preferences should be considered prior to the implementation of large-scale genomic newborn screening programs.

The EU project VAXaction: tacking effectively vaccine hesitancy in Europe

Abstract The main objective of VAX-ACTION is to support EU Member States and relevant stakeholders to implement the results of tailored, evidence-based interventions aimed to reduce vaccine hesitancy. Based on the evaluation of effectiveness of these interventions, which will be conducted in selected target regions in EU member states, recommendations will be drawn through diverse dissemination strategies to allow scaling up good practices to other member States, but also to the USA and Canada, where gaps in implementation strategies also have prevented effective, evidence-based interventions aimed to better deal with vaccine hesitancy. The first phase of the research involved some relevant systematic reviews with the aim of: 1. to map public health evidence and research results on large-scale vaccination programs in Europe and north America; 2. to map interventions aimed to address vaccine hesitancy regarding new and well-stablished vaccines and vaccination programs (Covid-19, mpox, national immunizations programs for children) in Europe and north America; 3. to identify successful and unsuccessful interventions designs aimed to address vaccine hesitancy, including challenges in the implementation, evaluation designs, and the feasibility of scaling-up solutions that are context-sensitive; 4. to identify significant similarities or dissimilarities in the designs and outcomes of interventions aimed to address vaccine hesitancy in northern countries where political and academic concern towards this phenomenon is growing; 5. to identify the extent to which ‘grounding’ (bottom-up) experiences aimed to address vaccine hesitancy are evidence-based, build on current international knowledge and guidelines, and whether they are internationally reported; 6. to systematize the mapping of interventions aimed to address vaccine hesitancy in the northern hemisphere in a way that can be shared and used by third parties. This contribution will illustrate the results of the first phase of the project.

Participation rate and yield of indirect cascade genetic screening for familial hypercholesterolemia using a web-based communication platform (CATCH): a randomized multicenter implementation trial

Abstract Introduction Cascade genetic screening for familial hypercholesterolemia (FH) is poorly performed when direct contact with relatives by health professionals is not allowed. We aimed to compare the effectiveness of implementing a web-based communication platform in a large-scale cascade genetic screening program for FH, while maintaining the confidentiality of indirect family contacts. Methods The CATCH study is a prospective randomized open-label multicenter implementation trial that promotes family cascade genetic screening in Swiss adults older than 16 years with a newly diagnosed pathogenic variant for FH. Each family was randomly assigned to a multigenerational indirect cascade genetic screening (1:1) either via the possibility to use of a web-based platform designed to send pre-prepared text messages or emails, and allowing to connect to a specialized clinical center, or a cascade genetic screening via the local recommended procedure. The primary outcome was the 6-month participation rate of relatives, defined as the number of genetic tests performed within 6 months after referral, over the number of eligible relatives for screening, i.e. living first-degree relatives aged 5 years or older. The secondary outcome was the 6-month yield of positive genetic tests, defined as the number of positive tests over the number of eligible relatives. Both outcome estimates were obtained after accounting for family clusters. Results Between 11/20 and 12/23, we enrolled 221 adults with a phenotype of FH for genetic testing, with 87 of them having confirmed genetic FH, corresponding to a total of 401 eligible relatives for cascade screening, with 102 relatives eventually undergoing genetic testing. Among the 87 index cases with genetic FH, 44 were randomly assigned to the web-based platform screening, and 43 were assigned to the local procedure screening. The 6-month participation rate of relatives was 71 of the 218 eligible relatives (29% [95% CI 21–38]) for the web-based platform screening, and 31 of the 183 eligible relatives (14% [95% CI 8–23]) for the local procedure screening (odds ratio (OR) 2.46 [95% CI 1.22–4.98]), p=0.012) (Figure). Similarly, the yield of detection of positive relatives was higher for the web-based platform screening, (16% [95% CI 11–23]) compared to the local procedure screening (7% [95% CI 4–13]), with OR of 2.43 [95% CI 1.11–5.30], p=0.026. Among the 55 positive relatives identified with genetic FH within 6-months, 13.0% were younger than 18 years, 25.5% were current smokers, and 56.0% were not using any lipid-lowering drugs. Conclusions The effectiveness of cascade genetic screening for FH was approximately doubled by integrating a web-based platform that facilitates family communication and access to specialized clinical centers. Modern communication technology is well suited to be integrated in large-scale indirect genetic screening programs to increase the early identification of patients at high cardiovascular risk.

7.O. Skills building seminar: Initiating change: Mainstreaming equity and diversity in public health

Abstract Background Consideration of the increasing population cultural and ethnic diversity and the widening of social gaps is essential for narrowing health inequities. While tailored and targeted measures for populations at risk of social disadvantage are needed, mainstreaming and integration of diversity and inclusion perspectives in all public health measures are required. To our knowledge, the EU Joint Action for Cardiovascular diseases and diabetes (JACARDI) is the first large-scale program to apply a systematic and harmonized approach for integrating equity and diversity perspectives. Objectives The main objective of the workshop is skills building in integration of equity and diversity perspectives in practice through: 1) Introducing the key requirements for achieving EU-wide programme change, drawing from several decades of experience in projects conducted in over 30 countries, including those partnered with the World Health Organization, governments and industry. 2) Outlining a practical tool in the format of an equity and diversity matrix designed for integrating equity and diversity perspectives developed within the JACARDI project to support implementation of 142 sub-projects in 21 partner countries. 3) A practical participatory group work based on the JACARDI equity and diversity maturity matrix, followed by a moderated discussion. The workshop acts as a valuable platform for sharing and building collaborative knowledge across European countries and empowering participants as initiators for sustainable, more equitable, and diversity inclusive public health actions. It provides practical and concrete skills on equity and diversity that participants can apply in their work and disseminate within their organizations. The presentations will build knowledge, while group work and the moderated discussion will build skills among participants on the workshop topic. Format of the workshop Two presentations followed by participatory group work and a moderated discussion among workshop participants and presenters. Key messages • Population diversity should be systematically mainstreamed in public health to effectively and sustainably narrow persisting health inequities. • An equity and diversity maturity matrix can be used as a practical tool for systematic integration and monitoring of diversity perspectives in practice.

Boltzmann sampling with quantum annealers via fast Stein correction

Despite the attempts to apply a quantum annealer to Boltzmann sampling, it is still impossible to perform accurate sampling at arbitrary temperatures. Conventional distribution correction methods such as importance sampling and resampling cannot be applied, because the analytical expression of sampling distribution is unknown for a quantum annealer. Stein correction [Q. Liu and J. Lee, in , Proceedings of Machine Learning Research (PMLR, 2017), Vol. 54, pp. 952–961] can correct the samples by weighting without the knowledge of the sampling distribution, but the naive implementation requires the solution of a large-scale quadratic program, hampering usage in practical problems. In this article, a fast and approximate method based on a random feature map and exponentiated gradient updates is developed to compute the sample weights and is used to correct the samples generated by D-Wave quantum annealers. In benchmarking problems, it is observed that the residual error of thermal average calculations is reduced significantly. If combined with our method, quantum annealers may emerge as a viable alternative to long-established Markov chain Monte Carlo methods. Published by the American Physical Society 2024

An efficient outcome-space branch-and-bound algorithm for solving a class of large-scale linear multiplicative programs

An efficient outcome-space branch-and-bound algorithm for solving a class of large-scale linear multiplicative programs

Nutritional Assessment Based on Mid-upper Arm Circumference Among Tribal Preschool Children of Three Distinct Ecological Zones of India

Undernutrition among infants and children retards the physical and cognitive growth and increases susceptibility to infections and diseases. Educational attainment and productivity of children get adversely affected by undernutrition, NFHS (2019–2020) and IIPS (2021) found the prevalence of undernutrition indicators to be high among the under-five children of the nation and tribal children to be in a more vulnerable condition. Mean mid-upper arm circumference (MUAC) is a quick, simple and precise screening tool to use in large-scale community-based nutritional programme. The present study aimed to assess the prevalence of undernutrition based on MUAC among three tribes of three distinct ecological zones of India, namely Bhil Tribe (Desert ecology), Dhodia tribe (Coastal ecology) and Kinnaura tribe (Himalayan ecology). The present cross-sectional study consists of 985 tribal children (509 boys and 476 girls) belonging to the age group 0–1 through 5+ years (below six years). Z-score was computed using WHO (2006) recommended age and sex-specific cutoff points for MUAC and the prevalence of undernutrition was assessed for children of below five years of age. MUAC has been found to have significant age difference among all communities ( p &lt; .001). Prevalence of undernutrition was found to be the highest among the Bhil tribe, the one residing in the desert ecology (41.03%) followed by Dhodia (18.06%) and Kinnaura tribe (12.16%). Among Bhil and Kinnaura children, prevalence of undernutrition was higher among the girls, while the Kinnaura boys manifested higher prevalence of undernutrition in comparison to their counterpart. Significant ( p &lt; .01) sex difference in undernutrition prevalence was found only in case of Bhil tribe (boys: 33.33%, girls: 48.02%). The prevalence of undernutrition significantly differs among the tribes of three distinct ecological zones ( p &lt; .001). The nutritional status of the tribal children, particularly that of the Bhil children, was unsatisfactory. To improve the nutritional wellbeing of the tribal population of the nation, studies at regular intervals focusing on the causes responsible for nutritional status are needed.

Exploring teacher characteristics and participation in TPACK-related online teacher professional development in Assam, India

Recent years have seen a significant increase in professional development opportunities to support teachers in enhancing their digital skills in India. However, to date, there is little evidence that teachers are confidently harnessing digital technologies within their classrooms. We suggest that this may be explained by insufficient attention on how teachers’ participation in TPACK-focused teacher professional development (TPD) programmes is mediated by their values, prior experiences and positioning within society. To explore this, we examined government upper primary and secondary school teachers’ experiences of participating in a course entitled ‘Constructivist teaching and learning with technology within the TPACK framework’ (CTLT), which was offered to over 500 teachers in 23 districts in the Indian state of Assam. Based on the survey responses of 209 (pre-course) and 109 (post-course) teachers, the findings of the study indicated that, contrary to expectations and much current scholarship, the female teachers significantly outperformed the male teachers in terms of course completion. However, the teachers who undertook the survey in English performed better than those who did so in Assamese. This paper explores possible reasons for these outcomes while recommending the need to take teacher characteristics into account when designing and implementing inclusive large-scale TPD programmes for TPACK.

Developing a large-scale quality improvement program for thyroid cancer surgery.

Surgical quality improvement (QI) plays a critical role in optimizing patient outcomes and reducing healthcare costs. QI programs focusing specifically on thyroid cancer surgical care are lacking. This study aimed to (a) select and introduce surgical quality indicators for thyroid cancer and (b) identify areas for QI at the state-level. A multidisciplinary team of thyroid cancer and QI experts selected 10 thyroid cancer-specific quality indicators and assessed the quality of thyroid cancer surgical care compared to current national guidelines. Analysis of the first year (January-December 2023) of data collection was performed using descriptive statistics. The thyroid cancer quality indicators included preoperative cytology, postoperative pathology, staging, cancer size, margin status, extrathyroidal extension, lymph nodes, postoperative complications within 30days, documented follow-up treatment, and documented surveillance plans. 112 surgeons performed 360 thyroidectomies for thyroid cancer at 51 hospitals. Preoperative cytology was not performed in 34.3% (n=103) of cases with thyroid cancer on final pathology. When the extent of surgery was evaluated by papillary cancer size, 50.0% (n=38) of patients with <1cm cancers underwent total thyroidectomy, and 13.8% (n=4) with >4cm underwent thyroid lobectomy. Positive margins were found in 16.2% (n=53). Postoperatively, 19.2% (n=69) of patients lacked documented follow-up, and 18.6% (n=67) lacked thyroid cancer surveillance plans. Establishing a dedicated QI program for thyroid cancer provides a previously unharnessed opportunity to enhance the quality of thyroid cancer surgical care. Statewide surgical quality collaboratives offer a model for establishing thyroid cancer QI initiatives across diverse healthcare settings in other states and countries.

Examining ingested microplastics in fish: Considerations on filter pore size, analysis time, and material costs to design cost-effective projects

In recent years the microplastics research community has called for methods harmonization and standardized metrics of reporting microplastic attributes. While alignment of research practices is essential in obtaining robust microplastic data, resource managers need to balance how the cost and effort of methodologies compare to data output. The intention of this study is to compare two recommended methods for isolating anthropogenic microparticles in fish gastrointestinal tracts. Using Icelandic capelin (Mallotus villosus) as a study species, with potassium hydroxide (KOH) digestion, we compared a 1.2 μm filtration and 45 μm sieving protocols for isolating ingested anthropogenic microparticles. We compared methods based on the amount of time they took to conduct, the cost of the materials and equipment required, levels of procedural contamination, and data output. We found no significant differences in the materials costs or procedural contamination between the two methods. However, the two protocols resulted in anthropogenic microparticles with significantly different characteristics (i.e. colour, length, morphology), and the 45 μm sieving protocol took longer to conduct per sample. Our results contribute towards a more holistic understanding of microplastic research methods, their relative costs, and how they contribute to data outputs and development of large-scale monitoring programs.

Geographical variation, socioeconomic inequalities of low birth weight, and its relationship with maternal dietary diversity: Insights from the maternal infant and young child nutrition programme in Bangladesh.

Globally, every year, 20 million neonates are born with weights below 2500 g and are considered low birth weight (LBW). About 90% of these births occur in low- and middle-income countries. Information regarding the geographical variation, socioeconomic inequalities of LBW neonates, and the relationship between maternal inadequate dietary diversity and LBW is limited in rural areas of Bangladesh. We aimed to explore the geographical disparities and socioeconomic inequalities in the prevalence of LBW and its association with inadequate maternal dietary diversity. We extracted data from a large-scale evaluation programme conducted as a part of the maternal infant and young child nutrition phase two in Bangladesh, implemented by BRAC. We used the concentration index (CIX) to measure the socioeconomic inequalities of LBW. We performed a cluster-adjusted multiple logistic regression analysis to determine the association between LBW and maternal dietary diversity. A total of 4651 children aged <5 years with their mother's information were included. The overall prevalence of LBW was 13.5%. About 16% of mothers living in the poorest wealth quintile gave birth to LBW babies, whereas 10% of mothers living in the richest households gave birth to LBW babies. The CIX exhibited LBW babies were more prevalent among the socioeconomically worst-off (poorest) group (CIX = -0.08), indicating mothers of the poorest households are vulnerable to giving birth to normal-weight babies. An adjusted multiple logistic regression model indicated that mothers with inadequate dietary diversity had higher odds (adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI) = 1.04, 1.54) of giving birth to LBW babies. Notably, in the interaction of mothers' age and dietary diversity, we found that adolescent mothers (aged ≤ 19 years) with inadequate dietary diversity had 2.56 times (AOR = 2.56; 95% CI = 1.14, 5.76) higher odds of giving birth to LBW babies compared to adult mothers (aged >19 years) who consumed diversified foods. Intervention strategies for reducing LBW prevalence should target the poorest households. Also, interventions for improving the dietary diversity of adolescent pregnant mothers are expected to reduce the number of LBW babies from the rural areas of Bangladesh.

Unravelling the “Ethos of Change” in African Urban Margins: Institutions, Stigmas, Experiences

Abstract How are desirable futures conceived in the African urban margins? What trajectories do individuals use to get there? And who decides what constitutes a desirable future? This special issue proposes the “ethos of change” as an analytical concept to better understand how urban margins in Africa shape specific lives and, in particular, aspirations for change. “Ethos of change” is a broad set of embodied norms, (self) narratives, and routine practices driving the trajectory of personal change to escape an initial self and environment that are both internalised as unsatisfactory and dishonourable. Based on case studies from Kenya, Cameroon, and Burkina Faso, analyses in this special issue focus on how individuals construct their experiences of violence, (de)radicalisation, displacement, and the intervention of large-scale state programmes. This introductory article offers an institutional framework for comprehending the other articles that constitute the special issue and summarises their contents. Additionally, it assesses how the special issue’s contribution advances our understanding of how to reconsider Africa’s urban margins as spaces for the production of difference, where individuals appropriate the idea of change with its modalities amidst multiple facets of stigma and symbolic violence in African urban margins.

A Nationwide Physical Activity Intervention for 654,500 Adults in Singapore: Cost-Utility Analysis.

Increasing physical inactivity is a primary risk factor for diabetes and hypertension, contributing to rising health care expenditure and productivity losses. As Singapore's aging population grows, there is an increased disease burden on Singapore's health systems. Large-scale physical activity interventions could potentially reduce the disease burden but face challenges with the uncertainty of long-term health impact and high implementation costs, hindering their adoption. We examined the cost-effectiveness of the Singapore National Steps Challenge (NSC), an annual nationwide mobile health (mHealth) intervention to increase physical activity, from both the health care provider perspective, which only considers the direct costs, and the societal perspective, which considers both the direct and indirect costs. We used a Markov model to assess the long-term impact of increased physical activity from the NSC on adults aged 17 years and older. A Monte Carlo simulation with 1000 samples was conducted to compare two situations: the NSC conducted yearly for 10 years against a no-intervention situation with no NSC. The model projected inpatient and outpatient costs and mortality arising from diabetes and hypertension, as well as their complications. Health outcomes were expressed in terms of the quality-adjusted life-years (QALYs) gained. All future costs and QALYs were discounted at 3% per annum. Sensitivity analyses were done to test the robustness of our model results. We estimated that conducting the NSC yearly for 10 years with a mean cohort size of 654,500 participants was projected to prevent 6200 diabetes cases (95% credible interval 3700 to 9100), 10,500 hypertension cases (95% credible interval 6550 to 15,200), and 4930 deaths (95% credible interval 3260 to 6930). This led to a reduction in health care costs of SGD (Singapore dollar) 448 million (95% credible interval SGD 132 million to SGD 1.09 billion; SGD 1=US $0.73 for the year 2019). There would be 78,800 (95% credible interval 55,700 to 102,000) QALYs gained. Using a willingness-to-pay threshold of SGD 10,000 per QALY gained, the NSC would be cost-saving. When indirect costs were included, the NSC was estimated to reduce societal costs by SGD 1.41 billion (95% credible interval SGD 353 million to SGD 3.80 billion). The model was most sensitive to changes in the inpatient cost of treatment for diabetes complications, time horizon, and program compliance. In this modeling study, increasing physical activity by conducting a yearly nationwide physical activity intervention was cost-saving, preventing diabetes and hypertension and reducing mortality from these diseases. Our results provide important information for decision-making in countries that may consider introducing similar large-scale physical activity programs.