Review Of National Policies Research Articles

Alcohol, youth and sport: recommendation and good practice examples from the FYFA European project.

Focus on Youth Football and Alcohol (FYFA) is a European project (EC, 3rd Health Program, HP-PJ-2016) involving research institutions from Belgium, Finland, Italy, Poland, Slovenia and the UK. The Istituto Superiore di Sanità (ISS), was the project leader of Work Package 5: "Review of national policies and practice in six Member States related to alcohol, young people, sport, marketing and football." The aim of WP5 was to determine the status quo of the policies and practices to reduce heavy episodic drinking related to young people, alcohol and sport at national level. This work investigates knowledge, attitudes and perceptions of experts from sport settings and from the prevention area giving insights on the perceived obstacles and facilitators, whenever available, to promote strategies to reduce alcohol related harm in youth within sport contexts. The presented work describes laws, regulations and attitudes. Furthermore, the results help identifying areas requiring development, highlighting examples of good practices. It emerges that prevention of alcohol-related harm to youth is important within sport settings and should be a priority for all FYFA countries. Despite the presence of regulations, there is a low level of knowledge and enforcement at national level and in the sport contexts; and there is the need of cooperation across organizations to implement alcohol policies for youth within sport settings. More efforts and resources are needed to overcome the main obstacles for effective implementation of alcohol policies, such as regulations on advertising and sponsorship, and alcohol selling, serving and consumption for young players. It is necessary to implement information strategies, prevention initiatives, training programs and to support the dialogue between sporting and prevention settings.

Trends and determinants of newborn mortality in Kyrgyzstan: a Countdown country case study

SummaryBackgroundKyrgyzstan has made considerable progress in reducing child mortality compared with other countries in the region, despite a comparatively low economic standing. However, maternal mortality is still high. Given the availability of an established birth registration system, we aimed to comprehensively assess the trends and determinants of reproductive, maternal, newborn, and child health in Kyrgyzstan.MethodsFor this Countdown to 2030 country case study, we used publicly available data repositories and the national birth registry of Kyrgyzstan to examine trends and inequalities of reproductive, maternal, and newborn health and mortality between 1990 and 2018, at a national and subnational level. Coverage of newborn and maternal health interventions was assessed and disaggregated by equity dimensions. We did Oaxaca-Blinder decomposition to determine the contextual factors associated with the observed decline in newborn mortality rates. We also undertook a comprehensive review of national policies and programmes, as well as a prospective Lives Saved Tool analysis, to highlight interventions that have the potential to avert the most maternal, neonatal, and child deaths.FindingsOver the past two decades, Kyrgyzstan reduced newborn mortality rates by 46% and mortality rates of children younger than 5 years by 69%, whereas maternal mortality rates were reduced by 7% and stillbirth rates by 29%. The leading causes of neonatal deaths were prematurity and asphyxia or hypoxia, and preterm small-for-gestational-age infants were more than 80 times more likely to die in their first month of life compared with those born appropriate-for-gestational age at term. Except for contraceptive use, coverage of essential interventions has increased and is generally high, with limited sociodemographic inequities. With scale-up of a few essential neonatal and maternal interventions, 39% of neonatal deaths, 11% of stillbirths, and 19% of maternal deaths could be prevented by 2030.InterpretationKyrgyzstan has reduced newborn mortality rates considerably, with the potential for further reduction. To achieve and exceed the Sustainable Development Goal 3 targets for newborn survival and reducing stillbirths, Kyrgyzstan needs to scale up packages of interventions for the care of small and sick babies, assure quality of care in all health-care facilities with regionalised perinatal care, and create a linked national registry for mothers and neonates with rapid feedback and accountability.FundingUS Fund for UNICEF under the Countdown to 2015, UNICEF Kyrgyzstan Office.

The Role of Nurses and Midwives in Expanding and Sustaining Voluntary Medical Male Circumcision Services for HIV Prevention: A Systematic and Policy Review.

Male circumcision reduces men's risk of acquiring HIV through heterosexual sex, and voluntary medical male circumcision (VMMC) is central to HIV prevention strategies in 15 sub-Saharan African countries. Nurses have emerged as primary VMMC providers; however, barriers remain to institutionalizing nurse-led VMMC. Patient safety concerns have hindered task sharing, and regulations governing nurse-performed VMMC are not always supportive or clear. We performed a systematic review on VMMC safety by provider cadre and a desk review of national policies governing the VMMC roles of nurses and midwives. Also, VMMC by nurses is safe and has become standard practice. Countries had multiple policy combinations among different documents, with only one disallowing VMMC by these cadres. Countries with alignment between policies often ensured that nursing workforces were equipped with clinical competencies through national certification. Regulatory clarity and formalized certification for nurse-performed VMMC can increase program sustainability and build nursing capacity to meet other critical basic surgical needs.

Prevention of Adolescent Pregnancy in Anglophone Sub-Saharan Africa: A Scoping Review of National Policies.

Background: Despite the existence of preventive policies across sub-Saharan Africa, countries within the sub-region lead global rankings for rates of adolescent pregnancy. The aim of this scoping review was to identify and review national policies on the prevention of adolescent pregnancy in Anglophone sub-Saharan Africa. Methods: Relevant policies were identified from searches of national government websites and the search engine Google. Recognised screening and data extraction processes were used; data were subjected to content analysis using a published Framework for Evaluating Program and Policy Design on Adolescent Reproductive Health. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews guidelines was used in reporting the review.Results:In line with the inclusion criteria that guided the selection of relevant policies in this study, 17 of 75 national policies were suitable for the analysis. All were backed by political recognition, were government and public initiatives, acknowledged a range of determinants of adolescent pregnancy and allocated human resources to policy activities. Few specified financial resourcing. Most policies acknowledged the importance of coordination and collaboration among public and private actors. All policies had objectives that addressed adolescent pregnancy but none were measurable or included timeframes. Provision of comprehensive sexuality education and adolescent reproductive health services were the most common recommendations. Monitoring and evaluation plans were present in all the policies. However, youth involvement in policy formulation, and plans for implementation, monitoring and evaluation was scarce. Conclusion: Overall, national policy strengths were seen in relation to their political recognition, and all aspects of policy formulation. Policy implementation strengths and weaknesses were identified, the latter in relation to clear descriptions of financial resources. Importantly, the absence of measurable and time-bound objectives or formal evaluation of policy effectiveness confounds demonstration of what has been delivered and achieved. Youth involvement was notably absent in many policies. For future policy-setting, governments and policy-makers should make efforts to engage young people in policy development and to be transparent, realistic and address the necessary financial resourcing. They should set quantifiable policy objectives that provide a basis for assessing the adoption, uptake and effectiveness of policies in relation to measurable objectives.

Prevention of birth defects in East Africa: A review of national policies

Close to 8 million children are born annually with a serious birth defect, accounting for 5% of all newborn deaths globally. Many birth defects are associated with folic acid insufficiency, non-communicable diseases (NCDs), teenage or advanced age pregnancies, short birth intervals, and exposure to harmful substances. The majority of countries with the highest birth defects prevalence are in Africa, and the East African Community has made important commitments to improving reproductive, child, and adolescent health and nutrition. The aim of this review was to identify the advances and gaps in national policies addressing birth defect risk factors in the East African Community (Burundi, Kenya, Rwanda, Tanzania, and Uganda) in order to inform additional actions. National laws, regulations and policies were reviewed from the East African Community countries related to grain fortification and supplementation with folic acid; reducing too-early, unwanted and rapid successive pregnancies; and addressing NCDs and exposure to tobacco. All five countries have adopted a policy of mandatory folic acid fortification of wheat and maize flour. However, only in Kenya and Tanzania, are the folic acid levels in line with international recommendations. And, only Uganda has a policy requiring folic acid supplementation administration in the preconceptional period. The East African Community countries have made efforts to reduce too-early, unwanted and rapid successive pregnancies. All countries have banned child marriage and three of five countries have introduced laws to allow unrestricted access to contraception for adolescents. With regards to promoting prevention and control of NCDs and reducing populations’ exposure, compliance with World Health Organization (WHO) guidelines is limited. Only two countries have developed multi-sectoral policies for NCDs and no countries comply fully with the recommendations of the Framework Convention on Tobacco Control. Much work remains in ensuring that opportunities for prevention of birth defects are fully realized in the East African Community countries. This review revealed that all countries in the East African Community have, to some extent, adopted policies that are conducive to reducing the risk of birth defects in the region, but significant gaps remain in some key areas of either policy development or implementation. Key words: Congenital abnormalities, Folic acid, Family planning services, Child marriage, Non-communicable Diseases

Trends and Determinants of Newborn Mortality in the Kyrgyz Republic: A Countdown Country Case Study

Background: The Kyrgyz Republic has made great progress in reducing neonatal mortality rate (NMR), compared to the region, despite its regional comparatively low GDP per capita. Given the availability of an established civil registration and vital statistics system, the country is uniquely positioned to undertake a comprehensive assessment of trends and determinants of newborn mortality. Methods: We used publicly available data repositories and the national birth registry data to examine trends and inequalities of reproductive, maternal and newborn health and mortality between 1990 and 2018 at a national and subnational level. Coverage of newborn and maternal health interventions were assessed and disaggregating by equity dimensions. Oaxaca-Blinder decomposition was done to determine the contextual factors associated with the observed decline in NMR. We undertook a comprehensive review of national policies and programs, as well as a prospective Lives Saved Tool (LiST) analysis to highlight interventions that will save the most lives. Findings: In the past two decades, with the help of investments and appropriate policies, the Kyrgyz Republic has reduced NMR by 54%, with the leading causes of death attributable to prematurity and asphyxia. Neonates born pre-term small-for-gestational age are over 80 times more likely to die in their first month of life, compared to those born full term, appropriate-for-gestational age. With the exception of contraceptive use, coverage of essential interventions is increasing and exceptionally high with limited sociodemographic inequities. By 2030, improved case management of premature babies will save the most neonatal lives. Interpretation: The Kyrgyz Republic has reduced NMR considerably, with the potential for further reduction given its remarkably high coverage and low inequities of preventative maternal and newborn health interventions. A particular focus is needed on scaling-up packages of interventions to care for small and sick babies, assuring quality of care in all healthcare facilities, and creating a linked national registry system for mothers and newborns. Funding Statement: US Fund for UNICEF under the Countdown to 2015 and UNICEF Kyrgyzstan Declaration of Interests: All authors declare no competing interests.

Facilitating the Participation of Children with Disabilities in Early Childhood Development Centres in Malawi: Developing a Sustainable Staff Training Programme

This article explores the development of a sustainable training programme supporting the inclusion of children with disabilities in early childhood, education and care (ECEC) centres in Malawi. This programme is based on a review of literature of curriculum, pedagogy and teaching approaches in ECEC in sub-Saharan Africa, alongside a review of national policy documents. The training was designed to enable staff to value the inclusion of children with disabilities in ECEC centres, as well as suggesting practical ways to do so. We set out our response to the gap in training of ECEC staff through the development of a supplementary integrated training programme, which, whilst respectful of the curriculum, policy and practice of Malawi, challenged staff to consider ways of including children with disabilities (CWD) and their families. We suggest this is a pragmatic and sustainable model that could be applied to training in other ECEC settings across the region in sub-Saharan Africa. It concludes with guiding principles for training those working in ECEC with young children with disabilities in low-income countries.

The crowded space of local accountability for maternal, newborn and child health: a case study of the South African health system.

Global and national accountability for maternal, newborn and child health (MNCH) is increasingly invoked as central to addressing preventable mortality and morbidity. Strategies of accountability for MNCH include policy and budget tracking, maternal and perinatal death surveillance, performance targets and various forms of social accountability. However, little is known about how the growing number of accountability strategies for MNCH is received by frontline actors, and how they are integrated into the overall functioning of local health systems. We conducted a case study of mechanisms of local accountability for MNCH in South Africa, involving a document review of national policies, programme reports, and other literature directly or indirectly related to MNCH, and in-depth research in one district. The latter included observations of accountability practices (e.g. through routine meetings) and in-depth interviews with 37 purposely selected health managers and frontline health workers involved in MNCH. Data collection and analysis were guided by a framework that defined accountability as answerability and action (both individual and collective), addressing performance, financial and public accountability, and involving both formal and informal processes. Nineteen individual accountability mechanisms were identified, 10 directly and 9 indirectly related to MNCH, most of which addressed performance accountability. Frontline managers and providers at local level are targeted by a web of multiple, formal accountability mechanisms, which are sometimes synergistic but often duplicative, together giving rise to local contexts of ‘accountability overloads’. These result in a tendency towards bureaucratic compliance, demotivation, reduced efficiency and effectiveness, and limited space for innovation. The functioning of formal accountability mechanisms is shaped by local cultures and relationships, creating an accountability ecosystem involving multiple actors and roles. There is a need to streamline formal accountability mechanisms and consider the kinds of actions that build positive cultures of local accountability.

Realising the Rights of Persons with Disability in Nepal: Policy Addresses From the Health, Education and Livelihoods Perspectives

Review of national policies and legislative measures made for the protection, prevention, promotion and rehabilitation rights of persons with disabilities in Nepal to most part adhered to international measures developed in the field. Protection and welfare act of persons with disabilities was introduced in 1982-83 in the country. The Constitution of Nepal-2015 gave ample space to the concerns of persons with disability; accordingly government prepared National Act related to the rights of the persons with Disability-2017. The Act explicitly outlined objectives, policy measures and action plans to establish the health rights, education rights and right to livelihood, skill development and employment of the persons with disabilities. Health rights include preventive, promotive, curative and rehabilitative issues along with right to sexual and reproductive health rights, management of pelvic organ prolepses and reproductive impairments of women and girls with disabilities. Still problem lies in collection and compilation of health information by disability status of persons. The National Childhood Disability Management Strategy (CDMS) – 2008 offered policy measures for the detection, management and prevention of further impairments of childhood disabilities reaching at the door-steps where it occurs. Government introduced inclusive education policy and policies of disability friendly livelihood/skill development and employment policies. However, implementation of the policy measures still in problem due to clarity lacks in policies regarding roles and responsibilities by levels of governments from local to federal governments.

Intersectoral coordination and diabetes prevention: building capacity through professional agency

Abstract Background Intersectoral coordination of disease prevention is highly complex. The case of women who develop diabetes during pregnancy (GDM) is a case in point: intersectoral coordination mainly concerns diabetes prevention and thus stretches over the life course of women and their families. Our study aims to analyse how health professions through their day-to-day practice contribute to the creation, maintenance and transformation of intersectoral coordination of diabetes prevention over the life course; and how contexts at systems/organisational influences such processes. Methods The study draws on organisational studies of professions and focuses on the mechanisms underlying the making of intersectoral coordination. As part of a pilot study, we conducted a review of the international literature on intersectoral coordination of public health, a review of national policy documents, and a secondary analysis of interviews conducted as part of the development of the Face-it intervention. Results The organisation of GDM diabetes prevention in Denmark emerges as fragmented. Care pathways are divided between different phases, types of services, sectors and health professions. There are additional variations among municipalities. Formal (intersectoral) coordination is also limited to vulnerable women and their families. GDM diabetes prevention involves a broad range of professions; professional agency in GDM diabetes prevention is dispersed. Clinical specialists in hospitals show the strongest interest, rooted in healthcare knowledge on prevention. General practitioners have a similar knowledge base, but consider prevention less central. The same applies to health visitors and midwives, whose knowledge base also includes social care. Conclusions Individual professions have a strong capacity for intersectoral agency. Strengthening this capacity requires alignment across professions and adaptation to specific contexts.

Developing Trade

Executive SummaryThe UK faces no easy options in determining how to develop its approach to international trade post-Brexit. If it finally decides to leave the European Customs Union and Single Market, it faces the possibility either of simply crashing out of the EU without a deal; trying to form market-access agreements and Free Trade Areas (FTAs) with the EU and other countries; or unilaterally reducing tariffs and liberalising trade with all countries. Each course raises significant practical difficulties, and entails major disadvantages compared with staying in the Customs Union and Single Market.The economic costs of a ‘no-deal’ approach stand to be very large, including inevitable tariffs, obstruction of UK access to EU markets, physical disruption at borders, a damping of investment and the much-discussed problem of the Irish border. Assuming ‘no-deal’ does not happen, negotiating FTAs with other countries would be possible only after a lengthy transition period, as in the Withdrawal Agreement voted down in Parliament, and would depend on the shape of the ultimate post-Brexit trading relationship between the EU and the UK. The process would be difficult, costly, and protracted; would likely be concluded on disadvantageous terms; would be even harder to apply to trade in services; and would yield extremely small gains given the volume of UK non-EU trade that is already covered by FTAs. Finally, unilateral liberalisation, while ameliorating some of the drawbacks of the first two options, faces the same problems of loss of access to European markets and disruption to trade; and would entail severe economic pain with only very gradual gains.The UK needs to conduct a much more profound and considered debate on these issues before deciding to set aside the large benefits of membership of the Customs Union and Single Market for the significant difficulties and tenuous gains offered by the alternatives. Public debate on the economic effects of trade policy has so far lacked the detailed but necessary analysis of these questions. It seems essential to establish a national policy review institution, modelled on the Australian Productivity Commission, in order to stimulate such a debate.

Dementia care: international perspectives.

As awareness of dementia increases, internationally derived knowledge and information about dementia care and practice can be helpful to improve the care of people with dementia and their families. It can serve as a stimulus to develop new ideas for the provision of such care. An international survey of 47 countries has shown a high degree of national interest and commitment to dementia treatment and care. In each, a local dementia expert provided a bespoke narrative about the care and treatment of people with dementia, a review of national policies and a glimpse as to what the future holds. The detailed results have been published in book form and are summarized here. The majority of countries have made national attempts to estimate the number of people with dementia, have licenced antidementia drugs and have the support of a national Alzheimer's association with a website containing independent advice. More than half have a national plan targeted at the development of care and in a further quarter, the development of such plans is in progress. There appears to have been a great increase in interest and awareness of dementia in the last few years.

Getting youth PrEPared: adolescent consent laws and implications for the availability of PrEP among youth in countries outside of the United States.

IntroductionYouth under the age of 25 are at high risk for HIV infection. While pre‐exposure prophylaxis (PrEP) has the potential to curb new infections within this population, it is unclear how country‐specific laws and policies that govern youth access to sexual and reproductive health (SRH) services impact access to PrEP. The purpose of this review was to analyse laws and policies concerning PrEP implementation and SRH services available to youth in countries with a high HIV incidence. To the best of our knowledge this is the first systematic assessment of country‐level policies that impact the availability of PrEP to adolescent populations.MethodsWe conducted a review of national policies published on or before 12 June 2018 that could impact adolescents’ access to PrEP, SRH services and ability to consent to medical intervention. Countries were included if: (1) there was a high incidence of HIV; (2) they had active PrEP trials or PrEP was available for distribution; (3) information regarding PrEP guidelines were publicly available. We also included a selected number of countries with lower adolescent HIV incidence. Internet and legal database searches were used to identify policies relevant to adolescent PrEP (e.g. age of consent to HIV testing).Results and DiscussionFifteen countries were selected for inclusion in this review. Countries varied considerably in their respective laws and policies governing adolescents’ access to PrEP, HIV testing and SRH services. Six countries had specific polices around the provision of PrEP to youth under the age of 18. Five countries required people to be 18 years or older to access HIV testing, and six countries had specific laws addressing adolescent consent for‐ and access to‐ contraceptives.ConclusionsAdolescents’ access to PrEP without parental consent remains limited or uncertain in many countries where this biomedical intervention is needed. Observational and qualitative studies are needed to determine if and how adolescent consent laws are followed in relation to adolescent PrEP provisions. Intensified efforts to amend laws that limit adolescent access to PrEP and restrict the establishment of national guidelines supporting adolescent PrEP are also needed to address the epidemic in this group.

National guidance and district-level practices in the supervision of community health workers in South Africa: a qualitative study

BackgroundSupportive supervision is considered critical to community health worker programme performance, but there is relatively little understanding of how it can be sustainably done at scale. Supportive supervision is a holistic concept that encompasses three key functions: management (ensuring performance), education (promoting development) and support (responding to needs and problems). Drawing on the experiences of the ward-based outreach team (WBOT) strategy, South Africa’s national community health worker (CHW) programme, this paper explores and describes approaches to supportive supervision in policy and programme guidelines and how these are implemented in supervision practices in the North West Province, an early adopter of the WBOT strategy. Outreach teams typically consist of six CHWs plus a nurse outreach team leader (OTL).MethodsA qualitative, descriptive study that combined a document review of national policy and guidelines with key informant interviews in two districts of the North West Province was conducted. An overall WBOT policy statement and four guidelines on aspects of the strategy, spanning the period 2011–2017, were reviewed for statements on the three core facets of supervision outlined above. Eight focus group discussions, involving facility managers, team leaders and community health workers (total 40 respondents), purposively selected from four sub-districts in two districts, assessed local-level supervision practices. Alignment across policy and guidance documents and between policy/guidance and practice was examined.FindingsWhile all the official policy documents and guidelines reviewed acknowledged the need for supervision and support, these elements were inadequately developed and poorly aligned, both in terms of scope and in providing firm guidance on the supervision of WBOTs. The practices of supervision entailed a variety of reporting lines, while development and support processes were informal and often lacking, and teams poorly resourced. There was internal cohesion and support within teams amongst CHWs and between CHWs and OTLs. However, primary health care clinic managers, who were supposed to supervise the WBOTs, struggled to fulfil this role amidst the high workloads in facilities, and relationships between WBOTs and facility staff often remained strained.ConclusionThis study identified weaknesses in both the design and implementation of the supervision system of WBOTs. The lack of explicit, coherent and holistic guidance in policy and the failure to address constraints to supervision at local level undermine the performance and sustainability of the WBOT strategy in South Africa.

Assessing the status of lifelong learning: Issues with composite indexes and surveys on participation

A quick review of national policy documents reveals how lifelong learning has evolved as the key principle for a comprehensive education and learning strategy from cradle to grave. This raises major challenges for how to assess and report the state of lifelong learning in UNESCO Member States. It is in this context that this article critically evaluates the efforts to develop a composite index on lifelong learning. In addition, the author reviews the two leading surveys on adult education and learning, the OECD’s Programme for the International Assessment of Adult Competencies (PIAAC) and the European Union’s Adult Education Survey (AES). He examines their potential to provide a national picture of the state of lifelong learning, pointing out some fundamental shortcomings in these surveys and in the way their data have been classified. The present approach to data gathering on adult and lifelong learning, with its deep roots in the skills agenda, creates a “reality” of adult learning where the broad humanistic traditions of adult education become invisible. Analyses of the European and Canadian composite indexes of lifelong learning reveal serious problems using this approach. Not only must one question the underlying framework based on Jacques Delors’ four pillars of learning, but also its practical use for directly assessing the impact of the various aspects of lifelong learning and education. A core argument in this article is that there is a need to broaden not only the indicators used to assess the state of lifelong learning, but also the approach to how outcomes are being understood and judged.

\u201cIf I had known, I would have applied\u201d: poor communication, job dissatisfaction, and attrition of rural health workers in Sierra Leone

BackgroundSierra Leone’s health outcomes rank among the worst in the world. A major challenge is the shortage of primary healthcare workers (HCWs) in rural areas due to especially high rates of attrition. This study was undertaken to determine the drivers of job dissatisfaction and poor retention among Sierra Leone’s rural HCWs.MethodsInterviews were conducted with 58 rural and 32 urban primary HCWs in Sierra Leone’s public health sector, complemented by key informant discussions and review of national policy documents. HCW interviews included (1) semi-structured discussion, (2) questionnaire, (3) card sort about HCW priorities, and (4) free-listing of most pressing challenges and needs. Sampling for HCW interviews was stratified purposive, emphasizing rural HCWs.ResultsAmong 90 HCWs interviewed, 67% were dissatisfied with their jobs (71% rural vs 52% urban) and 61% intended to leave their post (75% rural vs 38% urban). While working and living conditions and remuneration were significant factors, a major reason for rural HCW disenchantment was their inability to access worker rights, benefits, and advancement opportunities. This was caused by HCWs’ lack of knowledge about human resource (HR) policies and procedures, as well as ambiguity in many policies and inequitable implementation. HCWs reported feeling neglected and marginalized and perceived a lack of transparency. These issues can be attributed to the absence of systems for regular two-way communication between the Ministry of Health and HCWs; lack of official national documents with up-to-date, clear HR policies and procedures for HCWs; pay statements that do not provide a breakdown of financial allowances and withholdings; and lack of HCW induction.ConclusionsHCWs in Sierra Leone lacked accurate information about entitlements, policies, and procedures, and this was a driver of rural HCW job dissatisfaction and attrition. System-oriented, low-cost initiatives can address these underlying structural causes in Sierra Leone. These issues likely apply to other countries facing HCW retention challenges and should be considered in development of global HCW retention strategies.

Association between use of systematic reviews and national policy recommendations on screening newborn babies for rare diseases: systematic review and meta-analysis

ObjectiveTo understand whether international differences in recommendations of whether to screen for rare diseases using the newborn blood spot test might in part be explained by use of systematic review...

The impact of national policies on animal disease reporting within selected Pacific Island Countries and Territories (PICTs).

A semi-systematic literature review of national policies was carried out in relation to surveillance and disease reporting in Pacific Island Countries and Territories (PICTs). It also analysed the animal disease reporting structures in Fiji, Papua New Guinea (PNG), Vanuatu and the Solomon Islands. The strengths, weaknesses, opportunities and threats (SWOT) of those reporting structures were examined in relation to how they impacted the detection and management of animal diseases in PICTs. Field missions collected information on animal disease reporting structures and these were discussed in detail with country officials and documented. The findings from the literature review indicated that there is very little policy to support work in surveillance and disease reporting within national government structures of the countries studied. This increases the potential for disease transmission and the introduction of exotic diseases as the efficiency of disease reporting is low. The findings from the SWOT analysis of the reporting structures indicated that there were commonalities across the countries studied, i.e. reporting structures were long with multiple legs that were not functioning properly and this was worsened when positions were vacant in the reporting structure. The hierarchical nature of the reporting structure also reduced reporting efficiency as reports took a longer time to reach decision makers at the top of the structure. High officer turnover and the shortage of veterinarians in the countries studied also affected the efficiency of disease reporting as most in-county officials were inexperienced and could not recognise disease signs and there were no veterinarians to supervise them. Existing reporting structures need to be reviewed to remove duplication and shorten the chain. However, this could override existing command structures and would need to be documented and awareness created with the officers involved. There also needs to be more collaboration with FAO, OIE, academic institutions and national governments to create an environment conducive for the development of policies that support work on surveillance to improve disease reporting in PICTs. The shortage of veterinarians could be addressed by influencing national governments to create better policies to retain veterinarians in the animal health services; this should be supported by creating reasonable work conditions and remuneration packages. This should also be supported with policies to send young graduates to study veterinary science overseas and have a career path for them when they return. Engagement of retired veterinarians from developed countries and re-evaluating the criteria for veterinarian registration could be short-term solutions to address the shortage of veterinarians in PICTs.

HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis

SummaryBackgroundPretreatment drug resistance in people initiating or re-initiating antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTIs) might compromise HIV control in low-income and middle-income countries (LMICs). We aimed to assess the scale of this problem and whether it is associated with the intiation or re-initiation of ART in people who have had previous exposure to antiretroviral drugs.MethodsThis study was a systematic review and meta-regression analysis. We assessed regional prevalence of pretreatment drug resistance and risk of pretreatment drug resistance in people initiating ART who reported previous ART exposure. We systematically screened publications and unpublished datasets for pretreatment drug-resistance data in individuals in LMICs initiating or re-initiating first-line ART from LMICs. We searched for studies in PubMed and Embase and conference abstracts and presentations from the Conference on Retroviruses and Opportunistic Infections, the International AIDS Society Conference, and the International Drug Resistance Workshop for the period Jan 1, 2001, to Dec 31, 2016. To assess the prevalence of drug resistance within a specified region at any specific timepoint, we extracted study level data and pooled prevalence estimates within the region using an empty logistic regression model with a random effect at the study level. We used random effects meta-regression to relate sampling year to prevalence of pretreatment drug resistance within geographical regions.FindingsWe identified 358 datasets that contributed data to our analyses, representing 56 044 adults in 63 countries. Prevalence estimates of pretreatment NNRTI resistance in 2016 were 11·0% (7·5–15·9) in southern Africa, 10·1% (5·1–19·4) in eastern Africa, 7·2% (2·9–16·5) in western and central Africa, and 9·4% (6·6–13·2) in Latin America and the Caribbean. There were substantial increases in pretreatment NNRTI resistance per year in all regions. The yearly increases in the odds of pretreatment drug resistance were 23% (95% CI 16–29) in southern Africa, 17% (5–30) in eastern Africa, 17% (6–29) in western and central Africa, 11% (5–18) in Latin America and the Caribbean, and 11% (2–20) in Asia. Estimated increases in the absolute prevalence of pretreatment drug resistance between 2015 and 2016 ranged from 0·3% in Asia to 1·8% in southern Africa.InterpretationPretreatment drug resistance is increasing at substantial rate in LMICs, especially in sub-Saharan Africa. In 2016, the prevalence of pretreatment NNRTI resistance was near WHO's 10% threshold for changing first-line ART in southern and eastern Africa and Latin America, underscoring the need for routine national HIV drug-resistance surveillance and review of national policies for first-line ART regimen composition.FundingBill & Melinda Gates Foundation and World Health Organization.

Time to overcome pretreatment HIV drug resistance

Time to overcome pretreatment HIV drug resistance