World Health Organization Framework Research Articles

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

BackgroundIn response to the harm caused by tobacco use worldwide, the World Health Organization (WHO) World Health Assembly actioned the WHO Framework Convention on Tobacco Control (FCTC) in 2005. To help countries meet their FCTC obligations, the WHO introduced in 2008 the MPOWER policy package and by 2020 the FCTC had been ratified by 182 parties. The package consists of six evidence-based demand reduction smoking cessation policies to assist countries to achieve best practice. We used published evaluation results and replicated the published model to estimate current policy achievement and demonstrate the impact and equity of the MPOWER policy package in reducing the global number of smokers and smoking-attributable deaths (SADs) between 2007 and 2020.MethodsWe replicated an evaluation model (the Abridged SimSmoke model) used previously for country impact assessments and validated our replicated reduction in SADs for policies between 2014 and 2016 against the published results. The replicated model was then applied to report on the country level SADs averted from achieving the highest level of implementation, that is best practice in MPOWER policies, between 2016 and 2020. The latest results were then combined with past published results to estimate the reduction in SADs since the commencement of the MPOWER policy package. Country level income status was used to investigate the equity in the uptake of MPOWER policies worldwide.ResultsIdentical estimates for SADs in 41 out of 56 MPOWER policies implemented in 43 countries suggested good agreement in the model replication. The replicated model overestimated the reduction in SADs by 159,800 (1.5%) out of a total of 10.5 million SADs with three countries contributing to the majority of this replication discrepancy. Updated analysis estimated a reduction of 8.57 million smokers and 3.37 million SADs between 2016 and 2020. Between 2007 and 2020, 136 countries had adopted and maintained at least one MPOWER policy at the highest level which was associated with a reduction in 81.0 million smokers and 28.3 million SADs. Seventy five percent of this reduction was in middle income countries, 20% in high income and less than 5% in low income countries.ConclusionsConsiderable progress has been made by MPOWER policies to reduce the prevalence of smokers globally. However, there is inequality in the implementation and maintenance, reach and influence, and the number of SADs averted. Future research to modify the model could provide a more comprehensive evaluation of past and future progress in tobacco control policies, worldwide.

Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective.

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.

Tobacco packaging and labeling policies in the WHO African Region: Progress 15 years after adoption of the WHO Framework Convention on Tobacco Control Article 11 Implementation Guidelines.

Article 11 of the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC) requires Parties to adopt and implement effective tobacco packaging and labeling policies to communicate health risks and reduce tobacco consumption. The goal of this study was to assess adoption of these policies in the WHO African Region (AFRO). We reviewed tobacco packaging and labeling policies adopted in AFRO from the Campaign for Tobacco-Free Kids' Tobacco Control Laws database (w w w.tobaccocontrollaws.org). We assessed these policies based on WHO FCTC Article 11 and its Implementation Guidelines examining three sub-policy areas (health warning labels [HWLs], descriptive constituents and emissions information, and misleading packaging and labeling). We developed a scoring system to rank AFRO countries individually and by World Bank's income-level groups and documented the progress during 1985-2023. Forty (of 47) AFRO countries adopted national laws, of which a majority adopted large rotating pictorial HWLs and banned misleading descriptors; only Cote d'Ivoire and Mauritius adopted standardized packaging. The higher a country is in the World Bank's income-level group, the stronger their packaging and labeling policies are. This observation was not present in the sub-policy area of HWLs. Prior to approving the WHO FCTC Article 11 Implementation Guidelines, only 23 countries adopted text-only HWLs whereas 26 countries adopted pictorial HWLs after the approval. Several AFRO countries have adopted tobacco packaging and labeling policies that align with the WHO FCTC Article 11 Implementation Guidelines. More efforts could be directed toward the low-income group and disseminating standardized packaging throughout AFRO. In the WHO African Region (AFRO), the number of tobacco users is increasing, highlighting the need for tobacco packaging and labeling policies aligned with WHO FCTC Article 11 and its Implementation Guidelines as these are proven tobacco control strategies. This study provides a country-level and income-level group ranking of tobacco packaging and labeling policies and documents the evolution of health warning labels adopted in AFRO. It also identifies regional and income-level group successes and gaps in tobacco product packaging and labeling policies and provides recommendations to further align with WHO FCTC Article 11 and its Implementation Guidelines.

Postpandemic Sentinel Surveillance of Respiratory Diseases in the Context of the World Health Organization Mosaic Framework: Protocol for a Development and Evaluation Study Involving the English Primary Care Network 2023-2024.

Prepandemic sentinel surveillance focused on improved management of winter pressures, with influenza-like illness (ILI) being the key clinical indicator. The World Health Organization (WHO) global standards for influenza surveillance include monitoring acute respiratory infection (ARI) and ILI. The WHO's mosaic framework recommends that the surveillance strategies of countries include the virological monitoring of respiratory viruses with pandemic potential such as influenza. The Oxford-Royal College of General Practitioner Research and Surveillance Centre (RSC) in collaboration with the UK Health Security Agency (UKHSA) has provided sentinel surveillance since 1967, including virology since 1993. We aim to describe the RSC's plans for sentinel surveillance in the 2023-2024 season and evaluate these plans against the WHO mosaic framework. Our approach, which includes patient and public involvement, contributes to surveillance objectives across all 3 domains of the mosaic framework. We will generate an ARI phenotype to enable reporting of this indicator in addition to ILI. These data will support UKHSA's sentinel surveillance, including vaccine effectiveness and burden of disease studies. The panel of virology tests analyzed in UKHSA's reference laboratory will remain unchanged, with additional plans for point-of-care testing, pneumococcus testing, and asymptomatic screening. Our sampling framework for serological surveillance will provide greater representativeness and more samples from younger people. We will create a biomedical resource that enables linkage between clinical data held in the RSC and virology data, including sequencing data, held by the UKHSA. We describe the governance framework for the RSC. We are co-designing our communication about data sharing and sampling, contextualized by the mosaic framework, with national and general practice patient and public involvement groups. We present our ARI digital phenotype and the key data RSC network members are requested to include in computerized medical records. We will share data with the UKHSA to report vaccine effectiveness for COVID-19 and influenza, assess the disease burden of respiratory syncytial virus, and perform syndromic surveillance. Virological surveillance will include COVID-19, influenza, respiratory syncytial virus, and other common respiratory viruses. We plan to pilot point-of-care testing for group A streptococcus, urine tests for pneumococcus, and asymptomatic testing. We will integrate test requests and results with the laboratory-computerized medical record system. A biomedical resource will enable research linking clinical data to virology data. The legal basis for the RSC's pseudonymized data extract is The Health Service (Control of Patient Information) Regulations 2002, and all nonsurveillance uses require research ethics approval. The RSC extended its surveillance activities to meet more but not all of the mosaic framework's objectives. We have introduced an ARI indicator. We seek to expand our surveillance scope and could do more around transmissibility and the benefits and risks of nonvaccine therapies.

Factors Affecting the Availability of Essential Health Commodities in Tanzania with a Special Focus on the Tracer Commodities

Background: Access to essential health commodities is fundamental to healthcare system efficacy. These commodities are vital in delivering health services and form integral elements within the World Health Organization's strengthening framework, encompassing the six foundational building blocks. Regrettably, there has been a global increase in shortages and stockouts of essential health commodities in recent years. Objective: The study aimed to identify factors influencing the availability of essential health commodities throughout all levels of the supply chain in Tanzania. Methods: A cross-sectional that employed qualitative and quantitative data collection techniques. Quantitative data were analyzed using STATA version 16, while Qualitative data were thematically analyzed. Results: Factors contributing to stockouts of essential commodities at the national level include increased demand, delayed shipments from donors, decreased funding commitments, delayed disbursement of funds, global shortages, inadequate governance, debt within the Medical Stores Department, donor dependency for vertical program commodities, and long lead times by Medical Stores Department suppliers. At the Regional and District levels, such factors include a shortage of human resources, lack of Electronic Medical Records, limited interoperability of information systems, poor quality of logistics data, inadequate use of data for decision-making, and poor inventory management. At the healthcare facility level, they include an overwhelming number of exempted clients, which reduces facility revenues. Conclusion: More efforts are still needed to address both the upstream and downstream challenges needed to ensure sustainable access and availability of essential health commodities at service delivery points as a pathway for improving health sector performance.

Framework for evaluating the performance of local healthcare: international experiences and prospects for Italy.

The Italian National healthcare service currently lacks a synthetic framework for measuring the primary care legislative reform established by the National recovery and resilience plan and the legislative reform, Decree number 77/2022. This paper explores the existing international and national literature on primary care' monitoring and evaluation systems with the purpose of drawing guidelines to build up a global and systematic framework. The 2022 World health organization framework is the most advanced reference point as a result of more than twenty years of theoretical and field research. Indeed, it can be regarded as the basic model to be adapted to the specificities of the current Italian legislation and organization.

Assessment of Patient Safety in a Low-Resource Health Care System: Proposal for a Multimethod Study.

The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources. This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting. We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization's Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility. The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs. A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non-resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs. PRR1-10.2196/50532.

Development of an evidence-informed governance and stewardship framework for elderly healthcare in Iran: A qualitative study

BackgroundThe ageing population poses significant challenges to healthcare systems, necessitating the establishment of high-functioning, integrated frameworks for elderly healthcare. This study aimed to explore the key challenges associated with the stewardship of elderly care in Iran and to develop a holistic stewardship framework. MethodsFor this qualitative study, thirty semi-structured interviews were conducted with key Iranian healthcare stakeholders, utilizing purposive and snowball sampling during 2021–2022. Inductive open coding was utilized to generate new concepts related to key stewardship challenges. The World Health Organization's conceptual framework, outlining the three stewardship tasks, served as the basis for crafting a tailored framework for elderly healthcare stewardship in Iran. ResultsFourteen main challenges and 38 sub-challenges were identified for elderly healthcare stewardship in Iran, categorized according to the WHO framework's three stewardship tasks. Challenges related to WHO stewardship task 1, involving health policy formulation and vision definition, included challenges in vision definition, planning, policymaking, and intergovernmental institutional superiority. Challenges related to WHO stewardship task 2, delineating governance and stewardship through control and regulation, encompassed issues such as support for the elderly, system responsiveness, behavior of healthcare providers, organizational structure, and cross-sectoral leadership challenges. Challenges associated with WHO stewardship task 3, about the use of collective intelligence, explored stakeholder collaboration, information for decision-making, and challenges within the elderly information system, covering data documentation, reporting, analysis, accessibility, distribution, and circulation. Subsequently, a framework was developed, covering areas like defining the vision and direction of health policy, managing information systems, evidence-informed policymaking, and delivering elderly health services with a holistic approach. ConclusionThe present framework shows how a management information system, guided by evidenced-informed policymaking and the formulation of customized health policies, can facilitate the provision of elderly health services based on identified needs. It presents a governance and stewardship pathway that can be adopted by Iranian health policymakers and similar middle-income countries facing analogous challenges in ageing and aged care system stewardship, serving as a model for developing their own frameworks.

Reductions in smoking due to ratification of the Framework Convention for Tobacco Control in 171 countries.

Smoking globally kills over half of long-term smokers and causes about 7 million annual deaths. The World Health Organization Framework Convention for Tobacco Control (FCTC) is the main global policy strategy to combat smoking, but its effectiveness is uncertain. Our interrupted time series analyses compared before- and after-FCTC trends in the numbers and prevalence of smokers below the age of 25 years (when smoking initiation occurs and during which response to interventions is greatest) and on cessation at 45-59 years (when quitting probably occurs) in 170 countries, excluding China. Contrasting the 10 years after FCTC ratification with the income-specific before-FCTC trends, we observed cumulative decreases of 15.5% (95% confidence interval = -33.2 to -0.7) for the numbers of current smokers and decreases of -7.5% (95% CI = -10.6 to -4.5) for the prevalence of smoking below age 25 years. The quit ratio (comparing the numbers of former and ever smokers) at 45-59 years increased by 1.8% (1.2 to 2.3) 10 years after FCTC ratification. Countries raising taxes by at least 10 percentage points concurrent with ratification observed steeper decreases in all three outcomes than countries that did not. Over a decade across 170 countries, the FCTC was associated with 24 million fewer young smokers and 2 million more quitters.

Sustaining essential health services inLao PDR inthe context ofdonor transition andCOVID-19.

Lao People's Democratic Republic (Lao PDR) aims at graduating from least developed country status by 2026 and must increase the level of domestic financing for health. This paper examines how the government has prepared for the decline of external assistance and how donors have applied their transition approaches. Adapting a World Health Organization (WHO) framework, reflections and lessons were generated based on literature review, informal and formal consultations and focus group discussions with the Lao PDR government and development partners including budget impact discussion. The government has taken three approaches to transition from external to domestic funding: mobilizing domestic resources, increasing efficiency across programs and prioritization with a focus on strengthening primary health care (PHC). The government has increased gradually domestic government health expenditures as a share of the government expenditure from 2.6% in 2013 to 4.9% in 2019. The Ministry of Health has made efforts to design and roll out integrated service delivery of maternal, newborn, child, and adolescent health services, immunization and nutrition; integrated 13 information systems of key health programs into one single District Health Information Software 2; and prioritized PHC, which has led to shifting donors towards supporting PHC. Donors have revisited their aid policies designed to improve sustainability and ownership of the government. However, the government faces challenges in improving cross-programmatic efficiency at the operational level and in further increasing the health budget due to the economic crisis aggravated during Coronavirus disease 2019 (COVID-19). Working to implement donor transition strategies under the current economic situation and country challenges, calls into question the criteria used to evaluate transition. This criterion needs to include more appropriate indicators other than gross national income per capita, which does not reflect a country's readiness and capacity of the health system. There should be a more country-tailored strategy and support for considering the context and system-wide readiness during donor transition.

Healthy aging trajectories and their predictors among Chinese older adults: Evidence from a 7-year nationwide prospective cohort study

ObjectivesThis study aimed to identify healthy aging trajectories of Chinese older adults, and explore the factors contributing to these trajectories. MethodsWe used data from four waves (2011–2018) of China Health and Retirement Longitudinal Study. We developed a healthy aging metric based on the healthy aging framework of World Health Organization (WHO) and Bayesian multilevel item response theory (IRT) method. The healthy aging trajectories were identified using the latent class growth analysis. The predictors of trajectories were explored using multinomial logistic regression analysis. Additionally, we developed two alternative metrics for healthy aging based on the Chinese Healthy Ageing Index (CHAI) and Rowe and Kahn's model of successful aging, respectively. We compared these metrics to the one developed based on the WHO's healthy aging framework. ResultsWe identified three distinct healthy aging trajectories with varying scores and decline rates. Individuals who were female, had lower educational levels, resided in rural areas, experienced depression, had more chronic diseases, participated in fewer social activities, had fewer childhood friends, experienced more adverse childhood events, and had worse family financial status in childhood were more likely to experience a worse healthy aging trajectory compared to their counterparts. Supplementary analysis showed that healthy aging metric based on WHO definition and IRT method had the strongest association with health outcomes compared to the metrics based on CHAI, as well as Rowe and Kahn model. ConclusionsOur findings provide a foundation for the development of tailored interventions to enhance and sustain healthy aging among Chinese older adults.

Indian Model of Integrated Healthcare (IMIH): a conceptual framework for a coordinated referral system in resource-constrained settings

IntroductionWith the escalating burden of chronic disease and multimorbidity in India, owing to its ageing population and overwhelming health needs, the Indian Health care delivery System (HDS) is under constant pressure due to rising public expectations and ambitious new health goals. The three tired HDS should work in coherence to ensure continuity of care, which needs a coordinated referral system. This calls for optimising health care through Integrated care (IC). The existing IC models have been primarily developed and adopted in High-Income Countries. The present study attempts to review the applicability of existing IC models and frame a customised model for resource-constrained settings.MethodsA two-stage methodology was used. Firstly, a narrative literature review was done to identify gaps in existing IC models, as per the World Health Organization framework approach. The literature search was done from electronic journal article databases, and relevant literature that reported conceptual and theoretical concepts of IC. Secondly, we conceptualised an IC concept according to India's existing HDS, validated by multiple rounds of brainstorming among co-authors. Further senior co-authors independently reviewed the conceptualised IC model as per national relevance.ResultsExisting IC models were categorised as individual, group and disease-specific, and population-based models. The limitations of having prolonged delivery time, focusing only on chronic diseases and being economically expensive to implement, along with requirement of completely restructuring and reorganising the existing HDS makes the adoption of existing IC models not feasible for India. The Indian Model of Integrated Healthcare (IMIH) model proposes three levels of integration: Macro, Meso, and Micro levels, using the existing HDS. The core components include a Central Gateway Control Room, using existing digital platforms at macro levels, a bucket overflow model at the meso level, a Triple-layered Concentric Circle outpatient department (OPD) design, and a three-door OPD concept at the micro level.ConclusionIMIH offers features that consider resource constraints and local context of LMICs while being economically viable. It envisages a step toward UHC by optimising existing resources and ensuring a continuum of care. However, health being a state subject, various socio-political and legal/administrative issues warrant further discussion before implementation.

Bridging the gap in the implementation of the World Health Organization’s Framework Convention on Tobacco Control Article 5.3 in India: Insights from an opinion poll and stakeholder consultation

ABSTRACT Background: Article 5.3 of the World Health Organization Framework Convention on Tobacco Control (FCTC) outlines a roadmap for the parties to safeguard public health policies in compliance with the national law from the influence of commercial and other vested interests of the tobacco industry. Aim: The study was conducted with the aim to identify gaps and bring existing Indian policies in compliance with Article 5.3 of FCTC. Materials and Methods: A nationwide cross-sectional opinion poll involving respondents aged >18 years (n = 164) and a panel discussion (n = 31) were conducted. Results: The majority of stakeholders expressed (strongly agree = 65% and agree = 22.6%) the need for a nationwide policy to regulate interactions between public officials and the tobacco industry. About 56.7% felt the need to expand existing protocols and codes of conduct for public officials across India. Over 84% of the participants supported incorporating specific sections to implement Article 5.3 into the Cigarettes and Other Tobacco Products Act Amendment Bill 2020. The majority of participants supported the need for guidelines for medical bodies and prohibiting tobacco companies from participating in corporate social responsibility activities. Conclusion: The Government of India should comprehensively adopt Article 5.3, in all states and union territories, adopting a whole-of-government approach in partnership with the community and civil society under the “whole-of-society” approach for effective tobacco control measures.

Implementation Questions of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in Georgia

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) is an international treaty established by WHO to address the global health issue of tobacco consumption, necessitating implementation at the national legislative level.
 The article explores the global problem of tobacco use and how it led to the creation of an international treaty to regulate it. It discusses how the FCTC was planned and Georgia's role in it. The analysis covers the legal side of the FCTC, including international and local rules for putting it into action. The article also talks about the challenges that have made it difficult to meet the FCTC's obligations from both legal and political viewpoints. This is the first attempt to explain the FCTC and the issues it faces in being adopted and carried out in Georgia.

Bridging the gap between the conceptual and the practical – reflections on the opportunities and challenges of meaningful engagement of people with lived experience in the context of integrated community care.

Introduction: Participants will explore the opportunities and challenges of meaningful engagement of people with lived experience in the context of integrated community care (ICC), through a dialogue with up to three innovative ICC practices whose central premise is the co-production of wellbeing. The dialogue will be further nourished through consideration of the recently co-developed World Health Organisation (WHO) Framework for Meaningful Engagement of People with Lived Experience of Non-Communicable Diseases (NCDs), Mental Health and Neurological conditions.
 Context: There is ample evidence that integrated care is best suited to support those living with long-term chronic NCDs, mental health conditions and to those with medically complex needs. At the very core of ICC, lies the principle of co-developing health and wellbeing. Despite broad agreement around the benefits, there is a lack of clarity on how this is achieved and few examples of what this looks like in practice.
 The WHO is currently in the process of co-developing a Framework for Meaningful Engagement of People Living with NCDs, Mental Health and Neurological conditions. Complementing this is practical guidance being produced by the Transnational Forum for ICC (TransForm) based on a collection of experiences and reflections of innovative ICC practices around Europe and Canada on the meaningful engagement of people with lived experience.
 Key learning: The Framework will contribute to the advancement of understanding, knowledge and action on meaningful engagement and other related participatory approaches. The evidence base has been and will continue to driven by individuals with lived experience. The TransForm guidance on engaging people with lived experience will further help bridge the gap between the conceptual and the practical.
 
 Audience: All those seeking to better engage and co-produce services with people with lived experience but are not sure how to start and what this looks like in practice.
 Plan:
 
 10 mins – Setting the scene
 
 Joint presentation (WHO/TransForm)
 
 15 mins – Overview of three TransForm changemakers
 
 Brief presentations on each ICC practice, focusing on how they engage people with lived experience.
 
 20 mins – Participants dialogue with the TransForm changemakers
 
 Participants will choose one of the three Changemakers to discuss opportunities and challenges of meaningful engagement of people with lived experience
 
 5 mins – Summary feedback from each table
 
 Each group reports back the main opportunities and challenges identified through discussion
 
 10 mins – Opportunities and challenges in the context of the WHO framework
 
 Jack Fisher will close the session tying back the opportunities and challenges to the WHO Framework
 How are you going to engage with the audience? Each group would have one Changemaker and one facilitator to ensure conversation centres around the question of: How can the WHO Framework and TransForm’s legacy support your practice?
 How are you going to summarize the take home messages? There will be short feedback from each table on main points discussed – the facilitation team will then write up the discussions into a short and accessible summary which will be shared through social media and integrated care networks.

Knowledge and attitude of adolescents regarding e-cigarettes: A scoping review

The World Health Organization Framework Convention on Tobacco Control has informed countries to ban or regulate electronic cigarettes (e-cigarettes) because of their health adverse effects. Although e-cigarettes are regulated, their popularity has increased among teens.

Prevalence of anemia and its associated factors among children aged 6–23 months, in Ethiopia: a systematic review and meta analysis

IntroductionDespite several strategies exist for anemia prevention and control, it has been the major public health important problem in the world. Numerous immediate and long-term health issues were reported in children who have history of anemia including decreased work productivity in adult hood period. Although analyzing data on burden and risk factors of anemia are the recommended action areas of World Health Organization framework for accelerating anemia reduction, the aggregated national burden and contributors of anemia in Ethiopia has not been determined so far. There for, this systematic and meta-analysis study is aimed to assess the pooled prevalence and associated factors of anemia among children aged 6–23 months in Ethiopia.MethodsThe electronic databases including PubMed, Scopus, EMBASE, Web of Science, Science Direct, Google scholar and institutional repositories were searched using search terms. The studies that reported the prevalence and/or risk factors of anemia in children 6–23 months of age were included. The JBI quality assessment tool was used to evaluate the quality of each study. The data was extracted with Microsoft Excel, 2019 and analyzed with STATA 17.0 statistical software. A random effect model was used to estimate the pooled prevalence of anemia and its associated factors. The Cochrane Q-test statistics and I2 test were used to measure heterogeneity between the included studies. Furthermore, publication bias was examined using the funnel plot graph and statistical tests (Egger’s and begg tests). Outliers also visualized using Galbraith plot. When necessary, sensitivity analysis was also employed to detect small study effect.ResultTen studies with a total population of 14, 733 were included for analysis. The pooled prevalence of anemia among children aged 6–23 months of age in Ethiopia was found to be 57.76% (95%CI; 51.61–63.91; I2 = 97.192%; p < 0.001). Having history of diarrhea AOR = 2.44 (95%CI: 1.03–3.85), being stunted AOR = 2.00 (95%CI: 1.38–2.61), living in food insecure house hold AOR = 2.08 (95%CI: 1.10–3.07), consuming less diversified food AOR = 2.73 (95%CI: 2.06–3.39) and being 6–11 months of age AOR = 1.59 (95%CI: 1.23–1.95) were associated with anemia.Conclusion and recommendationThe prevalence of anemia is in the range of severe public health problem among children aged 6–23 months in Ethiopia. Diarrhea, stunting, house hold food insecurity, dietary diversity, and age were the predictors of anemia. Further, prospective cohort and random controlled trial studies are recommended. Further, random controlled trial especially effectiveness of nutritional education interventions trial is important. To reduce prevalence of anemia, strengthening diarrhea reduction program, securing household food insecurity, preventing stunting, giving special attention for infants age 6–11 months and encouraging food diversification are important.

OP59 Do Digital Health Terms Provide Sufficient Information To Allow For Health Technology Assessment?

IntroductionUmbrella digital health term (DHT) (digital health, eHealth, mHealth, telehealth, and telemedicine) definitions contain insufficient information about patient value for health economics and outcomes research and health technology assessment (HTA) purposes. Qualitative content analysis of secondary DHT (e.g., telesurgery and teleradiology) definitions was performed by the ISPOR Digital Health Special Interest Group to determine if they were more useful for health economics and outcomes research purposes.MethodsSecondary DHT definitions were extracted from a previous scoping review and consolidated by reviewer pairs using uniform rules. Definitions were analyzed for explicit (directly stated) or implicit (inferred) information on 24 categories: Patient, Intervention, Comparator, Outcome, Timing, Setting (PICOTS); the Shannon-Weaver communication model (SWE) (sender, message, encoder, channel, decoder, and receiver, extended with mode of information exchange); the quality domains of Agency for Healthcare Research and Quality (AHRQ) (safe, effective, patient-centered, timely, efficient, and equitable); information related to applied technology or geographic scope; and the World Health Organization (WHO) classification of digital health interventions v1.0 (digital health interventions category, health system challenges, and system categories).ResultsAcross 107 unique definitions of 73 secondary DHTs, the number of explicitly or implicitly addressed categories across the frameworks ranged from zero to 15, with references to elements of PICOTS (79.4%), SWE (90.7%), AHRQ (30.8%), applied technology (52.3%), geographic scope (0%), and WHO frameworks (86.9%). PICOTS information was found for Patients in 35 percent of definitions, Intervention in 59 percent, Comparator in 20 percent, and Outcomes in 18 percent.ConclusionsSecondary DHT definitions do not adequately specify PICOTS or other characteristics of interest for HTA. An online Delphi survey has been launched among a wider group of ISPOR members to identify the minimum information set to define patient facing DHTs for evidence summaries and value assessments. The results of this research should be shared for discussion with other digital health stakeholder groups.

Functional ability of older adults based on the World Health Organization framework of healthy ageing: a scoping review

Functional ability of older adults based on the World Health Organization framework of healthy ageing: a scoping review

A85Jake’s story: Teaching interprofessional working through the delivery of a live patient multi-disciplinary team meeting

The World Health Organization (WHO) Framework for Action on Interprofessional Education and Collaborative Practice (2010), states ‘Interprofessional education occurs when two or more professionals learn about, from and with each other to enable effective collaboration and improve health outcomes’ [1]. When healthcare students enter the practice workplace, they are required to work in an interprofessional team and make collaborative decisions to provide safe and effective patient care. With the increasing complexity of patient presentation, increase in life expectancy and disability years coupled with the challenges of resource and delivery within the healthcare system it is vital that practitioners have solid foundational skills in interprofessional working. To facilitate this healthcare educators are being required to think of innovative, authentic and contemptuous pedagogical tools to demonstrate interprofessional working, collaboration and interdisciplinary role awareness. To provide healthcare students with meaningful exposure to interpersonal working educators at Birmingham City University embarked on the design and delivery of a live simulated patient case conference. To promote authenticity the case conference was designed (with consent) around a living patient (Jake) with complex medical and social needs. A team of healthcare educators each took the roles of clinicians from both health, social and tertiary care service. A round table discussion was held related to Jakes’s inpatient care and decisions regarding hospital discharge. Jake has quadriplegic cerebral palsy and substantial medical, social and occupational needs. Jake’s mum is also present, demonstrating the need to have patient and carer collaboration. The session was observed live by students but also filmed and edited into an ongoing simulation learning resource with both clinical and non-clinical learning objectives. A facilitated debrief was held after the session. Feedback and anecdotal analysis of the session showed greater student engagement and understanding of the needs for interprofessional collaboration when discussing patient care and decision-making. The use of a real and living patient meant students could immerse themselves in Jake’s story and feel true empathy with his clinical case. For some students’ knowledge of interprofessional working and the roles of other disciplines proves a challenging concept to master. It is feasible and effective to utilize simulation (live and virtual) as a method of teaching hard to grasp but vital concepts of healthcare practice including interprofessional working and interdisciplinary role awareness. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.