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Article ; Online: Assessing the capacity of primary health care facilities in Nigeria to deliver eye health promotion: Results of a mixed-methods feasibility study.

Aghaji, Ada / Burchett, Helen E D / Hameed, Shaffa / Gilbert, Clare

PLOS global public health

2022 Volume 2, Issue 11, Page(s) e0000645

Abstract: Over 25 million people in sub-Saharan Africa are blind or visually impaired, the majority from avoidable causes. Health promotion and disease prevention are important strategies for eye health, through good governance, health literacy and increasing ... ...

Abstract	Over 25 million people in sub-Saharan Africa are blind or visually impaired, the majority from avoidable causes. Health promotion and disease prevention are important strategies for eye health, through good governance, health literacy and increasing access to eye care services. To increase equity in access for eyecare services, the World Health Organization Africa Region developed a package of interventions for primary eye care, which includes health promotion. The aim of this study was to assess the capacity of the primary healthcare system to deliver health promotion for eye care in Nigeria. Mixed methods were used during a survey of 48 government-owned primary health care facilities in Anambra state, Nigeria: interviews with district health supervisors, facility staff and village health workers, and a desk review of policy documents for primary health care and eye care in Nigeria. Findings were benchmarked against the capacities needed to deliver health promotion agreed through a Delphi exercise and were analysed using the World Health Organization's health system building blocks. Eye health promotion policies exist but are fragmented across different national health policies. Health promotion activities focussed on "mobilising" community members to access care provided in facilities, particularly for women of childbearing age and young children, and health education was limited. Only one in ten facilities engaged the elderly and a fifth delivered health promotion for eye care. Health promotion activities were supervised in 43.2% of facilities and transport to remote areas was limited. A robust eye health promotion strategy needs to be included in the National Eye Health Policy. The scope of existing health promotion will need to expand to include eye conditions and different age groups. Increasing eye health literacy should be emphasized. Governance, training health workers in eye health promotion, educational materials, and transport to visit communities will also be needed.
Language	English
Publishing date	2022-11-11
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0000645
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Article ; Online: Can cash transfer interventions increase contraceptive use and reduce adolescent birth and pregnancy in low and middle income countries? A systematic review and meta-analysis.

Kneale, Dylan / Kjaersgaard, Abel / de Melo, Malica / Joaquim Picardo, Joelma / Griffin, Sally / French, Rebecca S / Burchett, Helen E D

PLOS global public health

2023 Volume 3, Issue 11, Page(s) e0001631

Abstract: Becoming pregnant and giving birth under the age of 20 is associated with a range of adverse social, socioeconomic and health outcomes for adolescent girls and their children in Low and middle income countries. Cash transfers are an example of a ... ...

Abstract	Becoming pregnant and giving birth under the age of 20 is associated with a range of adverse social, socioeconomic and health outcomes for adolescent girls and their children in Low and middle income countries. Cash transfers are an example of a structural intervention that can change the local social and economic environment, and have been linked with positive health and social outcomes across several domains. As part of a wider review of structural adolescent contraception interventions, we conducted a systematic review on the impact of cash transfers on adolescent contraception and fertility. Fifteen studies were included in the review with eleven studies providing evidence for meta-analyses on contraception use, pregnancy and childbearing. The evidence suggests that cash transfer interventions are generally ineffective in raising levels of contraceptive use. However, cash transfer interventions did reduce levels of early pregnancy (OR 0.90, 95% CI 0.81 to 1.00). There was suggestive evidence that conditional, but not unconditional, cash transfers reduce levels of early childbearing. Given that much of the evidence is drawn from interventions providing cash transfers conditional on school attendance, supporting school attendance may enable adolescent girls and young women to make life choices that do not involve early pregnancy.
Language	English
Publishing date	2023-11-09
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0001631
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Article ; Online: When assessing generalisability, focusing on differences in population or setting alone is insufficient.

Burchett, Helen E D / Kneale, Dylan / Blanchard, Laurence / Thomas, James

Trials

2020 Volume 21, Issue 1, Page(s) 286

Abstract: Generalisability is typically only briefly mentioned in discussion sections of evaluation articles, which are unhelpful in judging whether an intervention could be implemented elsewhere, with similar effects. Several tools to assess generalisability ... ...

Abstract	Generalisability is typically only briefly mentioned in discussion sections of evaluation articles, which are unhelpful in judging whether an intervention could be implemented elsewhere, with similar effects. Several tools to assess generalisability exist, but they are difficult to operationalise and are rarely used. We believe a different approach is needed. Instead of focusing on similarities (or more likely, differences) in generic population and setting characteristics, generalisability assessments should focus on understanding an intervention's mechanism of action - why or how an intervention was effective. We believe changes are needed to four types of research. First, outcome evaluations should draw on programme theory. Second, process evaluations should aim to understand interventions' mechanism of action, rather than simply 'what happened'. Third, small scoping studies should be conducted in new settings, to explore how to enact identified mechanisms. Finally, innovative synthesis methods are required, in order to identify mechanisms of action where there is a lack of existing process evaluations.
MeSH term(s)	Humans ; Journalism, Medical ; Medical Writing ; Program Evaluation/methods ; Research Design
Language	English
Publishing date	2020-03-20
Publishing country	England
Document type	Letter
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1468-6708
ISSN (online)	1745-6215 ; 1468-6694
ISSN	1468-6708
DOI	10.1186/s13063-020-4178-6
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Article ; Online: Primary health care facility readiness to implement primary eye care in Nigeria: equipment, infrastructure, service delivery and health management information systems.

Aghaji, Ada / Burchett, Helen E D / Oguego, Ngozi / Hameed, Shaffa / Gilbert, Clare

BMC health services research

2021 Volume 21, Issue 1, Page(s) 1360

Abstract: Background: Over two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for ... ...

Abstract	Background: Over two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. However, there are limited data on the capacities needed for delivery, to guide policymakers and implementers on the feasibility of integration. The overall purpose of this study was to assess the technical capacity of the health system at primary level to deliver the WHO primary eye care package. Findings with respect to service delivery, equipment and health management information systems (HMIS) are presented in this paper. Methods: This was a mixed-methods, cross sectional feasibility study in Anambra State, Nigeria. Methods included a desk review of relevant Nigerian policies; a survey of 48 primary health facilities in six districts randomly selected using two stage sampling, and semi-structured interviews with six supervisors and nine purposively selected facility heads. Quantitative study tools included observational checklists and questionnaires. Survey data were analysed descriptively using STATA V.15.1 (Statcorp, Texas). Differences between health centres and health posts were analysed using the z-test statistic. Interview data were analysed using thematic analysis assisted by Open Code Software V.4.02. Results: There are enabling national health policies for eye care, but no policy specifically for primary eye care. 85% of facilities had no medication for eye conditions and one in eight had no vitamin A in stock. Eyecare was available in < 10% of the facilities. The services delivered focussed on maternal and child health, with low attendance by adults aged over 50 years with over 50% of facilities reporting ≤10 attendances per year per 1000 catchment population. No facility reported data on patients with eye conditions in their patient registers. Conclusion: A policy for primary eye care is needed which aligns with existing eye health policies. There are currently substantial capacity gaps in service delivery, equipment and data management which will need to be addressed if eye care is to be successfully integrated into primary care in Nigeria.
MeSH term(s)	Ambulatory Care Facilities ; Cross-Sectional Studies ; Humans ; Management Information Systems ; Nigeria ; Primary Health Care
Language	English
Publishing date	2021-12-20
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-021-07359-3
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Article ; Online: Human resource and governance challenges in the delivery of primary eye care: a mixed methods feasibility study in Nigeria.

Aghaji, Ada / Burchett, Helen E D / Oguego, Ngozi / Hameed, Shaffa / Gilbert, Clare

BMC health services research

2021 Volume 21, Issue 1, Page(s) 1321

Abstract: Background: To increase access to eye care, the World Health Organization's Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. To determine the technical feasibility of implementing this package, the capacity of ... ...

Abstract	Background: To increase access to eye care, the World Health Organization's Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. To determine the technical feasibility of implementing this package, the capacity of health systems at primary level needs to be assessed, to identify capacity gaps that would need to be addressed to deliver effective and sustainable PEC. This study reports on the human resource and governance challenges for delivering PEC in Anambra State, Nigeria. Methods: Design: This was a mixed methods feasibility study. A desk review of relevant Nigerian national health policy documents on both eye health and primary health care was conducted, and 48 primary health care facilities in Anambra state were surveyed. Data on human resource and governance in primary health facilities were collected using structured questionnaires and through observation with checklists. In-depth interviews were conducted with district supervisors and selected heads of facilities to explore the opportunities and challenges for the delivery of PEC in their facilities/districts. Data were analysed using the World Health Organization's health system framework. Results: A clear policy for PEC is lacking. Supervision was conducted at least quarterly in 54% of facilities and 56% of facilities did not use the standard clinical management guidelines. There were critical shortages of health workers with 82% of facilities working with less than 20% of the number recommended. Many facilities used volunteers and/or ad hoc workers to mitigate staff shortages. Conclusion: Our study highlights the policy, governance and health workforce gaps that will need to be addressed to deliver PEC in Nigeria. Developing and implementing a specific policy for PEC is recommended. Implementation of existing national health policies may help address health workforce shortages at the primary health care level.
MeSH term(s)	Feasibility Studies ; Health Policy ; Humans ; Nigeria ; Primary Health Care ; Workforce
Language	English
Publishing date	2021-12-10
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-021-07362-8
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Article ; Online: Integrated delivery of family planning and childhood immunization services: a qualitative study of factors influencing service responsiveness in Malawi.

Hamon, Jessie K / Kambanje, Misozi / Pryor, Shannon / Kaponda, Alice S / Mwale, Erick / Mayhew, Susannah H / Webster, Jayne / Burchett, Helen E D

Health policy and planning

2022 Volume 37, Issue 7, Page(s) 885–894

Abstract: Evidence from several countries in sub-Saharan Africa suggests that the integration of family planning (FP) with childhood immunization services can help reduce the unmet need for FP among postpartum women without undermining the uptake of immunizations. ...

Abstract	Evidence from several countries in sub-Saharan Africa suggests that the integration of family planning (FP) with childhood immunization services can help reduce the unmet need for FP among postpartum women without undermining the uptake of immunizations. However, the quality and responsiveness of FP services that are integrated with childhood immunizations remain understudied. A qualitative study was conducted in two districts of Malawi, which examined the factors influencing the responsiveness of FP services that were integrated with childhood immunizations in monthly public outreach clinics. Semi-structured interviews with clients (n = 23) and FP providers (n = 10) and a clinic audit were carried out in six clinics. Hardware (material) and software (relational) factors influencing service responsiveness were identified through thematic and framework analyses of interview transcripts, and clinic characteristics were summarized from the audit data to contextualize the qualitative findings. Overall, 13 factors were found to influence service responsiveness in terms of the ease of access, choice of provider, environment, service continuity, confidentiality, communication, dignity and FP counselling afforded to clients. Among these factors, hardware deficiencies, including the absence of a dedicated building for the provision of FP services and the lack of FP commodities in clinics, were perceived to negatively affect service responsiveness. Crucially, the providers' use of their agency to alter the delivery of services was found to mitigate the negative effects of some hardware deficits on the ease of access, choice of provider, environment and confidentiality experienced by clients. This study contributes to an emerging recognition that providers can offset the effect of hardware deficiencies when services are integrated if they are afforded sufficient flexibility to make independent decisions. Consideration of software elements in the design and delivery of FP services that are integrated with childhood immunizations is therefore critical to optimize the responsiveness of these services.
MeSH term(s)	Child ; Family Planning Services ; Female ; Humans ; Immunization ; Malawi ; Qualitative Research
Language	English
Publishing date	2022-06-17
Publishing country	England
Document type	Journal Article
ZDB-ID	632896-9
ISSN	1460-2237 ; 0268-1080
ISSN (online)	1460-2237
ISSN	0268-1080
DOI	10.1093/heapol/czac048
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Article ; Online: Integrated delivery of family planning and childhood immunisation services: a mixed methods assessment of service responsiveness.

Hamon, Jessie K / Kambanje, Misozi / Pryor, Shannon / Kaponda, Alice S / Mwale, Erick / Burchett, Helen E D / Mayhew, Susannah H / Webster, Jayne

BMC health services research

2022 Volume 22, Issue 1, Page(s) 572

Abstract: Background: Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by ... ...

Abstract	Background: Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely contact with FP services. However, little is known about the clients' experiences of FP services that are integrated with childhood immunisations, despite being crucial to contraceptive uptake and repeat service utilisation. Methods: The responsiveness of FP services that were integrated with childhood immunisations in Malawi was assessed using cross-sectional convergent mixed methods. Exit interviews with clients (n=146) and audits (n=15) were conducted in routine outreach clinics. Responsiveness scores across eight domains were determined according to the proportion of clients who rated each domain positively. Text summary analyses of qualitative data from cognitive interviewing probes were also conducted to explain responsiveness scores. Additionally, Spearman rank correlation and Pearson's chi-squared test were used to identify correlations between domain ratings and to examine associations between domain ratings and client, service and clinic characteristics. Results: Responsiveness scores varied across domains: dignity (97.9%); service continuity (90.9%); communication (88.7%); ease of access (77.2%); counselling (66.4%); confidentiality (62.0%); environment (53.9%) and choice of provider (28.4%). Despite some low performing domains, 98.6% of clients said they would recommend the clinic to a friend or family member interested in FP. The choice of provider, communication, confidentiality and counselling ratings were positively associated with clients' exclusive use of one clinic for FP services. Also, the organisation of services in the clinics and the providers' individual behaviours were found to be critical to service responsiveness. Conclusions: This study establishes that in routine outreach clinics, FP services can be responsive when integrated with childhood immunisations, particularly in terms of the dignity and service continuity afforded to clients, though less so in terms of the choice of provider, environment, and confidentiality experienced. Additionally, it demonstrates the value of combining cognitive interviewing techniques with Likert questions to assess service responsiveness.
MeSH term(s)	Ambulatory Care Facilities ; Child ; Contraceptive Agents ; Counseling ; Cross-Sectional Studies ; Family Planning Services ; Female ; Humans ; Immunization
Chemical Substances	Contraceptive Agents
Language	English
Publishing date	2022-04-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07983-7
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Article ; Online: Impact of active case-finding for tuberculosis on case-notifications in Blantyre, Malawi: A community-based cluster-randomised trial (SCALE).

Feasey, Helena R A / Khundi, McEwen / Soko, Rebecca Nzawa / Bottomley, Christian / Chiume, Lingstone / Burchett, Helen E D / Nliwasa, Marriott / Twabi, Hussein H / Mpunga, James A / MacPherson, Peter / Corbett, Elizabeth L

PLOS global public health

2023 Volume 3, Issue 12, Page(s) e0002683

Abstract: Active case-finding (ACF) for tuberculosis can help find the "missing millions" with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively ... ...

Abstract	Active case-finding (ACF) for tuberculosis can help find the "missing millions" with undiagnosed tuberculosis. In a cluster-randomised trial, we investigated impact of ACF on case-notifications in Blantyre, Malawi, where ACF has been intensively implemented following 2014 estimates of ~1,000 per 100,000 adults with undiagnosed TB. Following a pre-intervention prevalence survey (May 2019 to March 2020), constrained randomisation allocated neighbourhoods to either door-to-door ACF (sputum microscopy for reported cough >2 weeks) or standard-of-care (SOC). Implementation was interrupted by COVID-19. Cluster-level bacteriologically-confirmed case-notification rate (CNR) ratio within 91 days of ACF was our redefined primary outcome; comparison between arms used Poisson regression with random effects. Secondary outcomes were 91-day CNR ratios comparing all tuberculosis registrations and all non-ACF registrations. Interrupted time series (ITS) analysis of CNRs in the SOC arm examined prevalence survey impact. (ISRCTN11400592). 72 clusters served by 10 study-supported tuberculosis registration centres were randomised to ACF (261,244 adults, 58,944 person-years follow-up) or SOC (256,713 adults, 52,805 person-years). Of 1,192 ACF participants, 13 (1.09%) were smear-positive. Within 91 days, 113 (42 bacteriologically-confirmed) and 108 (33 bacteriologically-confirmed) tuberculosis patients were identified as ACF or SOC cluster residents, respectively. There was no difference by arm, with adjusted 91-day CNR ratios 1.12 (95% CI: 0.61-2.07) for bacteriologically-confirmed tuberculosis; 0.93 (95% CI: 0.68-1.28) for all tuberculosis registrations; and 0.86 (95%CI: 0.63-1.16) for non-ACF (routinely) diagnosed. Of 7,905 ACF and 7,992 SOC pre-intervention survey participants, 12 (0.15%) and 17 (0.21%), respectively, had culture/Xpert-confirmed tuberculosis. ITS analysis showed no survey impact on SOC CNRs. Despite residual undiagnosed tuberculosis of 150 per 100,000 population, there was no increase in tuberculosis notifications from this previously successful approach targeting symptomatic disease, likely due to previous TB ACF and rapid declines in TB burden. In such settings, future ACF should focus on targeted outreach and demand creation, alongside optimised facility-based screening. Trial Registration: ISRCTN11400592.
Language	English
Publishing date	2023-12-05
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002683
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Article ; Online: Developing and testing intervention theory by incorporating a views synthesis into a qualitative comparative analysis of intervention effectiveness.

Melendez-Torres, G J / Sutcliffe, Katy / Burchett, Helen E D / Rees, Rebecca / Thomas, James

Research synthesis methods

2019 Volume 10, Issue 3, Page(s) 389–397

Abstract: Qualitative comparative analysis (QCA) was originally developed as a tool for cross-national comparisons in macrosociology, but its use in evaluation and evidence synthesis of complex interventions is rapidly developing. QCA is theory-driven and relies ... ...

Abstract	Qualitative comparative analysis (QCA) was originally developed as a tool for cross-national comparisons in macrosociology, but its use in evaluation and evidence synthesis of complex interventions is rapidly developing. QCA is theory-driven and relies on Boolean logic to identify pathways to an outcome (eg, is the intervention effective or not?). We use the example of two linked systematic reviews on weight management programs (WMPs) for adults-one focusing on user views (a "views synthesis") and one focusing on the effectiveness of WMPs incorporating dietary and physical activity-to demonstrate how a synthesis of user views can supply a working theory to structure a QCA. We discuss how a views synthesis is especially apt to supply this working theory because user views can (a) represent a "middle-range theory" of the intervention; (b) bring a participatory, democratic perspective; and (c) provide an idiographic understanding of how the intervention works that external taxonomies may not be able to furnish. We then discuss the practical role that the views synthesis played in our QCA examining pathways to effectiveness: (a) by suggesting specific intervention features and sharpening the focus on the most salient features to be examined, (b) by supporting interpretation of findings, and (c) by bounding data analysis to prevent data dredging.
MeSH term(s)	Behavior ; Comparative Effectiveness Research ; Fuzzy Logic ; Health Promotion ; Humans ; Internationality ; Obesity/prevention & control ; Obesity/therapy ; Patient Participation ; Qualitative Research ; Regression Analysis ; Research Design ; Risk ; Sociology ; Systematic Reviews as Topic ; Weight Reduction Programs
Language	English
Publishing date	2019-02-20
Publishing country	England
Document type	Journal Article
ISSN	1759-2887
ISSN (online)	1759-2887
DOI	10.1002/jrsm.1341
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Article ; Online: Pregnant asylum seekers.

Burchett, Helen E D / Bragg, Ros

BMJ (Clinical research ed.)

2010 Volume 341, Page(s) c4691

MeSH term(s)	Female ; Health Services Accessibility ; Health Services Needs and Demand ; Humans ; Pregnancy ; Refugees ; Transients and Migrants
Language	English
Publishing date	2010-08-27
Publishing country	England
Document type	Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.c4691
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