Browsing by Person "Falconer, Jennifer"

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An analysis of clinical predictive values for radiographic pneumonia in children
(BMJ, 2020-08-13) Rees, Chris A.; Basnet, Sudha; Gentile, Angela; Gessner, Bradford D.; Kartasasmita, Cissy B.; Lucero, Marilla; Martinez, Luis; O'Grady, Kerry-Ann F.; Ruvinsky, Raul O.; Turner, Claudia; Campbell, Harry; Nair, Harish; Falconer, Jennifer; Williams, Linda J.; Horne, Margaret; Strand, Tor; Nisar, Yasir B.; Qazi, Shamim A.; Neuman, Mark I.; The study was funded by the Bill & Melinda Gates Foundation (#OPP1106190) through a grant to the WHO.
Introduction: Healthcare providers in resource-limited settings rely on the presence of tachypnoea and chest indrawing to establish a diagnosis of pneumonia in children. We aimed to determine the test characteristics of commonly assessed signs and symptoms for the radiographic diagnosis of pneumonia in children 0–59 months of age. Methods: We conducted an analysis using patient-level pooled data from 41 shared datasets of paediatric pneumonia. We included hospital-based studies in which >80% of children had chest radiography performed. Primary endpoint pneumonia (presence of dense opacity occupying a portion or entire lobe of the lung or presence of pleural effusion on chest radiograph) was used as the reference criterion radiographic standard. We assessed the sensitivity, specificity, and likelihood ratios for clinical findings, and combinations of findings, for the diagnosis of primary endpoint pneumonia among children 0–59 months of age. Results: Ten studies met inclusion criteria comprising 15 029 children; 24.9% (n=3743) had radiographic pneumonia. The presence of age-based tachypnoea demonstrated a sensitivity of 0.92 and a specificity of 0.22 while lower chest indrawing revealed a sensitivity of 0.74 and specificity of 0.15 for the diagnosis of radiographic pneumonia. The sensitivity and specificity for oxygen saturation <90% was 0.40 and 0.67, respectively, and was 0.17 and 0.88 for oxygen saturation <85%. Specificity was improved when individual clinical factors such as tachypnoea, fever and hypoxaemia were combined, however, the sensitivity was lower. Conclusions: No single sign or symptom was strongly associated with radiographic primary end point pneumonia in children. Performance characteristics were improved by combining individual signs and symptoms.
An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries
(BMC, 2021-06-29) Jailobaeva, Kanykey; Falconer, Jennifer; Loffreda, Giulia; Arakelyan, Stella; Witter, Sophie; Ager, Alastair
Background: Noncommunicable diseases (NCDs), including mental health, have become a major concern in low- and middle-income countries. Despite increased attention to them over the past decade, progress toward addressing NCDs has been slow. A lack of bold policy commitments has been suggested as one of the contributors to limited progress in NCD prevention and management. However, the policies of key global actors (bilateral, multilateral, and not-for-profit organisations) have been understudied. Methods: This study aimed to map the key global actors investing in action regarding NCDs and review their policies to examine the articulation of priorities regarding NCDs. Narrative synthesis of 70 documents and 31 policy papers was completed, and related to data collated from the Global Health Data Visualisation Tool. Results: In 2019 41% of development assistance for health committed to NCDs came from private philanthropies, while that for other global health priorities from this source was just 20%. Through a range of channels, bilateral donors were the other major source of NCD funding (contributing 41% of NCD funding). The UK and the US were the largest bilateral investors in NCDs, each contributing 8%. However, NCDs are still under-prioritised within bilateral portfolios – receiving just 0.48% of US funding and 1.66% of the UK. NGOs were the key channels of funding for NCDs, spending 48% of the funds from donors in 2019. The reviewed literature generally focused on NCD policies of WHO, with policies of multilateral and bilateral donors given limited attention. The analysis of policies indicated a limited prioritisation of NCDs in policy documents. NCDs are framed in the policies as a barrier to economic growth, poverty reduction, and health system sustainability. Bilateral donors prioritise prevention, while multilateral actors offer policy options for NCD prevention and care. Even where stated as a priority, however, funding allocations are not aligned. Conclusion: The growing threat of NCDs and their drivers are increasingly recognised. However, global actors’ policy priorities and funding allocations need to align better to address these NCD threats. Given the level of their investment and engagement, more research is needed into the role of private philanthropies and NGOs in this area.
Cholera diagnosis in human stool and detection in water: A systematic review and meta-analysis
(Public Library of Science, 2022-07-06) Falconer, Jennifer; Diaconu, Karin; O’May, Fiona; Gummaraju, Advaith; Victor-Uadiale, Ifeyinwa; Matragrano, Joseph; Njanpop-Lafourcade, Berthe-Marie; Ager, Alastair
Background: Cholera continues to pose a problem for low-resource, fragile and humanitarian contexts. Evidence suggests that 2.86 million cholera cases and 95,000 deaths due to cholera are reported annually. Without quick and effective diagnosis and treatment, case-fatality may be 50%. In line with the priorities of the Global Task Force on Cholera Control, we undertook a systematic review and meta-analysis of diagnostic test accuracy and other test characteristics of current tests for cholera detection in stool and water. Methods: We searched 11 bibliographic and grey literature databases. Data was extracted on test sensitivity, specificity and other product information. Meta-analyses of sensitivity and specificity were conducted for tests reported in three or more studies. Where fewer studies reported a test, estimates were summarised through narrative synthesis. Risk of Bias was assessed using QUADAS-2. Results: Searches identified 6,637 records; 41 studies reporting on 28 tests were included. Twenty-two tests had both sensitivities and specificities reported above 95% by at least one study, but there was, overall, wide variation in reported diagnostic accuracy across studies. For the three tests where meta-analyses were possible the highest sensitivity meta-estimate was found in the Cholera Screen test (98.6%, CI: 94.7%-99.7%) and the highest specificity meta-estimate in the Crystal VC on enriched samples (98.3%, CI: 92.8%-99.6%). There was a general lack of evidence regarding field use of tests, but where presented this indicated trends for lower diagnostic accuracy in field settings, with lesser-trained staff, and without the additional process of sample enrichment. Where reported, mean test turnaround times ranged from over 50% to 130% longer than manufacturer’s specification. Most studies had a low to unclear risk of bias. Conclusions: Currently available Rapid Diagnostic Tests can potentially provide high diagnostic and detection capability for cholera. However, stronger evidence is required regarding the conditions required to secure these levels of accuracy in field use, particularly in low-resource settings. Registration: PROSPERO (CRD42016048428).
Cholera diagnosis in human stool and detection in water: protocol for a systematic review of available technologies
(2018-02-20) Diaconu, Karin; Falconer, Jennifer; O'May, Fiona; Jimenez, Miguel; Matragrano, Joe; Njanpop-Lafourcade, Betty; Ager, Alastair
Background: Cholera is a highly infectious diarrheal disease spread via fecal contamination of water and food sources; it is endemic in parts of Africa and Asia and recent outbreaks have been reported in Haiti, the Zambia and Democratic Republic of the Congo. If left untreated, the disease can be fatal in less than 24 h and result in case fatality ratios of 30 - 50%. Cholera disproportionately affects those living in areas with poor access to water and sanitation: the long-term public health response is focused on improving water and hygiene facilities and access. Short-term measures for infection prevention and control, and disease characterization and surveillance, are impaired by d iagnostic delays: culture methods are slow and rely on the availability of infrastructure and specialist equipment. Rapid diagnostic tests have shown promise under field conditions and further innovations in this area have been proposed. Methods: This paper is the protocol for a systematic review focused on identifying current technologies and methods used for cholera diagnosis in stool, and detection in water. We will synthesize and appraise information on product technical specifications, accuracy and design features in order to inform infection prevention and control and innovation development. Embase, MEDLINE, CINAHL, Proquest, IndMed and the WHO and Campbell libraries will be searched. We will include studies reporting on field evaluations, including within-study comparisons against a reference standard, and laboratory evaluations reporting on product validation against field stool or water samples. We will extract data according to protocol and attempt meta-analyses if appropriate given data availability and quality. Discussion: The systematic review builds on a previous scoping review in this field and expands upon this by synthesising data on both product technical characteristics and design features. The review will be of particular value to stakeholders engaged in diagnostic procuremen t and manufacturers interested in developing cholera or diarrheal disease diagnostics.
External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia
(International Society of Global Health, 2021-10-09) Rees, Chris A.; Hooli, Shubhada; King, Carina; McCollum, Eric D.; Colbourn, Tim; Lufesi, Norman; Mwansambo, Charles; Lazzerini, Marzia; Madhi, Shabir Ahmed; Cutland, Clare; Nunes, Marta; Gessner, Bradford D.; Basnet, Sudha; Kartasasmita, Cissy B.; Mathew, Joseph L.; Zaman, Syed Mohammad Akram uz; Paranhos-Baccala, Glaucia; Bhatnagar, Shinjini; Wadhwa, Nitya; Lodha, Rakesh; Aneja, Satinder; Santosham, Mathuram; Picot, Valentina S.; Sylla, Mariam; Awasthi, Shally; Bavdekar, Ashish; Pape, Jean-William; Rouzier, Vanessa; Chou, Monidarin; Rakoto-Andrianarivelo, Mala; Wang, Jianwei; Nymadawa, Pagbajabyn; Vanhems, Philippe; Russomando, Graciela; Asghar, Rai; Banajeh, Salem; Iqbal, Imran; MacLeod, William; Maulen-Radovan, Irene; Mino, Greta; Saha, Samir; Singhi, Sunit; Thea, Donald M.; Clara, Alexey W.; Campbell, Harry.; Nair, Harish; Falconer, Jennifer; Williams, Linda J.; Horne, Margaret; Strand, Tor; Qazi, Shamim A.; Nisar, Yasir B.; Neuman, Mark I.
Background Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores. Methods We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules. Results The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73). Conclusions In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting.
Paying for performance to improve the delivery of health interventions in low- and middle-income countries (Review)
(Wiley, 2021-05-05) Diaconu, Karin; Falconer, Jennifer; Verbel Facuseh, Adrian V.; Fretheim, Atle; Witter, Sophie
Background There is a growing interest in paying for performance as a means to align the incentives of health workers and health providers with public health goals. While the volume of schemes implementing paying for performance has increased over the last decade, rigorous evidence on the effectiveness of these strategies in improving health care and health, particularly in low- and middle-income countries is lacking. This is an update on the 2012 review on this topic, which had identified a limited evidence base from which to draw conclusions.
Qualitative system dynamics modelling to support the design and implementation of tuberculosis infection prevention and control measures in South African primary health care facilities
(Oxford University Press (OUP), 2024-08-31) Diaconu, Karin; Karat, Aaron; Bozzani, Fiametta; McCreesh, Nicky; Falconer, Jennifer; Voce, Anna; Vassall, Anna; Grant, Alison D; Kielmann, Karina
Tuberculosis infection prevention and control (TB IPC) measures are a cornerstone of policy, but measures are diverse and variably implemented. Limited attention has been paid to the health system environment which influences successful implementation of these measures. We used qualitative system dynamics and group-model-building methods 1) develop a qualitative causal map of the interlinked drivers of Mycobacterium tuberculosis (Mtb) transmission in South African primary health care facilities which in turn, helped us to 2) identify plausible IPC interventions to reduce risk of transmission. Two one-day participatory workshops were held in 2019 with policy- and decision-makers at national and provincial level, and patient advocates and health professionals at clinic and district level. Causal loop diagrams were generated by participants and combined by investigators. The research team reviewed diagrams to identify the drivers of nosocomial transmission of Mtb in primary health care facilities. Interventions proposed by participants were mapped onto diagrams to identify anticipated mechanisms of action and effect. Three systemic drivers were identified: 1) Mtb nosocomial transmission is driven by bottlenecks in patient flow at given times; 2) IPC implementation and clinic processes are anchored within a staff “culture of nominal compliance”; and 3) limited systems-learning at policy level inhibits effective clinic management and IPC implementation. Interventions prioritised by workshop participants included infrastructural, organisational, and behavioural strategies that target three areas: 1) improve air quality; 2) improve use of personal protective equipment; and 3) reduce the number of individuals in the clinic. In addition to core mechanisms, participants elaborated specific additional enablers that would help sustain implementation. Qualitative system dynamics modelling (SDM) methods allowed us to capture stakeholder views and potential solutions to address the problem of sub-optimal TB IPC implementation. The participatory elements of SDM facilitated problem-solving and inclusion of multiple factors frequently neglected when considering implementation.
Understanding fragility: Implications for global health research and practice
(Oxford University Press, 2019-12-10) Diaconu, Karin; Falconer, Jennifer; Vidal, Nicole L.; O'May, Fiona; Azasi, Esther; Elimian, Kelly; Bou-Orm, Ibrahim; Sarb, Cristina; Witter, Sophie; Ager, Alastair
Advances in population health outcomes risk being slowed—and potentially reversed—by a range of threats increasingly presented as ‘fragility’. Widely used and critiqued within the development arena, the concept is increasingly used in the field of global health, where its relationship to population health, health service delivery, access and utilization is poorly specified. We present the first scoping review seeking to clarify the meaning, definitions and applications of the term in the global health literature. Adopting the theoretical framework of concept analysis, 10 bibliographic and grey literature sources, and five key journals, were searched to retrieve documents relating to fragility and health. Reviewers screened titles and abstracts and retained documents applying the term fragility in relation to health systems, services, health outcomes and population or community health. Data were extracted according to the protocol; all documents underwent bibliometric analysis. Narrative synthesis was then used to identify defining attributes of the concept in the field of global health. A total of 377 documents met inclusion criteria. There has been an exponential increase in applications of the concept in published literature over the last 10 years. Formal definitions of the term continue to be focused on the characteristics of ‘fragile and conflict-affected states’. However, synthesis indicates diverse use of the concept with respect to: level of application (e.g. from state to local community); emphasis on particular antecedent stressors (including factors beyond conflict and weak governance); and focus on health system or community resources (with an increasing tendency to focus on the interface between two). Amongst several themes identified, trust is noted as a key locus of fragility at this interface, with critical implications for health seeking, service utilization and health system and community resilience.