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The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

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Author: search.filters.author.Ager, AlastairSubject: search.filters.subject.Medicine and health sciences

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    Informing adaptation strategy through mapping the dynamics linking climate change, health, and other human systems: Case studies from Georgia, Lebanon, Mozambique and Costa Rica
    (Public Library of Science, 2023-04-19) Loffreda, Giulia; Chikovani, Ivdity; Mocumbi, Ana O.; Asmar, Michele Kosremelli; Blanco, Laura C.; Grant, Liz; Ager, Alastair
    While scientific research supporting mitigation of further global temperature rise remains a major priority, CoP26 and CoP27 saw increased recognition of the importance of research that informs adaptation to irreversible changes in climate and the increasing threats of extreme weather events. Such work is inevitably and appropriately contextual, but efforts to generalise principles that inform local strategies for adaptation and resilience are likely crucial. Systems approaches are particularly promising in this regard. This study adopted a system dynamics framing to consider linkages between climate change and population health across four low- and middle-income country settings with a view to identifying priority inter-sectoral adaptation measures in each. On the basis of a focused literature review in each setting, we developed preliminary causal loop diagrams (CLD) addressing dynamics operating in Mozambique, Lebanon, Costa Rica, and Georgia. Participatory workshops in each setting convened technical experts from different disciplines to review and refine this causal loop analysis, and identify key drivers and leverage points for adaptation strategy. While analyses reflected the unique dynamics of each setting, common leverage points were identified across sites. These comprised: i) early warning/preparedness regarding extreme events (thus mitigating risk exposure); ii) adapted agricultural practices (to sustain food security and community livelihoods in changing environmental conditions); iii) urban planning (to strengthen the quality of housing and infrastructure and thus reduce population exposure to risks); iv) health systems resilience (to maintain access to quality healthcare for treatment of disease associated with increased risk exposure and other conditions for which access may be disrupted by extreme events); and v) social security (supporting the livelihoods of vulnerable communities and enabling their access to public services, including healthcare). System dynamics modelling methods can provide a valuable mechanism for convening actors across multiple sectors to consider the development of adaptation strategies.
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    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).