The Institute for Global Health and Development
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Item High-income countries remain overrepresented in highly ranked public health journals: A descriptive analysis of research settings and authorship affiliations(Taylor & Francis, 2020-02-04) Plancikova, Dominika; Duric, Predrag; O'May, FionaScientific contribution in high-impact journals is largely from authors affiliated with institutions in high-income countries (HICs). Publication of papers by contribution of individual countries to leading journals can provide a picture of the most influential countries in a particular discipline. The aim of the study was to identify changes in the patterns in authorship and origin of original research articles in relation to countries’ income level in the field of public health in 2016 in comparison to previous studies. A descriptive analysis was conducted based on articles published in highly ranked public health journals in 2016. Based on the inclusion criteria, 368 research articles were identified. Over 80% of these studies were conducted in HICs. Authors were mainly based in HICs (84%), especially in the USA. The majority of first, last, and corresponding authors were affiliated with HICs (over 90%). Our study might serve as a prompt for editorial and advisory boards of the leading international journals to provide more opportunities for researchers based in low and middle-income countries.Item Addressing challenges in tuberculosis adherence via performance-based payments for integrated case management: Protocol for a cluster randomized controlled trial in Georgia(BMC, 2019-08-28) Chikovani, Ivdity; Diaconu, Karin; Duric, Predrag; Sulaberidze, Lela; Uchaneishvili, Maia; Mohammed, Nuredin Ibrahim; Zoidze, Akaki; Witter, SophieBackground: Tuberculosis is one of the greatest global health concerns and disease management is challenging particularly in low- and middle-income countries. Despite improvements in addressing this epidemic in Georgia, tuberculosis remains a significant public health concern due to sub-optimal patient management. Low remuneration for specialists, limited private-sector interest in provision of infectious disease care and incomplete integration in primary care are at the core of this problem.Item Delivery of integrated infectious disease control services under the new antenatal care guidelines: A service availability and readiness assessment of health facilities in Tanzania(2019-03-11) Odjidja, Emmanuel Nene; Gatasi, Ghislaine; Duric, PredragBACKGROUND:Tanzania remains among the countries with the highest burden of infectious diseases (notably HIV, Malaria and Tuberculosis) during pregnancy. In response, the country adopted World Health Organization's (WHO) latest antenatal care (ANC) guidelines which recommend comprehensive services including diagnostic screening and treatment for pregnant women during antenatal. However, as Tanzania makes efforts to scale up these services under the existing health system resources, it is crucial to understand its capacity to deliver these services in an integrated fashion. Using the WHO's service availability and readiness assessment(SARA) framework, this study assesses the capacity of the Tanzanian Health System to provide integrated Malaria, Tuberculosis and HIV services.Item Validity of hepatitis B and hepatitis C case definitions(Elsevier, 2019-02-13) Dakic, Zoran; Duric, Predrag; Fabri, Milotka; O'May, FionaBackground: Globally, an estimated 257 million people are living with chronic hepatitis B (HBV) infection and an estimated 71 million people with the chronic hepatitis C virus (HCV). The true public health dimensions and impact of hepatitis epidemics are poorly understood. Case definitions are fundamental parts of disease surveillance, representing sets of standardised criteria used to assess whether or not a person has a certain disease. The study evaluated the sensitivity and specificity of hepatitis B and hepatitis C case definitions, current at the time of data collection, recommended by the European Commission (EC) and the Centers for Disease Prevention and Control (CDC).Item A prospective cohort study on injuries among intensively physically active high school students(Wiley, 2018-12-02) Krtinic, Gordana; Duric, PredragBACKGROUND - The leading cause of nonfatal injuries in age group 14‐19 is sports injuries. Purpose of the study was to determine the association between intense physical activity and injury and to identify the circumstances and environment in which injuries are most likely to occur. METHODS - A prospective cohort study included 698 high school students 15‐19 years old, divided into those exposed and those unexposed to intense physical activity. The international standard questionnaire about physical activity (International Physical Activity Questionnaire—IPAQ) and the metabolic equivalent task (MET) scores were used. RESULTS - The risk of injuries was 7 times higher (relative risk [RR]: 7.041; 95% confidence interval [CI]: 6.071, 8.187) and the risk of injuries requiring treatment in health facilities was 15 times higher (RR: 14.717; 95% CI: 10.652, 20.592) in the intensely physically active adolescents. The risk of gaining sports injuries was 11 times higher in the exposed group (RR: 11.212; 95% CI: 9.013, 14.074), with a significantly higher incidence rate (Inc.) among men (82.9 per 100). Most injuries occurred in football (Inc. 4.4 per 1000 hours), volleyball (Inc. 3.9 per 1000 hours), and boxing/kickboxing (Inc. 3.7 per 1000 hours). CONCLUSIONS - Intensely physically active high school students have a much higher risk of injury, which usually occurs during training or a match.Item General practitioners' views towards diagnosing and treating depression in five South-Eastern European countries(Wiley, 2018-10-02) Duric, Predrag; Harhaji, Sanja; O'May, Fiona; Boderscova, Larisa; Chihai, Jana; Como, Ariel; Hranov, Georgi L.; Mihai, Adriana; Sotiri, EugjenAim: To assess and compare general practitioners’ views of diagnosing and treating depression in five South Eastern European countries. Methods: A cross-sectional study was conducted in Albania, Bulgaria, Moldova, Romania and Serbia. The sample included 467 general practitioners who completed a hard-copy self-administered questionnaire, consisting of self-assessment questions related to diagnosing and treating depression. Results: The most common barriers to managing depression in general practice reported by GPs were: patients’ unwillingness to discuss depressive symptoms (92.3%); appointment time too short to take an adequate history (91.9%), barriers for prescribing appropriate treatment (90.6%); and patients’ reluctance to be referred to a psychiatrist (89.1%). Most GPs (78.4%) agreed that recognizing depression was their responsibility, 71.7% were confident in diagnosing depression, but less than one third (29.6%) considered that they should treat it. Conclusions: Improvements to the organisation of mental health care in all five countries should consider better training for GPs in depression diagnosis and treatment; the availability of mental health care specialists at primary care level, with ensured equal and easy access for all patients; and the removal of potential legal barriers for diagnosis and treatment of depression.Item "Treatment is of primary importance, and social assistance is secondary": A qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying on TB treatment in Riga, Latvia(Public Library of Science, 2018-10-17) Kielmann, Karina; Vidal, Nicole L.; Riekstina, Vija; Krutikov, Maria; van der Werf, Marieke J.; Biraua, Evita; Duric, Predrag; Moore, David A. J.Background Vulnerable individuals with tuberculosis (TB) struggle to access and stay on treatment. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour. Aim To examine the influence of TB service organisation and culture on patients’ experience of starting and staying on treatment in Riga, Latvia. Methods An intervention package to support adherence to TB treatment amongst vulnerable patients in Riga, Latvia was piloted between August 2016 and March 2017. Qualitative observations (5), interviews with staff (20) and with TB patients (10) were conducted mid-way and at the end of the intervention to understand perceptions, processes, and experiences of TB care. Results The organisation of TB services is strongly influenced by a divide between medical and social aspects of TB care. Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care. Support for vulnerable patients is limited because of standardised programmatic approaches, resource constraints and restricted job descriptions for non-medical staff. Conclusion Providing support for vulnerable patients is challenged in this setting by the strict division between medical and social aspects of TB care, and the organisational focus on patient-related rather than systems-related barriers to access and adherence. Potential systems interventions include the introduction of multi-disciplinary approaches and teams in TB care, strengthening patient literacy at the point of treatment initiation, as well as stronger linkages with social care organisations.Item Evaluation of demand and supply predictors of uptake of intermittent preventive treatment for malaria in pregnancy in Malawi(MalariaWorld, 2017-12-08) Odjidja, Emmanuel Nene; Duric, PredragBackground. The intermittent preventive treatment (IPTp) policy of Malawi (2002) stipulates that IPTp is administered during antenatal care as a direct observation therapy (DOT). The policy further recommends that IPT should be administered monthly after 16 weeks of pregnancy until delivery. This study assessed both the demand and supply factors contributing to higher dropout of IPT after the first dose. Optimal number of doses was pegged at a minimum of three in accordance with WHO recommendation. Materials and methods. Data were analysed from the Malawi multiple indicator cluster survey (2015) and the service provision assessment (2014) of 6637 women (aged 15- 49 yrs), 763 facilities and 2105 health workers. The sample was made up of pregnant women, health facilities and workers involved in routine antenatal services across all regions of Malawi. A composite indicator was constructed to report integration of IPTp with ANC services and administration of IPTp-SP as DOT. Multivariate and logistic regression were conducted to determine associations. Results. Regression analysis found that: 1. Age of women (women 35-49 yrs, AOR 1.98; 95% CI 1.42 - 2.13, number of children as well as the number of ANC visits were associated with optimal uptake of IPTp. 2. Administering IPT as DOT was higher in facilities in rural areas (AOR 1.86; 95% CI 1.54 - 1.92) than in urban areas. 3. Administration of IPTp as DOT was relatively lower in across all facilities with highest being facilities managed by CHAM (72.8%, AOR 1.40; 95% CI 1.22 - 1.54) Conclusion. Health system bottlenecks were found to present the main cause of low coverage with optimal doses of IPTp. Incorporating these results into strategic policy IPTp formulation could help improve coverage to desired levels. This study could serve as plausible evidence for government and donors when planning malaria in pregnancy interventions, especially in remote parts of Malawi.Item Informal work-related injuries: a one year prospective study in a rural community in Serbia(Informa UK Limited, 2018-02-20) Duric, Predrag; Diaconu, Karin; O'May, Fiona; Rybovic, Jan; Stevenson, MarkWork-related injuries occurring during informal work often go unreported, yet lead to significant mortality and contribute substantially to disease burden due to injury-related disability. In Serbia, injury is a leading cause of death, with work-related injuries comprising a significant proportion. This study explored the frequency of and risk factors for these injuries in a rural Serbian community. During the 12-month study period, physicians from a municipal Primary Care Centre reported all presenting injuries using a specific injury report form. One in four injuries reported occurred during informal work practices, accounting for 71% of all reported work-related injuries. These occurred within the household in 85% of cases, and were more severe in males (79%). Regarding work-related injuries, informal workers were significantly older than formally employed workers, regardless of sex. Public policy should address safety improvements for informal workers, via provision of relevant training and protective equipment.Item Blood donors' awareness and attitudes towards blood transfusion safety in the Autonomous Province of Vojvodina, Serbia(Wiley, 2017-08-01) Bogdanovi, S.; Duric, Predrag; Jovanovi, R.; Bogdanovi, J.Objectives To assess the awareness and attitudes related to blood transfusion safety among blood donors from the Autonomous Province (AP) Vojvodina, Republic of Serbia. Background Blood donors are at the initial point of safe blood transfusion systems. The active participation of blood donors in the selection process contributes to increasing the safety of blood transfusions and reduces potential risks for the recipients. Materials and Methods This cross-sectional survey included 1191 blood donors from AP Vojvodina. The awareness and attitudes regarding safe blood supply were measured as 5-point scales of agreement/disagreement with statements on a Likert scale. The-data-were-analysed-using-non-parametric-methods-by frequency modalities. Results Male blood donors, the youngest-age-group-(18-20 years), those who donate blood for the first time and those with a-lower educational level showed the lowest awareness of, and the most negative attitudes about, blood safety. Conclusions The study found that there is a small but, for the safety of transfusion, significant number of blood donors who do not have a positive attitude or awareness of their own impact on safe transfusion therapy and who are not discovered during standard selection procedures.