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Assessing the impact of defining a global priority research agenda to address HIV-associated tuberculosis.
Tropical Medicine and International Health. 2016 Nov; 21(11):1420-1427.Objectives In 2010, the WHO issued 77 priority research questions (PRQs) to address HIV-associated TB. Objective of the this study was to assess the impact of defining the research agenda in stimulating and directing research around priority research questions. Methods We used number and type of scientific publications as a proxy to quantitatively assess the impact of research agenda setting. We conducted 77 single systematic reviews -one for every PRQ -building 77 different search strategies using PRQs’ keywords. Multivariate logistic regression models were applied to assess the quantity and quality of research produced over time and accounting for selected covariates. Results In 2009-2015, PRQs were addressed by 1631 publications (median: 11 studies published per PRQ, range 1-96). The most published area was ‘Intensified TB case finding’ (median: 23 studies/PRQ, range: 2-74). The majority (62.1%, n = 1013) were published as original studies, and more than half (58%, n = 585) were conducted in the African region. Original studies’ publication increased over the study period (P trend = <0.001). They focused more on the ‘Intensified TB case finding’ (OR = 2.17, 95% CI: 1.56-2.93) and ‘Drug-resistant TB and HIV infection’ (OR = 2.12, 95% CI: 1.47-3.06) areas than non-original studies. Original studies were published in journals of lower impact factor and received a smaller number of citations than non-original studies (OR = 0.54, 95% CI: 0.42-0.69). Conclusion The generation of evidence to address PRQs has increased over time particularly in selected fields. Setting a priority research agenda for HIV-associated TB might have positively influenced the direction and the conduct of research and contributed to the global response to such a major threat to health.
[Unpublished] 2004. Presented at the Conference on Gender Justice in Post-Conflict Situations, "Peace Needs Women and Women Need Justice”. Co-organized by the United Nations Development Fund for Women [UNIFEM] and the International Legal Assistance Consortium. New York, New York, September 15-17, 2004. 4 p.Unfortunately, this is extremely well documented in countries in conflict. Many of the reports submitted to the Security Council include mention of the use of rape as a weapon of war. Recently, a report of the United Nations Organization Mission in the Democratic Republic of the Congo (MONUC) on the situation of human rights in Ituri provided information on this problem which is as specific as it is frightening. But, paradoxically, in countries which are not in conflict, the issue of violence against women is often neglected, where it is not concealed. But the private sphere cannot be an area where rights do not apply. (excerpt)
ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand.
Social Science and Medicine. 2003 Sep; 57(6):1031-1044.This study explores Thai physicians’ rationales about their prescribing practices for treating childhood diarrhoea within the public hospital system in central Thailand. Presented first are findings of a prospective clinical audit and observations of 424 cases treated by38 physicians used to estimate the prevalence of sub-optimal prescribing practices according to Thai government and WHO treatment guidelines. Second, qualitative interview data are used to identify individual, inter-personal, socio-cultural and organisational factors influencing physicians’ case management practices. Importantly, we illustrate how physicians negotiate between competing priorities, such as perceived pressure by caretakers to over-prescribe for their child and the requirement of health authorities that physicians in the public health system act as health resource gatekeepers. The rationales offered by Thai physicians for adhering or not adhering to standard treatment guidelines for childhood diarrhoea are contextualised in the light of current clinical, ethical and philosophical debates about evidence-based guidelines. We argue that differing views about clinical autonomy, definitions of optimal care and optimal efficiency, and tensions between patient-oriented and community-wide health objectives determine how standard practice guidelines for childhood diarrhoea in Thailand are implemented. (author's)
Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. [Prestation de services, couverture des coûts et équité dans une région au Burkina-Faso exploitant l'Initiative de Bamako]
Bulletin of the World Health Organization. 2003 Jul; 81(7):532-538.Objective: To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso. Methods: Qualitative and quasi-experimental quantitative methodologies were used. Findings: Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at ‘‘case’’ health centres but increased by 30.5% at ‘‘control’’ health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor. Conclusion: The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentivesmust be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay. (author's)