Building trust and increasing inclusion in public health research: co-produced strategies for engaging UK ethnic minority communities in research.

Patient and public involvement and engagement (PPIE) is essential for improved research outcomes and reduced research waste. To be effective, PPIE should provide opportunities for diverse groups to contribute to all research stages. However, UK ethnic minority communities remain underrepresented in research. This article describes strategies adopted in a public health research project that were effective in building trust and increasing inclusion of ethnic minority communities. The study team of researchers and PPIE partners reflects lessons learnt during the project and describe six main strategies that built meaningful levels of trust and inclusion: 1) early start to recruitment of PPIE partners; 2) relationship-focused engagement; 3) co-production and consultation activities; 4) open communication and iterative feedback; 5) co-production of project closure activities, and; 6) diverse research team. Meaningful outcomes for the community included the involvement of people from ethnic minorities as research participants and PPIE partners, community wellbeing, co-production of public health recommendations co-presented at the UK Houses of Parliament, and consortium-wide impact evidenced by the enrolment of 51 active PPIE partners. PPIE partners reflect on their research involvement, offering advice to researchers and encouraging people from ethnic minority communities to take part in research. An important message from PPIE partners is that involvement should not be restricted to projects specific to ethnic minorities but become a routine part of general population research, recognising ethnic minorities as an integral part of UK society. In conclusion, this article demonstrates that with appropriate strategies, inclusion and diversity can be achieved in public health research. We recommend researchers, practitioners and policy makers adopt these strategies when planning their public health projects.

Antibiotic stewardship in low- and middle-income countries: the same but different?

BACKGROUND: Antibiotic resistance (ABR) is a quickly worsening problem worldwide, also in low- and middle-income countries (LMICs). Appropriate antibiotic use in humans and animals, i.e. antibiotic stewardship (ABS), is one of the cornerstones of the World Health Organization's global action plan for ABR. Many LMICs are in the process of developing stewardship programs. AIMS: We highlight challenges for ABS initiatives in LMICs, give an outline of (inter)national recommendations and demonstrate examples of effective, contextualized stewardship interventions. SOURCES: We searched PubMed for articles on ABS interventions in humans in LMICs. Relevant websites and experts were consulted for additional sources. CONTENT: Evidence on effective and feasible stewardship interventions in LMICs is limited, and challenges for implementation of interventions are numerous. Nevertheless, several initiatives at the international and local levels in Latin America, Africa and Asia have shown that ABS effective interventions are feasible in LMICs, although contextualization is essential. IMPLICATIONS: Specific guidance for setting up antimicrobial stewardship programs in LMICs should be developed. Strategic points might need to be progressively addressed in LMICs, such as (a) ensuring availability of diagnostic testing, (b) providing dedicated education in ABR both for healthcare workers and the general public, (c) creating or strengthening (inter)national agencies towards better regulations and audit on production, distribution and dispensing of drugs, (d) strengthening healthcare facilities, (e) exploring a broader synergism between policy makers, academia, professional bodies and civil society and (f) designing and studying easy and scalable ABS interventions for both hospital and community settings.

Prevalence of visual impairment and blindness in a Nairobi urban population.

OBJECTIVE: To determine the prevalence and causes of visual impairment and blindness among Kibera slum dwellers. DESIGN: Population based Survey. SETTING: Kibera Slums, Kibera Division, Nairobi, Kenya. SUBJECTS: One thousand four hundred and thirty eight randomly selected slum dwellers. RESULTS: The prevalence of blindness and visual impairment was 0.6% (95% CI: 0.21 to 1.0), and 6.2% (95% CI: 4.95 to 7.15) respectively. 37.5% of those found blind were due to cataract followed by refractive errors 25.0%. 58.1% of those with visual impairment had refractive errors while 35.5% had cataracts. Females had a higher prevalence of visual impairment compared to males but the difference was not statistically significant (P = 0.104). CONCLUSIONS: Prevalence of blindness in Kibera slums is slightly lower than the estimated national average (0.7%) while that of visual impairment is almost three times higher. The leading causes of blindness are cataract followed by refractive errors. For visual impairment, refractive error was the leading cause followed by cataract. RECOMMENDATION: Kibera slum dwellers are in need of comprehensive eye care services offering cataract surgery and low cost spectacles.

Barriers to utilisation of eye care services in Kibera slums of Nairobi.

OBJECTIVES: To identify the main barriers to utilisation of eye care services among the slum population of Kibera in Nairobi, Kenya. DESIGN: Community based survey. SETTING: Kibera slums, Nairobi City, Kenya. SUBJECTS: Randomly selected 1,438 Kibera slum dwellers aged over two years. RESULTS: Majority of subjects (83.3%) do not utilise the nearby well-established eye clinics. Twenty one percent of those with poor vision do not seek treatment at all. The main barriers to seeking eye care services were lack of money, ignorance and the problem not causing much discomfort to warrant medical attention. There was significant, association between the level of education and health seeking behaviour (P = 0.008). CONCLUSION: Majority of Kibera slum dwellers have no access to eye care. RECOMMENDATION: There is need to establish a comprehensive primary eye care project to provide low cost but quality services affordable to Kibera slum dwellers.