ABSTRACT
There is limited evidence around the cost-effectiveness of interventions to reduce violence against children in low- and middle-income countries. We used a decision-analytic model to evaluate the cost-effectiveness of three intervention scenarios for reducing adolescent emotional, physical, and sexual abuse in Mpumalanga Province, South Africa. The intervention scenarios were: 1) Community grant outreach to link households to South Africa's Child Support Grant (CSG) if they are eligible, but not receiving it; 2) Group-based parenting support; and 3) Group-based parenting support 'plus' linkage to the CSG. We estimated average cost-effectiveness ratios (ACERs) for intervention scenarios over a ten-year time horizon, and compared them to a South Africa-specific willingness-to-pay (WTP) threshold (USD3390). Health effects were expressed in disability-adjusted life years (DALYs) averted. Our model considered four combinations of routine service versus trial-based costing, and population-average versus high prevalence of violence. Under routine service costing, ACERs for grant outreach and parenting support were below the WTP threshold when considering a population-average prevalence of violence USD2850 (Lower: USD1840-Upper: USD10,500) and USD2620 (USD1520-USD9800) per DALY averted, respectively; and a high prevalence of violence USD1320 (USD908-USD5180) and USD1340 (USD758-USD4910) per DALY averted, respectively. The incremental cost-effectiveness of parenting support plus grant linkage relative to parenting support alone was USD462 (USD346-USD1610) and USD225 (USD150-USD811) per DALY averted at a population-average and high prevalence of violence, respectively. Under trial-based costing, only the ACER for grant outreach was below the WTP threshold when considering a high prevalence of violence USD2580 (USD1640-USD9370) per DALY averted. Confidence intervals for all ACERs crossed the WTP threshold. In conclusion, grant outreach and parenting support are likely to be cost-effective intervention scenarios for reducing violence against adolescents if they apply routine service costing and reach high risk groups. Combining parenting support with grant linkage is likely to be more cost-effective than parenting support alone.
ABSTRACT
BACKGROUND: Missed nursing care undermines nursing standards of care and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept is a neglected aspect of human resource for health thinking, and it remains understudied in low-income and middle-income country (LMIC) settings which have 90% of the global nursing workforce shortages. Our objective in this review was to document the prevalence of missed nursing care in LMIC, identify the categories of nursing care that are most missed and summarise the reasons for this. METHODS: We conducted a systematic review searching Medline, Embase, Global Health, WHO Global index medicus and CINAHL from their inception up until August 2021. Publications were included if they were conducted in an LMIC and reported on any combination of categories, reasons and factors associated with missed nursing care within in-patient settings. We assessed the quality of studies using the Newcastle Ottawa Scale. RESULTS: Thirty-one studies met our inclusion criteria. These studies were mainly cross-sectional, from upper middle-income settings and mostly relied on nurses' self-report of missed nursing care. The measurement tools used, and their reporting were inconsistent across the literature. Nursing care most frequently missed were non-clinical nursing activities including those of comfort and communication. Inadequate personnel numbers were the most important reasons given for missed care. CONCLUSIONS: Missed nursing care is reported for all key nursing task areas threatening care quality and safety. Data suggest nurses prioritise technical activities with more non-clinical activities missed, this undermines holistic nursing care. Improving staffing levels seems a key intervention potentially including sharing of less skilled activities. More research on missed nursing care and interventions to tackle it to improve quality and safety is needed in LMIC. PROSPERO registration number: CRD42021286897.
Subject(s)
Nursing Care , Nursing Staff, Hospital , Humans , Developing Countries , Cross-Sectional Studies , Quality of Health Care , HospitalsABSTRACT
OBJECTIVE: To identify nurse staffing and patient care outcome literature in published systematic reviews and map out the evidence gaps for low/middle-income countries (LMICs). METHODS: We included quantitative systematic reviews on nurse staffing levels and patient care outcomes in regular ward settings published in English. We excluded qualitative reviews or reviews on nursing skill mix. We searched the Cochrane Register of Systematic Reviews, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Medline, Embase and Cumulative Index to Nursing and Allied Health Literature from inception until July 2021. We used the A Measurement Tool to Assess Systematic Reviews -2 (AMSTAR-2) criteria for risk of bias assessment and conducted a narrative synthesis. RESULTS: From 843 papers, we included 14 in our final synthesis. There were overlaps in primary studies summarised across reviews, but overall, the reviews summarised 136 unique primary articles. Only 4 out of 14 reviews had data on LMIC publications and only 9 (6.6%) of 136 unique primary articles were conducted in LMICs. Only 8 of 23 patient care outcomes were reported from LMICs. Less research was conducted in contexts with staffing levels that are typical of many LMIC contexts. DISCUSSION: Our umbrella review identified very limited data for nurse staffing and patient care outcomes in LMICs. We also identified data from high-income countries might not be good proxies for LMICs as staffing levels where this research was conducted had comparatively better staffing levels than the few LMIC studies. This highlights a critical need for the conduct of nurse staffing research in LMIC contexts. LIMITATIONS: We included data on systematic reviews that scored low on our risk of bias assessment because we sought to provide a broad description of the research area. We only considered systematic reviews published in English and did not include any qualitative reviews in our synthesis. PROSPERO REGISTRATION NUMBER: CRD42021286908.
Subject(s)
Developing Countries , Outcome Assessment, Health Care , Humans , Patient Care , Systematic Reviews as Topic , WorkforceABSTRACT
Anaemia - a condition of low haemoglobin level in the blood is prevalent among women in Nigeria despite years of interventions. Wealth status have implications for this prevalence but there is a dearth of research examining this relationship and residential dimensions in it. The social determinant of health framework was employed to understand the rural-urban dimension of this relationship. Chi-square test and multivariate logit regression models were used to analyse data from the 2018 Nigeria Demographic and Health Survey (n=13,575). We found that anaemia status is higher among rural women (66%). The odds of being anaemic is higher with decreasing wealth status irrespective of place of residence but the odds are higher for poor women in urban areas compared to poor women in rural areas after adjusting for covariates. Maternal health interventions should be more innovative in their design of programs by being sensitive of residential dimension.
ABSTRACT
Background: Missed nursing care (care left undone or task incompletion) is viewed as an important early predictor of adverse patient care outcomes and is a useful indicator to determine the quality of patient care. Available systematic reviews on missed nursing care are based mainly on primary studies from developed countries, and there is limited evidence on missed nursing care from low-middle income countries (LMICs). We propose conducting a systematic review to identify the magnitude of missed nursing care and document factors and reasons associated with this phenomenon in LMIC settings. Methods and analysis: This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). We will conduct literature searching across the Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, from inception to 2021. Two independent reviewers will conduct searches and data abstraction, and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be determined using the Newcastle-Ottawa Scale (NOS). Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals PROSPERO registration number: CRD42021286897 (27 th October 2021).
ABSTRACT
Background: Adequate staffing is key to the delivery of nursing care and thus to improved inpatient and health service outcomes. Several systematic reviews have addressed the relationship between nurse staffing and these outcomes. Most primary studies within each systematic review are likely to be from high-income countries which have different practice contexts to low and middle-income countries (LMICs), although this has not been formally examined. We propose conducting an umbrella review to characterise the existing evidence linking nurse staffing to key outcomes and explicitly aim to identify evidence gaps in nurse staffing research in LMICs. Methods and analysis: This protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). Literature searching will be conducted across Ovid Medline, Embase and EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Two independent reviewers will conduct searching and data abstraction and discordance will be handled by discussion between both parties. The risk of bias of the individual studies will be performed using the AMSTAR-2 . Ethics and dissemination: Ethical permission is not required for this review as we will make use of already published data. We aim to publish the findings of our review in peer-reviewed journals. PROSPERO registration number: CRD42021286908.
ABSTRACT
Background: Since the coronavirus disease 2019 (COVID-19) outbreak was first reported in December 2019, many independent trials have been planned that aim to answer similar questions. Tools allowing researchers to review studies already underway can facilitate collaboration, cooperation and harmonisation. The Infectious Diseases Data Observatory (IDDO) has undertaken a living systematic review (LSR) to provide an open, accessible and frequently updated resource summarising characteristics of COVID-19 study registrations. Methods: Review of all eligible trial records identified by systematic searches as of 3 April 2020 and initial synthesis of clinical study characteristics were conducted. In partnership with Exaptive, an open access, cloud-based knowledge graph has been created using the results. Results: There were 728 study registrations which met eligibility criteria and were still active. Median (25 th, 75 th percentile) sample size was 130 (60, 400) for all studies and 134 (70, 300) for RCTs. Eight lower middle and low income countries were represented among the planned recruitment sites. Overall 109 pharmacological interventions or advanced therapy medicinal products covering 23 drug categories were studied. Majority (57%, 62/109) of them were planned only in one study arm, either alone or in combination with other interventions. There were 49 distinct combinations studied with 90% (44/49) of them administered in only one or two study arms. The data and interactive platform are available at https://iddo.cognitive.city/. Conclusions: Baseline review highlighted that the majority of investigations in the first three months of the outbreak were small studies with unique treatment arms, likely to be unpowered to provide solid evidence. The continued work of this LSR will allow a more dependable overview of interventions tested, predict the likely strength of evidence generated, allow fast and informative filtering of relevant trials for specific user groups and provide the rapid guidance needed by investigators and funders to avoid duplication of efforts.
