A5059585509- Global Maternal and Child Health
- Malaria Research and Control
- Health Policy Implementation Science
- Healthcare Systems and Reforms
- Mosquito-borne diseases and control
- Community Health and Development
- Evaluation and Performance Assessment
- Primary Care and Health Outcomes
- Hemoglobinopathies and Related Disorders
- Technology Adoption and User Behaviour
- Mobile Health and mHealth Applications
- Diverse Scientific Research Studies
- Neonatal Health and Biochemistry
- Child Nutrition and Water Access
- Global Public Health Policies and Epidemiology
- Global Health and Epidemiology
- HIV/AIDS Impact and Responses
- Youth Development and Social Support
- Health Literacy and Information Accessibility
- Vaccine Coverage and Hesitancy
- ICT in Developing Communities
- Antibiotic Use and Resistance
- Complex Systems and Decision Making
- Patient-Provider Communication in Healthcare
- Healthcare Policy and Management
McMaster University
2020-2024
London School of Hygiene & Tropical Medicine
2012-2017
University of London
2013-2017
Infectious Diseases Research Collaboration
2013
<b>Objectives</b> To examine the impact of use rapid diagnostic tests for malaria on prescribing antimicrobials, specifically antibiotics, acute febrile illness in Africa and Asia. <b>Design</b> Analysis<b></b>of nine preselected linked codesigned observational randomised studies (eight cluster or individually trials one study). <b>Setting</b> Public private healthcare settings, 2007-13, Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, Uganda. <b>Participants</b> 522 480 children adults with...
Since 2010, the World Health Organization has been recommending that all suspected cases of malaria be confirmed with parasite-based diagnosis before treatment. These guidelines represent a paradigm shift away from presumptive antimalarial treatment fever. Malaria rapid diagnostic tests (mRDTs) are central to implementing this policy, intended target artemisinin-based combination therapies (ACT) patients and improve management nonmalarial fevers. The ACT Consortium conducted ten linked...
There is increasing recognition among trialists of the challenges in understanding how particular 'real-life' contexts influence delivery and receipt complex health interventions. Evaluations interventions to change worker and/or patient behaviours service settings exemplify these challenges. When interpreting evaluation data, deviation from intended intervention implementation accounted for through process evaluations fidelity, reach, intensity. However, no such systematic approach has been...
Objectives The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on use and adherence results in different contexts. Design A comparative case study approach, analysing variation outcomes across settings. Setting Studies from ACT Consortium evaluating mRDTs with a range supporting 6 endemic countries. Providers were governmental or...
Background In Uganda, community services for febrile children are expanding from presumptive treatment of fever with anti-malarials through the home-based management (HBMF) programme, to include malaria, diarrhoea and pneumonia Integrated Community Case Management (ICCM). To understand level support available, capacity motivation health workers deliver these expanded services, we interviewed medicine distributors (CMDs), who had been involved in HBMF programme Tororo district, shortly before...
Background The implementation of eHealth in low-resource countries (LRCs) is challenged by limited resources and infrastructure, lack focus on agendas, ethical legal considerations, common system interoperability standards, unreliable power, shortage trained workers. Objective aim this study to describe the current situation a small number LRCs from perspectives their professional users. Methods We developed structural equation model that reflects opinions users who work LRC health care...
Abstract Background The distribution of the enzymopathy glucose-6-phosphate dehydrogenase (G6PD) deficiency is linked to areas high malaria endemicity due its association with protection from disease. G6PD also identified as cause severe haemolysis following administration anti-malarial drug primaquine and further use this will likely require identification on a population level. Current conventional methods for screening have various disadvantages field use. Methods WST8/1-methoxy PMS...
Despite significant investments and reforms, health care remains poor for many in Africa. To design an intervention to improve access quality of at facilities eastern Uganda, we aimed understand local priorities qualities care, factors that enable or prevent these from being enacted. In 2009 2010, carried out 69 in-depth interviews 6 focus group discussions with 65 workers 17 facilities, 10 113 community members Tororo District, Uganda. Health-care seekers valued technical, interpersonal...
Despite significant investments into health improvement programmes in Uganda, indicators and access to healthcare remain poor across the country. The PRIME trial aims evaluate impact of a complex intervention delivered public centres on outcomes children management malaria rural Uganda. consists four components: Health Centre Management; Fever Case Patient- Centered Services; support for supplies diagnostics antimalarial drugs. PROCESS study will use mixed methods processes, mechanisms...
BackgroundIn Uganda, health system challenges limit access to good quality healthcare and contribute slow progress on malaria control. We developed a complex intervention (PRIME), which was designed improve of care for at public centres.ObjectiveResponding calls increased transparency, we describe the PRIME intervention's design process, rationale, final content reflect choices encountered during this intervention.DesignTo develop intervention, followed multistep approach, including...
In Africa, inadequate health services contribute to the lack of progress on malaria control. Evidence impact interventions improve population-level indicators is needed. We are conducting a cluster-randomised trial assess whether complex intervention delivered at public centres in Uganda improves outcomes children and treatment malaria, as compared current standard care. Twenty (level II III) Tororo district will be included; 10 randomly assigned Clusters include households located within 2...
This article describes a theory-driven evaluation of one component an intervention to improve the quality health care at Ugandan public centres. Patient-centred services have been advocated widely, but such approaches received little attention in Africa. A cluster randomized trial is evaluating population-level outcomes with multiple components, including 'patient-centred services.' process was designed within this articulate and evaluate implementation programme theories intervention....
Background Rapid diagnostic tests for malaria (mRDTs) have been scaled-up widely across Africa. The PRIME study evaluated an intervention aiming to improve fever case management using mRDTs at public health centers in Uganda. Methods A cluster-randomized trial was conducted from 2010–13 Tororo, a high transmission setting. Twenty were randomized 1:1 ratio or control. included training center management, with mRDTs, and patient-centered services; plus provision of artemether-lumefantrine (AL)...
Optimizing quality of care for malaria and other febrile illnesses is a complex challenge major public health importance. To evaluate the impact an intervention aiming to improve case management on community children, cluster-randomized trial was conducted from 2010–2013 in Tororo, Uganda, where transmission high. Twenty centers were included; 10 randomized 1:1 ratio or control. Households within 2 km provided sampling frame evaluation. The PRIME included training fever using rapid...
Background The burden of childhood obesity and cardiometabolic risk factors affecting newcomer Canadians living in lower socioeconomic circumstances is a concerning public health issue. This paper describes Strengthening Community Roots : Anchoring Newcomers Wellness Sustainability ( SCORE! ), an academic-community research partnership to co-design interventions that nurture optimize healthy activity (HAL) among community children families new Canada Hamilton, Ontario, Canada. Methods/Design...
Abstract-Rigorous evidence of "what works" to improve health care is in demand, but methods for the development interventions have not been scrutinized same ways as evaluation. This article presents and examines intervention processes eight malaria East West Africa. A case study approach was used draw out experiences insights from multidisciplinary teams who undertook design evaluate these studies. Four steps appeared necessary design: (1) definition scope, with reference evaluation...
Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within randomized controlled trial comparing to recommended dosing of two artemisinin-based combination therapies (ACT) treat uncomplicated Freetown, Sierra Leone. This explored circumstances and factors that influenced caregiver ACT prescribed for their child trial. In-depth interviews were with 49 caregivers; all recorded, transcribed, translated. Transcripts coded...
This article presents an application of the causal inference approach to mediation analysis using example a complex intervention that aimed improve quality care at health centres in Uganda. Mediation is statistical method aims isolate mechanisms make work given context. We combined data from cluster randomized control trial and mixed-methods process evaluation. developed two models following our hypotheses how was intended through outcomes community. In adjusted analyses, there evidence...
Abstract Objectives A systems map for the Riverdale community in Hamilton, Ontario has documented programs, activities, and spaces healthy, nature-based activities. was created to provide an approachable resource members. As a means of understanding whether this would prove useful, interviews with organization leaders were conducted. The objectives study 1) characterize user engagement recreational active living programs services located around community, 2) determine existing barriers...
Increasing global inequities have led to ongoing critiques of both the historical roots and current practices in health. From this literature, questions emerged about future health Canada's role future. However, there is little research exploring Canadian policy for funding experience stakeholders that currently implement projects with funding. This study explores stakeholder perspectives how Feminist International Assistance Policy (FIAP) influences adolescent sexual reproductive (ASRH)...
Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is believed to confer protection against malaria and its distribution prevalence are geographically correlated with endemicity. This enzymopathy has been identified as the cause of haemolysis following administration antimalarial drug primaquine. Screening for G6PD prior primaquine together artemisinin combination therapy treatment or massdrug being considered elimination. Current conventional methods screening have limitations field use.
Background Interventions aiming to improve health systems should engage people on the front lines of care delivery. Evaluations these interventions focus multiple change processes and outcomes resulting from their implementation into dynamic social systems. The PRIME intervention was designed build workers’ (HWs) skills by supporting motivating them emotionally in challenging work environments with goal improving treatment attracting patients centres (HC) Eastern Uganda. We conducted a...