• 3D technology and telemedicine in humanitarian settings

      Moreau, P; Ismael, S; Masadeh, H; Katib, EA; Viaud, L; Nordon, C; Herfat, S (Elsevier, 2020-03-01)
    • An alternative classification to mixture modeling for longitudinal counts or binary measures

      Subtil, F; Boussari, O; Bastard, M; Etard, J-F; Ecochard, R; Génolini, C (SAGE Publications, 2014-09-01)
      Classifying patients according to longitudinal measures, or trajectory classification, has become frequent in clinical research. The k-means algorithm is increasingly used for this task in case of continuous variables with standard deviations that do not depend on the mean. One feature of count and binary data modeled by Poisson or logistic regression is that the variance depends on the mean; hence, the within-group variability changes from one group to another depending on the mean trajectory level. Mixture modeling could be used here for classification though its main purpose is to model the data. The results obtained may change according to the main objective. This article presents an extension of the k-means algorithm that takes into account the features of count and binary data by using the deviance as distance metric. This approach is justified by its analogy with the classification likelihood. Two applications are presented with binary and count data to show the differences between the classifications obtained with the usual Euclidean distance versus the deviance distance.
    • Applying the ICMJE authorship criteria to operational research in low-income countries: the need to engage programme managers and policy makers [letter]

      Zachariah, R; Reid, T; Van den Bergh, R; Dahmane, A; Kosgei, R J; Hinderaker, S G; Tayler-Smith, K; Manzi, M; Kizito, W; Khogali, M; et al. (Wiley-Blackwell, 2013-05-30)
    • Are Rapid Population Estimates Accurate? A Field Trial of Two Different Assessment Methods.

      Grais, RF; Coulombier, D; Ampuero, J; Lucas, M; Barretto, A; Jacquier, G; Diaz, F; Balandine, S; Mahoudeau, C; Brown, V; et al. (Published by Wiley-Blackwell, 2006-09)
      Emergencies resulting in large-scale displacement often lead to populations resettling in areas where basic health services and sanitation are unavailable. To plan relief-related activities quickly, rapid population size estimates are needed. The currently recommended Quadrat method estimates total population by extrapolating the average population size living in square blocks of known area to the total site surface. An alternative approach, the T-Square, provides a population estimate based on analysis of the spatial distribution of housing units taken throughout a site. We field tested both methods and validated the results against a census in Esturro Bairro, Beira, Mozambique. Compared to the census (population: 9,479), the T-Square yielded a better population estimate (9,523) than the Quadrat method (7,681; 95% confidence interval: 6,160-9,201), but was more difficult for field survey teams to implement. Although applicable only to similar sites, several general conclusions can be drawn for emergency planning.
    • Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi.

      Makombe, S D; Hochgesang, M; Jahn, A; Tweya, H; Hedt, B; Chuka, S; Yu, J K L; Aberle-Grasse, J; Pasulani, O; Bailey, C; et al. (2008-04)
      PROBLEM: As national antiretroviral treatment (ART) programmes scale-up, it is essential that information is complete, timely and accurate for site monitoring and national planning. The accuracy and completeness of reports independently compiled by ART facilities, however, is often not known. APPROACH: This study assessed the quality of quarterly aggregate summary data for April to June 2006 compiled and reported by ART facilities ("site report") as compared to the "gold standard" facility summary data compiled independently by the Ministry of Health supervision team ("supervision report"). Completeness and accuracy of key case registration and outcome variables were compared. Data were considered inaccurate if variables from the site reports were missing or differed by more than 5% from the supervision reports. Additionally, we compared the national summaries obtained from the two data sources. LOCAL SETTING: Monitoring and evaluation of Malawi's national ART programme is based on WHO's recommended tools for ART monitoring. It includes one master card for each ART patient and one patient register at each ART facility. Each quarter, sites complete cumulative cohort analyses and teams from the Ministry of Health conduct supervisory visits to all public sector ART sites to ensure the quality of reported data. RELEVANT CHANGES: Most sites had complete case registration and outcome data; however many sites did not report accurate data for several critical data fields, including reason for starting, outcome and regimen. The national summary using the site reports resulted in a 12% undercount in the national total number of persons on first-line treatment. Several facility-level characteristics were associated with data quality. LESSONS LEARNED: While many sites are able to generate complete data summaries, the accuracy of facility reports is not yet adequate for national monitoring. The Ministry of Health and its partners should continue to identify and support interventions such as supportive supervision to build sites' capacity to maintain and compile quality data to ensure that accurate information is available for site monitoring and national planning.
    • Beyond Open Data: Realising the Health Benefits of Sharing Data

      Pisani, E; Aaby, P; Breugelmans, JG; Carr, D; Groves, T; Helinski, M; Kamuya, D; Kern, S; Littler, K; Marsh, V; et al. (BMJ Publishing Group, 2016-10-10)
    • Blended SORT-IT for operational research capacity building: the model, its successes and challenges.

      Decroo, T; Van den Bergh, R; Kumar, AMV; Zachariah, R; Schillberg, E; Owiti, P; van den Boogaard, W; Benedetti, G; Shah, S; Ali, E; et al. (Taylor & Francis, 2018-05-10)
      The Structured Operational Research Training Initiative (SORT-IT) has been shown to be very effective in strengthening capacity for conducting operational research, publishing in scientific journals and fostering policy and practice change. The ‘classic’ model includes three face-to-face modules during which, respectively, a study protocol, a data analysis plan, and a manuscript are elaborated. Meanwhile, the lectures of the SORT-IT are available online as YouTube videos. Given the availability of this online material and the experiences with online mentorship of the faculty, we piloted a first blended distance/residential SORT-IT. To inform future implementers of our experience with blended operational research courses, we summarize the model, successes, and challenges of this approach in this perspective paper. The blended SORT-IT consisted of an online phase, covering modules 1 and 2, followed by a face-to-face writing module 3. Four out of six participants successfully completed the course, and submitted a manuscript to a peer-reviewed journal within four weeks of completing module 3. A blended approach may make the SORT-IT course more accessible to future participants and may favour the adoption of the course by other institutions, such as national Ministries of Health.
    • Bridging research integrity and global health epidemiology (BRIDGE) guidelines: explanation and elaboration

      Alba, S; Lenglet, A; Verdonck, K; Roth, J; Patil, R; Mendoza, W; Juvekar, S; Rumisha, SF (BMJ Publishing Group, 2020-10-28)
      Over the past decade, two movements have profoundly changed the environment in which global health epidemiologists work: research integrity and research fairness. Both ought to be equally nurtured by global health epidemiologists who aim to produce high quality impactful research. Yet bridging between these two aspirations can lead to practical and ethical dilemmas. In the light of these reflections we have proposed the BRIDGE guidelines for the conduct of fair global health epidemiology, targeted at stakeholders involved in the commissioning, conduct, appraisal and publication of global health research. The guidelines follow the conduct of a study chronologically from the early stages of study preparation until the dissemination and communication of findings. They can be used as a checklist by research teams, funders and other stakeholders to ensure that a study is conducted in line with both research integrity and research fairness principles. In this paper we offer a detailed explanation for each item of the BRIDGE guidelines. We have focused on practical implementation issues, making this document most of interest to those who are actually conducting the epidemiological work.
    • Bridging research integrity and global health epidemiology (BRIDGE) statement: guidelines for good epidemiological practice

      Alba, S; Verdonck, K; Lenglet, A; Rumisha, SF; Wienia, M; Teunissen, I; Straetemans, M; Mendoza, W; Jeannetot, D; Weibel, D; et al. (BMJ Publishing Group, 2020-10-28)
      Background Research integrity and research fairness have gained considerable momentum in the past decade and have direct implications for global health epidemiology. Research integrity and research fairness principles should be equally nurtured to produce high-quality impactful research—but bridging the two can lead to practical and ethical dilemmas. In order to provide practical guidance to researchers and epidemiologist, we set out to develop good epidemiological practice guidelines specifically for global health epidemiology, targeted at stakeholders involved in the commissioning, conduct, appraisal and publication of global health research. Methods We developed preliminary guidelines based on targeted online searches on existing best practices for epidemiological studies and sought to align these with key elements of global health research and research fairness. We validated these guidelines through a Delphi consultation study, to reach a consensus among a wide representation of stakeholders. Results A total of 45 experts provided input on the first round of e-Delphi consultation and 40 in the second. Respondents covered a range of organisations (including for example academia, ministries, NGOs, research funders, technical agencies) involved in epidemiological studies from countries around the world (Europe: 19; Africa: 10; North America: 7; Asia: 5; South-America: 3 Australia: 1). A selection of eight experts were invited for a face-to-face meeting. The final guidelines consist of a set of 6 standards and 42 accompanying criteria including study preparation, protocol development, data collection, data management, data analysis, dissemination and communication. Conclusion While guidelines will not by themselves guard global health from questionable and unfair research practices, they are certainly part of a concerted effort to ensure not only mutual accountability between individual researchers, their institutions and their funders but most importantly their joint accountability towards the communities they study and society at large.
    • Building leadership capacity and future leaders in operational research in low-income countries: why and how?

      Zachariah, R; Reid, T; Srinath, S; Chakaya, J; Legins, K; Karunakara, U; Harries, A D; Medical Department, Médecins Sans Frontières, Operational Centre Brussels, MSF-Luxembourg, Luxembourg. zachariah@internet.lu (2011-11)
      Very limited operational research (OR) emerges from programme settings in low-income countries where the greatest burden of disease lies. The price paid for this void includes a lack of understanding of how health systems are actually functioning, not knowing what works and what does not, and an inability to propose adapted and innovative solutions to programme problems. We use the National Tuberculosis Control Programme as an example to advocate for strong programme-level leadership to steer OR and build viable relationships between programme managers, researchers and policy makers. We highlight the need to create a stimulating environment for conducting OR and identify some of the main practical challenges and enabling factors at programme level. We focus on the important role of an OR focal point within programmes and practical approaches to training that can deliver timely and quantifiable outputs. Finally, we emphasise the need to measure successful OR leadership development at programme level and we propose parameters by which this can be assessed. This paper 1) provides reasons why programmes should take the lead in coordinating and directing OR, 2) identifies the practical challenges and enabling factors for implementing, managing and sustaining OR and 3) proposes parameters for measuring successful leadership capacity development in OR.
    • Challenges in measuring measles case fatality ratios in settings without vital registration

      Cairns, K L; Nandy, R; Grais, RF; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Health Section, UNICEF, UN Plaza, New York, NY, USA; Epicentre, Paris, France (2010-07-19)
      ABSTRACT: Measles, a highly infectious vaccine-preventable viral disease, is potentially fatal. Historically, measles case-fatality ratios (CFRs) have been reported to vary from 0.1% in the developed world to as high as 30% in emergency settings. Estimates of the global burden of mortality from measles, critical to prioritizing measles vaccination among other health interventions, are highly sensitive to the CFR estimates used in modeling; however, due to the lack of reliable, up-to-date data, considerable debate exists as to what CFR estimates are appropriate to use. To determine current measles CFRs in high-burden settings without vital registration we have conducted six retrospective measles mortality studies in such settings. This paper examines the methodological challenges of this work and our solutions to these challenges, including the integration of lessons from retrospective all-cause mortality studies into CFR studies, approaches to laboratory confirmation of outbreaks, and means of obtaining a representative sample of case-patients. Our experiences are relevant to those conducting retrospective CFR studies for measles or other diseases, and to those interested in all-cause mortality studies.
    • Clinic entrance interviews: a new method to assess needs after a sudden impact disaster

      Von Schreeb, J; Karlsson, N; Rosling, H (Open Medicine, 2007)
    • Clinical Field Research in a Post-conflict Setting

      Boggero, M (London School of Economics and Political Science and John Wiley & Sons Ltd, 2010-10)
    • Conducting operational research within a non governmental organization: the example of Medecins Sans Frontieres

      Zachariah, R; Ford, N; Draguez, B; Yun, O; Reid, T; Médecins Sans Frontières, Medical Department (Brussels Operational Centre- Operational Research), 68 Rue de Gasperich, L-1617, Luxembourg. (Elsevier, 2010-03-02)
      Like many other non governmental organizations (NGOs) that provide assistance to vulnerable populations living in difficult and resource-limited settings, Médecins Sans Frontières (MSF) is confronted with situations for which proven, effective interventions are often lacking and/or where there is need for strong advocacy for improving medical care. As a result, MSF has become an important contributor to health research, and has dedicated resources to guide operational research by establishing its own Ethics Review Board, an innovation fund, an online publications repository and by regularly contributing to major scientific conferences. However, this increased research activity has led to concern that priorities and resources may be diverted away from the essential mandate of care provision for NGOs. In response, this article discusses the potential role operational research can play within medical NGOs such as MSF, and highlights the relevance of operational research, the essential elements of developing it within the organisation and some of the perceived barriers and solutions.
    • Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children.

      Ashley, E A; Pinoges, L; Turyakira, E; Dorsey, G; Checchi, F; Bukirwa, H; van den Broek, I; Zongo, I; Urruta, P P P; van Herp, M; et al. (2008-08-09)
      BACKGROUND: Use of different methods for assessing the efficacy of artemisinin-based combination antimalarial treatments (ACTs) will result in different estimates being reported, with implications for changes in treatment policy. METHODS: Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a) reinfections excluded from the analysis (standard WHO per-protocol analysis) or (1b) reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a) WHO (2001) definitions of failure, or (2b) failure defined using parasitological criteria only. RESULTS: Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N = 1702), artesunate-sulphadoxine-pyrimethamine (AS+SP, N = 706) and artemether-lumefantrine (AL, N = 518).Using method (1a), the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference) and the others were: (i) method 1b = 1.3% [0 to 24.8], (ii) method 2a = 1.1% [0 to 21.5], and (iii) method 2b = 0% [-38 to 19.3].The standard per-protocol method (1a) tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a). It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size was lost when failures were classified on the first day of parasite recurrence and survival analytical methods were used. CONCLUSION: The primary purpose of an in vivo study should be to provide a precise estimate of the risk of antimalarial treatment failure due to drug resistance. Use of survival analysis is the most appropriate way to estimate failure rates with parasitological recurrence classified as treatment failure on the day it occurs.
    • Does research make a difference to public health? Time for scientific journals to cross the Rubicon

      Harries, A D; Zachariah, R; Ramsay, A; Kumar, A M V; Reid, A J; Terry, R F; Reeder, J C (International Union Against TB and Lung Disease, 2014-04-14)
    • Editing and publishing humanitarian medical research for Doctors Without Borders/ Médecins Sans Frontières

      Yun, O; Medecins Sans Frontieres/Doctors Without Borders, New York, USA (Council of Science Editors, 2009-08)
    • Effects of a refugee-assistance programme on host population in Guinea as measured by obstetric interventions.

      Van Damme, W; De Brouwere, V; Boelaert, M; Van Lerberghe, W; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. wvdamme@itg.be (Elsevier, 1998-05-30)
      BACKGROUND: Since 1990, 500000 people have fled from Liberia and Sierra Leone to Guinea, west Africa, where the government allowed them to settle freely, and provided medical assistance. We assessed whether the host population gained better access to hospital care during 1988-96. METHODS: In Guéckédou prefecture, we used data on major obstetric interventions performed in the district hospital between January, 1988, and August, 1996, and estimated the expected number of births to calculate the rate of major obstetric interventions for the host population. We calculated rates for 1988-90, 1991-93, and 1994-96 for three rural areas with different numbers of refugees. FINDINGS: Rates of major obstetric interventions for the host population increased from 0.03% (95% CI 0-0.09) to 1.06% (0.74-1.38) in the area with high numbers of refugees, from 0.34% (0.22-0.45) to 0.92% (0.74-1.11) in the area with medium numbers, and from 0.07% (0-0.17) to 0.27% (0.08-0.46) in the area with low numbers. The rate ratio over time was 4.35 (2.64-7.15), 1.70 (1.40-2.07), and 1.94 (0.97-3.87) for these areas, respectively. The rates of major obstetric interventions increased significantly more in the area with high numbers of refugees than in the other two areas. INTERPRETATION: In areas with high numbers of refugees, the refugee-assistance programme improved the health system and transport infrastructure. The presence of refugees also led to economic changes and a "refugee-induced demand". The non-directive refugee policy in Guinea made such changes possible and may be a cost-effective alternative to camps.