Session 1: Women's & Mental Health
Great Hall, 11.00
1. What evidence is there that engaging men to prevent violence against women works?
Team: Dani Bancroft, Rachel Merrick, Angeline Pesala, Shiron Rajendran, Anita Bolina
Commissioner: Professor David Osrin, UCL Institute of Global Health, SNEHA (Mumbai, India)
Abstract: Every day in 2017, 82 women were murdered by a current or former intimate partner. Whilst numerous studies have validated the utility of programmes empowering women to stem the perpetration of intimate partner violence (IPV), few have evaluated interventions that instead target men to reduce IPV against women, either as individual “batterers” or at the community level. With limited resources, there is a growing feminist rhetoric that a male-oriented approach when women are the victims should not be allocated funding. Therefore, this review seeks to assess what evidence there is that working with men does reduce IPV against women, and consider how this might inform policies of those working with men instead of – or as well as – women.
A systematic literature review was conducted for critical appraisal of programmes engaging men to prevent IPV against women. Medline, Global Health, Embase, PsychEXTRA, PsychInfo and Social Policy & Practice databases were searched for terms and subject headings associated with IPV, men and interventions on June 17, 2019. After removing duplicates, 11,845 papers were screened, of which 222 were included for data extraction. Currently, 35 full papers have been read, 18 of which are relevant to this project’s aim and thus had pertinent data extracted. The quality of included papers will be assessed, with main findings amalgamated via a narrative synthesis.
The majority (59%) of the studies reviewed so far suggest positive impacts of engaging men to reduce IPV. These have been mostly court-mandated batterer intervention programmes (BIPs). However, effect size was often marginal, and frequently diminished 12-months post-intervention. Moreover, intervention effectiveness was commonly measured distally by batterer self-reported accounts of abuse, changes in attitudes and norms, or by programme completion.
Whilst early findings suggest meaningful benefits of programmes seeking to engage men to prevent IPV, substantial methodological variations (including absence of an appropriate control group), significant participant drop-out (~40-50%) and relatively short (≤12 months) follow-up periods undermine previous reports of programmatic success for such interventions. Subsequently, more rigorous studies, including those with proximal measures of IPV like partner-reported abuse and judicial recidivism, are needed before policy recommendations can be made regarding the evidence for working with men to reduce IPV.
2. The relationship between social media use and body image in young people
Team: Olivia Rowe, Isobel Ashby, Ananya Arora, Ines Grange, Rhiannon Osbourne
Abstract: With over 3 billion active social media users in 2019, many academics are investigating possible negative impacts of social media usage. The following literature review investigates the relationship between social media and body image, including the potential moderators of this relationship. The purpose of this review is to highlight important areas for future research and provide guidelines for young people to encourage the healthier use of social media.
The data collection was conducted by searching standard databases for recent studies investigating this relationship in young people (below the age of 25 years old).
The review found strong support for a negative effect of social media usage on body image. This is likely mediated through the internalisation of a certain body ideal and comparison to peers and celebrities. Particular behaviours and personality styles influence the effect of any given social media site on body image, highlighting that it is the way the site is used, rather than the site itself, that influences body image.
We conclude with three guidelines to help individuals use social media more responsibly: restrict social media usage, censor social media content and educate yourself and others about digitally manipulated photos. Directions for future research are also suggested.
Session 2: Antimicrobial Resistance
Room 1, 11.00
Use of pull incentives to incentivise the pharmaceutical industry to develop antimicrobials: a systematic review and narrative synthesis
Team: Rebecca Leszczynski, Paul Kiet Tang, Vanessa Lok, Ali Khalid
Commissioner: Jeremy Lefroy
Antimicrobial resistance (AMR) is a global threat. Pharmaceutical companies are reluctant to invest in the development of new antimicrobials as they do not offer the same reward as other more profitable drug categories. New incentives are therefore required; these can be split into either push or pull mechanisms. Current incentives have focused on push mechanisms, but these have several limitations for antimicrobial drug development for which high sales volume is not the end goal. Less focus has been on pull mechanisms, which have greater potential for promoting drug development with low sales volume. In this study, we aimed to identify and propose a feasible incentive package focused on pull mechanisms alone or in combination with push mechanisms to encourage the pharmaceutical industry to invest in antimicrobials in a sustainable manner.
We performed a systematic review, searching Embase, MEDLINE, Web of Science, and Global Health from Jan 1, 2009, to Aug 10, 2019. We used both MeSH terms and keywords relevant to pull incentives and AMR. Only papers published in English were selected. De-duplication was done using RefWorks. All abstracts were screened by at least two independent reviewers in a blinded fashion using Rayyan. Conflicts and uncertainty were resolved by a third independent reviewer. Relevant abstracts were taken forward for full-paper screening. These papers were reviewed and data were extracted. The quality of included papers will be assessed and a narrative synthesis will be carried out to identify pull incentives evaluated in the literature.
We identified 779 papers of which 34 underwent full-paper screening with data extraction to determine the quality and relevance of these papers. Our preliminary results show that the literature has identified several viable pull mechanisms, including tradable exclusivity vouchers and de-linking sales volume to revenue. Data extraction is currently being finalised to complete synthesis of the final findings to facilitate the development of the policy recommendations.
We will report final details of the data extraction at the Polygeia Conference 2019. We hope this systematic review will provide the basis for policy makers and stakeholders to incentivise pharmaceutical companies to develop antimicrobials.
Session 3: Health Literacy & Technology
Great Hall, 12.30
1. A systematic review of the effectiveness of content and delivery of health literacy programs in native language curricula for non-native language speakers
Team: Yvonne Wasii Musa, Alba Le Cardinal, Laure Mourgue d'Algue
Commissioner: Dr. Ines Campos-Matos
As the number of international migrants continues to increase, the necessity to integrate these populations becomes a challenge that must be answered promptly. In the health sector, inability to do so compounds poor health outcomes to these non-native language speaker groups. Investments and interventions to integrate health literacy into language curricula have been developed as a solution to improving migrant health. This review aims to assess the most effective content and delivery methods of different health literacy programs embedded in language curricula for non-native language speakers.
Searches were conducted in September 2019 in nine databases including Cinnahl, Cochrane, Embase, ERIC, Medline, PsycINFO, Pubmed, Scorpus and web of science using the search terms, ‘health literacy’ and ‘curricul*’. All articles ever published on the subject were included if they were: peer reviewed, written in English, described a health literacy intervention embedded in a native language curriculum, described the intervention implementation and evaluation in non-native language speakers who are >18 years old.
16 articles were included, all originating from native English-speaking countries. Content delivered in the curricula varied from theme based, to disease specific, to comprehensive/non-specific content. Some studies highlighted different outcomes depending on the level of language fluency. Content was delivered using a combination of teaching methods in all the studies with resulting improvement in outcomes under study.
Few studies assess the effectiveness of different health literacy content and their delivery methods. Grounding the curriculum in a combination of adult learning methods rather than a single one guarantees effectiveness of delivery. The use of disease specific content as opposed to comprehensive content has not been shown to have superior outcomes. In addition, self-standing lessons rather than prolonged courses are more effective. Simple theme-based content that communicates practical information is more efficient than an in-depth scientific approach to health literacy. Furthermore, curricula content that can flexibly tailor to the needs and culture of its students is also more effective.
2. A Systematic Review Of The Effectiveness Of M-Health Interventions In The Prevention Of Cervical Countries In High- Income Countries
Team: Rahaf Abu Koura, Alay Rangel, Davina Nylander, Honey Ajisefini, Queena Luu
In 2018, an estimated 570,000 women were diagnosed with cervical cancer globally, ranking it fourth on the list of most frequent cancers in women. In 2015, 12-30 out of 100,000 women were affected by cervical cancer in Europe. The use of a comprehensive approach to cervical cancer prevention and control throughout the life course will help reduce the burden of the disease. Studies have shown that digital health and technology can play an important part in strengthening the prevention, control and management of cervical cancer. Through creating change in behaviour mediators such as knowledge, attitudes and beliefs, mHealth interventions can affect health-related behaviour and outcomes. The systematic review will identify and critically appraise studies to assess the effects of mHealth interventions in increasing awareness of cervical cancer and prevention of cervical cancer (including both vaccination and screening rates) in high income countries.
We searched for studies in PubMed/Medline, Embase, CINAHL Plus and Web of Science.
We excluded the following studies design: pilot studies, expert opinion, descriptive case studies, case series and technical reports and reviews. Studies carried out in low-to-middle income countries and those that included only males were also excluded. Randomised control trials, quasi-experimental studies and non-randomised control trials were used to assess how mHealth interventions can improve cervical cancer screening outcome.
Data collection and analysis: All five authors were involved in the screening then in the critical appraisal and data extraction of the identified eligible studies using a data extraction tool adapted from the Cochrane Intervention Review for Randomised Control Trials Data Extraction Form, EPOC Critical Appraisal Criteria and EPHPP Quality Assessment Tool. Data extracted included, study design, characteristics of study populations, interventions, controls and study results. In addition, the risk of bias of included studies was assessed independently by two reviewers.
We found 5850 studies in different electronic databases, 4165 studies were included after removing duplicated studies. All were screened and among them, 95 studies were fully assessed for eligibility criteria and then, 90 were excluded with reasons and 6 studies were included in meta- analysis. Currently, the meta-analysis and data interpretation is ongoing and will finalised by the end of this month.
Session 4: Environment & Development
Room 1, 12.30
1. A Guide to Microplastics: Risks and Alternatives
Team: Hampton Gray Gaddy, Anmol Arora, Eleanor Harris
Commissioner: Friends of the Earth UK
Abstract: Microplastics are pieces of plastic less than 5 millimetres in diameter. They can be intentionally produced that small (e.g. as exfoliants for cosmetic products) or be produced from the fragmentation of larger plastics (e.g. the washing of synthetic clothes and the weathering of plastic litter). Microplastic pollution has become ubiquitous in both human and natural environments. It has been found in ecosystems quite remote from human activity, and human populations are subject to a daily dose of microplastics in their air and water. Understandable concern about the potential human health impacts of microplastics has arisen, fuelled by a flurry of popular interest in the last few months. Google Trends indicates that global interest in microplastics in October 2019 is roughly 2x greater than that in the first half of 2019 and 9x that in 2016. A WHO report released this August tentatively states that microplastics pose ‘a low concern for human health’ under the narrow conditions they studied. However, there remain significant gaps in both the scientific and the public understandings of microplastic pollution. This paper serves as a research-based but policy-oriented introduction to the issue of microplastics. The key questions addressed are how they enter the environment, how they may affect human health, how they may affect other parts of the environment, what economic effects their potential harms may have, what major research questions about them remain to be addressed, how their potential harms can be reduced, and what the current policies regarding them are. We hope that this guide will allay likely unwarranted fears regarding microplastics, spur more research into microplastics, and raise awareness about what could be a significant global health and environmental challenge.
2. How does a transition to low carbon development address poverty alleviation in Global South cities?
Team: Uzor KJ, Gowens E, Marková L, Tee S, Tan YJ, Ali S
Commissioner: C40 Cities Climate Leadership Group
Countries in the global south face many challenges. Apart from extreme poverty, there is evidence that climate change will exert most of its deleterious effects in developing countries due to their limited adaptation and mitigation capabilities. Rapid population growth, rural to urban migration, infrastructural deficits, poor urban planning and high rate of unemployment has increased the number of urban poor. As these challenges evolve, development experts are looking into innovative ways of solving the problems. One of such solutions is the role of low carbon development in the reduction of environmental pollution and wealth creation.
We found that the use of biogas in India presents a tool to provide sustainable energy for poor families while reducing the impact of environmental degradation by channelling biological wastes to energy generation. It also reduces the time spent by women to look for alternative energy sources like firewood, thereby encouraging more female education and workforce participation—activities that are directly linked to economic productivity. In Senegal, private investors are collaborating with the government and multilateral development institutions to scale-up investments in wind farms and solar panels. This will increase electrification in Senegal, especially in rural areas, where access to electricity is limited. In addition to increasing access to electricity, spurring economic growth and job creation, these projects will reduce Senegal’s reliance on fossil fuels. Bicycle schemes in Chennai, Bogota, and Lima were shown to reduce environmental pollution from car emissions and improve the health status of participants by encouraging exercise. Also, they encourage a more equal and inclusive society.
This research provided evidence that low carbon development not only reduces carbon emissions but also provides pathways to improve the lives of poor populations. Low carbon initiatives like biogas development, wind farms, solar panels, and bicycle schemes provide sustainable and green energy for communities; reduces environmental pollution; and improves the health and economic productivity of the citizens. These links between good health, economic productivity, and development have been widely recognised and form the basis for sustainable development goals.
Session 5: Sustainable Development
Room 2, 12.30
1. Exploring the synergies between climate and biodiversity action plans within cities
Team: Rebekah Hinton, Julia Wiener, Lisa Kong, Michelle Parker, Iona Pickett, Pei Lynn Tan
Commissioner: C40 Climate Cities
Abstract: Cities across the world are preparing for and reacting to the effects of climate change on their ecosystems, including their human populations, by creating and implementing climate change action plans and, to a lesser extent, biodiversity action plans. In order to truly generate a sustainable cities with effective climate and biodiversity policies, potential synergies must be explored to generate action plans which have beneficial impacts on both climate and biodiversity.
This report investigates some of the key themes of city policies in which synergies between climate and biodiversity action plans can be identified and implemented. We investigate the role of urban planning, urban greening, urban agriculture, water management, waste management and air quality control on the biodiversity and climate policies of cities. We furthermore expand on some of the key cross-overs of these areas with social issues such as food security and nutrition, migration and relocation and public health. Using case studies from a range of cities around the world, alongside policy suggestions, we aim to highlight the importance of climate and biodiversity in generating sustainable, future cities.
2. Intersectoral collaboration and the Sustainable Development Goals
Team: Tim Lindsay, Isabella Weber, Lara Vecchi, Akhila Jayaram
Commissioner: Neil Squires (Public Health England)
The Sustainable Development Goals (SDGs) comprise an expansive and ambitious agenda across 17 themes and 169 targets. The SDGs explicitly emphasise that the individual themes and targets are fundamentally intertwined and cannot be achieved without a cohesiveness of planning and attention between them. We, therefore, propose that intersectional collaboration is essential to achieving the SDGs. However, what such collaboration looks like at this level is less clear.
Some policymakers have celebrated the interconnectedness of the SDGs as a leap towards creating coherence across themes that require mutual support and have shared goals. Others, however, have noted that some of the goals come into conflict with one another when specific regional and local issues collide. A requirement for intersectional collaboration is, therefore, simultaneously self-evidently necessary and a challenge.
We identify three examples of previous intersectoral collaboration to address a variety of issues – tobacco use in Austria, diabetes, and HIV. We evaluate the approaches taken to combat these health issues such as the FCTC and MPOWER framework and draw parallels with the SDGs. In doing so, we highlight methods of intersectoral collaboration that could be adopted to address the SDGs.
We identify past examples of successful intersectoral collaboration to provide a model for the utilisation of intersectoral collaboration in the future. Those working on the SDGs should not see intersectoral collaboration as applicable to only one type of goal or target, but rather as a framework that can be adapted and adjusted to suit the desired outcome. The complexity and interconnectedness of the SDGs demand an integrated and indivisible approach. In this respect, intersectoral collaboration could be the key to success.
1. Common identifying characteristics of "good" and "bad" health information
Team: Nusrat Khan, Haowen Kwan, Oieshi Saha, Lily-Rose Sharry, Olivia Shallcross, Thomas Birdseye
Commissioner: Tom Rudnai (Logically)
Fake news is a topic of increasingly popular discussion. The nature of the Internet means that everyone can post information, thus opening the floodgates to fake information. Health misinformation is of particular concern as it undermines public health and can be potentially harmful. There is a need for quality control over health information but a better understanding of fake medical news is needed. In this project we have conducted a literature review on fake medical news and put together a taxonomy of good and bad health information to help identify fake news in the future.
We investigated 4 topics: general health concerns, anti-vaccination, nutrition during pregnancy and cancer treatments. This allowed us to compare characteristics of fake news across different topics. Search were performed on medical databases including PubMed and Scopus. The search terms included “fake news” or “propaganda” and topic-specific terms such as “anti-cancer drugs”. There were few articles on these databases and we had to perform further searches in Google to include news and journal articles.
We were able to find 27 papers and articles commenting on health misinformation but there are few who have investigated the characteristics of fake medical news: 5 for general health, 5 for cancer treatment and none for anti-vaccination and pregnancy. Most tested commonly sited criteria such as design, disclosures, references and source and agreed that these are sufficient but some have shown that they are not always effective and may be inadequate as appraisal tools.
Overall, there are insufficient studies investigating the characteristics of ‘good’ and ‘bad’ health information. This is likely due to two significant barriers: the effort involved to read through the wealth of health information on the Internet and the difficulty in determining whether health information is “fake”. Commonly cited criteria are commonly cited for a reason, and while they may be a good indicator of “good” health information, conflicting results mean that more research is needed to confirm whether this is the case.
2. A systematic review of factors affecting uptake of available and pipeline vaccines
Team: Safia Akhtar, Chinedu, Segun, Tofunmi, Abdulbasit, Ayobami, Bimpe, Ella, Jaachi, Lawal, Molly, Ore, Priya
Vaccine-preventable disease outbreaks are at their largest since the declaration of their elimination. This is a considerable public health downfall, which deserves its listing as one of the World Health Organisation’s (WHO) ten threats to global health for 2019. This research aims to pinpoint the barriers to immunisation in various countries worldwide, taking into account the knowledge, attitudes and perceptions of different populations.
A systematic review of peer reviewed, and grey literature was conducted using a search strategy on Ovid MEDLINE database, to identify the factors affecting vaccination uptake for currently applied and pipeline vaccinations globally. Applied vaccinations included Cholera, Dengue, Diphtheria, Hepatitis A, B and E, Haemophilus influenzae type b, human papillomavirus, Influenza, Japanese encephalitis, Malaria, Measles, Meningococcal meningitis, Mumps, Pertussis, Pneumococcal disease, Poliomyelitis, Rabies, Rotavirus, Rubella, Tetanus, Tick-bourne encephalitis, Tuberculosis, Typhoid, Varicella and Yellow fever. Pipeline vaccinations included those for Ebola, HIV, Malaria, Syphilis, Tuberculosis and Zika. The same exclusion criteria were applied across searches to distinguish the most relevant papers.
Factors affecting uptake included: healthcare provision, economic means, physician recommendation, maternal/paternal education, health literacy. The research also identified particular subgroups that are more reluctant to vaccinations.
Wide-ranging barriers to vaccination still persist to the uptake to both applied and pipeline vaccinations. Recommendations should target policy makers at national level and should consider particular subgroups that may be more vulnerable to outbreaks.
3. Comparison of brief clinical delirium and cognitive testing amongst patients admitted via the Trauma and Orthopaedic (T&O) acute intake - a service evaluation on the clinical dependence, efficacy and accessibility of implementing Gwent Orientation and Awareness Listing (GOAL) testing in relation to the 4AT at the Royal Gwent Hospital Newport, UK.
Team: Miles Allison, Jack Wellington, Alexander Eggleton, Reem Naji, Inderpal Singh
GOAL is the brief delirium/cognitive clinical test currently employed at Royal Gwent Hospital Newport where the 4AT test is routinely utilized. To our knowledge, both tests have not been prospectively compared against, relative to equal patient cohorts.
We aim to, (1) evaluate two rapidly performed valid cognitive examinations amongst the same patient cohort, and (2) assess patient testing results among acute/emergency T&O admissions compared with previously obtained patient data presenting via the acute medical intake.
Verbal consent to cognitive testing by means of GOAL and 4AT was sought from patients presenting acutely to T&O over a four-week period. A GOAL score of <8/10 is deemed a “fail”, and on 4AT any error is deemed “possible cognitive impairment”. Patient documentation regarding dementia, epilepsy, psychiatric/neurological illness was recorded alongside living arrangements.
There were 146 patients, of whom 10 were not well enough to be scored, and 1 patient declined to participate. Therefore, results are based on a 135-patient cohort, all of whom were able to co-operate with both scores. Of these, 92 “passed” both tests, 40 “failed” on 4AT, of which 18 also “failed” on GOAL. There were 3 who “failed” on GOAL but passed on 4AT. Likelihood of test failure was significantly greater with 4AT (Х2 =7.65, p<0.01). Ages and comparisons on GOAL testing results with historical general medical patient cohort displayed significant differences between patient co-operation in acute medical and T&O intakes.
(1) The 4AT test is more likely to signal cognitive impairment than GOAL among T&O emergency admissions; (2) T&O intake patients are more likely to co-operate with cognitive testing by GOAL, and they perform better than acute medical emergency admissions.
4. What are the environmental and social influences on the mental well-being of women living in Afghanistan?
Team: Ilan Kelman, Sabeera Dar
Abstract: Access to mental healthcare services shows stark disparities around the globe. Afghanistan is a country that offers scarce facilities pertaining to mental health and is commonly cited as one in which the suicide rate of women is greater than that of men, unlike any other country in the world. The aim of this project is to explore how the mental well-being of women living in Afghanistan is multi-levelled and is affected by a complex interplay of factors; in this project I review literature that draws upon socio-cultural and environmental influences including the barriers facing women in accessing mental healthcare, how social and cultural norms around sexual and reproductive health rights influence the mental well-being of women and further consider how in the context of increased disaster rates, the psychological consequences of environmental risk show a gendered effect thus demanding special consideration.
5. How can anthropological perspectives contribute to adapting policy and practice in mental health to improve care for black and ethnic minority patients?
Team: Nivethitha Ram
Abstract: The thesis explores how an anthropological perspective, conceptualised as an interpretative approach rooted in complex systems thinking, can strengthen the validity of psychiatric knowledge that forms the evidence base for mental health care provided to ethnic minority patients within multicultural societies of the West. The work seeks to critique biomedical reductionism and challenge the hegemony of Western psychiatry in global mental health by identifying its blindspots both in theory (how we classify and understand mental illness) and in practice (how we prevent and treat mental illness). It discusses, using specific examples from varied contexts, how promoting mental health in ethnic minority populations necessitates the incorporation of cross-cultural perspectives on (i) aetiology; (ii) idioms of distress; (iii) acceptability of diagnostics and therapeutics, into evidence-based practice. The work takes an interdisciplinary approach, applying concepts from political philosophy and sociology (such as, decolonisation theory and epistemic injustice) to explain the higher prevalence of mental illness and poorer therapeutic outcomes observed in ethnic minority communities, as compared to the White British population. Grounding the discussion in pragmatic solutions, the work concludes that operationalising an anthropological perspective requires moving beyond technocratic cultural competence, towards training doctors in intersubjective, self-reflexive interpretation at the micro-level of the clinical encounter and at the macro-level of public health policy. Future directions lie in incorporating and evaluating emerging notions of structural competency and the medical humanities within undergraduate medical curricula to decolonise mental health work, improve provision of culturally congruent care within ethnic minority populations and, ultimately, reduce their disproportionate burden of disease.
6. Demographic Differences in the Overestimation of Self-Control: Evidence from Gym Data
Team: Tadeusz Ciecierski-Holmes
Abstract: Consumer behaviours that are difficult to reconcile with standard preferences and beliefs assumed widely in economics are found when studying gym memberships. Della Vigna and Malmendier (2006) demonstrated this, where a sample of gym members were paying, on average, more per attendance than they would otherwise pay for day passes. Using a larger sample over a longer time period, our results provide further evidence of these behaviours. First, out of 17,938 gym members sampled from a major US gym chain, 38% were found to be paying more in gym memberships than they could have paid in day passes. Second, surveyed gym members from a US university had realised gym attendances that were only half their expected gym attendance. Lastly, survival analysis performed on the significant time delays between final gym attendances and cancellation of memberships in conjunction with demographic data provides insight into the extent of demographic differences in consumer naivety to their future self-control. The wider implications of demographic differences in overestimation of self-control includes the asymmetric impact of subscription models on different demographic groups, and more widely this can provide insight into other health behaviours such as medication adherence.
7. Systematic Review Estimating the Burden of Dementia in Latin America and the Caribbean: A Bayesian Versus a Frequentist Approach
Team: Kit Chan, Igor Rudan, Yawen Xiang, Kim Vilmenay, Adrienne Poon, Christopher F Aitken
Abstract: Rapid increase in life expectancy has resulted in an increase in the global burden of dementia that is expected to become a leading cause of morbidity in the future. Low- and middle-income countries are expected to bear an increasing majority of the burden, but lack data for accurate burden estimates that are key for informing policy and planning. Bayesian methods have recently gained recognition over traditional frequentist approaches for modelling disease burden for their superiority in dealing with severely limited data. This study provides updated estimates of dementia prevalence in Latin America and the Caribbean (LAC) for the years 2015 and 2020. Given the paucity of data, estimates were developed using a Bayesian methodology and confirmed by the traditional frequentist approach, with the aim of providing methodological insights for future disease burden estimates.
A comprehensive systematic literature search was conducted to identify all relevant primary studies published between the years 2010-2018. The quality of the included studies was critically assessed. A random-effects model (REM) and a Bayesian normal-normal hierarchical model (NNHM) were used to obtain the pooled prevalence estimate of dementia for people aged 60 and above. The latter model was also developed to estimate age-specific dementia prevalence. Using UN population estimates, total and age-specific projections of the burden of dementia in 2015 and 2020 were calculated.
The prevalence of dementia in LAC was found to be 14% (10-21%) in those above age 60 based on REM, and 8% (5-11.5%) based on NNHM. The prevalence increased from 2% (1-4%) in people aged 60-69 to 29% (20-37%) in people above the age of 80. The number of people living with dementia in LAC in 2015 was estimated at 5.68 million, with future projections of 6.86 million in 2020.
The findings of this review found that burden of dementia in LAC is substantial and continues to rapidly grow. The projected rise in dementia cases in the future should prompt urgent governmental response to address this growing public health issue. We were also able to demonstrate that given the overall paucity of data, a Bayesian approach was superior for estimating disease prevalence and burden.
8. Targeting barriers to Maternal Healthcare in rural Bangladesh: an innovative approach
Team: Sabeera Dar, Hana Mahmood, Tafsir Ahmed, Latifa Haque, Tafhima Haider
Commissioner: The Maternal Aid Association (Maa)
Abstract: The Millennium Development Goals (MDG), set by the United Nations in 2000, put emphasis on reducing maternal mortality worldwide by 2015. During the MDG era, maternal mortality ratio (MMR) declined in Bangladesh. However, despite this initial progress, MMR remained stagnant between 2010 and 2016, with the recorded 196 per 100,000 live births in 2016 being almost identical to 2010 levels. Unfortunately, Bangladesh continues to have one of the highest maternal and neonatal mortality rates in the world. In recognition of this burden, Bangladesh has adopted the Global Strategy, and is committed to reaching the Sustainable Development Goals (SDG) targets. This involves reducing MMR to as low as 70 per 100,000 live births. In order to achieve these ambitious SDG targets, Bangladesh will have to significantly accelerate the rate of reduction of maternal deaths from that which was observed during the MDG era.
‘The Three-Delay Model’ describes major barriers to improving maternal healthcare. This includes delays in deciding to seek care; reaching care and receiving adequate healthcare. Several interventions have been deployed to overcome such barriers in rural Bangladesh. Unfortunately, a promising, long-term solution is yet to be designed. The Maternal Aid Association (Maa) hypothesises that the slow progress is due to the fragmented nature of the healthcare system in rural Bangladesh.
Based on this idea, Maa has devised an innovative solution to improve maternal healthcare in rural Bangladesh, termed The Maa Hub-spoke (HS) model. This is a primary healthcare model, specifically targeting pregnant women in rural communities in Bangladesh. The main aims of this model are: 1) to educate local women on maternal health using Women’s Groups; 2) to provide antenatal care, screening and advice in the homes of pregnant women using Health Brigade Members; 3) to provide a sustainable workforce of trained doctors for rural maternal health clinics; 4) to connect a healthcare workforce using the newly designed Maa-Connect App, enabling rapid identification and referral of ‘high-risk’ pregnant women to receive adequate care.
9. Cancer care in humanitarian crises
Team: Holly Sadler, Carla Fuentes-Lopez, Alice Knapton, Claire Otasowie, Bogdan Sisca
Balancing the demands for curative and palliative care is particularly challenging in humanitarian settings. Limited access to funds, medicines, and qualified personnel in such environments present barriers to effective treatment, thereby increasing the burden of untreatable disease, including terminal cancers.
Yet, humanitarian aid often prioritises interventions to save life, rather than to alleviate suffering for those facing death. As such, nations plunged into crisis may not consider palliative care an immediate priority.
In order to identify practices which could be implemented to improve end-of-life care, this work aims to explore the need for palliative cancer care in the context of humanitarian crises, and the barriers that complicate its provision.
Focussing on areas in Sub-Saharan Africa and the Eastern Mediterranean regions, we assess the burden of cancer and characterise the greatest barriers to diagnosis and treatment. In these regions, breast and cervical cancers cause the most mortality in females, while lung, prostate, and colorectal cancers predominate in males.
These pertinent examples illustrate the diversity in care requirements, existing infrastructure and attitudes to care in areas experiencing humanitarian crises. They also highlight more general trends in humanitarian medicine. Notably, major challenges are posed by a lack of national palliative care policy; poor training for healthcare professionals; limited access to pain relief; and remarkable cultural heterogeneity.
We go on to identify those cancers which can be treated in humanitarian settings, highlighting them as a subset to which curative therapies should be prioritised. We also consider prevalent cancers which cannot be treated effectively and therefore require a palliative approach.
Finally, we consider how the demands for curative and palliative care can be balanced in humanitarian oncology. Using best practice guidelines developed in other nations, we reflect on the results that can be achieved through a holistic approach and advocate for integrated care.
Prioritising resources is key in humanitarian health. In these settings, few resources are allocated to palliative care. An integrated curative and palliative approach to cancer care may boost patient outcomes, with relatively little investment.