imelda bates

Advancing the science of health research capacity strengthening in low-income and middle-income countries: a scoping review of the published literature, 2000–2016

Publisher: BMJ

Date: 12-2017

DOI: 10.1136/BMJOPEN-2017-018718

Abstract: Substantial development assistance and research funding are invested in health research capacity strengthening (HRCS) interventions in low-income and middle-income countries, yet the effectiveness, impact and value for money of these investments are not well understood. A major constraint to evidence-informed HRCS intervention has been the disparate nature of the research effort to date. This review aims to map and critically analyse the existing HRCS effort to better understand the level, type, cohesion and conceptual sophistication of the current evidence base. The overall goal of this article is to advance the development of a unified, implementation-focused HRCS science. We used a scoping review methodology to identify peer-reviewed HRCS literature within the following databases: PubMed, Global Health and Scopus. HRCS publications available in English between the period 2000 and 2016 were included. 1195 articles were retrieved of which 172 met the final inclusion criteria. A priori thematic analysis of all included articles was completed. Content analysis of identified HRCS definitions was conducted. The number of HRCS publications increased exponentially between 2000 and 2016. Most publications during this period were perspective, opinion or commentary pieces however, original research publications were the primary publication type since 2013. Twenty-five different definitions of research capacity strengthening were identified, of which three aligned with current HRCS guidelines. The review findings indicate that an HRCS research field with a focus on implementation science is emerging, although the conceptual and empirical bases are not yet sufficiently advanced to effectively inform HRCS programme planning. Consolidating an HRCS implementation science therefore presents as a viable option that may accelerate the development of a useful evidence base to inform HRCS programme planning. Identifying an agreed operational definition of HRCS, standardising HRCS-related terminology, developing a needs-based HRCS-specific research agenda and synthesising currently available evidence may be useful first steps.

Measuring the outcome and impact of research capacity strengthening initiatives: A review of indicators used or described in the published and grey literature

Publisher: F1000 Research Ltd

Date: 04-06-2020

DOI: 10.12688/F1000RESEARCH.24144.1

Abstract: Background: Development partners and research councils are increasingly investing in research capacity strengthening initiatives in low- and middle-income countries to support sustainable research systems. However, there are few reported evaluations of research capacity strengthening initiatives and no agreed evaluation metrics. Methods: To advance progress towards a standardised set of outcome and impact indicators, this paper presents a structured review of research capacity strengthening indicators described in the published and grey literature. Results: We identified a total of 668 indicators of which 40% measured output, 59.5% outcome and 0.5% impact. Only 1% of outcome and impact indicators met all four quality criteria applied. A majority (63%) of reported outcome indicators clustered in four focal areas, including: research management and support (97/400), the attainment and application of new research skills and knowledge (62/400), research collaboration (53/400), and knowledge transfer (39/400). Conclusions: Whilst this review identified few ex les of quality research capacity strengthening indicators, it has identified priority focal areas in which outcome and impact indicators could be developed as well as a small set of ‘candidate’ indicators that could form the basis of development efforts.

Use of clinical judgement to guide administration of blood transfusions in Malawi

Publisher: Oxford University Press (OUP)

Date: 09-2200

DOI: 10.1016/S0035-9203(01)90022-7

Abstract: The aim of this study was to investigate whether clinicians in Malawi could use clinical judgement alone to administer blood transfusions in accordance with guidelines. Clinicians at a district hospital did not use the Lovibond Comparator haemoglobin results provided by their laboratory as they felt them to be unreliable, preferring instead to rely on their clinical judgement alone to guide transfusion practice. Their transfusion practice and the Lovibond haemoglobin results were monitored against the World Health Organization recommended haemiglobincyanide method for haemoglobin measurement without the clinicians having access to this result. The Lovibond Comparator method was shown to have a sensitivity of only 21% to detect trigger haemoglobin values for transfusion published in local guidelines. Without access to a useful haemoglobin result, clinicians gave 67% of transfusions in accordance with the haemoglobin trigger values in the guidelines. This study shows that clinical features alone can provide a reasonable guide about the need for transfusion, and that poor quality laboratory tests limit the effectiveness of transfusion guidelines.

Practical actions for fostering cross-disciplinary global health research: lessons from a narrative literature review

Publisher: BMJ

Date: 04-2020

DOI: 10.1136/BMJGH-2020-002293

Abstract: Global health research involves disciplines within and beyond the health sciences. A cross-disciplinary collaborative research approach enables an interchange of knowledge and experience and stimulates innovative responses to complex health challenges. However, there is little robust evidence to guide the design and implementation of cross-disciplinary research in global health, h ering effective collective action. This review synthesised evidence on practical actions for fostering cross-disciplinary research to provide guidance on the design and implementation of research in global health. We searched five electronic databases using key words. The search included original research and research notes articles in English. We used a framework adapted from the socio-ecological model and thematic synthesis for data analysis. Thirty-six original research and 27 research notes articles were included in the review. These were predominantly from high-income countries and indicated that practical actions on fostering cross-disciplinary research are closely linked to leadership and teamwork which should be planned and implemented at research team and institutional levels. The publications also indicated that in idual qualities such as being receptive to new ideas and funders’ power and influence have practical implications for conducting cross-disciplinary research. Practical actions that in iduals, research team leaders, academic institutions and funders can undertake to foster cross-disciplinary research were identified. Our review found evidence from high-income countries, not low-and-middle-income countries, about practices that can improve cross-disciplinary research in global health. Critical knowledge gaps exist around how leadership and teamwork processes can better integrate expertise from different disciplines to make cross-disciplinary research more effective.

The operation, quality and costs of a district hospital laboratory service in Malawi

Publisher: Oxford University Press (OUP)

Date: 07-2003

DOI: 10.1016/S0035-9203(03)90070-8

Abstract: Laboratory services are run down in many low-income countries, severely constraining their input to patient care and disease surveillance. There are few data about the quality and cost of in idual components of the laboratory service in poorer countries, yet this information is essential if optimal use is to be made of scarce resources. Staff time, range of tests, workload, and safety procedures were monitored over 12 months (1997-98) in a typical district hospital laboratory in Malawi. Data were collected to calculate the total economic cost of these services. Of the 31203 tests performed, 84% were to support blood transfusion and diagnosis of malaria and tuberculosis (TB). Test quality was reasonable for malaria and TB microscopy and blood transfusion, but poor for haemoglobin estimation. The cost per test ranged from US dollars 0.35 for haemoglobin to US dollars 11.7 per unit of blood issued and the total annual cost of the laboratory service was US dollars 32618. Blood transfusion and microscopy for malaria and TB comprised the majority of tests. Ensuring that these tests are of the highest quality will therefore have the most impact in reducing wastage of laboratory resources. Inadequate quality of haemoglobin estimations is a particular problem. The findings of this study are likely to be relevant to other low-income countries with similar disease burdens.

External Financial Aid to Blood Transfusion Services in Sub-Saharan Africa: A Need for Reflection

Publisher: Public Library of Science (PLoS)

Date: 11-09-2012

DOI: 10.1371/JOURNAL.PMED.1001309

Packed red cells versus whole blood transfusion for severe paediatric anaemia, pregnancy‐related anaemia and obstetric bleeding: an analysis of clinical practice guidelines from sub‐Saharan Africa and

Publisher: Wiley

Date: 22-11-2018

DOI: 10.1111/TMI.13173

Abstract: Blood component transfusion is increasingly promoted in sub-Saharan Africa (SSA), but is resource-intensive so whole blood is often used. We examined SSA recommendations about whole blood and packed red cell transfusions for pregnancy-related bleeding or anaemia, and paediatric anaemia, and evaluated the evidence underpinning these recommendations. Relevant SSA guidelines were identified using five electronic databases, websites for SSA Ministries of Health, blood transfusion services and WHO. To facilitate comparisons, indications for transfusing packed red cells or whole blood within these guidelines and reasons given for these recommendations were recorded on a pre-designed matrix. The AGREE II tool was used to appraise guidelines that gave a reason for recommending either packed red cells or whole blood. We systematically searched MEDLINE, CINAHL, Global Health, Cochrane library and NHSBT Transfusion Evidence Library, using PRISMA guidelines, for clinical studies comparing whole blood with packed red cells or combined blood components in obstetric bleeding or anaemia, or paediatric anaemia. Characteristics and findings of included studies were extracted in a standardised format and narratively summarised. 32 English language guidelines from 15 SSA countries mentioned packed red cell or whole blood use for our conditions of interest. Only seven guidelines justified their recommendation for using packed red cells or whole blood. No recommendations or justifications had supporting citations to research evidence. 33 full-text papers, from 11 234 citations, were reviewed but only one study met our inclusion criteria. This was a single-centre study in post-partum haemorrhage. Evidence comparing whole blood and packed red cell transfusion for common paediatric and maternal indications is virtually absent in SSA. Therefore, it is unclear whether policies promoting red cells over whole blood transfusion are clinically appropriate. Building a relevant evidence base will help develop effective policies promoting the most appropriate use of blood in African settings.

Liverpool School Of Tropical Medicine

Location: United Kingdom of Great Britain and Northern Ireland

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Joint Committee On Higher Medical Training

Location: United Kingdom of Great Britain and Northern Ireland

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Kwame Nkrumah University Of Science And Technology

Location: Ghana

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Postgraduate Certificate In Higher Education (Distinction)

Location: United Kingdom of Great Britain and Northern Ireland

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Royal College Of Physicians

Location: United Kingdom of Great Britain and Northern Ireland

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University Of Cumbria - Lancaster Campus

Location: United Kingdom of Great Britain and Northern Ireland

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University Of London

Location: United Kingdom of Great Britain and Northern Ireland

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GCRF: One Health Regional Network For The Horn Of Africa (HORN)

Start Date: 2017

End Date: 2021

Funder: Biotechnology and Biological Sciences Research Council

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