International Festival of Public Health

Posters

Cooking on gas: what do people in South West Cameroon think about LPG as a clean fuel for cooking, and how do their opinions affect fuel use?

Presenting Author: Alison Pye (Cumbria County Council)

Other Author(s): Sara Ronzi, Elisa Puzzolo, Daniel Pope

Abstract Text:

Introduction: Household air pollution (HAP), caused by the combustion of solid fuels for cooking, heating and lighting is responsible for almost 5% of the global burden of disease and over 3 million premature deaths worldwide, predominantly in low and middle-income countries (LMIC). In response, the World Health Organisation (WHO) has recommended the urgent need to scale adoption of clean fuels, such as Liquefied petroleum gas (LPG), in LMICs. To achieve such scale, it is necessary to understand the factors that enable and constrain populations from switching from polluting solid fuels to clean energy. We conducted cross-sectional surveys in rural and peri-urban communities in South West Cameroon to identify the factors and perceptions that influence the adoption and sustained use of LPG as a clean fuel for cooking.

Methods: Questionnaire data was collected over two phases in 2016 and 2017 from 3343 households in South West Cameroon. Trained field workers collected data on the demographic composition of households, primary and secondary fuel use, cooking behaviours and perceptions of LPG as a clean fuel. Logistic regression was used to summarise the relationship between LPG use and perceptions of LPG, as well as demographic and household factors. Results LPG was reported as a primary cooking fuel by just over half (56%) of households, although the majority (81%) still used polluting solid fuels (wood or charcoal). For people in rural communities only 16% reported using LPG as their primary cooking fuel with just three households (1.2%) using it exclusively. Positive perceptions of LPG included cleanliness (95%) and efficiency (88%), but there were also concerns about safety (64%) and expense (69%). Positive perceptions about LPG safety (OR=2.49, 95%CI=2.04, 3.05), cooking speed (OR=4.31, 95%CI=2.62, 7.10), affordability (OR=1.7, 95%CI=1.38, 2.09), availability (OR=2.17, 95%CI=1.72, 2.73), and its ability to cook most dishes (OR=3.79, 95%CI=2.87, 5.01), were significantly associated with more exclusive LPG use. Socio-economic factors such as education and wealth also significantly increased the likelihood of LPG adoption, where-as rising age reduced it.

Conclusions: This study shows the importance of community perceptions in influencing the adoption of LPG as a clean household fuel. It is essential that these are considered when implementing any programs to scale access to clean household energy. Whilst the positive attributes of LPG in terms of efficiency and cleanliness are well known, addressing concerns over safety should be a priority when encouraging households to transition away from polluting traditional fuels. Assisting households to meet the start-up costs of using LPG could also be an effective strategy in stimulating adoption.

A visual representation of NICE quality standards on the risk factors associated with non communicable disease

Presenting Author: Alison Tariq (National Institute for Health and Care Excellence)

Other Author(s): Julie Kennedy

Abstract Text:

Background: Non communicable diseases have been identified as one of the top 10 threats to global health in 2019. NICE has published multiple evidence based guidelines on non communicable disease including; diabetes, cancer and heart disease, as well as guidance on associated behavioral risks factors. NICE quality standards on these behavioural risk factors provide a comprehensive suite of statements and measures which can support organisations to focus efforts in the prevention and control of non communicable disease.

Objective: To visually demonstrate, through a single infographic, the suite of NICE quality standards on behavioural risk factors associated with non communicable disease.

Discussion: NICE quality standards set out the priority areas for quality improvement in health, public health and social care. They focus on specific aspects of evidence-based recommendations highlighted by stakeholders as current priorities. The suite of quality standards focussed on the behavioural risk factors for non communicable disease brings together high priority actions for improvement which organisations can use to help prevent and control levels of non communicable disease. An infographic can be used to communicate all this information in a consolidated way to suit user needs.

Implications: Innovative ways need to be developed to communicate complex information sets to users.

Developing the health & wellbeing role of our future healthcare workforce using a community outreach approach in school settings

Presenting Author: Alison Farrar (Health Education England North West Office)

Other Author(s): David Allison, Maxine Holt, Gay Rabie, Hayley Willacy, Diane Hart.

Abstract Text:

One of the priorities of the Five Year Forward View (NHS, 2014) has stressed the need for a radical upgrade in prevention and health promotion in order to ensure the future health of our children. Health promotion & prevention skills are now expected to be achieved during pre-registration healthcare training programmes (NMC 2010, GMC 2018) and self-care is a key NHS objective for communities. A proof of concept approach with four HEI’s in the North West established health & wellbeing community outreach interventions in local school settings, enabling undergraduates to put key health & wellbeing skills and knowledge into practice as well as supporting widening participation into NHS careers. Funded by HEE North West, the project aimed to provide a valued experiential learning opportunity for healthcare undergraduates (recognising the health improvement role of all healthcare workers) as well as an opportunity for local schools to access additional support for young people’s health & wellbeing and raising awareness of NHS career opportunities. Feedback from undergraduates indicated a better understanding and increased confidence amongst healthcare undergraduates of the health & wellbeing issues faced by young people. Outcomes included developing learning resources, partnership working, core teaching skills and acting as ambassadors for their profession and HEI. Schools welcomed the work that contributed towards their PHSE agenda and OFSTED requirements. Participating HEI’s have drafted a joint case study to share the work and are now working in collaboration with HEE NW as a working reference group to expand the work across the North of England for 2019 / 20. Creating effective peer led working partnerships to create a culture of health promotion in healthcare education provision is key to adoption and spread.

A realist evaluation of community (health) development projects in Wales

Presenting Author: Andrew Rogers (The University of Manchester)

Other Author(s): Paul Brocklehurst, Glynne Roberts, Lynne Williams, Gail Findlay, Joanna Charles

Abstract Text:

Community development for health and wellbeing is back in fashion across Wales. Renewed interest in governance at the community level, building local resilience and empowering people to make the most of their wellbeing assets is influencing a wide range of projects. The Well-Being of Future Generations (Wales) Act (2015) [1] provides a further impetus to this through requiring all public bodies to work together to make an impact upon sustainable development by driving them, through better collaboration and joint action, to build wellbeing within communities.
However, this very faddism brings inherent problems as the history of community development is vast, draws from many disciplines and ideologies yet these are often hidden in implementation ([2]. The result is that projects borrow approaches uncritically and consequently in application in local circumstances the initiatives don’t quite ‘fit’.
Each community development trend has brought theories, values and principles, even toolkits, but on the whole these suggest what works not how projects work, for which communities, and in which specific types of circumstance (contexts) the mechanisms operating within projects will ‘fire’ to make an impact and produce wellbeing outcomes [3].
Using realist evaluation methodologies [4] this research attempts to ‘unpack the black box’ of community health development.
Realist methodology is a theory driven approach to programme evaluation and is suited to this study as it helps to penetrate the complexities of interventions, unpacking what is really working in such projects to enable a more granular learning to be applied and uniquely reconstructed in other contexts. Often communities look at programmes and interventions successful elsewhere and try to replicate them within in their own different local contexts but with limited results. This research provides them with the tools to build their own success not merely patents to copy.
Phase 1 has explored with community stakeholders what is working in practice, what myriad theories of change are driving the actors and actions in these projects and how the two are related.
Concept mapping was undertaken alongside stakeholder workshops in four place-based community projects (Isolation/Loneliness in Anglesey, Youth Sheds in Denbigh, The Holway Housing Estate, and, Wrexham Homelessness). Soft systems methodology [5] was used to facilitate stakeholders to express through rich pictures “what makes a good community (health) development project?”
In realist research this stage aims to develop candidate theories, or ‘context- mechanism – outcome’ (CMO) configurations [2]. Four initial propositions emerged from the first phase to test further in a realist review:
1. Appreciate and build identity between members of a community
2. Develop individual and community coherence
3. Provide physical and personal space
4. Reframing from ‘what is wrong’ to ‘what is strong’
These four emerging propositions will now be further developed into CMO configurations and a purposive search for and appraisal of the evidence to support them will be undertaken in Phase 2 of the research.

The secondary care burden of influenza disease in Greater Manchester, 2017/18

Presenting Author: Craig Davidson (Sanofi Pasteur)

Other Author(s): Luke Skinner, Olivia Portman

Abstract Text:

Introduction: Seasonal influenza disease epidemics are a known contributor to winter pressures in the UK with some severe cases resulting in hospitalisation from complications. In 2017/18 alone, it is estimated that influenza was associated with 15,969 excess deaths as well as most of the 2,095 acute respiratory illness outbreaks reported to Public Health England in this season.1 Our objective was to analyse Hospital Episodes Statistics (HES) data to describe the direct secondary care burden of diagnosed influenza cases in Greater Manchester throughout the 2017/18 season.

Methods: We extracted publicly available data using the HES database for October 2017 to March 2018 influenza season. All non-elective hospital admissions, patient counts, bed days, tariff costs, and deaths with primary or secondary diagnosis ICD-10 codes related to influenza (J09-11) were extracted. Admissions and patient numbers were rounded up to the nearest 5 in accordance with NHS Digital guidelines. From these data we calculated average length of stay, cost per admission, and death rate across the population. Healthcare Resource Group (HRG) codes were used to identify the most common costs associated with influenza hospitalisations.

Results: In the 2017/18 season, 2,685 influenza admissions were recorded for 2,455 individual patients. This resulted in 19,550 bed days and total hospital costs of £6,264,528. The average length of stay was 7.3 days and average cost per admission was £2,333. When considering total influenza-related admissions, 5.5% were associated with death in hospital. The most common HRG codes for flu admissions were ‘infectious diseases’, ‘viral pneumonia’ and ‘paediatric lower respiratory tract disorders’.

Conclusion: Influenza has a substantial, negative impact on the Greater Manchester healthcare system even before considering primary care burden and a broader societal burden. Prioritising prevention of disease through vaccination programmes could result in considerable savings for the healthcare system and reduce pressure on hospital resources throughout the influenza season.

The impact of influenza hospitalisation on different age groups in Greater Manchester, 2017/18

Presenting Author: Craig Davidson (Sanofi Pasteur)

Other Author(s): Luke Skinner, Olivia Portman

Abstract Text:

Introduction: The risk of serious illness from influenza is known to be higher in older people, infants under six months of age, and those with underlying health conditions.1 In the 2017/18 season, despite relatively high influenza vaccination uptake, UK surveillance reports noted a consistent pattern of outbreaks in care homes and a very high impact on intensive care unit admissions for older adults.2 Our objective was to quantify the secondary care burden of influenza for different age groups in Greater Manchester during the 2017/18 season from a healthcare system perspective.

Methods: We extracted publicly available data from the Hospital Episodes Statistics (HES) database for October 2017 to March 2018. All non-elective hospital admissions, patient counts, bed days, tariff costs, and deaths with primary or secondary diagnosis ICD-10 codes related to influenza (J09-11) were extracted for the following age bands: 0-64, 65-74, 75+ years. Admissions and patient numbers were rounded up to the nearest 5 in accordance with NHS Digital guidelines. From these data we calculated the average length of stay, cost per admission, and death rate across each cohort. Healthcare Resource Group (HRG) codes were used to identify the most common costs associated with influenza hospitalisations.

Results: In the 2017/18 influenza season, 45% of reported influenza-related hospitalisations, 67% of influenza-related bed days, and 60% of influenza-related hospital spend occurred in adults aged 65 years and above. Average length of hospital stay and cost per admission were highest in the 75 years and above cohort (Table 1).

Table 1 – Influenza-related hospital outcomes by age group

Outcome	Age Group (Years)
	Under 65	65-74	75+
Number of Admissions	1350	410	696
Average length of stay (days)	4.6	8.5	11.2
Average cost per admission	£1,770	£2,626	£3,149

The most common influenza-associated HRG codes were similar across different ages. DZ11 (Lobar, Atypical or Viral Pneumonia, with Multiple Interventions) was the HRG code associated with the highest number of bed days and highest costs in the <65, 65-74 and 75+ groups.

Many patients are not admitted as ‘respiratory’ and WJ06 (Sepsis without Interventions) and WJ03 ‘Standard Infectious Diseases’ are common HRG codes for all age groups.

Conclusion: The overall secondary care burden of influenza was largely in those over the age of 65 years in the season studied. The average length of stay was over six days longer in those over 75 than those aged under 65 and the average cost of admission is £1300 more. Optimisation of the influenza vaccination programme for those aged 65 years and over may be one way to reduce winter pressures and reduce the hospital impact from influenza.

“Danger: Men at Work”? A Proposal for the Exploration of Emotional Labour of Male Healthcare Workers

Presenting Author: Imo Emah (Edge Hill University)

Other Author(s): -

Abstract Text:

Abstract text not available.

Measuring informed participation in organised breast, cervical and colorectal cancer screening programmes: A systematic review

Presenting Author: Jennifer Priaulx (University of Kent)

Other Author(s): Lindsay Forbes

Abstract Text:

Background: Population-based cancer screening programmes are recommended for the early detection or prevention of breast, cervical and colorectal cancer in Europe and elsewhere. The uptake by invited individuals is one method used by screening organisers to measure performance. Although it is now standard practice to promote ‘informed choice’, informed participation is not yet included in routine monitoring systems. This systematic review aims to evaluate the different approaches to measuring informed participation.

Methods: We searched databases including MEDLINE, EMBASE and PsycINFO from start to November 2018 using terms relating to cancer screening and informed participation. We later supplemented the search with grey literature. We included any type of study that measured informed participation for an organised cancer screening programme. Data was extracted into a semi-structured thematic framework based on the concepts of knowledge, attitude and behaviour.

Results: We included 27 publications of 20 unique studies. We also included eight systematic reviews, primarily to check for additional studies, including a prior review of measures of informed participation from 2006. All studies referred to the same definition, originally conceptualised for antenatal screening, where adequate knowledge alongside behaviour that reflects either a negative or positive attitude defines informed participation. Nevertheless, there was considerable variation in the concepts measured, complexity, the type of questions included and how they were scored. The number of measured concepts of knowledge ranged from four to fourteen. Concepts included knowledge of cancer, screening, its harms and benefits. Attitudinal scales were more consistent, rating whether screening was bad, good, beneficial, harmful or important. Behaviour could be intended, self-reported or recorded data. Additional measurements (e.g. decisional conflict) also varied. Validation testing was not widely reported.

Conclusion: There has been limited progress in harmonising measures of informed participation for cancer screening programmes and most measures are not suitable for routine national monitoring systems.

Modern Slavery and Public Health

Presenting Author: Katie Comer (Health Education Yorkshire and Humber)

Other Author(s): Andy Leonard

Abstract Text:

Background: It is a known fact in Modern slavery that victims are chosen due to a vulnerability, and that these victims suffer from trauma due to their subsequent exploitation and are likely to encounter health services at some point.

Research Objectives or Program Description: Dr Katie Comer, a public health registrar employed by Leeds Teaching Hospitals began working alongside Andy Leonard, the modern slavery coordinator for Yorkshire and Humber began to explore how the health service and public health could better be involved in modern slavery and build better partnerships with the police to aid the preventative agenda within Yorkshire and the Humber but also nationally. This was looked at in terms of primary, secondary and tertiary prevention or prevention, identification and victim care as described in the report.

Methods or Activities: The Modern Slavery Transformation Unit was approached and provided examples throughout the country of cases of modern slavery where: ohealth professionals were the first port of call for victims and this led to successful outcomes oAny missed opportunities oExamples of good practice where relationships / partnerships have been set up, and pathways to refer safeguarding concerns from health to police exist oSofter intelligence where concerns have led to successful outcomes Different hospital trusts, health professionals and NGOs were approached for discussion on successes, problems and potential solutions. A literature search was also conducted looking at modern slavery and other violent crime and public health actions to inform partnership recommendations.

Results or Evaluation: The results from both the police forces and the NHS professionals highlighted key areas of strengths and weaknesses. All agreed that collaboration was key and the problems and solutions were not the responsibility of one organisation. Other key themes included, pathways partnerships and data sharing with or without consent and education and training.

Conclusions or Implications: Recommendations produced thus far •A consideration of first responder status being given to NHS professionals in some format. •There needs to be more clarity on information sharing agreements between NHS trusts and staff and the police and other organisations when consent is not given or cannot be obtained. •Strengthening of partnerships across all organisations and nationally. The examples we have found highlight the strengths of partnership working and where good practice was identified the partnerships made played a significant part in a successful outcome. • All partners spoken to recommend the sharing of good practice not just within their own organisations but throughout the modern slavery network •Health to be included in the National Modern Slavery Strategy as a key partner

Spatial inequalities in premature mortality related to tobacco smoking among the Czech adult population, 2011–2015

Presenting Author: Ladislav Kážmér (National Institute of Mental Health)

Other Author(s): Andrej Baroš

Abstract Text:

The study provides with a detailed analysis of spatial inequalities in premature mortality related to tobacco smoking in the contemporary Czech adult population. In this study, premature mortality is considered as deaths within the age of 25–64 years. The spatial inequalities are analysed with respect to selected cause-specific deaths, characterised by the highest smoking-attributable fractions; i.e. lung cancers (C33–C34), and chronic obstructive pulmonary diseases (J40–J44, J47). In the analysis, a detailed Bayesian modelling framework is applied, analysing the inequalities in age-standardised mortality ratios from the lowest spatial level of the Czech municipalities, and proceeding to the higher spatial levels (counties, regions).

Smoking, gender and macro-social gender inequalities. Multilevel evidence from 21 European countries.

Presenting Author: Ladislav Kážmér (National Institute of Mental Health)

Other Author(s): -

Abstract Text:

Abstract text not available.

Online dating and sexually transmitted infections in England: an ecological study using Google Trends data

Presenting Author: Leifa Jennings (HEE NW)

Other Author(s): Chris Kypridemos

Abstract Text:

Abstract text not available.

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The Impact of the Well Newcastle Gateshead pathfinder on 4 communities in Newcastle and Gateshead.

Presenting Author: Mark Mulqueen (Blue Stone Consortium)

Other Author(s): -

Abstract Text:

Well Newcastle Gateshead is one of the pathfinders of Well North, a Public Health England funded initiative across ten areas in the North of England to improve the health of the poorest people fastest. The Well Newcastle Gateshead pathfinder is managed by Blue Stone Consortium, a grouping of over forty voluntary, community and social enterprise organisations in Gateshead and Newcastle. The Well Newcastle Gateshead Arts Fund was established in late 2017 to support projects and initiatives that improve the health and wellbeing of our communities by using engagement in arts and cultural activities as a catalyst for positive change. We want to explore how we can use local assets and encourage sustainable relationships between artists, community, voluntary and health organisations to deliver positive health and wellbeing outcomes. We are focused on four areas within Newcastle and Gateshead. In Felling and Inner West Newcastle, we are focusing on working with children aged 2-7 and their families with the aim of improving school readiness. In Byker and Chopwell, we are working to tackle social isolation, mental health and low self-esteem in adults. The Well Newcastle Gateshead Arts Fund has supported 15 projects since its establishment, pledging a total of £127,129 - £46,937 in the inner west of Newcastle, £47,307 in Byker and £22,885 in Chopwell and £10,000 in Felling. Funded projects have secured a total of £189,472 in partnership funding and in-kind contributions, further enabling their work and unlocking more investment in our target areas. Overall, our projects are benefitting 3,105 people and are helping to make our communities vibrant, connected and healthy places to live.

Identifying Risky Behaviours: Addressing the real issues faced by young people in Cardiff.

Presenting Author: Martha-Jane Powell (Cardiff and Vale Local Public Health Team, Public Health Wales)

Other Author(s): George Grindle

Abstract Text:

Two Cardiff and Vale Young People multi-agency services, Switched On and SHOT, have teamed up to offer secondary schools sessions which incorporate Substance Use/Misuse and Sex and Relationships Education in a joint session. The aim is to offer pupils key information about both wellbeing topics, and linking the information to key health issues and potential safety concerns. Prudent Healthcare: This joint project working meets Principle 3: Do only what is needed – no more, no less – and do no harm, and Principle 4: Reduce inappropriate variation using evidence-based practices consistently and transparently. Secondary schools throughout the Cardiff locality were offered sessions which were relevant and interactive, engaging all ages of pupils attending the sessions. Both teams involved are multi-disciplinary and have complemented one another in this approach during a pilot period. Session content includes how to stay safe and keep others safe when substances are used and how sexual activity/assault might become more likely to occur. For example we highlight issues around drink spiking and sexual assault. Alcohol and drugs have been frequently linked to violent incidents and accidents but substances are also a key factor in sexual assaults (Bellis 2008, Finney 2004). Each session includes a pre and post pupil quiz which measures demonstrated learning. At the end of the pilot period (March 2018), the project has now gained funding from Families First for a further 3 years. This will allow the project to progress further and develop elements of the work which the team are already delivering.

Effect of maternal post-partum depression on child cognitive development in boys and girls: A systematic review

Presenting Author: Nadine Ebeid (St Luke's International University, Japan)

Other Author(s): Kevin Urayama (St Luke's International University, Japan)

Abstract Text:

Researchers have explored the relationship between maternal post-partum depression and cognitive development of the offspring, but the results remain inconclusive regarding the presence of a difference in the effect based on the child’s gender. This study aims to assess the cumulative evidence from the current body of literature on the association between maternal post-partum depression and child cognitive development in boys and girls separately. A search for articles was performed through PubMed, The Cochrane Library, PsycInfo, and Embase, and was supplemented by manual search of the reference lists. Articles exploring the epidemiological association between maternal post-partum depression and cognitive development in boys and girls were included. Eight articles were considered eligible for this review; half of them focused on child cognitive development at the preschool age of 3-6 years, 2 articles for the age of 18 months, and 2 articles targeting older children (ages 11 and 16 years). Collective results show lower cognitive development especially among boys of post-partum depressed mothers, and particularly when associated with low social class. This finding appears consistent across all age groups. Further research that target representative populations from developing countries may be important considering the observed role of social class and overall higher rates of maternal depression in those regions.

India's Mental Health: Role of NGOs in reducing inequalities

Presenting Author: Nupur Chowdhury (University of Sheffield)

Other Author(s): -

Abstract Text:

Abstract text not available.

A volunteer-led initiative for Global Health capacity building - Peoples-uni

Presenting Author: Jill Stocks (People's Open Access Education Initiative)

Other Author(s): Judith Strobl, Rajan Madhok, Richard Heller

Abstract Text:

People’s Open Access Education Initiative (Peoples-uni, http://peoples-uni.org) aims to contribute to improvements in the health of populations in low- to middle-income countries by building public health capacity via e-learning at affordable cost. Volunteer tutors provide the educational input and have come from over 50 countries to date. They are now joined by graduates of the programme, who join as tutors and perform collaborative research. During 18 semesters since 2008, 1619 students from 92 countries (71% from Africa) enrolled. 128 students were accepted on an MPH programme accredited by a UK university - 94 earned an MPH (73%) and a further 18 (14%) achieved a Postgraduate Diploma or Certificate. An external evaluation concluded: “There was strong evidence that Peoples-uni had achieved its stated goals. Potential impacts on students included knowledge to enhance practice and appreciation of context, enhanced research capacity through knowledge of public health, critical thinking and evidence-based programming, and empowerment of students about the potential of education as a means of improving their lives.” A survey of volunteers found that 75% were keen to continue in their role for the foreseeable future and 71% felt very well looked after by their module leaders and colleagues. The programme is now validated by Euclid University and students can gain an accredited MPH from them through study with Peoples-uni. Peoples-uni Open Online Courses (http://ooc.peoples-uni.org) is a sister site for free self-paced courses, including topics not often found in MPH courses, and is available to host courses developed by other providers. We seek to engage with those who are also interested in building global health capacity, either individuals who might volunteer as tutors (including dissertation supervisors), or organisations who might join as academic partners. Publications can be seen at http://www.peoples-uni.org/content/publications-and-presentations-about-peoples-uni

The Health Equity Voice

Presenting Author: Rose Mary Nakame (REMI East Africa)

Other Author(s): -

Abstract Text:

Background The burden that falls onto Uganda’s rural health workers (1 medical person: 714 people) serving in under-equipped facilities has often been neglected. However, its consequences have been made headlines in the media, building public distrust, damaging the standing of the health profession and unknowingly raising the barriers to accessing quality healthcare (VSO, 2012) instead of fixing the broken system to benefit the common man (87%). Introduction “The Health Equity Voice” project equips health workers and students studying to join the profession with skills to tell their own stories of serving in the public hospitals, collects stories from young African Leaders whom through their work are bridging the health inequality gaps, profiles the stories on a web platform and through newsletter, curates them for the public and creates awareness about the platform so as to inform health budgeting, programming, policy, public opinion, and academia. These stories help re-shape thinking and attitude of users of public health facilities, while restoring the pride of the health workforce as a source of motivation and share new ways of increasing access to quality health care in resource-limited settings. Objectives/Key activities 1. Empower the health workers to utilize story as a medium for advocacy for better health systems. 2. To collect stories from health workers that paint the picture of the day-day life of a health worker in the rural public hospitals located which are then profiled on “The Health Equity Voice” Platform. 3. To establish and utilize “The Health Equity Voice” Platform as a tool for health equity advocacy among all stakeholders including policy makers and implementers culminating into better public health programming, budgeting, reporting, and service delivery. These stories will inform the nurturing of the next generation of health workers, future research, innovation, entrepreneurship, and Global Health Diplomacy efforts. 4. To publish a quarterly newsletter of “The Health Equity Voice” of the 15 most inspiring stories from the Young African Leaders living in Africa who are bridging the health inequality gaps on the continent through innovation, policy and public health programming and share it widely. Results The Project has so far run for 15months and the following have been the outcomes: • 49 rural Health workers trained in Uganda as recorded by attendance sheets • 49 stories collected • 3 Field visits done in Masaka, Wakiso and Mityana Districts. These involve meetings with the District Health Officer(s), Medical Superintendent, Senior Principal Nursing officer and Health Staff. • A number of meetings held with the policy makers and Civil society organizations through the RMNCAH Coalition and NursingNow and Edgewood college of social innovation where we sensitize them about the themes that are arising from the collected stories to inform Public Health policy, programming and social innovation. • 3 Speaking opportunities at UW-Madison with Academicians, iMilwaukee Evaluators and Public Health Experts • Media Features in HuffingtonPost, U.S. Office of Global Health Diplomacy and United Nations Sustainable Development Solutions (SDSN) • Partnership with OnchArt to turn the stories into visual art images for better advocacy. Challenges 1. Limited funding to upscale the project to even hard to reach areas 2. Lack of desired learning materials to cater to the different learning needs of the participants 3. Barriers in the dissemination of project information Global Health Implications The project is utilizing an integrated approach towards achieving SDG3 and SDG5. This is due to the fact that 70% of the health workforce is female and improving the rural health system would, in turn, empower them too. In addition, the empowerment of Health workers to tell their stories turns them into their own advocates for an efficient, transparent and accountable health sector whilst, the sharing of success stories and voices of Young African Leaders who are solving the health inequity gaps accelerates the dissemination of what works in resource-limited settings. Apart from this, the utilization of “The Health Equity Voice” serves as an advocacy tool for better public health programming, budgeting, reporting, and service delivery, therefore, providing insights for further research, innovation, and entrepreneurship in public health. References Our Side of the Story Ugandan health workers speak up Coalition for Health Promotion and Social Development HEPS-Uganda, The Coalition for Health Promotion and Social Development. (n.d.). Retrieved from www.heps.or.ug Sustainable Development Solutions Network: 50 youth-led solutions and ideas that are successfully contributing towards the achievement of the 2030 Agenda. Link: http://www.youthsolutions.report/submit/ Wakiso Hospital Shut After Museveni Fires Staff. (n.d.). Retrieved February 8, 2019, from https://www.newvision.co.ug/new_vision/news/1431796/nakawuka-health-centre-shut-staff-fired https://www.huffingtonpost.com/entry/14-local-change-makers-making-global impact_us_5a5e70a9e4b01203d8097674 http://www.nursingnow.org/health-equity-voice-stories-east-african-rural-healthworkers/ www.remieastafrica.org

Are Depression Interventions in Adults with Diabetes Mellitus and Depression Cost-Effective?

Presenting Author: Simran Bedi (The University of Manchester)

Other Author(s): -

Abstract Text:

Background: Diabetes and depression are two common chronic conditions affecting the world population. Diabetes mellitus is categorised by abnormal metabolism leading to elevated levels of blood sugar. Depression is a mental illness resulting in individuals experiencing fatigue, low moods and loss of interest or pleasure in activities. Patients suffering from co-morbid diabetes and depression are subject to increased health complications resulting in increased disability, lower quality of life and higher levels of mortality. Coexistent diabetes and depression exemplify mental-physical comorbidity which escalates costs for healthcare providers worldwide. Up to date evidence on the cost-effectiveness of the latest care models and interventions is essential for physicians and decision-makers to deliver efficient care. This systematic review updates a previous review conducted in 2012. The preceding review identified a marked paucity of data with all studies being piloted in the US. The main objective of this paper is to provide an update of the cost-effectiveness of interventions for the treatment of depression in people with diabetes.

Methods: Relevant records published in English since May 2012 were identified via searching Ovid MEDLINE, Embase and PsycInfo online databases. The search strategy was adapted and applied from the prior review. The inclusion criteria comprised of economic evaluations within studies comparing two or more interventions to manage moderate to severe depression in adults with diabetes. The significant data of the selected papers for inclusion were extrapolated using a standardised data extraction form based on the NHS EED handbook and supplemented by the CASP critical evaluation checklist.

Results: Out of 544 papers obtained, 3 records met the inclusion criteria (2 cohort studies and 1 randomised controlled trial). All 3 papers were cost-effectiveness analyses, of which 1 was conducted in the US, 1 in Canada and 1 in Germany. One study only measured outcomes in the form of QALYs whilst the other 2 studies included depression-free days also. Trial follow up periods ranged from 6 months to 18 months. Across the studies, results ranged from incremental cost-saving to additional costs of the study intervention by $1021 (US$, 2016). The probability of cost-effectiveness ranged from 15%-97% across the studies. All of the studies had individual limitations which are taken into account during discussion of the evidence.

Discussion: This systematic review evaluates recent data published since 2012 to assess the advancements in this field. All 3 studies identified in this review concluded that their depression intervention was equally if not more clinically successful and had potential to be more cost-effective compared to the usual care of depression in people with diabetes. However, due to the limitations of the study methods and of the cost-effectiveness analyses, it is evident that larger and lengthier studies are required to establish whether these interventions would be cost-efficient and beneficial in the long term.

Hierarchical clustering of English local authorities by sub-domains of the English Indices of Multiple Deprivation

Presenting Author: Steven Senior (The University of Manchester)

Other Author(s): -

Abstract Text:

Background: The English Indices of Multiple Deprivation (IMD) is widely used as a measure of deprivation of geographic areas in analyses of health inequalities between places. However, similarly ranked areas can differ substantially in the underlying sub-domains and indicators that are used to calculate the IMD score. These sub-domains and indicators contain a richer set of data that might be useful for classifying local authorities. Clustering methods offer a set of techniques to identify groups of areas with similar patterns of deprivation. This could offer insights into areas that face similar challenges.

Methods: Hierarchical agglomerative (i.e. bottom-up) clustering methods were applied to sub-domain scores for 152 upper-tier local authorities. Recent advances in statistical testing allow clusters to be identified that are unlikely to have arisen from random partitioning of a homogeneous group.

Results: Five statistically significant clusters of local authorities were identified. These clusters represented local authorities that were: (i) Most deprived, predominantly urban; (ii)Least deprived, predominantly rural; (iii) Less deprived, rural; (iv)Deprived, high crime, high barriers to housing; and (v)Deprived, low education, poor employment, poor health. Clusters only partially reflected a spectrum of multiple deprivation. In particular, clusters iv and v had similar overall deprivation scores, but different average sub-domain scores. Conclusion Hierarchical clustering methods can be used to identify five distinct clusters that do not correspond closely to quintiles of deprivation. These methods can be used to draw on the richer set of information contained in the IMD sub-domains and may help to identify places that face similar challenges, and places that appear similar in terms of IMD scores, but that face different challenges.

Tuberculosis (TB) in Nigeria: a 21st century global public health challenge

Presenting Author: Usman Tijjani Shehu (University of Salford)

Other Author(s): Abdulsalam Mohammed Yakasai, Alex Clarke-Cornwell

Abstract Text:

This article is a narrative review of the Tuberculosis (TB) in Nigeria: a 21st century global public health challenge. Complete research articles related to TB which includes prevalence, incidences, risk factors, mode of transmission, comorbidity, challenges of prevention and treatment of TB (such as diagnostic tools and recent medications) were gathered from online database searches and individually critiqued for scientific rigor based on epidemiology of TB. Articles relating to 30 TB were reviewed. All but 15 articles were on prevalence and incidence of TB around the world, seven articles on prevalence and incidences of TB in Sub-Sahara Africa, and eight articles on challenges refer to an obstacle or barriers that prevent tackling or control of TB transmission from occurring. The results of this review provide information to those interested in epidemiological study of infectious diseases like TB. The rehabilitation professionals such as Cardiopulmonary Physiotherapists may use this information to develop the best assessment instrument and non-pharmacological intervention for persons living with TB.