Browsing by Author "Durao, Solange"
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- ItemAn approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries(World Health Organization, 2016) Rehfuess, Eva A.; Durao, Solange; Kyamanywa, Patrick; Meerpohl, Joerg J.; Young, Taryn; Rohwer, Anke; The Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+)ENGLISH SUMMARY : To derive evidence-based and stakeholder-informed research priorities for implementation in African settings, the international research consortium Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) developed and applied a pragmatic approach. First, an online survey and face-to-face consultation between CEBHA+ partners and policy-makers generated priority research areas. Second, evidence maps for these priority research areas identified gaps and related priority research questions. Finally, study protocols were developed for inclusion within a grant proposal. Policy and practice representatives were involved throughout the process. Tuberculosis, diabetes, hypertension and road traffic injuries were selected as priority research areas. Evidence maps covered screening and models of care for diabetes and hypertension, population-level prevention of diabetes and hypertension and their risk factors, and prevention and management of road traffic injuries. Analysis of these maps yielded three priority research questions on hypertension and diabetes and one on road traffic injuries. The four resulting study protocols employ a broad range of primary and secondary research methods; a fifth promotes an integrated methodological approach across all research activities. The CEBHA+ approach, in particular evidence mapping, helped to formulate research questions and study protocols that would be owned by African partners, fill gaps in the evidence base, address policy and practice needs and be feasible given the existing research infrastructure and expertise. The consortium believes that the continuous involvement of decision-makers throughout the research process is an important means of ensuring that studies are relevant to the African context and that findings are rapidly implemented.
- ItemAssessing the completeness and comparability of outcomes in systematic reviews addressing food security : protocol for a methodological study(BMC (part of Springer Nature), 2020-01-09) Durao, Solange; Visser, Marianne; Kredo, Tamara; Saldanha, Ian J.Background: Systematic reviews should specify all outcomes at the protocol stage. Pre-specification helps prevent outcome choice from being influenced by knowledge of included study results. Completely specified outcomes comprise five elements: (1) domain (title), (2) specific measurement (technique/instrument), (3) specific metric (data format for analysis), (4) method of aggregation (how group data are summarised), and (5) time points. This study aims to assess the completeness of outcome pre-specification in systematic reviews of interventions to improve food security, specifically food availability, in low- and middle-income countries, as well as to assess the comparability of outcome elements across reviews reporting the same outcome domains. Methods: We will examine systematic reviews from an ongoing overview of systematic reviews, which assessed the effects of interventions addressing food insecurity through improving food production, access, or utilisation compared with no intervention or a different intervention, on nutrition outcomes. We will examine the original protocols; if unavailable, we will examine the “Methods” section of the systematic reviews’ most recent version. One investigator will identify and group all outcome domains that the authors of the included protocols intended to measure in the systematic review and a second investigator will verify the domains. For outcome domains reported in at least 25% of protocols, one author will extract data using a pre-specified form and a second author will verify the data. We will use descriptive statistics to report the number, types, and degree of specification of outcomes in included protocols. We will assess the extent of completeness of outcome pre-specification based on the number of outcome elements (out of five). We will assess comparability of outcome domains through examining how individual elements are described across SRs reporting the same outcome domains. Discussion: Our findings will contribute to understanding about the best approach to pre-specify outcomes for systematic reviews and primary research in the field of food security.
- ItemCommunity-level interventions for improving access to food in low- and middle-income countries(Cochrane, 2015-02-02) Schoonees, Anel; Durao, Solange; Ramokolo, Vundli; Oliveira, Julicristie Machado De; Kristjansson, ElizabethThis is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective : To determine the effects of community-level interventions that aim to improve access to nutritious food in LMICs, for both the whole community and for disadvantaged or at-risk individuals or groups within a community, such as infants and children, women, the elderly, the poor, the unemployed, or minority groups. Secondary objectives : To determine the features of community-level interventions that enable or impede the effective implementation of these interventions to improve access to food. To identify unintended consequences of interventions to improve access to food.
- ItemEvidence synthesis and translation for nutrition interventions to combat micronutrient deficiencies with particular focus on food fortification(MDPI, 2016) Lawrence, Mark; Wingrove, Kate; Naude, Celeste; Durao, SolangeOver two billion people suffer from micronutrient deficiencies. Food fortification is a prominent nutrition intervention to combat such deficiencies; however, its effectiveness, risks, and ethical implications vary depending on the contexts associated with the deficiency it is addressing and the circumstances with its implementation. The aim of this research was to analyse the profile of nutrition interventions for combating micronutrient deficiency with particular focus on food fortification reported in existing systematic reviews (SRs), guidelines and policy statements, and implementation actions for nutrition. A review of secondary data available from online databases of SRs, guidelines and policy statements, and implementation actions, categorised as either “nutrition-specific interventions” (NSpI) or “nutrition-sensitive interventions” (NSeI), was conducted. Currently, there is evidence available for a diversity of food fortification topics, and there has been much translation into action. Indeed, food fortification and micronutrient supplementation interventions and NSpI more broadly dominate the profile of interventions for which there were SRs, guidelines, and policy statements available. The findings demonstrate that, although there is a rational linear relationship between evidence synthesis and translation in formulating policy and actions to combat micronutrient deficiencies, the various nutrition interventions available to help combat micronutrient deficiencies are not equally represented in the evidence synthesis and translation processes. Effective and safe policies and actions to combat micronutrient deficiencies require decisions to be informed from a body of evidence that consists of evidence from a variety of interventions. Into the future, investment in making available a higher number of SRs, guidelines and policy statements, and actions of NSeI is indicated.
- ItemEvidence synthesis workshops : moving from face-to-face to online learning(BMJ Publishing, 2021-10) McCaul, Michael; Durao, Solange; Kredo, Tamara; Garner, Paul; Young, Taryn; Rohwer, AnkePostgraduate training is moving from face-to-face workshops or courses to online learning to help increase access to knowledge, expertise and skills, and save the cost of face-to-face training. However, moving from face-to-face to online learning for many of us academics is intimidating, and appears even more difficult without the help of a team of technologists. In this paper, we describe our approach, our experiences and the lessons we learnt from converting a Primer in Systematic Reviews face-to-face workshop to a 6-week online course designed for healthcare professionals in Africa. We learnt that the team needs a balance of skills and experience, including technical know-how and content knowledge; that the learning strategies needed to achieve the learning objectives must match the content delivery. The online approach should result in both building knowledge and developing skills, and include interactive and participatory approaches. Finally, the design and delivery needs to keep in mind the limited and expensive internet access in some resource-poor settings in Africa.
- ItemNutritional supplements for people being treated for active tuberculosis : a technical summary(Health & Medical Publishing Group, 2018) Grobler, L.; Durao, Solange; Van der Merwe, S. M.; Wessels, J.; Naude, Celeste E.Tuberculosis and nutrition are intrinsically linked in a complex relationship. Altered metabolism and loss of appetite associated with tuberculosis may result in undernutrition, which in turn may worsen the disease or delay recovery. We highlight an updated Cochrane review assessing the effects of oral nutritional supplements in people with active tuberculosis who are receiving antituberculosis drug therapy. The review authors conducted a comprehensive search (February 2016) for all randomised controlled trials comparing any oral nutritional supplement, given for at least 4 weeks, with no nutritional intervention, placebo or dietary advice only in people receiving antituberculosis treatment. Of the 35 trials (N=8 283 participants) included, seven assessed the provision of free food or high-energy supplements, six assessed multi-micronutrient supplementation, and 21 assessed single- or dual-micronutrient supplementation. There is currently insufficient evidence to indicate whether routinely providing free food or high-energy supplements improves antituberculosis treatment outcomes (i.e. reduced death and increased cure rates at 6 and 12 months), but it probably improves weight gain in some settings. Plasma levels of zinc, vitamin D, vitamin E and selenium probably improve with supplementation, but currently no reliable evidence demonstrates that routine supplementation with multi-, single or dual micronutrients above the recommended daily intake has clinical benefits (i.e. reduced death, increased cure rate at 6 and 12 months, improved nutritional status) in patients receiving antituberculosis treatment. In South Africa, most provinces implement a supplementation protocol based on nutritional assessment and classification of individuals rather than on disease diagnosis or treatment status.
- ItemPrevention and treatment of acute malnutrition in humanitarian emergencies : a multi-organisation collaboration to increase access to synthesised evidence(SpringerOpen (part of Springer Nature), 2019-05-31) Allen, Claire; Jansen, Jeroen; Naude, Celeste; Durao, Solange; Mehta, Monaz; Von Elm, Erik; Van Der Kam, Saskia; Prudhon, Claudine; Mayberry, Amy; McGrath, Marie; Alae-Carew, Carmelia; Berkley, James A.; Fracassi, Patrizia; Aburto, Nancy; Jenkins, Mica; Bourdaire, Jessica; Lang, Shona; Nevitte, Alex; Kuhn, Isla; Lee, Shaun; Hafezi, HannahBackground: Program decision-making to prevent and treat acute malnutrition in an emergency can be hampered by a lack of accessible and relevant overviews of directly available robust research evidence. There is often evidence from related settings such as from low-income countries, but this is dispersed across many databases, may be inaccessible and requires assessment of its relevance to the humanitarian setting. We describe a process whereby a multi-disciplinary, international group of specialists worked together to build relevant and effective collections of available systematic reviews on acute malnutrition, published and disseminated as online collections, to improve access to the evidence and concise, synthesised, relevant up to date evidence for programming. By describing this process, we hope to inspire other professional groups to take part in similar multi-stakeholder, multi-disciplinary projects. Objectives: This project was designed to make the evidence from relevant systematic reviews about malnutrition as accessible as possible to support evidence-based decision-making and to guide future research on the prevention and treatment of acute malnutrition in humanitarian emergencies. Methods: Between March 2017 and March 2018, a large group (21 volunteers and stakeholders) with different backgrounds collaborated to review and curate collections of systematic reviews of interventions for the prevention and treatment of moderate and severe acute malnutrition relevant to humanitarian emergencies. The methodology loosely followed general guidance for overviews of systematic reviews with a pre-defined question (formulated using the PICOS format) and search strategies applied to multiple databases. Pairs of collaborators first screened the search yields to identify potentially eligible reviews, where after other pairs screened the list of potentially eligible reviews for relevance and thus included in the final collections. Results: Search strategies were run in 12 databases, in the week of 15 September 2017, yielding a total of 4646 records after de-duplication. At this point, Cochrane reviews (n = 463) and non-Cochrane reviews (n = 4183) were separated and handled by different teams to compile three linked collections, namely the Evidence Aid Collection, consisting of relevant non-Cochrane reviews, and two Cochrane Special Collections, consisting of relevant Cochrane reviews, one for prevention and the other for treatment of acute malnutrition. The collections were published on the Evidence Aid website on 12 March 2018 and Cochrane website in August 2018. Discussion: Through this collaboration, we have successfully generated three collections of systematic reviews to guide prevention and management of acute malnutrition in humanitarian emergencies: an Evidence Aid collection of non-Cochrane reviews, and two Cochrane Special Collections of Cochrane reviews. These collections provide accessible synthesised evidence that can be used to inform decision-making on strategies and policies in the humanitarian emergency and disaster risk reduction sectors and to guide future research by identifying gaps in robust evidence and areas that are under-researched. These collections did not set out to assess methodological quality, appraise in detail what the reviews found or summarise the evidence, but rather to curate the identified relevant systematic reviews into online resources for others to use. This unique collaboration of different individuals, organisations and stakeholders, and the collation of robust evidence can be repeated for other subjects, and Evidence Aid is eager to support new collections around other topics relevant to humanitarian emergencies.
- ItemPriority setting for new systematic reviews : processes and lessons learned in three regions in Africa(BMJ Publishing Group, 2019) Effa, Emmanuel E.; Oduwole, Olabisi; Schoonees, Anel; Hohlfeld, Ameer; Durao, Solange; Kredo, Tamara; Mbuagbaw, Lawrence; Meremikwu, Martin; Ongolo-Zogo, Pierre; Wiysonge, Charles S.; Young, TarynPriority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle-income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect on the approaches and specific processes adopted across three regions of Africa, present some of the outcomes and share the lessons learnt while carrying out these activities. Priority setting for new systematic reviews was conducted between 2016 and 2018 across three regions in Africa. Different approaches were used: Multimodal approach (Central Africa), Modified Delphi approach (West Africa) and Multilevel stakeholder discussion (Southern-Eastern Africa). Several questions that can feed into systematic reviews have emerged from these activities. We have learnt that collaborative subregional efforts using an integrative approach can effectively lead to the identification of region specific priorities. Systematic review workshops including discussion about the role and value of reviews to inform policy and research agendas were a useful part of the engagements. This may also enable relevant stakeholders to contribute towards the priority setting process in meaningful ways. However, certain shared challenges were identified, including that emerging priorities may be overlooked due to differences in burden of disease data and differences in language can hinder effective participation by stakeholders. We found that face-to-face contact is crucial for success and follow-up engagement with stakeholders is critical in driving acceptance of the findings and planning future progress.
- ItemScope and quality of Cochrane reviews of nutrition interventions : a cross-sectional study(BioMed Central, 2017-04) Naude, Celeste E.; Durao, Solange; Harper, Abigail; Volmink, JimmyENGLISH SUMMARY : Background: All countries face significant challenges from complex manifestations of malnutrition, which affects one in three people globally. Systematic reviews provide ready-to-use syntheses of quality-appraised evidence to inform decision-making for actions. To enhance the utility and quality of future Cochrane nutrition evidence, we described the scope and quality of all nutrition systematic reviews in the Cochrane Database of Systematic Reviews (CDSR). Methods: We screened all active CDSR records (31 July 2015) to identify reviews and protocols using pre-specified eligibility criteria and definitions. Duplicate, independent data extraction included criteria for inclusion of studies in completed reviews (PICOS). We assessed methodological quality (AMSTAR), use of GRADE, mapped reviews against 2013 Global Burden of Disease data, and categorised the paradigm (medical, lifestyle and socio-ecological) of the review question. We analysed our results using descriptive statistics. Results: We screened 8484 records, and included 470 (8%) completed reviews (in 45 Cochrane Review Groups (CRGs)) and 169 (7%) protocols (in 41 CRGs) published by 47 of 53 CRGs with reviews. Most completed reviews were produced by the Pregnancy and Childbirth (n = 73), Neonatal (n = 64), Metabolic and Endocrine Disorders (n = 33), Developmental, Psychosocial and Learning Problems (n = 26), Kidney and Transplant (n = 18) and Heart (n = 18) CRGs. Only 27% (n = 129) of reviews had searches for new studies in 2013 or thereafter. Supplementation/supplement interventions were most common (50%; n = 235; majority with micronutrients; 73%, n = 173), followed by food interventions (20%; n = 95). All reviews included randomised controlled trials; about 5% included other designs; 25% used GRADE; the median AMSTAR score was 9 (interquartile range: 7 to 10), 51% were high (AMSTAR 9-11) and 49% moderate (AMSTAR 5-8) quality. More than 80% framed questions using a medical paradigm. For top causes of years-of-life-lost, most reviews addressed preterm birth, diabetes and ischaemic heart disease; for leading risk factors for disability-adjusted-life-years, most targeted childhood undernutrition and high body mass index. Conclusions: Nutrition reviews comprised 8% of active CDSR records, were widely distributed across nearly all CRGs and reflected the double nutrition burden. This analysis presents a comprehensive description of the scope and quality of Cochrane nutrition reviews, and identifies gaps for future activities to support actions to address the nutrition burden, in line with the current nutrition agenda and impetus.