Browsing by Author "Machingaidze, Shingai"
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- ItemCurrent knowledge and future research directions on fecal bacterial patterns and their association with asthma(Frontiers Media, 2016) Claassen-Weitz, Shantelle; Wiysonge, Charles S.; Machingaidze, Shingai; Thabane, Lehana; Horsnell, William G. C.; Zar, Heather J.; Nicol, Mark P.; Kaba, MamadouENGLISH SUMMARY : Asthma is a complex respiratory condition that involves interplay between genetic predisposition, environmental, and immunological factors (Edwards et al., 2012). It is considered to be one of the most common chronic diseases, affecting ~300 million people (Masoli et al., 2004), and causing an estimated 250,000 deaths annually (Bateman et al., 2008). Furthermore, because of an increased Westernized lifestyle and urbanization in developing countries, it is estimated that by 2025 the global burden of asthma will increase by 100 million people (Masoli et al., 2004).
- ItemMapping South African allied health primary care clinical guideline activity : establishing a stakeholder reference sample(BioMed Central, 2016-10-10) Dizon, Janine Margarita; Grimmer, Karen; Machingaidze, Shingai; McLaren, Pam; Louw, QuinetteENGLISH SUMMARY : Background: Little is known about allied health (AH) clinical practice guideline (CPG) activity in South Africa, and particularly in relation to primary health care (PHC). This paper reports on a scoping study undertaken to establish a reference framework, from which a comprehensive maximum variation sample could be selected. This was required to underpin robust sampling for a qualitative study aimed at understanding South African primary care AH therapy CPG activities. This paper builds on findings from the South African Guidelines Evaluation (Project SAGE) Flagship grant. Methods: South African government websites were searched for structures of departments and portfolios, and available CPGs. Professional AH association websites were searched for CPGs, purposively-identified key informants were interviewed, and CPGs previously identified for priority South African primary care conditions were critiqued for AH therapy involvement. Results: Key informants described potentially complex relationships between players who may be engaged in South African AH CPGs, in both public and private sectors. There were disability/rehabilitation portfolios at national and provincial governments, but no uniformity in provincial government organisation of, or support for, PHC AH services. There were no AH primary care therapy CPGs on government websites, although there was ‘clinical guidance’ in various forms on professional association websites. Only two CPGs of priority South African PHC conditions included mention of any AH therapy (physiotherapy for adult asthma and chronic obstructive pulmonary disease). Conclusion: A comprehensive and wide-reaching stakeholder reference framework would be required in order to capture the heterogeneity of AH primary care CPG activity in South Africa. This should involve the voices of national and purposively-selected provincial governments, academic institutions, consultants, public sector managers and clinicians, private practitioners, professional associations, and private sector insurers. Provincial governments should be selected to reflect heterogeneity in local economics, population demographics and availability of university AH training programs. This investigation should aim to determine the areas of PHC in which AH are engaged.
- ItemNew vaccine introductions in Africa before and during the decade of vaccines –are we making progress?(Elsevier, 2019) Sambala, Evanson Z.; Wiyeh, Alison B.; Ngcobo, Ntombenhle; Machingaidze, Shingai; Wiysonge, Charles S.Vaccines are excellent investments with far-reaching rewards beyond individual and population health, but their introduction into national programs has been historically slow in Africa. We provide an overview of the introduction of new and underutilized vaccines in countries of the WHO African Region by 2017, using data from the WHO-UNICEF Joint Reporting Form. By 2017, all 47 countries had introduced vaccines containing hepatitis B (compared to 11% in 2000 and 98% in 2010) and Haemophilus influenzae type b (Hib) (compared to 4% in 2000 and 91% in 2010). The proportion of countries that had introduced other vaccines by 2017 was 83% for pneumococcal conjugate vaccine (PCV) from 7% in 2010, 72% for rotavirus vaccine from 2% in 2010, 55% for the second dose of a measles-containing vaccine (MCV2) (compared to 11% in 2000 and 17% in 2010), and 45% for rubella-containing vaccines (RCV) (compared to 4% in 2000 and 7% in 2010). From 2000 to 2010, there was no significant difference between countries eligible (N = 36) and those not eligible (N = 10) for Gavi support in the introduction of hepatitis B and PCV. However, Gavi eligible countries were more likely to introduce Hib and non-Gavi eligible countries were more likely to introduce MCV2 and RCV. From 2010 to 2017, the only significant differences that remained between the two groups of countries were with mumps, inactivated polio and seasonal influenza vaccines; which non-Gavi eligible countries were more likely to have introduced. There has been significant progress in the introduction of new childhood vaccines in Africa, mostly driven by Gavi support. As many countries are expected to transition out of Gavi support soon, there is need for countries in the region to identify predictable, reliable and sustainable immunization funding mechanisms. This requires commitments and actions that go beyond the purchase of vaccines.
- ItemNext generation clinical guidance for primary care in South Africa – credible, consistent and pragmatic(Public Library of Science, 2018-03-30) Machingaidze, Shingai; Grimmer, Karen; Louw, Quinette; Kredo, Tamara; Young, Taryn; Volmink, JimmyBackground: Agreed international development standards underpin high quality de novo clinical practice guidelines (CPGs). There is however, no international consensus on how high quality CPGs should ‘look’; or on whether high quality CPGs from one country can be viably implemented elsewhere. Writing de novo CPGs is generally resource-intensive and expensive, making this challenging in resource-poor environments. This paper proposes an alternative, efficient method of producing high quality CPGs in such circumstances, using existing CPGs layered by local knowledge, contexts and products. Methods: We undertook a mixed methods case study in South African (SA) primary healthcare (PHC), building on findings from four independent studies. These comprised an overview of international CPG activities; a rapid literature review on international CPG development practices; critical appraisal of 16 purposively-sampled SA PHC CPGs; and additional interrogation of these CPGs regarding how, why and for whom, they had been produced, and how they ‘looked’. Results: Despite a common aim to improve SA PHC healthcare practices, the included CPGs had different, unclear and inconsistent production processes, terminology and evidence presentation styles. None aligned with international quality standards. However many included innovative succinct guidance for end-users (which we classified as evidence-based summary recommendations, patient management tools or protocols). We developed a three-tiered model, a checklist and a glossary of common terms, for more efficient future production of better quality, contextually-relevant, locally-implementable SA PHC CPGs. Tier 1 involves transparent synthesis of existing high quality CPG recommendations; Tier 2 reflects local expertise to layer Tier 1 evidence with local contexts; and Tier 3 comprises tailored locally-relevant end-user guidance. Conclusion: Our model could be relevant for any resource-poor environment. It should reduce effort and costs in finding and synthesising available research evidence, whilst efficiently focusing scant resources on contextually-relevant evidence-based guidance, and implementation.
- ItemSouth African clinical practice guidelines quality measured with complex and rapid appraisal instruments(BioMed Central, 2016-04-27) Grimmer, Karen; Machingaidze, Shingai; Dizon, Janine; Kredo, Tamara; Louw, Quinette; Young, TarynENGLISH SUMMARY : Background: Critically appraising the quality of clinical practice guidelines (CPGs) is an essential element of evidence implementation. Critical appraisal considers the quality of CPG construction and reporting processes, and the credibility of the body of evidence underpinning ecommendations. To date, the focus on CPG critical appraisal has come from researchers and evaluators, using complex appraisal instruments. Rapid critical appraisal is a relatively new approach for CPGs, which targets busy end-users such as service managers and clinicians. This paper compares the findings of two critical appraisal instruments: a rapid instrument (iCAHE) and a complex instrument (AGREE II). They were applied independently to 16 purposively-sampled, heterogeneous South African CPGs, written for eleven primary health care conditions/health areas. Overall scores, and scores in the two instruments’ common domains Scope and Purpose, Stakeholder involvement, Underlying evidence/Rigour of Development, Clarity), were compared using Pearson r correlations and intraclass correlation coefficients. CPGs with differences of 10 % or greater between scores were identified and reasons sought for such differences. The time taken to apply the instruments was recorded. Results: Both instruments identified the generally poor quality of the included CPGs, particularly in Rigour of Development. Correlation and agreement between instrument scores was moderate, and there were no overall significant score differences. Large differences in scores for some CPGs could be explained by differences in instrument construction and focus, and CPG construction. The iCAHE instrument was demonstrably quicker to use than the AGREE II instrument. Conclusions: Either instrument could be used with confidence to assess the quality of CPGs. The choice of appraisal instrument depends on the needs and time of end-users. Having an alternative (rapid) critical appraisal tool will potentially encourage busy end-users to identify and use good quality CPGs to inform practice decisions.
- ItemSouth African Guidelines Excellence (SAGE) : clinical practice guidelines - quality and credibility(Health and Medical Publishing Group, 2015) Machingaidze, Shingai; Kredo, Tamara; Louw, Quinette; Young, Taryn; Grimmer, KarenENGLISH SUMMARY : In this editorial, the first in a series of six, we present issues critical to CPG development and uptake, relevant to South Africa (SA) and beyond. While recent local efforts to improve CPG quality and credibility in SA are commendable, opportunities to progress SA CPG quality and uptake are limited by the lack of a central, nationally recognised and accepted CPG development unit. Such a unit has the potential to significantly increase SA efforts to improve and standardise high-quality, credible CPG development, reporting and uptake. To this end, the Project SAGE (South African Guidelines Excellence) team is engaging in a 3-year stakeholder-driven process that aims to better understand the guideline development arena in SA, and improve the standard of local guideline development, adaptation, contextualisation, and ultimately implementation of primary healthcare guidelines.
- ItemSouth African Guidelines Excellence (SAGE) : efficient, effective and unbiased clinical practice guideline teams(Health & Medical Publishing Group, 2016) Grimmer, Karen; Dizon, Janine Margarita; Louw, Quinette; Kredo, Tamara; Young, Taryn; Machingaidze, ShingaiENGLISH SUMMARY : A range of different evidence-based methods for clinical practice guideline activities have been established, and there is common agreement in these that poorly conceived CPG team composition and management can jeopardise CPG integrity. Recognised CPG initiatives therefore provide guidance on CPG team construction and management. In this editorial, we outline steps for effective, efficient and outcome-focused CPG team membership, roles and management: (i) determine responsibilities and tasks; (ii) identify ‘experts’ and their ‘voices’; (iii) identify a CPG team leader; (iv) determine and declare conflicts of interest; (v) determine CPG team terms of reference; (vi) establish CPG timeframes and tailored capacity development; and (vii) establish consensus. Writing CPGs can be time-consuming and expensive.Efforts therefore need to be underpinned by efficient, respectful and agreed processes. Justifying CPG team membership, declaring conflicts of interest, identifying efficient ways of hearing constituent ‘voices’, defining and time-lining team tasks and roles, providing necessary training, and respecting individuals’ efforts and time should ensure that CPG team members enjoy their experiences. This will contribute to growing CPG expertise in South Africa and beyond.
- ItemSouth African Guidelines Excellence (SAGE) : What’s in a name?(Health & Medical Publishing Group, 2016) Kredo, Tamara; Machingaidze, Shingai; Louw, Quinette; Young, Taryn; Grimmer, KarenENGLISH SUMMARY : Project SAGE (South African Guidelines Excellence) is a 3-year research project, funded by the South African Medical Research Council, through the South African University Flagship Project scheme (http://www.mrc.ac.za/cochrane/sage.htm). Using stakeholder-driven processes, SAGE will provide tools to assist effective South African (SA) clinical practice guideline (CPG) activities in developing, adapting, adopting, contextualising and implementing primary care CPGs. In a resource-limited setting such as SA, where access to resources for health is limited, ensuring best use of effective and cost-effective primary care diagnostics and treatments is key to reducing waste, improving access and hence improving quality of care.
- ItemTo adopt, to adapt, or to contextualise? The big question in clinical practice guideline development(BioMed Central, 2016-09-13) Dizon, Janine Margarita; Machingaidze, Shingai; Grimmer, KarenENGLISH SUMMARY : Aim: Developing new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context. Results: The first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply ‘adopt’ this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to ‘contextualise’ the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to ‘adapt’ the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.
- ItemTrends in the types and quality of childhood immunisations research output from Africa 1970-2010 : mapping the evidence base(BioMed Central, 2014-02) Machingaidze, Shingai; Hussey, Gregory D.; Wiysonge, Charles S.Background: Over the past four decades, extraordinary progress has been made in establishing and improving childhood immunization programmes around Africa. In order to ensure effective and sustainable positive growth of these childhood immunisations programmes, the development, adaptation and implementation of all interventions (programme activities, new vaccines, new strategies and policies) should be informed by the best available local evidence. Methods: An assessment of the peer-reviewed literature on childhood immunization research published in English from 1970 to 2010 was conducted in PubMed and Africa-Wide databases. All study types were eligible for inclusion. A standard form was used to extract information from all studies identified as relevant and entered into a Microsoft Access database for analysis. Results: Our initial search yielded 5436 articles from the two databases, from which 848 full text articles were identified as relevant. Among studies classified as clinical research (417), 40% were clinical trials, 24% were burden of disease/epidemiology and 36% were other clinical studies. Among studies classified as operational research (431), 77% related to programme management, 18% were policy related and 5% were related to vaccine financing. Studies were conducted in 48 African countries with six countries (South Africa, The Gambia, Nigeria, Senegal, Guinea-Bissau and Kenya) accounting for 56% of the total research output. Studies were published in 152 different journals with impact factors ranging from 0.192 to 53.29; with a median impact factor of 3.572. Conclusion: A similar proportion of clinical versus operational research output was found. However, an uneven distribution across Africa was observed with only six countries accounting for over half of the research output. The research conducted was of moderate to high quality, with 62% being published in journals with 2010 impact factors greater than two. Urgent attention should be given to the development of research capacity in low performing countries around Africa, with increased focus on the process of turning immunisations programme research evidence into policy and practice, as well as increased focus on issues relating to vaccine financing and sustainability in Africa.
- ItemUnderstanding interventions for improving routine immunization coverage in children in low- and middle-income countries : a systematic review protocol(BioMed Central, 2013-11) Machingaidze, Shingai; Rehfuess, Eva; Von Kries, Rudiger; Hussey, Gregory D.; Wiysonge, Charles S.Background: Virtually all low- and middle-income countries are dependent on the World Health Organization’s Expanded Program on Immunization for delivery of vaccines to children. The Expanded Program on Immunization delivers routine immunization services from health facilities free of charge. Understanding interventions for improving immunization coverage remains key in achieving universal childhood immunization. Methods: We will conduct a systematic review that aims to assess the effectiveness of the full range of potential interventions to improve routine immunization coverage in children in low- and middle-income countries. We will include intervention studies, as well as observational studies. We will search the Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, electronic databases for eligible studies published by 31 August 2013. At least two authors will independently screen search outputs, select studies, extract data and assess the risk of bias (using separate criteria for interventions and observational studies); resolving any disagreements by discussion and consensus. The use of logic models and the Cochrane Complexity Matrix will be explored in order to better understand and contextualize studies. We will express the result of each study as a risk ratio with its corresponding 95% confidence intervals for dichotomous data, or mean difference with its standard deviation for continuous data. We will conduct meta-analysis for the same type of participants, interventions, study designs, and outcome measures where homogeneity of data allows. Use of harvest plots may be explored as an alternative. Heterogeneity will be assessed using the χ2 test of heterogeneity, and quantified using the I2 statistic. This protocol has not been registered with PROSPERO. Discussion: This review will allow us to document evidence across a broad range of intervention types for improving routine immunization coverage in children and also distinguish between those that are well supported by evidence (to direct policy recommendations) and those that are not well supported (to direct research agenda).
- ItemThe use of supplementary immunisation activities to improve uptake of current and future vaccines in low-income and middle-income countries : a systematic review protocol(BMJ Publishing Group, 2014-01) Kagina, Benjamin M.; Wiysonge, Charles S.; Machingaidze, Shingai; Abdullahi, Leila H.; Adebayo, Esther; Uthman, Olalekan A.; Hussey, Gregory D.ENGLISH SUMMARY : Introduction: Immunisation coverage data in low-income and middle-income countries (LMICs) suggest that more strategies need to be implemented to achieve and sustain optimal vaccine uptake. Among possible strategies to improve immunisation coverage are supplementary immunisation activities (SIAs). We are therefore interested in conducting a systematic review to assess whether SIAs complement routine immunisation programmes to improve vaccination coverage and prevent disease outbreaks. Methods: Our systematic review will focus on studies conducted in LMICs. With the help of an information specialist, we will search for eligible studies in PubMed, Web of Science, Scopus, Africa-Wide, Cochrane Library, WHOLIS, CINAHL, PDQ-Evidence as well as reference lists of relevant publications. Additionally, we will contact relevant organisations such as WHO and GAVI. Two authors will independently extract data from eligible studies and independently assess risk of bias by assessing the adequacy of study characteristics. The primary meta-analysis will use random effects models due to expected interstudies heterogeneity. Dichotomous data will be analysed using relative risk and continuous data using weighted mean differences (or standardised mean differences), both with 95% CIs. Discussion: The findings from this systematic review will be discussed in the context of strengthening routine childhood immunisation services, routine adolescent immunisation services and introduction of future vaccines against tuberculosis and HIV/AIDS. Study strengths: Unbiased selection of many studies conducted in different settings. This will strengthen the validity of the review results. Study limitations: Heterogeneity of the study settings of the low-income, lower-middle-income and upper-middle-income countries as well as heterogeneity in study designs.