Browsing by Author "Green, A."
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Item Assessment of capacity for Health Policy and Systems Research and Analysis in seven African universities: Results from the CHEPSAA project(Health Policy and Planning, 2014-10) Mirzoev, T.; Lê, G.; Green, A.; Orgill, M.; Komba, A.; Esena, R.K.; Nyapada, L.; Uzochukwu, B.; Amde, W.K.; Nxumalo, N.; Gilson, L.The importance of health policy and systems research and analysis (HPSR+A) is widely recognized. Universities are central to strengthening and sustaining the HPSR+A capacity as they teach the next generation of decision-makers and health professionals. However, little is known about the capacity of universities, specifically, to develop the field. In this article, we report results of capacity selfassessments by seven universities within five African countries, conducted through the Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA). The capacity assessments focused on both capacity 'assets' and 'needs', and covered the wider context, as well as organizational and individual capacity levels. Six thematic areas of capacity were examined: leadership and governance, organizations' resources, scope of HPSR+A teaching and research, communication, networking and getting research into policy and practice (GRIPP), demand for HPRS+A and resource environment. The self-assessments by each university used combinations of document reviews, semi-structured interviews and staff surveys, followed by comparative analysis. A framework approach, guided by the six thematic areas, was used to analyse data. We found that HPSR+A is an international priority, and an existing activity in Africa, though still neglected field with challenges including its reliance on unpredictable international funding. All universities have capacity assets, such as ongoing HPSR+A teaching and research. There are, however, varying levels of assets (such as differences in staff numbers, group sizes and amount of HPSR+A teaching and research), which, combined with different capacity needs at all three levels (such as individual training, improvement in systems for quality assurance and fostering demand for HPSR+A work), can shape a future agenda for HPSR+A capacity strengthening. Capacity assets and needs at different levels appear related. Possible integrated strategies for strengthening universities' capacity include: refining HPSR+Avision, mainstreaming the subject into under- and post-graduate teaching, developing emerging leaders and aligning HPSR+A capacity strengthening within the wider organizational development. © The Author 2013; all rights reserved.Item Can action research strengthen district health management and improve health workforce performance? A research protocol(BMJ Open, 2013-08) Mshelia, C.; Huss, R.; Mirzoev, T.; Elsey, H.; Baine, S.O.; Aikins, M.; Kamuzora, P.; Bosch-Capblanch, X.; Raven, J.; Wyss, K.; Green, A.; Martineau, T.Introduction: The single biggest barrier for countries in sub-Saharan Africa (SSA) to scale up the necessary health services for addressing the three health-related Millennium Development Goals and achieving Universal Health Coverage is the lack of an adequate and well-performing health workforce. This deficit needs to be addressed both by training more new health personnel and by improving the performance of the existing and future health workforce. However, efforts have mostly been focused on training new staff and less on improving the performance of the existing health workforce. The purpose of this paper is to disseminate the protocol for the PERFORM project and reflect on the key challenges encountered during the development of this methodology and how they are being overcome. Methods: The overall aim of the PERFORM project is to identify ways of strengthening district management in order to address health workforce inadequacies by improving health workforce performance in SSA. The study will take place in three districts each in Ghana, Tanzania and Uganda using an action research approach. With the support of the country research teams, the district health management teams (DHMTs) will lead on planning, implementation, observation, reflection and redefinition of the activities in the study. Taking into account the national and local human resource (HR) and health systems (HS) policies and practices already in place, 'bundles' of HR/HS strategies that are feasible within the context and affordable within the districts' budget will be developed by the DHMTs to strengthen priority areas of health workforce performance. A comparative analysis of the findings from the three districts in each country will add new knowledge on the effects of these HR/HS bundles on DHMT management and workforce performance and the impact of an action research approach on improving the effectiveness of the DHMTs in implementing these interventions. Discussion: Different challenges were faced during the development of the methodology. These include the changing context in the study districts, competing with other projects and duties for the time of district managers, complexity of the study design, maintaining the anonymity and confidentiality of study participants as well as how to record the processes during the study. We also discuss how these challenges are being addressed. The dissemination of this research protocol is intended to generate interest in the PERFORM project and also stimulate discussion on the use of action research in complex studies such as this on strengthening district health management to improve health workforce performance.Item Genome-wide and fine-resolution association analysis of malaria in west Africa(2009-06) Jallow, M.; Teo, Y.Y.; Small, K. S.; Koram, K.A.; Deloukas, P.; Clark, T.G.; Kivinen, K.; Bojang, K.A.; Conway, D.J.; Pinder, M.; Sirugo, G.; Sisay-Joof, F.; Usen, S.; Auburn, S.; Bumpstead, S.J.; Campino, S.; Coffey, A.; Dunham, A.; Fry, A.E.; Green, A.; Gwilliam, R.; Hurt, S.E.; Inouye, M.; Jeffreys, A.E.; Mendy, A.; Palotie, A.; Potter, S.; Ragoussis, J.; Rogers, J.; Rowlands, K.; Somaskantharajah, E.; Whittaker, P.; Wilson, M.; Kwiatkowski, D.P.We report a genome-wide association (GWA) study of severe malaria in The Gambia. The initial GWA scan included 2,500 children genotyped on the Affymetrix 500K GeneChip, and a replication study included 3,400 children. We used this to examine the performance of GWA methods in Africa. We found considerable population stratification, and also that signals of association at known malaria resistance loci were greatly attenuated owing to weak linkage disequilibrium (LD). To investigate possible solutions to the problem of low LD, we focused on the HbS locus, sequencing this region of the genome in 62 Gambian individuals and then using these data to conduct multipoint imputation in the GWA samples. This increased the signal of association, from P = 4 × 10 7 to P = 4 × 10 14, with the peak of the signal located precisely at the HbS causal variant. Our findings provide proof of principle that fine-resolution multipoint imputation, based on population-specific sequencing data, can substantially boost authentic GWA signals and enable fine mapping of causal variants in African populations.Item Integrated Assessment of Artisanal and Small-Scale Gold Mining in Ghana-Part 1: Human Health Review(International Journal of Environmental Research and Public Health, 2015-05) Basu, N.; Clarke, E.; Green, A.; Calys-Tagoe, B.; Chan, L.; Dzodzomenyo, M.; Fobil, J.; Long, R.N.; Neitzel, R.L.; Obiri, S.; Odei, E.; Ovadje, L.; Quansah, R.; Rajaee, M.; Wilson, M.L.This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors’ recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere. © 2015 by the authors; licensee MDPI, Basel, Switzerland.Item Integrated Assessment of Artisanal and Small-Scale Gold Mining in Ghana-Part 2: Natural Sciences Review.(International Journal of Environmental Research and Public Health, 2015-07) Rajaee, M.; Obiri, S.; Green, A.; Long, R.; Cobbina, S.J.; Nartey, V.; Buck, D.; Antwi, E.; Basu, N.This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors’ recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere. (PDF) Integrated Assessment of Artisanal and Small-Scale Gold Mining in Ghana—Part 1: Human Health Review. Available from: https://www.researchgate.net/publication/277349673_Integrated_Assessment_of_Artisanal_and_Small-Scale_Gold_Mining_in_Ghana-Part_1_Human_Health_Review [accessed Sep 13 2018].Item Positive selection of a CD36 nonsense variant in sub-saharan Africa, but no association with severe malaria phenotypes(2009) Fry, A.E.; Ghansa, A.; Small, K. S.; Palma, A.; Auburn, S.; Diakite, M.; Green, A.; Campino, S.; Teo, Y.Y.; Clarke, T.G.; Jeffreys, A.E.; Wilson, J.; Jallow, M.; Sisay-Joof, F.; Pinder, M.; Griffiths, M.J.; Peshu, N.; William, T.N.; Newton, C.R.; Marsh, K.; Molyneux, M.E.; Taylor, T.E.; Koram, K.A.; Oduro, A.R.; Roger, W.O.; Rockett, K.A.; Sabeti, P.C.; Kwiatkowski, D.P.The prevalence of CD36 deficiency in East Asian and African populations suggests that the causal variants are under selection by severe malaria. Previous analysis of data from the International HapMap Project indicated that a CD36 haplotype bearing a nonsense mutation (T1264G; rs3211938) had undergone recent positive selection in the Yoruba of Nigeria. To investigate the global distribution of this putative selection event, we genotyped T1264G in 3420 individuals from 66 populations. We confirmed the high frequency of 1264G in the Yoruba (26%). However, the 1264G allele is less common in other African populations and absent from all non-African populations without recent African admixture. Using long-range linkage disequilibrium, we studied two West African groups in depth. Evidence for recent positive selection at the locus was demonstrable in the Yoruba, although not in Gambians. We screened 70 variants from across CD36 for an association with severe malaria phenotypes, employing a case-control study of 1350 subjects and a family study of 1288 parent-offspring trios. No marker was significantly associated with severe malaria. We focused on T1264G, genotyping 10 922 samples from four African populations. The nonsense allele was not associated with severe malaria (pooled allelic odds ratio 1.0; 95% confidence interval 0.89-1.12; P = 0.98). These results suggest a range of possible explanations including the existence of alternative selection pressures on CD36, co-evolution between host and parasite or confounding caused by allelic heterogeneity of CD36 deficiency. © 2009 The Author(s).