Use of a digital job-aid in improving antenatal clinical protocols and quality of care in rural primary-level health facilities in Burkina Faso: a quasi-experimental evaluation.

OBJECTIVE: We assessed the impact of a digital clinical decision support (CDS) tool in improving health providers adherence to recommended antenatal protocols and service quality in rural primary-level health facilities in Burkina Faso. DESIGN: A quasi-experimental evaluation based on a cross-sectional post-intervention assessment comparing the intervention district to a comparison group. SETTING AND PARTICIPANTS: The study included 331 direct observations and exit interviews of pregnant women seeking antenatal care (ANC) across 48 rural primary-level health facilities in Burkina Faso in 2021. INTERVENTION: Digital CDS tool to improve health providers adherence to recommended antenatal protocols. OUTCOME MEASURES: We analysed the quality of care on both the supply and demand sides. Quality-of-care service scores were based on actual care provided and expected care according to standards. Pregnant women's knowledge of counselling and satisfaction score after receiving care were also calculated. Other outcomes included time of clinical encounter. RESULTS: The overall quality of health service provision was comparable across intervention and comparison health facilities (52% vs 51%) despite there being a significantly higher proportion of lower skilled providers in the intervention arm (42.5% vs 17.8%). On average, ANC visits were longer in the intervention area (median 24 min, IQR 18) versus comparison area (median 12 min, IQR: 8). The intervention arm had a significantly higher score difference in women's knowledge of received counselling (16.4 points, 95% CI 10.37 to 22.49), and women's satisfaction (16.18 points, 95% CI: 9.95 to 22.40). CONCLUSION: Digital CDS tools provide a valuable opportunity to achieve substantial improvements of the quality of ANC and broadly maternal and newborn health in settings with high burden mortality and less trained health cadres when adequately implemented.

Connectedness Is Critical: A Social Network Analysis to Support Emerging Women Leaders in Global Health.

Background: Global health networks serve to bring members together towards a specific objective. However, for myriad reasons, women often lack access to networks that facilitate leadership and career development. In 2020, the Johns Hopkins Center for Global Health launched Emerging Women Leaders in Global Health (EDGE) with a virtual seminar series featuring diverse women leaders followed by an online networking space. Objectives: The purpose of this paper is to use social network analysis (SNA) to describe the network, the connections within it, and the values placed on those connections to inform future programming. Methods: We asked EDGE participants to fill out a survey to collect network-specific data. Then, we developed a sociogram and calculated social network metrics based on region, type of organization, and professional career stage. Findings: The EDGE network had 103 unique connections, and each node, on average, was connected to two other nodes. Early professionals that work in Global North academic institutions were the most prevalent members and most efficiently connected with other members of the network. However, senior professionals from the Global South are key to bridging gaps between regions and across sectors. Conclusions: Early career professionals from the Global North and senior professionals from the Global South need to work in synergy to improve the connectedness of emerging women leaders around the world.

Multisectoral action coalitions for road safety in Brazil: An organizational social network analysis in São Paulo and Fortaleza.

OBJECTIVE: This research was conducted to explore the nature of multisectoral action for road safety in Brazil. In an effort to improve the implementation of complex interventions, we sought to characterize the relationships and exchange patterns within a network tied to the Bloomberg Initiative for Global Road Safety (BIGRS) in Fortaleza and São Paulo, Brazil. METHODS: We conducted an organizational social network analysis based on in-person surveys and key informant interviews with 57 individuals across the two cities from August to October 2019. Survey data included network dimensions such as the frequency of interaction, perceived value of interaction, resource sharing, coordination, data/research sharing, practical guidance, and access to decision makers. We coded and analyzed interview transcripts according to network properties of structure, governance, development, and outcomes, as well as in situ codes that emerged from the data. RESULTS: We found differences in all network properties between road safety networks in Fortaleza and São Paulo. Fortaleza was characterized by a centralized, dense, and relatively new network, whereas São Paulo was larger, diffuse, diverse, and established. Government agencies were central in both networks, but an international nongovernmental organization (NGO) was highly central in Fortaleza and a local NGO was highly central in São Paulo. Few actors on the periphery of both networks were connected to one another or decision makers, which revealed sectors to engage for enhancing network connectivity. Finally, politics were understood to be key in facilitating network activity, data (especially their integration and transparency) were considered to be influential for decision making, and strategic planning was acknowledged as a central concern for network expansion and fluidity. CONCLUSIONS: Multisectoral action for road safety can be reinforced by carefully disentangling the social dynamics of implementation. Organizational social network analysis, supplemented with interview data, can provide a deeper explanation for how members behave and understand their work. In this way, research can help build a collective identity and impetus to action on road safety, contributing to a healthier and more equitable world.

Seroprevalence of HPV serotypes 6, 11, 16 and 18 in unvaccinated children from Mexico City.

Data regarding humoral immunity against HPV infection are scarce. Most analyses focus on the identification of viruses on mucous membranes and primarily refer to women of reproductive age. The aim of this work was to estimate the seroprevalence of antibodies against HPV serotypes 6, 11, 16 and 18 among unvaccinated boys living in Mexico City. A cross-sectional study of 257 male students from 48 public primary schools in Mexico City, whose ages fluctuated between 9 and 14 years, was carried out. Immunological status was assessed by applying the competitive Luminex Immunoassay of HPV (cLIA). Among the study population, we initially found that 38.52% (n = 99) of the children tested positive against one or more of the HPV 6, 11, 16 and/or 18 serotypes. The most commonly found serotype was isolated HPV 18 or in combination with other serotypes (22% and 31%, respectively), followed by HPV 6 with frequencies of 4.7% and 11%, respectively; however, lower frequencies were estimated for HPV 16 (2%; 6%) and isolated HPV 11, 4%. If a second set of cut-off points for seropositivity is applied, the overall prevalence for any serotype is reduced to 15.2%. As it appears that a significant sector of the study population has had basal contact with an HPV serotype, we recommend considering the possibility of vaccination against HPV at earlier ages.