KIT Royal Tropical Institute

Amsterdam, Netherlands

KIT Royal Tropical Institute

Amsterdam, Netherlands
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Woodward A.,London School of Hygiene and Tropical Medicine | Sheahan K.,University of North Carolina at Chapel Hill | Sondorp E.,KIT Royal Tropical Institute
Health Research Policy and Systems | Year: 2017

Background: High quality health systems research (HSR) in fragile and conflict-affected states (FCAS) is essential to guiding the policies and programmes that will improve access to health services and, ultimately, health outcomes. Yet, conducting HSR in FCAS is challenging. An understanding of these challenges is essential to tackling them and to supporting research conducted in these complex environments. Led by the Thematic Working Group on Health Systems in FCAS, the primary aim of this study was to develop a research agenda on HSR in FCAS. The secondary aim was to identify the challenges associated with conducting HSR in these contexts. This paper presents these challenges. Methods: Guided by a purposely-selected steering group, this qualitative study collected respondents' perspectives through an online survey (n = 61) and a group discussion at the Third Global Symposium on HSR in September 2014 (n = 11). Respondents with knowledge and/or experience of HSR in FCAS were intentionally recruited. Results: Of those ever involved in HSR in FCAS (45/61, 75%), almost all (98%) experienced challenges in conducting their research. Challenges fall under three broad thematic areas: (1) lack of appropriate support; (2) complex local research environment, including access constraints, weak local research capacity, collaboration challenges and lack of trust in the research process; and (3) limited research application, including rapidly outdated findings and lack of engagement with the research process and results. Conclusions: This study shows that those familiar with HSR in FCAS face many challenges in gaining support for and in conducting and applying high-quality research. There is a need for more sustainable support, including commitment to and long-term funding of HSR in FCAS; investment in capacity building within FCAS to meet the challenges related to implementation of research in these complex environments; relationship and trust building among stakeholders involved in HSR, particularly between local and international researchers and between researchers and participants; and innovative and flexible approaches to research design and implementation in these insecure and rapidly changing contexts. © 2017 The Author(s).


de Lepper A.M.,University Utrecht | de Lepper A.M.,KIT Royal Tropical Institute | Eijkemans M.J.C.,University Utrecht | van Beijma H.,Text to Change Europe | And 3 more authors.
Tropical Medicine and International Health | Year: 2013

Objective: The use of mobile phones can improve and strengthen (preventive) health care in low- and middle-income countries. We aimed to retrospectively assess the response patterns of participants in free SMS health education quizzes in Uganda. Methods: Study participants were employees of two companies and their community networks. We investigated how quickly individuals responded to quiz question(s) and assessed possible influencing factors. Cox regression and anova analyses were used. Results: Fifty percentage of responders answered within 50 min. The response chance declined with every additional day after sending an incentive via SMS (Hazard Ratio 0.993, CI 95% 0.981-0.984). Quiz topics influenced both participation rates and response time. Response time was shortest for questions on HIV and sexual behaviour. Response rates were high for HIV (79%) and malaria (78.4%), but only 37.4% for demographic topics. Network providers had a substantial effect on response behaviour. Conclusion: Interactive SMS programs are a fast method to reach the target population and incentives increase response rates. The most important factor influencing response time and participation rate is the network provider. Future research should focus on developing evidence-based guidelines for the design, implementation and evaluation of SMS-based interventions. © 2013 Blackwell Publishing Ltd.


Schouten G.,Wageningen University | Schouten G.,Erasmus University Rotterdam | Bitzer V.,KIT Royal Tropical Institute
Ecological Economics | Year: 2015

The objective of this paper is to understand and trace the emergence of Southern standards in global agricultural value chains. While the trend towards private standards established by developed country or 'Northern' actors has received significant attention in the literature, recently an emergent counter-trend can be observed which manifests in the development of standards by Southern producer country actors. This may be attributed to the perceived lack of legitimacy of global standards, especially from a Southern perspective. The paper therefore applies a legitimacy perspective to analyse the emergence of new Southern standards in Indonesian and Malaysian palm oil, Brazilian soy and South African fruit production. The analysis reveals that Southern standards both target different audiences to obtain legitimacy and rely on different sources of legitimacy as compared to established Northern standards. This is done explicitly in order to create cognitive and moral distance to Northern standards and ultimately to reclaim the issue areas occupied by Northern standards. The paper discusses and reflects on the implications of the emergence of Southern standards for sustainability governance and concludes with the identification of future research opportunities on Southern standards. © 2015 Elsevier B.V.


Idema W.J.,Rotterdam University | Majer I.M.,Rotterdam University | Pahan D.,Rural Health Program | Oskam L.,KIT Royal Tropical Institute | And 2 more authors.
PLoS Neglected Tropical Diseases | Year: 2010

Background: With 249,007 new leprosy patients detected globally in 2008, it remains necessary to develop new and effective interventions to interrupt the transmission of M. leprae. We assessed the economic benefits of single dose rifampicin (SDR) for contacts as chemoprophylactic intervention in the control of leprosy. Methods: We conducted a single centre, double blind, cluster randomised, placebo controlled trial in northwest t Bangladeshbetween 2002 and 2007, including 21,711 close contacts of 1,037 patients with newly diagnosed leprosy. We gave a single dose of rifampicin or placebo to close contacts, with follow-up for four years. The main outcome measure was the development of clinical leprosy. We assessed the cost effectiveness by calculating the incremental cost effectiveness ratio (ICER) between the standard multidrug therapy (MDT) program with the additional chemoprophylaxis intervention versus the standard MDT program only. The ICER was expressed in US dollars per prevented leprosy case. Findings: Chemoprophylaxis with SDR for preventing leprosy among contacts of leprosy patients is cost-effective at all contact levels and thereby a cost-effective prevention strategy. In total, $6,009 incremental cost was invested and 38 incremental leprosy cases were prevented, resulting in an ICER of $158 per one additional prevented leprosy case. It was the most cost-effective in neighbours of neighbours and social contacts (ICER $214), slightly less cost-effective in next door neighbours (ICER $497) and least cost-effective among household contacts (ICER $856). Conclusion: Chemoprophylaxis with single dose rifampicin given to contacts of newly diagnosed leprosy patients is a costeffective intervention strategy. Implementation studies are necessary to establish whether this intervention is acceptable and feasible in other leprosy endemic areas of the world. © 2010 Idema et al.


Richardus J.H.,Rotterdam University | Oskam L.,KIT Royal Tropical Institute
Clinics in Dermatology | Year: 2015

Elimination of leprosy cannot be achieved by multidrug therapy alone, and new tools are needed to prevent leprosy. A randomized controlled trial with chemoprophylaxis for contacts of leprosy patients using a single dose of rifampicin (SDR) has shown an overall protective effect of approximately 60%, effective in the first 2 years after the intervention. When a contact who previously received bacillus Calmette-Guérin (BCG) vaccination also receives SDR, the protective effect is additive, approximating 80%. Vaccine trials have been conducted with BCG, often in combination with Mycobacterium leprae or related Mycobacterium vaccines as immunoprophylaxis for contacts of leprosy patients, with BCG giving the best results. Meta-analysis shows that the protective effect of BCG vaccination is larger in observational studies than in trials, 60% versus 41%, and is higher among contacts of leprosy patients than among the general population, 68% versus 53%. We believe that a future leprosy control strategy should include contact management, consisting of a contact survey, at which time preventive interventions could be added, such as chemoprophylaxis and immunoprophylaxis. Modeling studies have shown that both interventions will lower the incidence of leprosy in the population. Implementation studies of such contact-based strategy are now called for. © 2015 Elsevier Inc.

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