Publications by authors named "Divya Parmar"

Article Synopsis
  • - The text reviews the effectiveness of school-based interventions aimed at promoting healthy eating among adolescents aged 10-19 years, noting that while healthy eating is crucial, poor diets are still common in this age group.
  • - A systematic search identified 17 reviews of interventions from 2000 to 2023, mostly conducted in high-income countries, with the majority rated as having high methodological quality, indicating reliable findings.
  • - Multi-component interventions, which engage students, schools, families, and communities together, were found to significantly enhance adolescents' knowledge and habits regarding healthy eating, especially when supported by technological and systemic changes.
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While modelling and simulation are powerful techniques for exploring complex phenomena, if they are not coupled with suitable real-world data any results obtained are likely to require extensive validation. We consider this problem in the context of search game modelling, and suggest that both demographic and behaviour data are used to configure certain model parameters. We show this integration in practice by using a combined dataset of over 150,000 individuals to configure a specific search game model that captures the environment, population, interventions and individual behaviours relating to winter health service pressures.

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Nearly 31% of the Ghanaian population are adolescents, and these populations persistently face high rates of teenage pregnancies and unsafe abortions. This is despite sexual and reproductive health (SRH) being taught in the school curriculum. In this qualitative study, we explore the factors affecting adolescents' access to, and experiences of, SRH services in Accra, Ghana.

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The paper examines the health system's response to COVID-19 in Sierra Leone. It aims to explore how the pandemic affected service delivery, health workers, patient access to services, leadership, and governance. It also examines to what extent the legacy of the 2013-16 Ebola outbreak influenced the COVID-19 response and public perception.

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Article Synopsis
  • There isn’t much knowledge about how health insurance helps women compared to men, especially in India.
  • The study looked at a government health plan in India to see how many men and women joined it.
  • It found there wasn’t a big difference in enrollment between men and women, but female-headed households were more likely to join, showing women want to invest in health when given the chance.
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The COVID-19 pandemic has triggered several changes in countries' health purchasing arrangements to accompany the adjustments in service delivery in order to meet the urgent and additional demands for COVID-19-related services. However, evidence on how these adjustments have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria, Philippines, Romania and Ukraine).

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Background: Primary dyslipidaemias, including familial hypercholesterolaemia, are underdiagnosed genetic disorders that substantially increase risk for premature coronary artery disease in adults. Early identification of primary dyslipidaemias via lipid clinic referral optimises patient management and enables cascade screening of relatives. Improving the identification of primary dyslipidaemias, and understanding disparities in ascertainment and management, is an NHS priority.

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  • India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY), an extensive health insurance program aimed at over 500 million economically disadvantaged individuals, covering hospitalization costs at both public and private facilities.
  • A study involving over 57,000 PM-JAY eligible individuals revealed that while the program did not increase overall hospitalizations, it did increase the likelihood of using private healthcare facilities by 4.6%.
  • PM-JAY led to a significant reduction in out-of-pocket expenses (OOPE) by 13% and catastrophic health expenditures (CHE) by 21%, primarily benefiting those using private hospitals, indicating that the program has shifted healthcare utilization from public to private facilities for disadvantaged groups.
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The literature suggests that a first barrier towards accessing benefits of health insurance in low- and middle-income countries is lack of awareness of one's benefits. Yet, across settings and emerging schemes, limited scientific evidence is available on levels of awareness and their determinants. To fill this gap, we assessed socio-demographic and economic determinants of beneficiaries' awareness of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the national health insurance scheme launched in India in 2018, and their awareness of own eligibility.

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Objective: Health-related research in sub-Saharan Africa (SSA) has grown over the years. However, concerns have been raised about the state of research ethics committees (RECs). This scoping review examines the literature on RECs for health-related research in SSA and identifies strategies that have been applied to strengthen the RECs.

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Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on hospital utilisation in a sub-Saharan country, Sierra Leone.

Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals) and qualitative interviews with healthcare workers and patients.

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Objective: To evaluate the type of contraceptives used by women in need of family planning in India and the inequalities associated with that use according to women's age, education, wealth, subnational region of residence and empowerment level.

Methods: Using data from the Indian National Family and Health Survey-4 (2015-2016), we evaluated the proportion of partnered women aged 15-49 years with demand for family planning satisfied (DFPS) with modern contraceptive methods. We also explored the share of each type of contraception [short- (e.

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Introduction: Health research in low-income and middle-income countries, which face the greatest burden of disease, is a vital component of efforts to combat global health inequality. With increased research, there has also been concern about ethical and regulatory issues and the state of research ethics committees, with various attempts to strengthen them. This scoping review examines the literature on ethics committees for health-related research in sub-Saharan Africa, with a focus on regulatory governance and leadership, administrative and financial capacity, and conduct of ethical reviews.

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In September 2018, India launched Pradhan Mantri Jan Arogya Yojana (PM-JAY), a nationally implemented government-funded health insurance scheme to improve access to quality inpatient care, increase financial protection, and reduce unmet need for the most vulnerable population groups. This protocol describes the methodology adopted to evaluate implementation processes and early effects of PM-JAY in seven Indian states. The study adopts a mixed and multi-methods concurrent triangulation design including three components: 1.

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Article Synopsis
  • * It found that cooking with gas, coal, wood, and other traditional fuels significantly increases the odds of developing arthritis compared to using electricity.
  • * Additionally, factors like gender, age, body weight, alcohol consumption, and certain comorbidities were linked to higher chances of arthritis, while being underweight and having a higher education level were associated with lower odds.
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The launch of the Millennium Development Goals in 2000, followed by the Sustainable Development Goals in 2015, and the increasing focus on achieving universal health coverage has led to numerous interventions on both supply- and demand-sides of health systems in low- and middle-income countries. While tremendous progress has been achieved, inequities in access to healthcare persist, leading to calls for a closer examination of the equity implications of these interventions. This paper examines the equity implications of two such interventions in the context of maternal healthcare in Senegal.

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Background: In the past decade, the negative impact of disrespectful maternity care on women's utilisation and experiences of facility-based delivery has been well documented. Less is known about midwives' perspectives on these labour ward dynamics. Yet efforts to provide care that satisfies women's psycho-socio-cultural needs rest on midwives' capacity and willingness to provide it.

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We assess the impact of India's National Rural Employment Guarantee (NREG) scheme, the world's largest workfare scheme, on healthcare utilisation - specifically maternal healthcare. The primary objective of NREG is to improve the income of rural households by guaranteeing 100 days of employment. We expect that by improving household income, thereby reducing some of the financial barriers, such as out-of-pocket payments, NREG can increase utilisation of maternal health services.

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Almost 172 million people live in complex emergencies globally resulting from political and/or economic instability. The provision and continuity of health care in complex emergencies remain a significant challenge. Health agencies are often hesitant to implement tuberculosis programmes in particular because its treatment requires a longer commitment than most acute diseases.

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To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership.

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Article Synopsis
  • - The study emphasizes the importance of addressing psycho-social elements in maternity care, as neglecting these aspects in low-income contexts leads to dehumanized and disrespectful treatment of women during childbirth.
  • - A systematic review revealed that disrespectful intrapartum care is driven by a power struggle between midwives and women, with care being more institution-centered than focused on the woman's needs.
  • - The research highlights the gap in the dialogue about maternity care, pointing out that midwives' perspectives on interpersonal care are often overlooked, suggesting that their input is crucial for improving birth experiences.
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Article Synopsis
  • The objective of the study was to systematically review empirical research on the health impacts of the 2008 financial crisis in Europe, focusing on various health outcomes.
  • A total of 41 studies were included in the review, highlighting issues like increased suicides and deteriorating mental health, although most studies were found to be at high risk of bias.
  • The review concluded that the financial crisis had varying effects on health outcomes, with stronger evidence for its negative impact on suicides and mental health, indicating the need for improved research in this area.
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