Composite Quality

Of Metaepidemiological Evidence

Wits researchers involved: Steffen Mickenautsch

To survey current meta-epidemiological studies to identify additional trial design characteristics that may be associated with significant over- or underestimation of the treatment effect and to use such identified characteristics as a basis for the formulation of new CQS appraisal criteria.

Materials and methods

A retrieval of eligible studies was made from two systematic reviews on this topic (latest search May 2015) and searched the databases PubMed and Embase for further studies from June 2015 –March 2022 All data were extracted by one author and verified by another Sufficiently homogeneous estimates from single studies were pooled using random-effects meta-analysis Trial design characteristics associated with statistically significant estimates from single datasets (which could not be pooled) and meta-analyses were used as a basis to formulate new or amend existing CQS criteria

Results

A total of 38 meta-epidemiological studies were identified From these, seven trial design characteristics associated with statistically significant over- or underestimation of the true therapeutic effect were found.

Conclusion

One new criterion concerning double-blinding was added to the CQS, and the original criteria for concealing the random allocation sequence and for minimum sample size were amended

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The Value of Explicit, Deliberative, and Context-Specified Ethics Analysis for Health Technology

Assessment: Evidence from a Novel Approach Piloted in South Africa

Wits researchers involved (PRICELESS SA): Aviva Tugendhaft, Susan Goldstein, Atiya Mosam, Karen Hofman

This article explores the perceived value, including associated strengths and challenges, of using a context-specified ethics framework to guide deliberative health technology appraisals.

Methods

The South African Values and Ethics for Universal Health Coverage (SAVE-UHC) approach, piloted in South Africa, consisted of 2 phases: (1) convening a national multistakeholder working group to develop a provisional ethics framework and (2) testing the provisional ethics framework through simulated health technology assessment appraisal committee meetings (SACs) Three SACs each reviewed 2 case studies of sample health interventions using the framework Participants completed postappraisal questionnaires and engaged in focus group discussions

Results

The SACs involved 27 participants across 3 provinces Findings from the postappraisal questionnaires demonstrated general support for the SAVE-UHC approach and content of the framework, high levels of satisfaction with the recommendations produced, and general sentiment that participants were able to actively contribute to appraisals.

Conclusion

This work highlights how the combination of a contextspecified ethics framework and structured deliberative appraisals can contribute to the quality of health technology appraisals and transparency of health priority setting *Read the full study

Active travel and paratransit use in African cities: Mixed-method systematic review and meta-ethnography

Wits researchers involved: Lee Randall, Lisa Jayne Ware, Lisa Micklesfield, Gudani Mukoma, Sostina

Spiwe Matina

Active travel, as a key form of physical activity, can help offset noncommunicable diseases as rapidly urbanising countries undergo epidemiological transition. In Africa, a human mobility transition is underway as cities sprawl and motorization rise and preserving active travel modes (walking, cycling and public transport) is important for public health. Across the continent, public transport is dominated by paratransit, privately owned informal modes serving the general public.

Methods

This study reviewed the literature on active travel and paratransit in African cities, published from January 2008 to January 2019 It included 19 quantitative, 14 mixed-method and 8 qualitative studies (n = 41), narratively synthesizing the quantitative data and metaethnographically analysing the qualitative data

Findings

Integrated findings showed that walking was high, cycling was low and paratransit was a critical mobility option for poor peripheral residents facing long livelihood-generation journeys As an indigenous solution to dysfunctional mobility systems shaped by colonial and apartheid legacies it was an effective connector, penetrating areas unserved by formal public transport and helping break cycles of poverty

From a public health perspective, it preserved active travel by reducing mode-shifting to private vehicles Yet many city authorities viewed it as rogue, out of keeping with the ‘ideal modern city’, adopting official anti-paratransit stances without necessarily considering the contribution of active travel to public health

Interpretation

The studies varied in quality and showed uneven geographic representation, with data from Central and Northern Africa especially sparse; notably, there was a high prevalence of non-local authors and out-ofcountry funding Nevertheless, drawing together a rich cross-disciplinary set of studies spanning over a decade, the review expands the literature at the intersection of transport and health with its novel focus on paratransit as a key active travel mode in African cities Further innovative research could improve paratransit's legibility for policymakers and practitioners, fostering its inclusion in integrated transport plans

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Global investments in pandemic preparedness and COVID-19: Development assistance and domestic spending on health between 1990 and 2026

response, and pandemic preparedness and response using a keyword search were used for this study Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need

Findings

Wits researchers involved: Micheal Boachie

The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. This study aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in

Pandemic Preparedness

Methods

In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, four sources of health spending were estimated, namely: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. To estimate spending, the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) were used An estimated development assistance for general health, COVID-19

In 2019, at the onset of the COVID-19 pandemic, US$9 2 trillion (95% uncertainty interval [UI] 9 1-9 3) was spent on health worldwide This study found great disparities in the number of resources devoted to health, with high-income countries spending $7 3 trillion (95% UI 7 2-7 4) in 2019; 293 7 times the $24 8 billion (95% UI 24 3-25 3) spent by low-income countries in 2019 That same year, $43·1 billion in development assistance was provided to maintain or improve health.

The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1 8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37 8 billion was provided for the health-related COVID-19 response Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252 2% of the recommended target Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP

Interpretation

There was an unprecedented scale-up in DAH in 2020 and 2021 This study poses a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

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