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 post-appraisal questionnaires and engaged in focus group discussions.

Results

The SACs involved 27 participants across 3 provinces Findings from the post-appraisal 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 Qualitative data showed participants perceived using a contextspecified ethics framework in deliberative decisionmaking: (1) supported wider consideration of and deliberation about morally relevant features of the health coverage decisions, thereby contributing to the quality of appraisals; (2) could improve transparency; and (3) offered benefits to those directly involved in the priority-setting process Participants also identified some challenges and concerns associated with the approach

Conclusion

The SAVE-UHC approach presents a novel way to develop and pilot a locally contextualized, explicit ethics framework for health priority setting This work highlights how the combination of a context-specified ethics framework and structured deliberative appraisals can contribute to the quality of health technology appraisals and transparency of health priority setting

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Indirect Effects of COVID-19 on maternal and child health in South Africa

quintiles, geographical areas and provinces To account for confounding by underlying seasonal or linear trends, a segmented fixed effect panel model was subsequently fitted

Results

Wits researchers involved: This study is a collaboration of researchers of PRICELESS SA and Wits Agincourt

The unfinished burden of poor maternal and child health contributes to the quadruple burden of disease in South Africa with the direct and indirect effects of the COVID-19 pandemic yet to be fully documented To investigate the indirect effects of COVID-19 on maternal and child health in different geographical regions and relative wealth quintiles.

Methods

This study estimated the effects of COVID-19 on maternal and child health from April 2020 to June 2021 These estimates were made by calculating mean changes across facilities, relative wealth index (RWI)

A total of 4956 public sector facilities were included in the analysis. Between April and September 2020, full immunisation and first dose of measles declined by 6 99% and 2 44%, respectively In the follow-up months, measles first dose increased by 4 88% while full immunisation remained negative ( 0 65%), especially in poorer quintiles. At the facility level, the mean change in incidence and mortality due to pneumonia, diarrhoea and severe acute malnutrition was negative Change in first antenatal visits, delivery by 15–19-year olds, delivery by C-section and maternal mortality was positive but not significant.

Conclusion

COVID-19 disrupted the utilisation of child health services While the reduction in child health services at the start of the pandemic was followed by an increase in subsequent months, the recovery was not uniform across different quintiles and geographical areas This study highlights the disproportionate impact of the pandemic and the need for targeted interventions to improve utilisation of health services

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MRI findings of children with suspected hypoxic-ischaemic injury at a Tertiary Academic Hospital in Johannesburg, South Africa

Hypoxic ischaemic injury (HII) is characterized by altered cerebral blood flow and decreased oxygenation resulting in neurologic dysfunction. Clinical manifestations of hypoxic ischaemic injury range from neonatal encephalopathy to seizure disorders and cerebral palsy in older children. HII and its clinical sequelae present a global health burden with significant morbidity and mortality in neonates, infants and older children Magnetic resonance imaging (MRI) is recognized as the gold standard in identifying the aetiology of neonatal encephalopathy, identifying patterns of HII and a diagnostic tool for predicting long-term neurologic outcomes

Materials and Methods

Hypoxic ischaemic brain injury and its clinical sequalae

Cont present a global health burden MRI is the imaging modality of choice to investigate hypoxic-ischaemic injury As there is limited data from low and middleincome countries describing MRI findings of children with suspected hypoxic-ischaemic brain injury, this research describes the MRI findings of children with suspected hypoxic-ischaemic brain injury in a resource-limited setting

Results

A total of 128 MRI studies were evaluated MRI evidence of hypoxic-ischaemic injury was found in 42 2% of children Normal MRI findings were present in 41 (32 0%) children; and punctate periventricular white matter injuries in 19 5%, watershed injury in 3 1%, central injury in 10 2% and diffuse injury in 23.4% of MRI studies. Preterm infants more commonly demonstrated periventricular white matter injury

Conclusion

Periventricular white matter pattern of injury was the most common type in premature infants, congruent with international cohorts Despite the majority of children with suspected hypoxic-ischaemic injury being imaged beyond the infant period, MRI findings may have implications for medicolegal recourse.

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Compliance of medical practitioners with diabetic treatment guidelines in West Rand, Gauteng

This study was conducted in the outpatient department of Dr Yusuf Dadoo Hospital in West Rand, Gauteng. A total of 323 records of patients seen from August 2019 to December 2019 were reviewed, and some of the basic variables were assessed according to the most recent diabetic treatment guidelines SEMDSA 2017.

Results

Wits researchers involved: Nneka Ohanson, Deidré Pretorius

Diabetes mellitus is increasing globally and is associated with multiple complications. Guidelines have been formulated to standardise care among people living with diabetes mellitus (DM), but research shows poor compliance with treatment guidelines. This study aimed to assess how well healthcare practitioners in a district hospital in Gauteng complied with the most recent diabetic treatment guideline, Society for Endocrinology Metabolism and Diabetes South Africa (SEMDSA) 2017.

Methods

A retrospective cross-sectional review of patient records living with diabetes was done

Files were audited in four categories: comorbidities, examinations, investigations and the presence of complications Six monthly glycated haemoglobin (HbA1c) was assessed in 40 (12 4%), annual creatinine assessed in 179 (55.4%) and lipogram in 154 (47.7%) of patients More than 70% of patients had uncontrolled glycaemia and two people were screened for erectile dysfunction

Conclusion and Contribution

Monitoring and control parameters were infrequently done as per guideline recommendations The resultant effects were poor glycaemic control and thus numerous complications

Targeted strategies to improve medical practitioner compliance to guidelines including further research to study factors associated with poor compliance with guidelines are needed to improve the overall care of people living with DM in the West Rand and thus minimise the risk of complications among patients in the district

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