David Hipgrave

• BSc, MBBS, PhD, FRACP
• Staff member at National University of Singapore Saw Swee Hock School of Public Health; SingHealth Duke-NUS Global Health Institute

Objectives: The present study was carried out to investigate COVID-19 vaccination coverage among populations of internally displaced persons (IDPs), refugees, and host communities in northern Iraq and the related underlying factors. Methods: Through a cross-sectional study conducted in five governorates in April–May 2022, 4,564 individuals were sur...

Background Approximately 25% of facility births take place in private health facilities. Recent national studies of maternal and newborn health (MNH) service availability and quality have focused solely on the status of public sector facilities, leaving a striking gap in information on the quality of maternal and newborn care services. Methods A r...

Background: Interventions to improve early childhood development have previously addressed only one or a few risk factors. Learning Clubs is a structured, facilitated, multicomponent programme designed to address eight potentially modifiable risk factors, and offered from mid-pregnancy to 12 months post partum; we aimed to establish whether this p...

Background: Approximately 25% of facility births take place in private health facilities. Recent national studies of maternal and newborn health (MNH) service availability and quality have focused solely on the status of public sector facilities, leaving a striking gap in information on the quality of maternal and newborn care services. Methods: A...

Full article available online at Lancet Global https://doi.org/10.1016/S2214-109X(22)00005-5

Financing of Primary Health Care

Background Addressing non-communicable disease (NCDs) is a global priority in the Sustainable Development Goals, especially for adolescents. However, existing literature on NCD burden, risk factors and determinants, and effective interventions and policies for targeting these diseases in adolescents, is limited. This study develops an evidence-base...

Despite dramatic improvements in survival, nutrition, and education over recent decades, today's children face an uncertain future. Climate change, ecological degradation, migrating populations, conflict, pervasive inequalities, and predatory commercial practices threaten the health and future of children in every country. In 2015, the world's coun...

Introduction Economic evaluations of complex interventions in early child development are required to guide policy and programme development, but a few are yet available. Methods and analysis Although significant gains have been made in maternal and child health in resource-constrained environments, this has mainly been concentrated on improving p...

Low- and middle-income countries (LMICs) face many challenges and competing demands in the health sector, including maternal and newborn mortality. The allocation of financial and human resources for maximum health impact is important for social and economic development. Governments must prioritize carefully and allocate scarce resources to maximum...

Background: Learning Clubs is a multi-component intervention to address the eight common risk factors for women's health, and infant's health and development in resource-constrained settings. We are testing in a cluster randomized controlled trial in rural Vietnam whether this intervention improves cognitive development in children when they are a...

The health of China’s population improved dramatically during the first 30 years of the People’s Republic, established in 1949. By the mid-1970s, China was already undergoing the epidemiologic transition, years ahead of other nations of similar economic status, and by 1980, life expectancy (67 years) exceeded that of most similarly low-income natio...

Role of district health management teams in child health strategies Well functioning district health systems are essential for planning and implementation of health services, and their efforts are key to improving quality of care and achieving health goals, say Tanya Doherty and colleagues Key messages • Districts, led by district health management...

Introduction Optimal early childhood development is an international priority. Risks during pregnancy and early childhood have lasting effects because growth is rapid. We will test whether a complex intervention addressing multiple modifiable risks: maternal nutrition, mental health, parenting capabilities, infant health and development and gender-...

This systematic literature review compared the epidemiological (EPI) research and the qualitative social and behavioral science (SBS) research published during the West Africa Ebola virus disease (EVD) epidemic. Beginning with an initial capture of over 2,000 articles, we extracted 236 EPI and 171 SBS studies to examine how disciplinary priorities...

District team problem solving (DTPS) was developed by WHO in the 1980s to explicitly engage local stakeholders in decentralized planning and, in later iterations, budgeting of health services. It became WHO's global flagship approach to district-level health priority-setting and planning. DTPS entails multisectoral stakeholders (the team) using loc...

Newborn health in Afghanistan is receiving increased attention, but reduction in newborn deaths there has not kept pace with declines in maternal and child mortality. Using the continuum of care and health systems building block frameworks, this article identifies, organizes and provides a synthesis of the available evidence on and gaps in coverage...

We agree with the Editorial (May, 2017) that stated “community health workers are desperately needed globally” but “often still stand…at the fringes of the health system, undefined and unsupported and therefore unable to completely fulfil their potential”. As the 40th anniversary of the Alma Ata Declaration approaches, it is time to appropriately r...

Described as the ‘invisible epidemic’, non-communicable diseases (NCDs) are the world’s leading cause of death. Most are caused by preventable factors, including poor diet, tobacco use, harmful use of alcohol and physical inactivity. Diabetes, cancer and cardiovascular and chronic lung diseases were responsible for 38 million (68%) of global deaths...

Objective To evaluate interventions to improve routine vaccination coverage and caregiver knowledge in China's remote west, where routine immunisation is relatively weak. Design Prospective pre–post (2006–2010) evaluation in project counties; retrospective comparison based on 2004 administrative data at baseline and surveyed post-intervention (2010...

Objectives: To examine the acceptability, use, effects on early isolation, and contribution to Ebola virus disease (EVD) transmission of Community Care Centers (CCCs), which were rapidly deployed in Sierra Leone during an accelerated phase of the 2014-2015 EVD epidemic. Methods: Focus group discussions, triads, and key informant interviews asses...

This nutritional epidemiology study compares salt and sodium intake in China in 2000 and in 2009-2012.Noncommunicable diseases are increasing globally, with major socioeconomic implications.1 The World Health Organization2 proposed 9 noncommunicable disease–related targets, including 30% reduction in salt/sodium intake to reduce risk of hypertensio...

David Hipgrave and colleagues argue that sustained collaboration is required to improve population health and health services in North Korea.

Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of complementary food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was p...

Making progress towards universal health coverage (UHC) requires that health workers are adequate in numbers, prepared for their jobs and motivated to perform. In establishing the best ways to develop the health workforce, relatively little attention has been paid to the trends and implications of dual practice – concurrent employment in public and...

In modern decentralised health systems, district and local managers are increasingly responsible for financing, managing, and delivering healthcare. However, their lack of adequate skills and competencies are a critical barrier to improved performance of health systems. Given the financial and human resource, constraints of relying on traditional f...

The use of mobile technologies for health related activities (mHealth) is a new but rapidly progressing activity with global penetration. However, few programs have been implemented at scale. The objective of this paper is to review the background and evidence on mHealth, particularly with respect to the benefits and challenges of scale-up. A compr...

Decisions on the allocation of scarce resources are rarely made purely on the basis of technical criteria: political and other factors also shape decision-makers’ choices. It is therefore important to understand how and why governments in developing countries prioritise and allocate their own resources (as well as those of development partners), if...

The health of China’s population improved dramatically during the first 30 years of the People’s Republic, established in 1949. By the mid-1970s, China was already undergoing the epidemiologic transition, years ahead of other nations of similar economic status, and by 1980, life expectancy (67 years) exceeded that of most similarly low-income natio...

Objectives: To determine the causes of death among infants in high-mortality areas of western China with the use of globally recognized methods. Study design: A survey of all infant deaths identified over 1 year in 4 counties in Yunnan and Xinjiang in which combined verbal autopsy was combined with a physician's diagnosis of the cause to calcula...

Background/objectives: Infant and young child feeding (IYCF) has not been documented in central and western China, where anaemia is prevalent. To support policy advocacy, we assessed IYCF and anaemia there using standardized methods. Subjects/methods: A community-based, cross-sectional survey of 2244 children aged 6-23 months in 26 counties of 1...

Background Disparity in maternal mortality exists between rural–urban migrant and urban resident women in China, but little research has provided evidence for related policy development. The objective of this study was to identify associations with and risks for maternal death among rural–urban migrant women in order to improve health services for...

Setting priority for health programming and budget allocation is an important issue, but there is little consensus on related processes. It is particularly relevant in low resource settings and at province- and district- or “meso-level”, where contextual influences may be greater, information scarce and capacity lower. Although recent changes in di...

Health professionals often undertake private work whilst also employed by government. Such dual practice (DP) is found in both high-income and lower- and middle-income countries (LMIC) around the world, with varying degrees of tolerance. This review focuses on DP in South and East Asia in the context of the rapidly expanding mixed health systems in...

David Hipgrave and colleagues argue that we must find more effective, equitable, feasible and affordable ways to engage the public in health priority setting in developing countries. Please see later in the article for the Editors' Summary

To describe breastfeeding practices in rural China using globally recommended indicators and to compare them with practices in neighbouring countries and large emerging economies. A community-based, cross-sectional survey of 2354 children younger than 2 years in 26 poor, rural counties in 12 central and western provinces was conducted. Associations...

To evaluate implementation of the National Essential Medicines Scheme (NEMS) in rural China. Two rural counties/districts in each of three provinces where NEMS had been implemented were surveyed. Information was collected from NEMS staff at the province, county/district, township and village levels; patients with chronic disease were also interview...

Despite worldwide economic and scientific development, over a quarter of the world's population remains anemic; about half of this burden is due to iron deficiency anemia (IDA). IDA is most prevalent among preschool children and women. Among women, iron supplementation improves physical and cognitive performance, work productivity and wellbeing and...

China's current health system reform (HSR) is striving to resolve deep inequities in health outcomes. Achieving this goal is difficult not only because of continuously increasing income disparities in China but also because of weaknesses in healthcare financing and delivery at the local level. We explore to what extent sub-national governments, whi...

David Hipgrave and colleagues discuss health system reform in China and argue that parallel reforms in governance, financing, and accountability are also needed to ensure health equity.

Iodine deficiency disorders were prevalent in China until the introduction of universal salt iodization in 1995. Concerns have recently arisen about possible excess iodine intake in this context. To document iodine intake and the contribution from iodized salt in China, we surveyed dietary iodine intake during China's nationally representative 2007...

Between 1990 and 2006, China reduced its under-five mortality rate (U5MR) from 64.6 to 20.6 per 1000 live births and achieved the fourth United Nation's Millennium Development Goal nine years ahead of target. This study explores the contribution of social, economic and political determinants, health system and policy determinants, and health progra...

The effectiveness and impact of China’s health system reform has not yet been objectively assessed, but government is pushing ahead with impressive new initiatives involving village doctors and a computerised health management information system that should improve availability of data.

China's progress on communicable disease control (CDC) in the 30 years after establishment of the People's Republic in 1949 is widely regarded as remarkable. Life expectancy soared by around 30 years, infant mortality plummeted and smallpox, sexually transmitted diseases and many other infections were either eliminated or decreased massively in inc...

(BJOG. 2010;117(6):1527–36)

China's success in improving the quality of and access to obstetric care in hospitals offers an opportunity to examine the effect of a large-scale facility-based strategy on neonatal mortality. We aimed to establish this effect by assessing how the institutional strategy of intrapartum care has affected neonatal mortality and its regional inequalit...

Distribution of breast milk substitutes (BMS) after the 2006 Yogyakarta earthquake was uncontrolled and widespread. We assessed the magnitude of BMS distribution after the earthquake, its impact on feeding practices and the association between consumption of infant formula and diarrhoea among infants and young children. One month after the earthqua...

China's economic reforms have raised concerns over rising inequalities in maternal mortality, but it is not known whether the gap across socio-economic regions has increased over time. A population-based, longitudinal, ecological correlation study. China. Records from the National Maternal and Child Mortality Surveillance System between 1996 and 20...

Achieving the objective of China's current health system reform, namely equitable improvements in health outcomes, will be difficult not least because of the continuously growing income disparities in the country. The analysis in this paper shows that since 2000, disparity in selected health outcomes has been declining across provinces, largely due...

A survey was conducted in 2006 to assess the coverage and timeliness of the birth dose of hepatitis B vaccine (HepB(1)) and related influences among children in rural areas of Guangxi, Guizhou, Tibet, and Shaanxi provinces, People's Republic of China. A total of 3,390 children born in 2004 were surveyed in four counties in each province, where a pr...

In Vietnam, the rate of transmission of hepatitis B virus (HBV) from mother-to-newborn is high. Studies have shown that people infected with HBV during early infancy are more likely to become chronically infected than those exposed later in life. Mother-to-newborn transmission of hepatitis B can be prevented by vaccination soon after birth. Vaccina...

Vaccinating newborns against hepatitis B within 24 h of birth followed by two subsequent doses usually prevents mother-to-child transmission, but is demanding on health staff and systems especially in developing countries. To provide an evidence-base for guidelines on birth-dosing, a research study including key informant interviews, focus group di...

Hepatitis B virus infection is a serious problem globally, and particularly in the Western Pacific Region where the population suffers disproportionately from the infection and its sequelae. By 2001, every immunization programme in the Region had included hepatitis B vaccine in their schedule. However, many challenges remain if every one of the 26...

The heat stability of hepatitis B vaccine (HepB vaccine) should enable its storage outside the cold chain (OCC), increasing access to the birth dose in areas lacking refrigeration. We compared the immunogenicity of a locally produced vaccine among infants who received three doses stored within the cold chain (n = 358) or for whom the first dose was...

Administration of a birth dose of hepatitis B vaccine (HepB vaccine) to neonates is recommended to prevent mother-to-infant transmission and chronic infection with the hepatitis B virus (HBV). Although manufacturers recommend HepB vaccine distribution and storage at 2-8 degrees C, recognition of the heat stability of hepatitis B surface antigen sti...

Administration of a birth dose of hepatitis B vaccine (HepB vaccine) to neonates is recommended to prevent mother-to-infant transmission and chronic infection with the hepatitis B virus (HBV). Although manufacturers recommend HepB vaccine distribution and storage at 2-8 °C, recognition of the heat stability of hepatitis B surface antigen stimulated...

Context The Aceh province of Indonesia suffered unimaginable damage as a result of the earthquake and tsunami on December 26, 2004. According to the Indonesian government, more than 125000 people were killed, over 111000 persons are still missing,and over 400000 persons are currently displaced within the province. Objectives--To determine the nutri...

To examine the feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternity services provided at commune health centres in rural Vietnam. A survey of 200 women who gave birth in July-August 2000 and 196 pregnant women in 34 communes in Quang Xuong District, Thanh Hoa Province, Vietnam. Inter-rater reliabilit...

To ascertain hepatitis B virus (HBV) infection rates for Vietnam, we surveyed HBV markers in two districts of Thanh Hoa province. We randomly selected 536 infants (9- < or = 18 months old), 228 children (4 to < or = 6 years old), 219 adolescents (14 to < or = 16 years old), and 596 adults (25 to < or = 40 years old). On questioning, none of those s...

To ascertain hepatitis B virus (HBV) infection rates for Vietnam, we surveyed HBV markers in two districts of Thanh Hoa province. We randomly selected 536 infants (9-less than or equal to18 months old), 228 children (4 to :5 6 years old), 219 adolescents (14 to less than or equal to 16 years old), and 596 adults (25 to less than or equal to 40 year...

We have analyzed artemisinin sensitivity in Plasmodium falciparum isolates obtained from patients in South Vietnam and show that artemisinin sensitivity does not differ before and after drug treatment. There was an increase in the level of mefloquine resistance in the isolates after drug treatment that was concomitant with a decrease in chloroquine...

Resistance to antimalarial chemotherapy is a major concern for malaria control in Viet Nam. In this study undertaken in 1998, 65 patients with uncomplicated Plasmodium falciparum malaria were monitored for 28 days after completion of a 5-day treatment course with artemisinin. Overall 36 · 9% (24/65) of patients had recurrent parasitaemia during the...

To determine the proportion of Australian travellers to Africa at risk of Schistosoma infection, and the proportion of those infected. Retrospective postal survey of 360 patients who had attended Fairfield Hospital travel clinic in 1994 and stated an intention to travel to Malawi, Zimbabwe or Botswana. Self-reported risk status for Schistosoma infe...