Richard Lilford

• PhD., FRCOG., FRCP., FFPH
• Professor at University of Birmingham

Background: People with sensory neuropathy caused by leprosy suffer from recurrent ulcers. Self-care is used to promote ulcer healing and reduce recurrence. The challenge is to maximise use of self-care and to optimise the way it is practised. RedAid Nigeria in South-East Nigeria adapted and implemented a recently developed international guideline...

Introduction Leprosy is a curable disease, treated by multidrug therapy. However, patients are often left with neuropathic damage leading to lifelong vulnerability to ulcers. Quantifying the value of interventions to improve ulcer healing is challenging as data on the health impact of plantar ulcers are scarce, especially in low- and middle-income...

Background A comprehensive summary of evidence about oral health in slum settings that could inform policy directions is lacking. Objective To summarise the latest evidence regarding oral disease burden and their determinants, perceptions, practices, and service utilization in the slums and non-slum urban settings of LMICs. Design Systematic revi...

Background Real-time disease surveillance is an important component of infection control in at-risk populations. However, data on cases or from lab testing is often not available in many low-resource settings. Rapid diagnostic tests (RDT), including immunochromatographic assays, may provide a low cost, expedited source of infection data. Methods W...

Background Experimental studies of wound healing often use survival analysis and time to event outcomes or differences in wound area at a specific time point. However, these methods do not use a potentially large number of observations made over the course of a trial and may be inefficient. A model-based approach can leverage all trial data, but th...

Background Diarrheal disease is a significant cause of morbidity and mortality in under-fives in many low- and middle-income countries. Changes in food safety, hygiene practices, and nutrition around the weaning period may reduce the risk of disease and improve infant development. The MaaCiwara study aims to evaluate the effectiveness of a communit...

Introduction: Traditional healers play a crucial role in healthcare provision, particularly in low- and middle-income countries. Thus, there is a global interest in understanding the possibilities for collaboration between traditional healers and biomedical professionals. We believe there is the need for a comprehensive review on collaboration betw...

Introduction Cancer outcome is largely determined by stage at diagnosis. We hypothesised that people living in Low- and Middle-Income Countries may be reaching diagnosis at an early stage, reflecting growth in awareness of the disease and its symptoms. We examined stage at diagnosis for four common cancers presenting at a referral centre in Nigeria...

Background/introduction One of the key recommendations for the new WHO global strategy for oral health is inclusion of disadvantaged populations and their engagement in policy dialogues such that their needs and views are addressed in policy decisions. Objectives This study explored oral health perceptions, practices and care-seeking experiences o...

This scoping review aims to identify and critically appraise published economic evaluations of self-help group (SHG) interventions in low- and middle-income countries (LMICs) that seek to improve health and potentially also non-health outcomes. Through a systematic search of MEDLINE ALL (Ovid), EMBASE Ovid, PsychINFO, EconLit (Ovid) and Global Inde...

We conducted an independent evaluation on the effectiveness of an organisational-level monetary incentive to encourage small and medium-sized enterprises (SMEs) to improve employees’ health and wellbeing. This was A mixed-methods cluster randomised trial with four arms: high monetary incentive, low monetary incentive, and two no monetary incentive...

Introduction Leprosy occurs among very poor people who may be stigmatised and pushed further to the margins of society. Programmes to improve social integration and stimulate economic development have been implemented to help break the vicious cycle of poverty, reduced quality of life and ulcer recurrence. These involve forming groups of people, wi...

Urban slum residents have access to a broad range of facilities of varying quality. The choices they make can significantly influence their health outcomes. Discrete Choice Experiments (DCEs) are a widely-used health economic methodology for understanding how individuals make trade-offs between attributes of goods or services when choosing between...

Background Diarrhoeal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. We descri...

Objective To track elective surgery activity before, during and after the COVID-19 pandemic in England. To examine for hypothesised differences in use of independent vs NHS hospitals, and more urgent vs less urgent operations over the pre- and post-COVID time windows. Design We extracted data from the Hospital Episodes Statistics database from 1st...

Tooth jewelry boosts the appearance and confidence of wearers. However, its use may carry adverse health consequences. This paper creates awareness about a practice not previously reported in Nigeria, to prevent negative health consequences while appropriate measures are taken to quantify and describe the determinants and plan appropriate intervent...

Water, sanitation and hygiene interventions have been the subject of cluster trials of unprecedented size, scale and cost in recent years. However, the question 'what works in water, sanitation, hygiene (WASH)?' remains poorly understood. Evaluations of community interventions to prevent infectious disease typically use lab-confirmed infection as a...

Objective To identify factors associated with accessing and utilisation of healthcare and provision of health services in slums. Design A scoping review incorporating a conceptual framework for configuring reported factors. Data sources MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library were searched from their inception to December...

Oral diseases constitute a neglected epidemic in Low and Middle-Income Countries (LMICs). An understanding of its distribution and severity in different settings can aid the planning of preventive and therapeutic services. This study assessed the oral health conditions, risk factors, and treatment needs among adult residents in the slum and compare...

Background Diarrheal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. This artic...

Background Real-time disease surveillance is an important component of infection control in at-risk populations. However, data on cases or from lab testing is often not available in many low-resource settings. Rapid diagnostic tests (RDT), including immunochromatographic assays, may provide a low cost, expedited source of infection data. Methods W...

Objective First, to obtain regional estimates of prevalence of hypertension and type 2 diabetes in urban slums; and second, to compare these with those in urban and rural areas. Design Systematic review and meta-analysis. Eligibility criteria Studies that reported hypertension prevalence using the definition of blood pressure ≥140/90 mm Hg and/or...

Importance Visual screening for oral cancer has been found to be useful in a large randomized clinical trial in Kerala, India, showing substantial reduction in mortality. To address the shortage of medical personnel in resource-deficient regions, using the services of community health workers has been proposed as a strategy to fill the gap in human...

Background Diarrheal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. This artic...

Background Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods We conducted hous...

Objectives To evaluate the spatiotemporal distribution of the incidence of COVID-19 hospitalisations in Birmingham, UK during the first wave of the pandemic to support the design of public health disease control policies. Design A geospatial statistical model was estimated as part of a real-time disease surveillance system to predict local daily i...

Objectives During the COVID pandemic the UK saw two peaks in the prevalence of hospital admissions resulting in disruption of routine hospital services in the English National Health Service. This study aimed to track the effect of these peaks on various types of surgery representing differences in urgency, importance, and complexity. Design Databa...

Objective Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. Methods W...

Health service delivery interventions include a range of hospital ‘quality improvement’ initiatives and broader health system policies. These interventions act through multiple causal pathways to affect patient outcomes and they present distinct challenges for evaluation. In this article, we propose an empirical approach to estimating the effect of...

Background Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limi...

The current COVID-19 pandemic has focused attention on the vulnerability of the human race in the face of communicable disease. But the pandemic also serves as a wake-up call to the cataclysmic impact that would befall the world if nuclear weapons were ever to be used again. Overwhelming pressure on health-services, considerable disruption to norma...

Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. Methods In seven slums in Bangl...

Background Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery r...

Claims that hospital admissions for heart attack and stroke have declined over the COVID-19 pandemic have been made in at least 16 newspaper articles in the UK (Table 1). In contrast, data from the West Midlands Ambulance Service (WMAS) have not reported any reduction in call-outs for patients with stroke or ST-Elevation Myocardial Infarction (STEM...

Background: Publication and related biases (including publication bias, time-lag bias, outcome reporting bias and p-hacking) have been well documented in clinical research, but relatively little is known about their presence and extent in health services research (HSR). This paper aims to systematically review evidence concerning publication and r...

Objectives Poor discharge communication is associated with negative health outcomes in high-income countries. However, quality of discharge communication has received little attention in India and many other low and middle-income countries. Primary objective To investigate verbal and documented discharge communication for chronic non-communicable...

Objectives: While the presence of publication bias in clinical research is well documented, little is known about its role in the reporting of health services research. This paper explores stakeholder perceptions and experiences with regard to the role of publication and related biases in quantitative research relating to the quality, accessibilit...

Strategies to identify and mitigate publication bias and outcome reporting bias are frequently adopted in systematic reviews of clinical interventions but it is not clear how often these are applied in systematic reviews relating to quantitative health services and delivery research (HSDR). We examined whether these biases are mentioned and/or othe...

In a recent issue of Journal of Medical Ethics (JME), we discussed the ethical review of evaluations of interventions that would occur whether or not the evaluation was taking place. We concluded that standard research ethics frameworks including the Ottawa Statement, which requires justification for all aspects of an intervention and its roll-out,...

Objective To examine implementation of evidence in orthopaedic practice following publication of the results of three pivotal clinical trials. Design Case studies based on three orthopaedic trials funded in sequence by the National Institute for Health Research Health Technology Assessment (HTA) programme. These trials dealt with treatment of frac...

Objectives 1) To investigate patient and healthcare provider (HCP) knowledge, attitudes and barriers to handover and healthcare communication during inpatient care. 2) To explore potential interventions for improving the storage and transfer of healthcare information. Design Qualitative study comprising 41 semi-structured, individual interviews an...

Public health and service delivery programmes, interventions and policies (collectively, ‘programmes’) are typically developed and implemented for the primary purpose of effecting change rather than generating knowledge. Nonetheless, evaluations of these programmes may produce valuable learning that helps determine effectiveness and costs as well a...

Objective: The objective of this study was to evaluate the differences between patients who undergo cholecystectomy following index admission for cholecystitis, and those who are managed nonoperatively. Summary background data: Index emergency cholecystectomy following acute cholecystitis is widely recommended by national guidelines, but its eff...

Objective To evaluate the effectiveness of reminder letters informed by social normative theory (a type of ‘nudge theory’) on uptake of seasonal influenza vaccination by front-line hospital staff. Design Individually randomised controlled trial. Setting A large acute care hospital in England. Participants Front-line staff employed by the hospita...

Background A system of clinical records accessible by both patients and their attending healthcare professionals facilitates continuity of care and patient-centred care, thereby improving clinical outcomes. The need for such a system has become greater as the proportion of patients with chronic non-communicable diseases (NCDs) requiring ongoing car...

Recruitment and selection are critical components of human resource management. They influence both the quantity and quality of the healthcare workforce. In this article, we use two different examples of primary care workers, General Practitioners in the UK and Community Health Workers in low- and middle- income countries, to illustrate how recruit...

The use of standardized mortality rates (SMRs) to profile hospitals presumes differences in preventable deaths, and at least one health system has suggested measuring preventable death rates of hospitals for comparison across time or in league tables. The influence of reliability on the optimal review number per case note or hospital for such a pro...

Policy Points • The use of standardized mortality rates (SMRs) to profile hospitals presumes differences in preventable deaths, and at least one health system has suggested measuring preventable death rates of hospitals for comparison across time or in league tables. The influence of reliability on the optimal review number per case note or hospit...

Diarrhoeal disease is one of the leading causes of illness and death in young children: a problem exacerbated by a lack of access to safe sanitation facilities. But the effects of different types of sanitation facilities, and the relationship between their levels of coverage in an area and disease risk, remain uncertain. We specify a hierarchical m...

Additional information regarding the study settings. (DOCX)

Sample size calculation for the quantitative study component. (DOCX)

Additional information regarding the national healthcare structure in India. (DOCX)

Background: Low and middle income countries (LMICs) face severe resource limitations but the highest burden of disease. There is a growing evidence base on effective and cost-effective interventions for these diseases. However, questions remain about the most cost-effective method of delivery for these interventions. We aimed to review the scope,...

Background Increasingly, collaborative participatory methods requiring open and honest interaction between a range of stakeholders are being used to improve health service delivery. To be successful these methodologies must incorporate perspectives from a range of patients and staff. Yet, if unaccounted for, the complex relationships amongst staff...

This report presents the Consolidated Standards of Reporting Trials (CONSORT) extension for the stepped wedge cluster randomised trial (SW-CRT). The SW-CRT involves randomisation of clusters to different sequences that dictate the order (or timing) at which each cluster will switch to the intervention condition. The statement was developed to allow...

Background Ensuring that selection processes for Community Health Workers (CHWs) are effective is important due to the scale and scope of modern CHW programmes. However they are relatively understudied. While community involvement in selection should never be eliminated entirely, there are other complementary methods that could be used to help iden...

Objective To determine whether the higher weekend admission mortality risk is attributable to increased severity of illness. Design Retrospective analysis of 4 years weekend and weekday adult emergency admissions to a university teaching hospital in England. Outcome measures 30-day postadmission weekend:weekday mortality ratios adjusted for sever...

Background Community Health Workers (CHWs) have a crucial role in improving health in their communities and their role is being expanded in many parts of the world. However, the effectiveness of CHWs is limited by poor training and the education of CHWs has received little scientific attention. Methods Our study was carried out in two districts of...

CHW workshop costs. Costs of the workshops in an Excel file. (XLSX)

Knowledge questionnaires. List of HAST and WSRHR assessment questions for knowledge test. (DOCX)

Confidence questionnaires. List of HAST and WSRHR rating questions to measure confidence in advising clients. (DOCX)

Satisfaction questionnaires. List of HAST and WSRHR rating questions to measure satisfaction. (DOCX)

Background Bariatric surgery reduces cardiovascular events and mortality risk in obese individuals. However, it is unclear whether diabetes modified this effect. We aimed to examine mortality, cardiovascular and cancer risk following bariatric surgery in adults with and without pre‐existing diabetes and compare mortality risk to the general populat...

Background Publication bias is a major threat to the validity of systematic reviews (SRs). Strategies to identify and reduce publication bias are routinely incorporated into SRs of clinical interventions, but the level of adoption of these strategies in SRs relating to health services and delivery research (HSDR) is unclear. The objectives of this...

Background: It is unknown whether statin use among people living with HIV results in a reduction in all-cause mortality. We aimed to evaluate the effect of statin use on all-cause mortality among people living with HIV. Methods: We conducted comprehensive literature searches of Medline, Embase, CINAHL, the Cochrane Library, and cross-references...

There are well-developed guidelines for economic evaluation of clearly defined clinical interventions, but no such guidelines for economic analysis of service interventions. Distinctive challenges for analysis of service interventions include diffuse effects, wider system impacts, and variability in implementation, costs and effects. Cost-effective...

Introduction This protocol concerns the evaluation of increased specialist staffing at weekends in hospitals in England. Seven-day health services are a key policy for the UK government and other health systems trying to improve use of infrastructure and resources. A particular motivation for the 7-day policy has been the observed increase in the r...

Introduction: The mortality associated with weekend admission to hospital (the 'weekend effect') has for many years been attributed to deficiencies in quality of hospital care, often assumed to be due to suboptimal senior medical staffing at weekends. This protocol describes a case note review to determine whether there are differences in care qua...

Background Increasing numbers of blood tests are being ordered in primary care settings and the swift and accurate communication of test results is central to providing high quality care. The process of testing and result communication is complex and reliant on the coordinated actions of care providers, external groups in laboratory and hospital se...

Background Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources. Undiscerning procurement processes are at the heart of this issue.We conducted a systematic review of the literature to August 2013 with no ti...

Objectives: The stockpiling of neuraminidase inhibitor (NAI) antivirals as a defence against pandemic influenza is a significant public health policy decision that must be made despite a lack of conclusive evidence from randomised controlled trials regarding the effectiveness of NAIs on important clinical end points such as mortality. The objective...