Gates Open Research

Journal Information
EISSN : 25724754
Current Publisher: F1000 Research Ltd (10.12688)
Total articles ≅ 358
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Elena Bertozzi, Amelia Bertozzi-Villa, Swathi Padankatti, Aparna Sridhar
Published: 30 June 2020
Gates Open Research, Volume 4; doi:10.12688/gatesopenres.13129.1

Abstract:
Background: We describe challenges associated with incorporating knowledge assessment into an educational game on a sensitive topic and discuss possible motivations for, and solutions to, these challenges. Methods: The My Future Family Game (MFF) is a tool for collecting data about family planning intentions. The game was expanded to include information about human anatomy and sexual reproduction. To assess the efficacy of the game as a tool for teaching sexual education, we designed a pre-post study with assessments before and after the game which was deployed in three schools in and around Chennai, India in summer of 2018. Results: The pre-post process did not effectively assess knowledge gain and made the game less enjoyable. Although all participants completed the pre-test because it was required to access the main game, many did not complete the post test. As a result, the post-test scores are of limited use in assessing the efficacy of the intervention as an educational tool. This deployment demonstrated that pre-post testing has to be integrated in a way that motivates players to improve their scores in the post-test. The pre-test results did provide useful information about players’ knowledge of human anatomy and mechanisms of human reproduction prior to gameplay and validated the tool as a means of data collection. Conclusion: Adding outcomes assessment required asking players questions about sexual anatomy and function with little or no introduction. This process undermined elements of the initial game design and made the process less enjoyable for participants. Understanding these failures has been a vital step in the process of iterative game design. Modifications were made to the pre-post test process for future deployments so that the process of assessment does not diminish enthusiasm for game play or enjoyment and motivates completion of the post-test as part of gameplay.
Published: 29 June 2020
Gates Open Research; doi:10.12688/gatesopenres

Abstract:
Gates Open Research is an innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing.
Fraser I Lewis, Godfrey Guga, Paschal Mdoe, Esto Mduma, Cloupas Mahopo, Pascal Bessong, Stephanie A Richard, Benjamin J J McCormick
Published: 29 June 2020
Gates Open Research, Volume 4; doi:10.12688/gatesopenres.13123.1

Abstract:
Background: Growth trajectories are highly variable between children, making epidemiological analyses challenging both to the identification of malnutrition interventions at the population level and also risk assessment at individual level. We introduce stochastic differential equation (SDE) models into child growth research. SDEs describe flexible dynamic processes comprising: drift - gradual smooth changes – such as physiology or gut microbiome, and diffusion - sudden perturbations, such as illness or infection. Methods: We present a case study applying SDE models to child growth trajectory data from the Haydom, Tanzania and Venda, South Africa sites within the MAL-ED cohort. These data comprise n=460 children aged 0-24 months. A comparison with classical curve fitting (linear mixed models) is also presented. Results: The SDE models offered a wide range of new flexible shapes and parameterizations compared to classical additive models, with performance as good or better than standard approaches. The predictions from the SDE models suggest distinct longitudinal clusters that form distinct ‘streams’ hidden by the large between-child variability. Conclusions: Using SDE models to predict future growth trajectories revealed new insights in the observed data, where trajectories appear to cluster together in bands, which may have a future risk assessment application. SDEs offer an attractive approach for child growth modelling and potentially offer new insights.
Keith P. Klugman, Solomon Zewdu, Barbara E. Mahon, Scott F. Dowell, Padmini Srikantiah, Kayla F. Laserson, Jordan W. Tappero, Anita K. Zaidi, Trevor Mundel
Published: 26 June 2020
Gates Open Research, Volume 4; doi:10.12688/gatesopenres.13151.1

Abstract:
More than 85% of Covid-19 mortality in high income countries is among people 65 years of age or older. Recent disaggregated data from the UK and US show that minority communities have increased mortality among younger age groups and in South Africa initial data suggest that the majority of deaths from Covid-19 are under 65 years of age. These observations suggest significant potential for increased Covid-19 mortality among younger populations in Africa and South Asia and may impact age-based selection of high-risk groups eligible for a future vaccine.
Tosin Somorin, Samuel Getahun, Santiago Septien, Ian Mabbet, Athanasios Kolios, Chris Buckley
Published: 25 June 2020
Gates Open Research, Volume 4; doi:10.12688/gatesopenres.13137.1

Abstract:
Background: Drying is an important step for the thermochemical conversion of solid fuels, but it is energy-intensive for treating highly moist materials. Methods: To inform the thermal treatment of faecal sludge (FS), this study investigated the drying characteristics and kinetics of various faecal wastes using thermogravimetric analysis and isothermal heating conditions. Results: The findings show that FS from anaerobic baffled reactor (ABR) and ventilated improved pit (VIP) latrines exhibit similar drying characteristics, with maximum drying rates at 0.04 mg/min during a constant rate period that is followed by a distinct falling rate period. On the contrary, fresh human faeces (HF) and FS from urine-diverting dry toilets (UDDT) exhibited a falling rate period regime with no prior or intermittent constant rate periods. The absence of constant rate period in these samples suggested limited amounts of unbound water that can be removed by dewatering and vice versa for VIP and ABR faecal sludges. The activation energies and effective moisture diffusivity for the sludges varied from 20 to 30 kJ/mol and 3∙10-7 to 1∙10-5 m2/s at 55°C and sludge thickness of 3mm. The Page model was consistent in modelling the different sludges across all temperatures. Conclusions: These results presented in this study can inform the design and development of innovative drying methods for FS treatment.
Deepa Sankaran, Priyanshu Sharma, Lisa Lazarus, Tapaswini Swain, Bhanu Pilli, P. Manish Kumar, Vasanthakumar Namasivayam, James Blanchard, Stephen Moses
Published: 23 June 2020
Gates Open Research, Volume 3; doi:10.12688/gatesopenres.13055.2

Abstract:
Iron and folic acid (IFA) supplementation is one of the most cost-effective interventions to prevent and treat anemia during pregnancy. Despite having the highest global burden of anemia among pregnant women, rates of IFA uptake in pregnancy in India are still very low, particularly in the state of Uttar Pradesh. While there have been several studies that explored challenges around IFA consumption and adherence, there is a paucity of studies that have synthesized this information into a single visual tool that can help program implementers understand the challenges and identify potential areas of intervention. Timeline maps were developed as a visual qualitative tool to explore the nuances of health behaviors among pregnant women with respect to antenatal care (ANC) services, including IFA consumption. Timeline maps were used to visually document critical events pertaining to ANC services chronologically, including details on contact points with the health system and events specific to IFA distribution, consumption and counselling. Six research assistants (RAs) were trained on how to use timeline maps and record participant narratives. The RAs later participated in a focus group discussion to gain insight about their experiences using the tool. RAs reported that the timeline maps were easy-to-use and facilitated in-depth conversations with participants. RAs shared that they were able to actively engage the participants in co-creating the maps. The visual nature of the tool prompted participants’ recall of key pregnancy events and reflexivity. Challenges reported with the tool/process included recollection of past events and potential misrepresentation of information. These highlight a need to restructure training processes. Our findings indicate that timeline maps have the potential to be used in a variety of other program contexts, and merit further exploration.
Sara Kassabian, Sara Fewer, Gavin Yamey, Claire D. Brindis
Published: 22 June 2020
Gates Open Research, Volume 4; doi:10.12688/gatesopenres.13098.1

Abstract:
Background: Preterm birth, defined as infants born before 37 weeks of gestation, is the largest contributor to child mortality. Despite new evidence highlighting the global burden of prematurity, policymakers have failed to adequately prioritize preterm birth despite the magnitude of its health impacts. Given current levels of political attention and investment, it is unlikely that the global community will be adequately mobilized to meet the 2012 Born Too Soon report goal of reducing the preterm birth rate by 50% by 2025. Methods: This study adapts the Shiffman and Smith framework for political priority to examine four components contributing to policy action in global health: actor power, ideas, political context, and issue characteristics. We conducted key informant interviews with 18 experts in prematurity and reproductive, maternal, newborn, and child health (RMNCH) and reviewed key literature on preterm birth. We aimed to identify the factors that shape the global political priority of preterm birth and to describe policy opportunities to increase its priority moving forward. Results: The global preterm birth community (academic researchers, multilateral organizations, government agencies, and civil society organizations) lacks evidence about the causes of and solutions to preterm birth; and country-level data quality is poor with gaps in the understanding required for implementing effective interventions. Limited funding compounds these challenges, creating divisions among experts on what policy actions to recommend. These factors contribute to the lack of priority and underrepresentation of preterm birth within the larger RMNCH agenda. Conclusion: Increasing the political priority of prematurity is essential to reduce preventable newborn and child mortality, a key target of the 2030 Sustainable Development Goal for health (target 3.2). This study identifies three policy recommendations for the preterm birth community: address data and evidence gaps, clarify and invest in viable solutions, and bring visibility to prematurity within the larger RMNCH agendas.
Sumit Kane, Prarthna Dayal, Tanmay Mahapatra, Sanjiv Kumar, Shikha Bhasin, Aboli Gore, Aritra Das, Sandeep Reddy, Ajay Mahal, Suneeta Krishnan, et al.
Published: 18 June 2020
Gates Open Research, Volume 4; doi:10.12688/gatesopenres.13134.1

Abstract:
Background: Few studies have explicitly examined the implementation of change interventions in low- and middle-income country (LMIC) public health services. We contribute to implementation science by adding to the knowledge base on strategies for implementing change interventions in large, hierarchical and bureaucratic public services in LMIC health systems. Methods: Using a mix of methods, we critically interrogate the implementation of an intervention to improve quality of obstetric and newborn services across 692 facilities in Uttar Pradesh and Bihar states of India to reveal how to go about making change happen in LMIC public health services. Results: We found that focusing the interventions on a discreet part of the health service (labour rooms) ensured minimal disruption of the status quo and created room for initiating change. Establishing and maintaining respectful, trusting relationships is critical, and it takes time and much effort to cultivate such relationships. Investing in doing so allows one to create a safe space for change; it helps thaw entrenched practices, behaviours and attitudes, thereby creating opportunities for change. Those at the frontline of change processes need to be enabled and supported to: lead by example, model and embody desirable behaviours, be empathetic and humble, and make the change process a positive and meaningful experience for all involved. They need discretionary space to tailor activities to local contexts and need support from higher levels of the organisation to exercise discretion. Conclusions: We conclude that making change happen in LMIC public health services, is possible, and is best approached as a flexible, incremental, localised, learning process. Smaller change interventions targeting discreet parts of the public health services, if appropriately contextualised, can set the stage for incremental system wide changes and improvements to be initiated. To succeed, change initiatives need to cultivate and foster support across all levels of the organisation.
David S. Kennedy, Vk Vu, Hannah Ritchie, Rebecca Bartlein, Oliver Rothschild, Daniel G. Bauch, Max Roser, Anna C. Seale
Published: 18 June 2020
Gates Open Research, Volume 4; doi:10.12688/gatesopenres.13140.1

Abstract:
Background: In designing responses to the COVID-19 pandemic, it is critical to understand what has already worked well. We aimed to identify countries with emerging success stories from whom policymakers might draw important lessons. Methods: We developed a process to first include countries with large enough populations that results were unlikely to be due to chance, that had sufficient cases for response mechanisms to be tested, and that shared the necessary publicly available data. Within these countries, we looked at indicators suggesting success in terms of detecting disease, containing the outbreak, and treating those who were unwell. To support comparability, we measured indicators per capita (per million) and across time. We then used the indicators to identify three countries with emerging success stories to include some diversity in global region, population demographics and form of government. Results: We identified 66 countries that met our inclusion criteria on 18th May 2020. Several of these countries had indicators of success against the set indicators at different times in the outbreak. Vietnam had high levels of testing and successful containment with no deaths reported. South Korea had high levels of testing early in the outbreak, supporting containment. Germany had high levels of sustained testing and slower increases in cases and deaths than seen in other comparable settings. Conclusions: At the time of our assessment, Vietnam and South Korea were able to contain the outbreak of COVID-19 and avoid the exponential growth in cases seen elsewhere. Germany had more cases and deaths, but was nevertheless able to contain and mitigate the outbreak. Despite the many limitations to the data currently available, looking at comparative data can help identify countries from whom we can draw lessons, so that countries can inform and adapt their strategies for success in response to COVID-19.
Jade Benjamin-Chung, Jr. John M. Colford, Andrew Mertens, Alan E. Hubbard, Benjamin F. Arnold
Published: 17 June 2020
Gates Open Research, Volume 4; doi:10.12688/gatesopenres.13108.2

Abstract:
Failures to reproduce research findings across scientific disciplines from psychology to physics have garnered increasing attention in recent years. External replication of published findings by outside investigators has emerged as a method to detect errors and bias in the published literature. However, some studies influence policy and practice before external replication efforts can confirm or challenge the original contributions. Uncovering and resolving errors before publication would increase the efficiency of the scientific process by increasing the accuracy of published evidence. Here we summarize the rationale and best practices for internal replication, a process in which multiple independent data analysts replicate an analysis and correct errors prior to publication. We explain how internal replication should reduce errors and bias that arise during data analyses and argue that it will be most effective when coupled with pre-specified hypotheses and analysis plans and performed with data analysts masked to experimental group assignments. By improving the reproducibility of published evidence, internal replication should contribute to more rapid scientific advances.
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