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The Sanitation, Hygiene Education and Water Supply in Bangladesh Programme (SHEWA-B) was a 5-year intervention aiming to improve water, sanitation and hygiene (WASH) practices among 20 million rural residents through community hygiene promoters. This analysis evaluates the impact of SHEWA-B on knowledge, behaviour and childhood diarrhoea outcomes.The evaluation included repeated cross-sectional surveys and health surveillance in matched cohorts in intervention and control clusters. Cross-sectional surveys and structured observations at baseline, midline, and endline assessed the availability of WASH technology, caregiver knowledge and behaviour. Fieldworkers collected monthly health data in a subset of control and intervention households to determine the prevalence of diarrhoea.Of 5091 households surveyed, participants residing in intervention clusters showed minimal improvements in knowledge, reported behaviour, or use of WASH technology compared to the control clusters. During structured observations, intervention households increased more than control households at handwashing before preparing food and after cleaning a baby's anus when comparing endline to baseline, but these changes were not seen when comparing endline to the midline. The prevalence of childhood diarrhoea remained similar in both groups before (10.2% in intervention, 10.0% in control) and after (8.8% in intervention, 11.7% in control) midline changes were made to improve the intervention. Intervention clusters showed no improvement in diarrhoea over time compared to control clusters.SHEWA-B's community-based WASH promotion did not yield the intended impact on knowledge, behaviour or health. Greater priority should be given to approaches that have demonstrated effectiveness. Including rigorous evaluations would broaden the evidence base to support and improve large-scale programmes.

In the USA, chronic kidney disease (CKD) affects 1 in 7 adults and costs $100 billion annually. The DAPA-CKD trial found dapagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, to be effective in reducing CKD progression and mortality in patients with diabetic and non-diabetic CKD. Currently, SGLT2 inhibitors are not considered standard of care for patients with non-diabetic CKD.Determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic CKD.Markov model with lifetime time horizon and US healthcare sector perspective.Patients with non-diabetic CKD INTERVENTION: Dapagliflozin plus standard care versus standard care only.Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3% annually; total incidence of kidney failure on kidney replacement therapy; average years on kidney replacement therapy.Adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted QALYS (from 6.75 to 8.06), and reduced the total incidence of kidney failure on kidney replacement therapy (KRT) (from 17.4 to 11.0%) and average years on KRT (from 0.77 to 0.43) over the lifetime of the cohort. Dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs (from $245,900 to $324,8900, or $60,000 per QALY gained). Results were robust to variations in assumptions about dapagliflozin's efficacy over time and by CKD stage, added costs of kidney replacement therapy, and expected population annual CKD progression rates and sensitive to the cost of dapagliflozin. The net 1-year budgetary implication of treating all US patients with non-diabetic CKD could be up to $21 billion.Dapagliflozin improved life expectancy and reduced progression of CKD, the proportion of patients requiring kidney replacement therapy, and time on kidney replacement therapy in patients with non-diabetic CKD. Use of dapagliflozin meets conventional criteria for cost-effectiveness.

BACKGROUND The COVID-19 pandemic created an urgent global need for healthcare worker (HCW) training. Initial COVID-19-related online courses focused primarily on training public health workers and physicians caring for patients in intensive care units (ICUs). However, in resource-constrained settings, nurses and general practitioners are responsible for providing most COVID-19 patient medical care, typically lacking the training and equipment necessary to manage complex, critically ill patients. In these environments, early recognition and interventions to prevent patient deterioration are essential to optimizing outcomes. We developed a massive open online course (MOOC) for HCWs in resource-constrained settings aimed at training bedside providers caring for patients with COVID-19. OBJECTIVE This study evaluates the impact of this MOOC by assessing HCW course engagement, knowledge, confidence in caring for COVID-19 patients, and user experience. METHODS From May thru June of 2020, the course was rapidly developed by a team of physicians, educators, medical illustrators, and education technology staff, and was subsequently launched on two online platforms in July 2020. The approximately 4-hour course comprises 6 video-based modules with accompanying handouts. Student knowledge was assessed using pre- and post-module quizzes and a final exam, while demographics and user experience were evaluated by pre- and post-course surveys and data collected through the platforms. RESULTS From July 17th to September 24th, 30,859 students enrolled, 18,818 started, and 7,101 completed the course. Most participants worked in healthcare (86%) and resided in lower middle- (36%) or upper middle- (21%) income countries. Higher course completion rates were observed among learners who were from upper middle-income (aOR 1.152 [95% CI 1.019-1.303]) and lower middle-income countries (aOR 1.229 [95% CI 1.104-1.368]). Significant knowledge gains were observed from pre-module (mean 56% [SD 17%]) to post-module quizzes (80% [SD 15%], P CONCLUSIONS This study demonstrates the potential of MOOCs to rapidly provide access to emerging medical knowledge during a public health crisis, particularly for HCWs in high- and middle-income countries. Further research is required to understand the impact of such online courses on patient care and how to better reach learners in low-income countries.

BackgroundEnsuring access to accurate and actionable health information is crucial during the COVID-19 pandemic, especially in low-resource settings. Among marginalized groups, there are disparities in access to information, along with significant mistrust of government sources. Non-governmental organizations (NGOs) involved in community-level health education can play an important role in bridging mistrust and targeting information to reach vulnerable populations. There is a lack of research on the experiences and needs of organizations involved in disseminating health information during the pandemic. MethodsThis study uses a qualitative approach to investigate the current strategies, challenges, and needs of community-based organizations involved in COVID-19 public education. From May to June 2020, we conducted 19 semi-structured interviews with leaders of organizations in South Africa and Zambia. Participants were asked a series of open-ended questions in three domains: 1) the impact of the pandemic on the communities served by the organization, 2) their COVID-19 response, and 3) organization needs and challenges during the pandemic. Interviews were recorded, transcribed, and coded using thematic analysis. Coding and analysis were conducted by four study authors and every interview was independently coded by 2 separate authors to maximize internal validity and consistency.Results5 themes relevant to the roles and challenges of locally active NGO’s were identified: (1) they intimately understand community needs during the pandemic; (2) they adapt to pandemic constraints to continue supporting vulnerable populations; (3) they play a unique role in educating the public about COVID-19 due to established access and trust within communities; (4) they are able to customize health education and information to address nuanced needs of local communities served; and (5) they need external support to effectively respond to the pandemic.ConclusionsOverall, our study contributes a deeper understanding of the role of NGOs in providing needed support and customized health education for vulnerable communities during a global public health crisis. To maximize their ability to support their communities, NGO’s would benefit from access to educational resources designed to be easily modified, support in navigating technological and safety challenges during the pandemic, and sustainable funding.