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Evidence from small-scale randomised controlled trials suggests that interventions relying on community involvement through a participatory learning and action (PLA) approach can improve health outcomes in resource-poor settings. However, it is only poorly understood whether PLA-based interventions are effective after scale-up in a real-world setting. In a cluster-randomised controlled trial in Bihar, India, we assessed whether the PLA approach improved health, nutrition, water, sanitation, and hygiene (HNWASH) outcomes in adults and children when implemented state-wide by a government-supported agency. In the intervention, trained female facilitators ran 20 structured participatory meetings about key HNWASH topics in state-supported women's groups. Unlike the strong results of small-scale trials, in the scaled-up government implemented intervention we do not observe systematic improvements in HNWASH knowledge, attitudes, practices or health outcomes. We discuss aspects of programme implementation that could explain these null effects. Our findings call for caution when promising public health interventions are transformed into large policy programmes. [ABSTRACT FROM AUTHOR]

Early-childhood interventions are important for poverty reduction but difficult to target. We study two interventions in rural India for children below age 2 that are simple and easy to scale: a durable device for iron fortification at home and caregiver training in dialogic reading. Outcomes were measured blinded. When delivered together, the interventions improved receptive language skills of children who were not anemic at baseline, suggesting that health endowment complements parental investments in the production of human capital. The dialogic reading intervention further shows positive spillovers on untreated children. Overall, shorter-lived interventions are potentially effective in healthier populations. [ABSTRACT FROM AUTHOR]

Background As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. Methods and findings We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) [greater than or equal to]240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) [greater than or equal to]160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, and Americas. Lipid screening was significantly associated with older age, female sex, higher education, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Awareness of diagnosis was significantly associated with older age, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Lastly, treatment of hypercholesterolemia was significantly associated with comorbid hypertension and diabetes, and control of lipid measures with comorbid diabetes. The main limitations of this study are a potential recall bias in self-reported information on received health services as well as diminished comparability due to varying survey years and varying lipid guideline application across country and clinical settings. Conclusions Cascade performance was poor across all stages, indicating large unmet need for hypercholesterolemia care in this sample of LMICs-calling for greater policy and research attention toward this cardiovascular disease (CVD) risk factor and highlighting opportunities for improved prevention of CVD., Author(s): Maja E. Marcus 1,*, Cara Ebert 2, Pascal Geldsetzer 3,4, Michaela Theilmann 4, Brice Wilfried Bicaba 5, Glennis Andall-Brereton 6, Pascal Bovet 7,8, Farshad Farzadfar 9, Mongal Singh Gurung [...]