Robert W. Scherpbier

Dutch national Training Institute for Global Health and Tropical Medicine (OIGT)

Implementation research (IR) has proved to be a potential catalyst in facilitating the uptake of evidence-based innovations into routine practices and thereby maximizing public health outcomes. IR not only focuses on the effectiveness of the innovations but also identifies and addresses the barriers and facilitators to maximize their uptake into ro...

Background The emergency of antimicrobial resistance due to irrational antimicrobial use has put public health under threat. Accredited Drug Dispensing Outlets (ADDOs) play an important role in enhancing availability and accessibility of antimicrobials, however, there is a scarcity of studies assessing antimicrobial dispensing practices in these ou...

Background In 2017, Tanzania launched the National Action Plan for Antimicrobial Resistance (NAPAR), 2017–2022 and implementation of antibiotic stewardship programmes (ASPs) was one of the agendas. Since the launch of the National Action Plan, no study has been done to assess its implementation. Objectives To explore the experiences of prescribers...

Background: Misuse of antibiotics has been associated with poor knowledge, attitude and practice (KAP). Therefore, this study aimed to assess if KAP of prescribers and dispensers could drive irrational use of antibiotics among children in Tanzania. Methods: A convergent parallel mixed-methods study design that employed quantitative and qualitati...

Parents are the important implementers on appropriate/inappropriate use of antibiotics, especially in the pediatric population. Limited studies have associated poor knowledge, attitude, and practice (KAP) among parents with antibiotics misuse. Therefore, this study was conducted to determine the parents’ KAP and factors associated with inappropriat...

UNICEF operates in 190 countries and territories, where it advocates for the protection of children’s rights and helps meet children’s basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers;...

UNICEF operates in 190 countries and territories where it advocates for the protection of children's rights, help meet children’s basic needs and reach their full potential. Embedded Implementation Research (IR) is an approach to health systems strengthening in which: a) generation and use of research is led by decision makers and implementers, b)...

Objectives This study investigated whether an integrated, community-based and nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay in children. The study also considered how the programme could be sustained to promote early development in children aged under 3 years in the poorest areas of rural Chi...

Limited data exist related to low birth weight (LBW) incidence and risk factors in Western China. This paper aims to assess LBW and its relationship with antenatal care (ANC) in the poor counties of Western China. A community-based study in rural Western China was conducted in 2011. A kernel distribution was used to estimate the adjusted LBW incide...

( BMJ . 2018;360:k817) Overuse of cesarean sections throughout the world is a cause of concern due to the potential adverse health effects on the mother and the child. In China, between 2008 and 2014, the cesarean section rate increased from 29% to 35%, although wide variations among provinces existed. To address this issue, the Chinese government...

Background: China's immunization program is one of the oldest and largest in the world. Rates of vaccine-preventable diseases (VPD) are comparable to those in high-income countries. The program's evolution has been characterized by ambitious target setting and innovative strategies that have not been widely described. Methods: We reviewed nation...

Background With the aim to support planning of essential child care in the 13th Five-year Plan Period (2016–20), a number of core child survival interventions were identified and analysed in terms of cost-effectiveness with participation of UNICEF experts and the Chinese health decision-makers. Methods After systematic comparison of the China Chil...

Objectives: This study investigated whether an integrated, community-based and nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay in children. The study also considered how the programme could be sustained to promote early development in children aged under 3 years in the poorest areas of rural Ch...

(Abstracted from BMJ 2018;360:k817) Health care communities around the world have expressed concerns about the health effects of increased cesarean delivery rates. In China, complex factors such as financial incentives and medicolegal concerns have influenced the high cesarean rates.

Objectives The aims of the study were to determine the prevalence of suspected developmental delay in children living in poor areas of rural China and to investigate factors influencing child developmental delay. Design A community-based, cross-sectional survey was conducted. Eighty-three villages in Shanxi and Guizhou Provinces, China. Participa...

Background To compare text messaging and face-to-face interviews to conduct a survey on childhood diarrhoea and pneumonia. Methods Caregivers of young children able to send text messages in Zhao County in rural China were included in this crossover study. Villages (clusters) were randomized into two groups using the ratio 1:1.6 to account for an e...

Background: Use of Haemophilus influenzae type b conjugate vaccine is effective in reducing the disease burden but its coverage in China is unclear. The aim of this meta-analysis is to assess the coverage of Hib conjugate vaccines in children in Mainland China. Methods: We systematically searched Pubmed, Web of Science, Medline, CNKI and Wanfang...

Objective To examine how the relaxation of the one child policy and policies to reduce caesarean section rates might have affected trends over time in caesarean section rates and perinatal and pregnancy related mortality in China. Design Observational study. Setting China’s National Maternal Near Miss Surveillance System (NMNMSS). Participants 6...

Supplementary information: appendix tables 1-4

Objectives: To examine the effects of early comprehensive interventions on home environment and child neurodevelopment among children younger than 3 years in poor rural areas of China, as well as the underlying mediating and moderating mechanisms. Study design: Non-randomized intervention study was conducted among 216 children aged 0-3 years in...

Appropriate infant and young child feeding could reduce morbidity and mortality and could improve cognitive development of children. However, nationwide data on exclusive breastfeeding and complementary feeding status in China are scarce. The aim of this study was to assess current exclusive breastfeeding and complementary feeding status in China....

Objective: To explore whether Integrated Early Childhood Development (IECD) program has effectively improved the nurturing care for children aged 0-35 months in rural China. Methods: IECD has been implemented by the government of China with support from the United Nations Children's Fund (UNICEF) in four poverty-stricken rural counties since 2014....

Objective In China, Hib vaccine is a private-sector vaccine that is an option for parents to select to give to their children; it must be paid for out-of-pocket because it is not included in the government's Expanded Program on Immunization (EPI). We evaluated utilization patterns of Hib vaccine to provide evidence in support of development of a na...

Background: Previous studies about inequality in children's health focused more on physical health than the neurodevelopment. In this study, we aimed to evaluate the inequality in early childhood neurodevelopment in poor rural China and explore the contributions of socioeconomic factors to the inequality. Method: Information of 2120 children age...

Background Communication for Development (C4D) is a strategy promoted by the United Nations Children’s Fund to foster positive and measurable changes at the individual, family, community, social, and policy levels of society. In western China, C4D activities have previously been conducted as part of province-level immunization programs. In this stu...

Background Haemophilus influenzae type b is an important cause of invasive bacterial disease in children worldwide. The establishment of epidemiological estimates is an essential first step towards the introduction of H influenzae type b vaccine into the Chinese national immunisation programme. We therefore undertook a systematic review and meta-an...

As a key indicator of childhood malnutrition, few studies have focused on stunting in relation to various socio-economic factors in which disadvantaged groups face in China. We conducted a community-based cross-sectional study incorporating forty-two rural counties in seven western provinces of China in 2011. In total, 5196 children aged 6–23 month...

Background Haemophilus influenzae type b (Hib) is an important cause of invasive bacterial disease in children worldwide. The limited awareness of disease burden is a major barrier to the introduction of Hib vaccine into China’s National Immunization Program. Therefore, we conducted a systematic review and meta-analysis to estimate carriage of Hib...

Background Large investments are currently made in community–based complementary food supplement (Ying Yang Bao, YYB) programs to improve nutrition of young children in rural areas in China. However, there is a lack of knowledge about the experience and challenges of implementing YYB programs in China. We aimed to: 1) monitor distribution of YYB; 2...

Cognitive capital is an emerging paradigm that captures the criticality of investing in children whilst neural proliferation and development of brain architecture are at their peak. Distinct from financial capital, cognitive capital represents investment in future human potential from interventions in nutrition, health, education, child protection,...

The prevention of iodine deficiency through salt iodization has been recognized as a global success story, and China stands at the forefront of this achievement with one of the most successful programs in the world. High level political commitment, national mandatory legislation, a state-managed edible salt industry and a complex and highly sophist...

Background Poor growth and micronutrient deficiency mainly attack older infants and young children. Some countries have adopted clinically effective measures to combat malnutrition, but the compliance and improvement in efficacy of intervention vehicles in national programs require evaluation. Methods Baseline and follow-up cross-sectional surveys...

Study protocol. (DOCX)

Trend checklist. (DOCX)

Yingyangbao intake, child feeding practices, growth status and micronutrient status in children. (DOCX)

Background: China has achieved Millennium Development Goal 4 to reduce under-5 mortality rate by two-thirds between 1990 and 2015. In this study, we estimated the national and subnational levels and causes of child mortality in China annually from 1996 to 2015 to draw implications for achievement of the SDGs for China and other low-income and middl...

Objective: This study aimed to identify new evidence about the burden and risk factors of low birthweight (LBW) in China using national facility-based data. Methods: The association between sociodemographic and obstetric characteristics and LBW was examined using a multilevel model, taking into account the clustering of livebirths within hospitals...

Objective To assess the effectiveness of dietary counselling and complementary food supplements on anaemia and stunting prevalence in children aged 6–23 months. Design A controlled intervention study with measurements of height and haemoglobin levels, and cross-sectional surveys in August 2012 (baseline), 2013 (mid-term) and 2014 (end-line). Sett...

Background Violence against children (VAC) prevention is the priority of public health; and to master the prevalence state and risk factors of VAC is the base to develop the prevention strategies. This study aimed to obtain the prevalence features and to find the risk factors of VAC in China, and provide basis and formulate the prevention strategie...

Objectives: To examine the effect of parental rural-to-urban internal migration on nutritional status of left-behind children and how this is related to guardianship. Methods: We used UNICEF China's maternal and child health survey data to investigate stunting prevalence and feeding practices in children left behind by rural-to-urban internal mi...

China has achieved the first Millennium Development Goal(MDG)of halving,between 1990and 2015,the proportion of people who suffer from hunger.Particularly impressive progress has been made to improve the nutritional status of Chinese children in recent years.The international scientific community has recognized stunting,with its long-term impact on...

Very little is known about the burden and determinants of stillbirths in China. We used data from a national surveillance system for health facility births to compute a stillbirth rate representative of all facility births in China and to explore sociodemographic and obstetric factors associated with variation in the stillbirth rate. We used data...

BACKGROUND:Malnutrition and anemia affect large numbers of young children living in poor areas of China. Multi-micronutrient deficiencies may be related to the prevalence of anemia in different populations, and identifying the risk factors that render children susceptible to anemia is the first step in combating anemia effectively. METHODS:In this...

China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (Li...

Poverty and its associated factors put children at risk for developmental delay. The aim of this study was to describe the neurodevelopment of children under three years of age in poverty-stricken areas of China and explore possible associated factors. A cross-sectional survey was conducted among 2837 children aged 1-35 months in poverty-stricken a...

To examine the extent to which effective interventions to prevent unintentional child injury are reflected in the laws and regulations of China. We focused on the six common causes of fatal child injuries - drowning, road traffic injury, falls, poisoning, burns and suffocation. We investigated 27 interventions recommended by the United Nations Chil...

Objectives To obtain a general overview of infant and young child feeding practices in one rural county in China and identify current delivery channels and challenges. Design A cross-sectional study. Setting A rural county, Zhao County, in Hebei Province, China. Participants 10 clusters were first selected within each township (16 townships in tota...

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...

Aim To assess the quality of outpatient pediatric care provided by township and village doctors, prevalence of common childhood diseases, care-seeking behavior, and coverage of key interventions in Zhao County in China. Methods We conducted two cross-sectional surveys: 1) maternal, newborn, and child health household survey including1601 caregiver...

An effective data collection method is crucial for high quality monitoring of health interventions. The traditional face-to-face data collection method is labor intensive, expensive, and time consuming. With the rapid increase of mobile phone subscribers, text messaging has the potential to be used for evaluation of population health interventions...

Face-to-face interviews by trained field workers are commonly used in household surveys. However, this data collection method is labor-intensive, time-consuming, expensive, prone to interviewer and recall bias and not easily scalable to increase sample representativeness. To explore the feasibility of using text messaging to collect information on...

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...

Aim To evaluate the quality of antenatal care (ANC) in Hebei Province and compare it between the public and private sector and within the public sector. Methods We conducted a Maternal, Newborn and Child Health Household Survey in 2010 using a two-stage sampling procedure and included 1079 mothers. The quality of ANC was assessed on the basis of t...

Aim To develop affordable, appropriate, and nutritious recipes based on local food resources and dietary practices that have the potential to improve infant feeding practices. Methods We carried out a mixed methods study following the World Health Organization’s evaluation guidelines on the promotion of child feeding. We recruited caregivers with...

Objective: The purpose of this qualitative case study was to assess the feasibility of scaling up exclusive breastfeeding for 6 months, antibiotics for pneumonia and integrated management of childhood illness (IMCI) child interventions in three districts of the Cusco region, Peru. Methods: During field visits, constraints, synergies and solutions...

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.

Maternal, Newborn, and Child Health (MNCH) household survey data are collected mainly with pen-and-paper. Smartphone data collection may have advantages over pen-and-paper, but little evidence exists on how they compare. To compare smartphone data collection versus the use of pen-and-paper for infant feeding practices of the MNCH household survey....

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...

OBJECTIVE: To cross-validate the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. METHODS: After the main cost categories for each country were identified, validati...

To cross-validate the global cost of scaling up child survival interventions to achieve the fourth Millennium Development Goal (MDG4) as estimated by the World Health Organization (WHO) in 2007 by using the latest country-provided data and new assumptions. After the main cost categories for each country were identified, validation questionnaires we...

Summaries of the contextual factors identified, the interventions, the mechanisms triggered and the outcomes in the RCTs. Additional File 1 summarises the RCTs, the context, the intervention, the mechanisms triggered and the reported outcomes. Additional File 1 shows that in all the trials, more than one type of intervention was applied to improve...

A key constraint to saturating coverage of interventions for reducing the burden of childhood illnesses in Low and Middle Income Countries (LMIC) is the lack of human resources. Community health workers (CHW) are potentially important actors in bridging this gap. Evidence exists on effectiveness of CHW in management of some childhood illnesses (IMC...

To describe the effects of social inequities on the health and nutrition of children in low and middle income countries. We reviewed existing data on socioeconomic disparities within-countries relative to the use of services, nutritional status, morbidity, and mortality. A conceptual framework including five major hierarchical categories affecting...

WHO and UNICEF launched the Integrated Management of Childhood Illness (IMCI) strategy in the mid-1990s to reduce deaths from diarrhoea, pneumonia, malaria, measles, and malnutrition in children younger than 5 years. We assessed the effect of IMCI on health and nutrition of children younger than 5 years in Bangladesh. In this cluster randomised tri...

The Practical Approach to Lung Health in South Africa (PALSA) initiative aimed to develop an integrated symptom- and sign-based (syndromic) respiratory disease guideline for nurse care practitioners working in primary care in a developing country. A multidisciplinary team developed the guideline after reviewing local barriers to respiratory health...

Countries with high rates of child mortality tend to have shortages of qualified health workers. Little rigorous evidence has been done to assess how much the quality of care varies between types of health workers. We compared the performance of different categories of health workers who are trained in Integrated Management of Childhood Illness (IM...

In 2008, the Countdown to 2015 initiative identified 68 priority countries for action on maternal, newborn, and child health. Much attention was paid to monitoring country-level progress in achieving high and equitable coverage with interventions effective in reducing mortality of mothers, newborn infants, and children up to 5 years of age. To have...

To estimate the additional resources required to scale up interventions to reduce child mortality and morbidity within the context of the fourth Millennium Development Goals aim to reduce mortality among children aged<5 years by two-thirds by 2015. A costing model was developed to estimate the financial resources needed in 75 countries to scale up...

OBJECTIVE: To estimate the additional resources required to scale up interventions to reduce child mortality and morbidity within the context of the fourth Millennium Development Goal’s aim to reduce mortality among children aged

To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United...

OBJECTIVE: To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. METHODS: We conducted interviews with key informants at the national and district levels in Brazil,...

Practical Approach to Lung Health in South Africa guideline. The guideline evaluated in this study.

To evaluate the diagnostic accuracy of the integrated Practical Approach to Lung Health in South Africa (PALSA) guideline in identifying patients requiring bacteriological screening for tuberculosis (TB), and to determine which clinical features best predict suspected and bacteriologically-confirmed tuberculosis among patients with respiratory symp...

Appropriate consideration of contextual factors is essential for ensuring internal and external validity of randomized and non-randomized evaluations. Contextual factors may confound the association between delivery of the intervention and its potential health impact. They may also modify the effect of the intervention or programme, thus affecting...

To summarize the expectations held by World Health Organization programme personnel about how the introduction of the Integrated Management of Childhood Illness (IMCI) strategy would lead to improvements in child health and nutrition, to compare these expectations with what was learned from the Multi-Country Evaluation of IMCI Effectiveness, Cost a...

In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to con...

Clinical practice guidelines are used widely to improve the quality of primary health care in different health systems, including those of low-income countries. Often developed at international level and adapted to national contexts to increase the feasibility of effective uptake, guideline initiatives aim to transfer global scientific knowledge in...

Setting: 6 outpatient departments (OPD) of 3 hospitals and 2 health centres in Lilongwe.Objective: To assess the existing health worker practice in providing care to patients with respiratory symptoms in the OPD. Methods:Between 1 and 31 July 2002 exit interviews were conducted with patients from OPD consultation rooms and possessing a prescription...

The World Health Organization strategies, Integrated Management of Childhood Illness and Practical Approach to Lung health provide assessment and management guidelines for health workers in developing countries. We reviewed issues important to lung health in adolescents to highlight whether differences in factors such as adolescent behaviour have c...