Health Technology Assessment in Action

Measuring the Economic Costs of Diarrheal Diseases in Nigeria: A 2021 GBD Study

Nsikakabasi Samuel George , Lucky Iseghehi — Sun, 14 Sep 2025 05:31:58 +0000

Background: This study aims to quantify the economic burden of diarrheal diseases in Nigeria considering the year 2021.

Methods: The study considered the value of life-year (VLYs) approach using the World Health Organization (WHO) and Lancet commissions’ recommendations, which assigns a monetary value to each life-year for sub-Saharan Africa. The economic burden was calculated by multiplying the GDP per capita and disability-adjusted life years (DALYs) by 4.2. The cost of illness (COI) analysis considered direct healthcare costs, non-healthcare costs, and indirect costs from morbidity and mortality. The COI values are calculated by adding the total direct medical costs (DMCs), direct non-medical costs (DNMCs), and indirect costs (morbidity and mortality). The study utilized data from the IHME Global Burden of Disease (GBD) 2021 website, the World Bank Database, and the ILO data explorer.

Results: Using the approach of the WHO, the value of life lost due to diarrheal illnesses in Nigeria in 2021 was 8.3 trillion Naira (56.7 billion US$) at one-times the GDP per capita and 24.9 trillion Naira (170 billion US$). The COI analysis revealed an economic burden of 109 billion Naira (744 million US$), with productivity loss from mortality contributing the most to the economic burden at 74%, followed by productivity losses from morbidity at 19%, with 7% attributed to direct medical and non-medical costs.

Conclusions: This study reveals a need to implement and strengthen existing actions to ensure a drastic reduction in the economic burden of diarrheal diseases. By implementing targeted interventions, preventing and controlling diarrheal disease and improving the well-being of communities in Nigeria is feasible.

The Relationship Between Organizational Socialization and Social Responsibility: A Descriptive Cross-sectional Study at Tabriz University of Medical Sciences

Sun, 14 Sep 2025 05:38:18 +0000

Background: The provision of health services by medical universities is a crucial responsibility, and the organizational socialization status of employees plays a significant role in fulfilling this responsibility. However, there is a lack of sufficient evidence examining this relationship within medical universities.

Objectives: This study aimed to investigate the correlation between organizational socialization and social responsibility among staff members at Tabriz University of Medical Sciences.

Methods: This descriptive cross-sectional study was conducted in 2023. The study population comprised staff members of Tabriz University of Medical Sciences. Standard questionnaires on organizational socialization by Chao and social responsibility by Carol were utilized. Data analysis was performed using SPSS version 22, with results presented through descriptive and inferential statistics at a significance level of 0.05.

Results: Of the 140 distributed questionnaires, 129 were completed and returned, yielding a response rate of 92%. Findings indicated that the levels of organizational socialization (28.94 ± 16.12) and social responsibility (30.76 ± 9.03) among headquarters staff were below the desired levels. A significant relationship was observed between the total scores of organizational socialization and social responsibility (P < 0.001). Also, the results showed that with an increase of one unit in the overall organizational socialization score, the overall social responsibility score increased by 0.419.

Conclusions: This finding suggests that attention to organizational socialization can facilitate the improvement and increased social responsibility of employees. University managers can include necessary programs to enhance these components in their agenda to have employees with higher organizational commitment and greater satisfaction.

Impoverishing Health Expenditure in Iran Before and After the COVID-19 Pandemic: A National Cross-sectional Study

Sun, 14 Sep 2025 05:46:12 +0000

Background: The COVID-19 pandemic has altered healthcare service utilization patterns and, consequently, the financial protection indicators.

Objectives: This study aims to examine the impoverishment caused by health expenditures before and during the COVID-19 pandemic in Iran.

Methods: This retrospective-descriptive study was conducted using six years of national income and expenditure data (2016 - 2021) from 228,910 households. We measured the occurrence and intensity indices of impoverishing health expenditure, such as the poverty headcount (PH), normalized poverty gap (NPG), and normalized mean positive poverty gap (NMPG), at the rural and urban levels separately. Results: The PH increased from 2016 to 2018, decreased in 2019, and rose again in 2020 and 2021. Moreover, the occurrence of impoverishment health expenditure was at its lowest level in 2016 compared to previous years. PH was consistently higher in rural areas. NPG increased from 2016 to 2018, decreased in 2019, and increased again in 2020 and 2021. The NMPG index ranged from 0.11% to 0.62% in rural areas, and from 0.34% to 1.18% in urban areas.

Conclusion: Impoverishing health expenditure in Iran was significant, especially for rural residents. The COVID-19 pandemic did not change this trend. Reforming economic policies and providing targeted financial support for vulnerable populations are crucial.

Factors Influencing Adherence to Anti-hypertensive Medications: A Cross- sectional Study Among the Najran Population, Saudi Arabia

Abdullah I Aedh — Sun, 14 Sep 2025 05:47:45 +0000

Background: Anti-hypertensive drugs are crucial for managing hypertension, a significant cause of morbidity and mortality globally. However, adherence to anti-hypertensive medications is often suboptimal, leading to poor blood pressure control and an increased risk of cardiovascular events.

Objectives: This study aims to determine the elements affecting the Najran population’s adherence to anti-hypertensive medication. Methods: A cross-sectional study was conducted in Najran, Saudi Arabia, with 208 hypertensive patients recruited from primary care clinics. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Descriptive statistics, bivariate analysis, and multivariate logistic regression were performed to identify factors associated with non-adherence. A P-value < 0.05 was considered statistically significant.

Results: The mean MMAS-8 score was 4.66 ± 2.53, indicating moderate non-adherence. Non-adherence was significantly associated with female sex (P = 0.001), single marital status (P = 0.001), lower education level (P < 0.001), private employment (P = 0.005), and rural residency (P = 0.002). Multivariate analysis showed that female sex [odds ratio (OR) = 2.56, P = 0.001], single status (OR = 3.29, P = 0.001), primary education (OR = 2.89, P = 0.005), and rural residency (OR = 3.12, P = 0.012) were independent predictors of non-adherence.

Conclusions: Several factors are associated with non-adherence to anti-hypertensive medications among the Najran population in Saudi Arabia. Female sex, single marital status, primary education, private sector employment, and rural residency were independent predictors of non-adherence. These findings suggest that interventions to improve adherence to anti-hypertensive medications should consider these factors and be tailored to the specific needs and challenges faced by individuals in the studied subgroups.

Efficacy of Wii Balance Board-Based Exergame Training Among Individuals with Cerebellar Ataxia: A Feasibility Study

Sayan Pratihar , Karthiga Rajasekaran , Shanmuga Priya Raji Reddy Parasuraman — Sun, 14 Sep 2025 05:51:43 +0000

Background: Conventional rehabilitation methods have shown limited and transient improvements, necessitating personalized approaches in the diverse population of cerebellar ataxia (CA). Wii balance board exergame training, integrating physical exercise with interactive video games, presents a novel and engaging neuro-rehabilitation strategy.

Objectives: The primary objective of this study was to assess the clinical feasibility of implementing Wii Balance Board-based exergame training among individuals with various forms of CA. The secondary objective was to investigate the preliminary efficacy and assess the enjoyment of the intervention.

Methods: The study incorporates a pilot randomized control trial and feasibility study design. We recruited 10 patients using a block randomization method. The Wii balance board training was administered for 18 sessions, 3 sessions per week, over 6 weeks. The primary outcomes of feasibility testing were evaluated through clinical research log documentation, while secondary outcomes of balance, ataxia severity rate, functional independence, and enjoyment were assessed with the mini-BESTest, Scale for Assessment and Rating of Ataxia (SARA), Functional Independence Measure Scale (FIMs), and Exergame Enjoyment Questionnaire (EEQ). Data were analyzed using descriptive statistics and non-parametric tests to evaluate changes in outcomes.

Results: The study enrollment rate was 77% (n = 10). The Wii intervention group showed a 100% (n = 5) retention rate compared to 80% (n = 4) in the control group (CG). The Wii intervention group demonstrated a tendency towards better outcomes at follow-up in SARA (P = 0.063, effect size/RM = 0.84) and Mini-BESTest (P = 0.071, effect size/RM = 0.79) but not in the case of FIM (P = 0.794, effect size/RM = 0.14), along with reporting a moderate level of enjoyment.

Conclusions: Wii Balance Board-based exergame training is considered feasible for implementation in clinical settings among individuals with various forms of CA, suggesting the conduction of a larger definitive study to further explore the intervention’s efficacy.

Challenges of Implementing Electronic Prescribing in a Low-Income Country: A Qualitative Study

Sun, 14 Sep 2025 06:00:03 +0000

Background: Electronic prescribing (E-prescribing) is a novel digital tool that can provide a complete patient profile and further helps to avoid prescription errors.

Objectives: In this study, we aimed to evaluate the present state of E-prescribing in Iran, identify its process, and diagnose its software flaws. Methods: Semi-structured interviews with several user groups, health system executives, and patients were conducted for this qualitative study (concluded in 2022), and MAXQDA 11 software was used for coding and data management.

Results: According to our interviews, the challenges of the E-prescribing process include a lack of appropriate culture, support for service providers, and physician cooperation; poor management; frequent system interruptions; extra workload imposed on pharmacies; and a failure to adapt systems for underprivileged areas. Moreover, the software themselves have a number of flaws, notably inconsistent and missing medical codes, their inability to keep up with an increase in the workload, difficulty in connecting some older systems with the latest ones, and a lack of a user-friendly interface.

Conclusions: Despite the continual improvements in the E-prescribing system, its further effective implementation in our country requires ongoing interaction with all stakeholders, enlisting their opinions, and resolving its problems as quickly as feasible.

Comparative Analysis of National Cancer Control Programs: Insights from Iran, USA, UK, Turkey, and Finland

Abbas Mazinani , Majid Mirmohammadkhani , Leila Najafi , Israfil Roshdi — Sun, 14 Sep 2025 06:06:21 +0000

Background: National cancer control programs (NCCPs) are pivotal in addressing the global burden of cancer through prevention, detection, treatment, and supportive care strategies. Comparing the effectiveness of these programs is crucial for optimizing cancer care practices worldwide.

Objectives: This study evaluates NCCPs in Iran, the USA, the UK, Turkey, and Finland to provide insights into enhancing global cancer care practices.

Methods: We compared Iran’s NCCP with those of selected countries, focusing on key components including prevention, screening, diagnosis, treatment, supportive care, research, and registration. A systematic literature search identified relevant articles discussing NCCPs of Iran and comparison countries. Peer-reviewed journals and reputable databases were utilized for article retrieval. Inclusion criteria comprised English articles offering comprehensive information on NCCP components, while exclusion criteria involved articles not directly comparing NCCPs or lacking relevant data. Qualitative analysis of selected articles identified similarities and differences in program implementation and effectiveness. Grey literature and official government documents supplemented findings.

Results: Five studies on NCCPs from America, England, Finland, Turkey, and Iran were identified, revealing diverse approaches and shared objectives in global cancer treatment management. While comprehensive program components were similar across nations, nuanced differences emerged. More developed nations exhibited detailed strategies, while challenges such as treatment access and palliative care integration persisted elsewhere. Variations in prevention initiatives, screening methods, treatment accessibility, and research funding mechanisms underscored the complexity of global cancer control efforts.

Conclusions: This study compares NCCPs in Iran, the USA, the UK, Turkey, and Finland. While all programs share common objectives, differences in strategies and resources exist. More developed nations often have detailed plans, while challenges like treatment access persist elsewhere. Variations in prevention, screening, treatment, and research underscore the complexity of global cancer care. By understanding these nuances, policymakers can better tailor NCCPs to address diverse population needs and improve cancer care outcomes worldwide.

Navigating Conflict: Priority Setting Challenges and Best Practices

Sun, 14 Sep 2025 06:15:12 +0000

Many low- and middle-income countries currently contend with conflict arising from war, political instability, or sanctions. These conflicts have directly impacted the accessibility and availability of healthcare services and products, resulting in increased mortality rates and endangering public health. The complex economic, social, and political circumstances stemming from these conflicts pose significant challenges to the effective functioning of health systems. This letter will explore the experiences of setting priorities in health amidst countries under different conflicts, including prolonged chronic conflict (Sudan, Somalia), sanctions (Iran), and temporary conflict (Thailand). It aims to provide insight into the

distinct obstacles and potential solutions associated with prioritizing health under these complex settings.