Nick Wooding - Academia.edu (original) (raw)
Papers by Nick Wooding
*<p>boda boda refers to motorcycles a common and popular two wheel means of transport for m... more *<p>boda boda refers to motorcycles a common and popular two wheel means of transport for mostly short distances in the country ? Exclusions due to change of client mind not included in screen failure rates.</p
Education for Primary Care, 2013
We start this time with some Teaching Tips. We are delighted that Jenny Gavriel has agreed to wri... more We start this time with some Teaching Tips. We are delighted that Jenny Gavriel has agreed to write a series of short ‘tips’ for us. She introduces them herself. Next we have an interesting approach to practice team development. Mark Sloan describes the concept of ‘balance wheels’. This is a tool that can help to highlight areas of practice that are, or are not, functioning well. Mark clearly describes how they can be used. Finally the ever-productive Wessex team have joined forces with colleagues from the Netherlands to describe the pros and cons of international exchange. It sounds a very refreshing thing to do.
<p>Cost model at a high volume SMC urban site at IHK, Uganda PrePex study 2012.</p
The Pan African medical journal, Dec 28, 2012
Introduction It has been proven in several randomized clinical trials that HIV transmission from ... more Introduction It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach. Methods A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented. Results A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs. Conclusion Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up.
The Lancet. Global health, 2018
Interventions to reduce child deaths in Africa have often underachieved, causing the Millennium D... more Interventions to reduce child deaths in Africa have often underachieved, causing the Millennium Development Goal targets to be missed. We assessed whether a community enquiry into the circumstances of death could improve intervention effectiveness by identifying local avoidable factors and explaining implementation failures. Deaths of children younger than 5 years were ascertained by community informants in two districts in Mali (762 deaths) and three districts in Uganda (442 deaths) in 2011-15. Deaths were investigated by interviewing parents and health workers. Investigation findings were reviewed by a panel of local health-care workers and community representatives, who formulated recommendations to address avoidable factors and, subsequently, oversaw their implementation. At least one avoidable factor was identified in 97% (95% CI 96-98, 737 of 756) of deaths in children younger than 5 years in Mali and 95% (93-97, 389 of 409) in Uganda. Suboptimal newborn care was a factor in 7...
PLoS ONE, 2013
Introduction: Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in... more Introduction: Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs) to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013. Objective: To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets. Methods: A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained. Results: The moderate adverse events (AE) ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is 30.55,3530.55, 35% (30.55,357.90) higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20. Conclusion: PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource.
Education for Primary Care, 2014
Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors, 2014
It is now well recognised that the consultation should be patient-centred. Roger Neighbour, in hi... more It is now well recognised that the consultation should be patient-centred. Roger Neighbour, in his book The Inner Consultation, categorises some of the current consultation models according to whether they are doctoror patient-centred;1 the Stott and Davis model falls into the doctor-centred category. However, one of the beauties of their model is its simplicity since it has only four areas, and allows some flexibility in consultation style.2 The areas covered are:
T he Apostle Paul knew all about hardships. He spoke these words soon after being stoned and left... more T he Apostle Paul knew all about hardships. He spoke these words soon after being stoned and left for dead. Perhaps the main hardship some doctors have faced recently (apart from MTAS) will have been the interest rate rises and higher mortgage repayments. Even as Christian doctors we may rely more on our salaries than on God. We are called to suffer hardships for the kingdom of God but we rarely do so. The day after studying this passage I was at a medical charity discussing a missionary who was struggling as the only doctor running a Christian hospital in a Muslim area in Africa. Someone said, 'Surely people in CMF could go to help?' The next day the BMJ arrived with two challenging articles. The first was by Professor Chris Lavy, Ten years in Malawi: was it worth it? 1 He described how, having just become a consultant and started up private practice in orthopaedics, he gave it up to go to Malawi, a country with the same population as London but no orthopaedic surgeon. He m...
British Journal of General Practice, 2009
*<p>boda boda refers to motorcycles a common and popular two wheel means of transport for m... more *<p>boda boda refers to motorcycles a common and popular two wheel means of transport for mostly short distances in the country ? Exclusions due to change of client mind not included in screen failure rates.</p
Education for Primary Care, 2013
We start this time with some Teaching Tips. We are delighted that Jenny Gavriel has agreed to wri... more We start this time with some Teaching Tips. We are delighted that Jenny Gavriel has agreed to write a series of short ‘tips’ for us. She introduces them herself. Next we have an interesting approach to practice team development. Mark Sloan describes the concept of ‘balance wheels’. This is a tool that can help to highlight areas of practice that are, or are not, functioning well. Mark clearly describes how they can be used. Finally the ever-productive Wessex team have joined forces with colleagues from the Netherlands to describe the pros and cons of international exchange. It sounds a very refreshing thing to do.
<p>Cost model at a high volume SMC urban site at IHK, Uganda PrePex study 2012.</p
The Pan African medical journal, Dec 28, 2012
Introduction It has been proven in several randomized clinical trials that HIV transmission from ... more Introduction It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach. Methods A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented. Results A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs. Conclusion Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up.
The Lancet. Global health, 2018
Interventions to reduce child deaths in Africa have often underachieved, causing the Millennium D... more Interventions to reduce child deaths in Africa have often underachieved, causing the Millennium Development Goal targets to be missed. We assessed whether a community enquiry into the circumstances of death could improve intervention effectiveness by identifying local avoidable factors and explaining implementation failures. Deaths of children younger than 5 years were ascertained by community informants in two districts in Mali (762 deaths) and three districts in Uganda (442 deaths) in 2011-15. Deaths were investigated by interviewing parents and health workers. Investigation findings were reviewed by a panel of local health-care workers and community representatives, who formulated recommendations to address avoidable factors and, subsequently, oversaw their implementation. At least one avoidable factor was identified in 97% (95% CI 96-98, 737 of 756) of deaths in children younger than 5 years in Mali and 95% (93-97, 389 of 409) in Uganda. Suboptimal newborn care was a factor in 7...
PLoS ONE, 2013
Introduction: Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in... more Introduction: Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs) to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013. Objective: To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets. Methods: A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained. Results: The moderate adverse events (AE) ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is 30.55,3530.55, 35% (30.55,357.90) higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20. Conclusion: PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource.
Education for Primary Care, 2014
Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors, 2014
It is now well recognised that the consultation should be patient-centred. Roger Neighbour, in hi... more It is now well recognised that the consultation should be patient-centred. Roger Neighbour, in his book The Inner Consultation, categorises some of the current consultation models according to whether they are doctoror patient-centred;1 the Stott and Davis model falls into the doctor-centred category. However, one of the beauties of their model is its simplicity since it has only four areas, and allows some flexibility in consultation style.2 The areas covered are:
T he Apostle Paul knew all about hardships. He spoke these words soon after being stoned and left... more T he Apostle Paul knew all about hardships. He spoke these words soon after being stoned and left for dead. Perhaps the main hardship some doctors have faced recently (apart from MTAS) will have been the interest rate rises and higher mortgage repayments. Even as Christian doctors we may rely more on our salaries than on God. We are called to suffer hardships for the kingdom of God but we rarely do so. The day after studying this passage I was at a medical charity discussing a missionary who was struggling as the only doctor running a Christian hospital in a Muslim area in Africa. Someone said, 'Surely people in CMF could go to help?' The next day the BMJ arrived with two challenging articles. The first was by Professor Chris Lavy, Ten years in Malawi: was it worth it? 1 He described how, having just become a consultant and started up private practice in orthopaedics, he gave it up to go to Malawi, a country with the same population as London but no orthopaedic surgeon. He m...
British Journal of General Practice, 2009