Daniel Semakula

Background Every day we are faced with different treatment claims, in the news, in social media, and by our family and friends. Some of these claims are true, but many are unsubstantiated. Without being supported by reliable evidence such guidance can lead to waste and harmful health choices. The Informed Health Choices (IHC) Network facilitates development of interventions for teaching children and adults the ability to assess treatment claims (informedhealthchoices.org). Our objective was to develop and evaluate a new assessment tool developed from the item bank for use in an upcoming trial of lower secondary school resources in Uganda, Kenya, and Rwanda. Methods A cross-sectional study evaluating a questionnaire including two item-sets was used. The first evaluated ability using multiple-choice questions (scored dichotomously) and the other evaluated intended behaviour and self-efficacy (measured using Likert scales). This study was conducted in Uganda, Kenya, and Rwanda in 2021. We recruited children (over 12 years old) and adults through schools and our networks. We entered 1,671 responses into our analysis. Summary and individual fit to the Rasch model (including Cronbach’s Alpha) were assessed using the RUMM2030 software. Results Both item-sets were found to have good fit to the Rasch model and were acceptable to our target audience. The reliability was good (Cronbach’s alpha >0.7). Observations of the individual item and person fit provided us with guidance on how we could improve the design, scoring, and administration of the two item-sets. There was no local dependency in either of the item-sets, and both item-sets were found to have acceptable unidimensionality. Conclusion Overall, the two item-sets were found to have satisfactory measurement properties. Based on our analysis, we consider these instruments to be suitable for our target audiences in Uganda, Kenya and Rwanda.

Background We conducted an overview of systematic reviews about the effects of teaching strategies that can be used to teach primary and secondary school students to think critically. Our objective was to inform decisions about what teaching strategies to use in resources that we developed to teach critical thinking about health in secondary schools. Methods We mapped characteristics of systematic reviews of teaching strategies and summarised findings from the most relevant reviews to teaching students to think critically about health. We included reviews that assessed the effects of teaching strategies that could potentially be used in primary or secondary schools to teach students to think critically, had a Methods section with explicit selection criteria, reported at least one outcome measure of the ability to undertake one of four basic types of cognitive tasks (memory, procedural, comprehension, or opinion), and were published after 1999. Results We included 326 systematic reviews. The reviews evaluated a wide range of teaching strategies for a variety of purposes. Important limitations of the reviews included not considering adverse effects (99% of the reviews), not assessing the risk of bias for included studies (93% of the reviews), and not assessing the credibility of subgroup effects (100% of the reviews). We summarised the findings for 37 teaching strategies that we considered most relevant. The certainty of the evidence of the effects varied from very low to moderate. We used 12 of the strategies in resources that we developed to teach secondary students to think critically about health. Conclusions A tremendous amount of work has gone into evaluating the effects of a wide range of teaching strategies. The results of this research can inform decisions about how to teach critical thinking and future research. However, well-designed, up-to-date systematic reviews are still needed for many teaching strategies.

Background We conducted an overview of systematic reviews about the effects of teaching strategies that can be used to teach primary and secondary school students to think critically. Our objective was to inform decisions about what teaching strategies to use in resources that we developed to teach critical thinking about health in secondary schools. Methods We mapped characteristics of systematic reviews of teaching strategies and summarised findings from the most relevant reviews to teaching students to think critically about health. We included reviews that assessed the effects of teaching strategies that could potentially be used in primary or secondary schools to teach students to think critically, had a Methods section with explicit selection criteria, reported at least one outcome measure of the ability to undertake one of four basic types of cognitive tasks (memory, procedural, comprehension, or opinion), and were published after 1999. Results We included 326 systematic reviews. The reviews evaluated a wide range of teaching strategies for a variety of purposes. Important limitations of the reviews included not considering adverse effects (99% of the reviews), not assessing the risk of bias for included studies (93% of the reviews), and not assessing the credibility of subgroup effects (100% of the reviews). We summarised the findings for 37 teaching strategies that we considered most relevant. The certainty of the evidence of the effects varied from very low to moderate. We used 12 of the strategies in resources that we developed to teach secondary students to think critically about health. Conclusions A tremendous amount of work has gone into evaluating the effects of a wide range of teaching strategies. The results of this research can inform decisions about how to teach critical thinking and future research. However, well-designed, up-to-date systematic reviews are still needed for many teaching strategies.

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Uganda experienced 2 COVID-19 waves that challenged health professional education. All health professions training institutions (HPTIs) in Uganda closed in March 2020. Cognizant of the threat to quality education and the frontline workforce, the National Council for Higher Education (NCHE) and Seed Global Health partnered to examine the risks and benefits of HPTI reopening through the Safe Schools Initiative (SSI). This article described the processes to unify stakeholders in health professions education and the outcomes from these discussions during the COVID-19 pandemic in Uganda. During the first COVID-19 wave, the SSI conducted consultative meetings with key stakeholders. The SSI developed guidelines around student welfare and issued standard operating procedures (SOPs) for HPTI reopening. The NCHE recommended in-person learning for final-year students and online learning for junior years, resulting in HPTIs being the first academic institutions to reopen in the country. During the second COVID-19 wave, schools closed again. The SSI utilized recently published literature and quantitative data to inform decision making in addition to expert consensus. The NCHE recommended immediate phased reopening for students in clinical years, blended learning for nonclinical years, and prioritizing health professions education in future lockdowns. Consequently, HPTIs reopened within a month of closure. The SSI demonstrated that national advocacy for health professions education can be effective when engaging stakeholders to build consensus around difficult decisions. Key lessons learned from the SSI include the following: (1) collaborating across sectors in health professions education can amplify change, (2) occupational health guidelines must include health professions students, (3) investing in online education and simulation has value in outbreak-prone areas, and (4) systemic inequities in health professions education will require persistence and advocacy to correct. Future pandemic preparedness must prioritize HPTIs to ensure quality education and continuity of a frontline workforce.

Background: Every day we are faced with different treatment claims, in the news, in social media, and by our family and friends. Some of these claims are true, but many are unsubstantiated. Without being supported by reliable evidence such guidance can lead to waste and harmful health choices. The Informed Health Choices (IHC) Network facilitates development of interventions for teaching children and adults the ability to assess treatment claims (informedhealthchoices.org). Our objective was to develop and evaluate a new assessment tool developed from the item bank for use in an upcoming trial of lower secondary school resources in Uganda, Kenya, and Rwanda. Methods: A cross-sectional study evaluating a questionnaire including two item-sets was used. The first evaluated ability using multiple-choice questions (scored dichotomously) and the other evaluated intended behaviour and self-efficacy (measured using Likert scales). This study was conducted in Uganda, Kenya, and Rwanda in 2021. We recruited children (over 12 years old) and adults through schools and our networks. We entered 1,671 responses into our analysis. Summary and individual fit to the Rasch model (including Cronbach’s Alpha) were assessed using the RUMM2030 software. Results : Both item-sets were found to have good fit to the Rasch model and were acceptable to our target audience. The reliability was good (Cronbach’s alpha >0.7). Observations of the individual item and person fit provided us with guidance on how we could improve the design, scoring, and administration of the two item-sets. There was no local dependency in either of the item-sets, and both item-sets were found to have acceptable unidimensionality. Conclusion : To our knowledge, this is the first instrument validated for measuring ability to assess treatment claims in Uganda, Kenya and Rwanda. Overall, the two item-sets were found to have satisfactory measurement properties.

Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centered design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Objectives: To determine the distribution of career aspirations for the discipline of specialty among undergraduate medical students in sub-Saharan Africa (SSA). Design: We searched PubMed/MEDLINE, EMBASE Google Scholar and Google for studies published between 1 January 2000 and 31 June 2021. Two reviewers extracted data from eligible studies, with disagreements resolved through consensus with a third reviewer. The random effects model was used to pool proportions, presented with the corresponding 95% CI. Heterogeneity was assessed using Cochrane’s (Q) test but quantified with I ² values. Sources of heterogeneity were checked using meta-regression analysis while publication bias was assessed using funnel plot and Egger’s test. Setting: SSA. Participants: Undergraduate medical students. Outcomes: Primary outcome was pooled proportion of career aspirations for the discipline of medical specialty and the secondary outcome was reasons for the specialty selection. Results: We identified 789 citations but meta-analysed 32 studies, with an overall sample size of 8231 participants. The most popular career aspiration for the discipline of specialty was surgery (29.5%; 95% CI 25.0% to 34.2%), followed by internal medicine (17.3%, 95% CI 11.7% to 23.7%), and then obstetrics and gynaecology (15.0%, 95% CI 12.3% to 17.9%), and paediatrics (11.3%; 95% CI 9.6% to 13.2%). The less popular medical disciplines of specialty included public health, orthopaedics, ophthalmology, family medicine, pathology, anaesthesiology, dermatology, otolaryngology, psychiatry and emergency medicine. The reasons for the selection of a medical discipline for specialty related to mentor and peer influences, prospect for economic gains, personal factors, long-term career interests and goals and discipline-specific factors. Conclusion: Surgery is the most preferred career aspiration for medical students in SSA, followed by internal medicine. The choices do not necessarily match the disease burden on the continent and medical schools should consider strengthening career counselling and mentoring in their curriculum. PROSPERO registration number: CRD42021260501.

Introduction: Accurate and affordable laboratory testing is key to timely diagnosis and appropriate management of patients with COVID-19. New laboratory test protocols are released into the market under emergency use authorisation with limited evidence on diagnostic test accuracy. As such, robust evidence on the diagnostic accuracy and the costs of available tests is urgently needed to inform policy and practice especially in resource-limited settings. We aim to determine the diagnostic test accuracy, cost-effectiveness and utility of laboratory test strategies for COVID-19 in low-income and middle-income countries. Methods and analysis: This will be a multistaged, protocol-driven systematic review conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for diagnostic test accuracy studies. We will search for relevant literature in at least six public health databases, including PubMed, Google Scholar, MEDLINE, Scopus, Web of Science and the WHO Global Index Medicus. In addition, we will search Cochrane Library, COVID-END and grey literature databases to identify additional relevant articles before double-screening and abstraction of data. We will conduct a structured narrative and quantitative synthesis of the results guided by the Fryback and Thornbury framework for assessing a diagnostic test. The primary outcome is COVID-19 diagnostic test accuracy. Using the GRADE approach specific to diagnostic accuracy tests, we will appraise the overall quality of evidence and report the results following the original PRISMA statement. The protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO; https://www.crd.york.ac.uk/prospero/ ). Ethics and dissemination: Ethical review was done by the School of Biomedical Sciences Research Ethics Committee and the Uganda National Council for Science and Technology. The published article will be accessible to policy and decision makers. The findings of this review will guide clinical practice and policy decisions and highlight areas for future research. PROSPERO registration number CRD42020209528.