Objective To estimate the most up-to-date price and expenditure elasticities of demand for cigarettes, beer and soda in Uganda to inform the optimal design of health taxes and contribute to reducing the burden of non-communicable diseases while increasing government tax revenue.Methods We used eight waves of the nationally representative Uganda National Panel Survey (2005/2006–2019/2020) and applied the Deaton demand framework, which exploited spatial price variation while correcting for quality substitution and measurement error in unit values. We adjusted the basic model for possible bias that may arise from the panel nature of the data.Results Our results reveal that budget shares have declined with total expenditure, and quality upgrading was evident for cigarettes and beer but not for soda. Estimated own-price elasticity for cigarettes was −0.871 (95% CI −1.431 to −0.311; p=0.002). For beer and soda, the own-price elasticity was −0.362 (95% CI −4.609 to 3.885; p=0.867) and −0.153 (95% CI −2.054 to 1.746; p=0.874) and neither was statistically significant. Expenditure elasticities were positive and significant for all three commodities: cigarettes (0.460, p<0.001), beer (0.790, p<0.001) and soda (0.670, p<0.001). These findings imply that increasing excise taxes on cigarettes is likely to generate health gains through reduced consumption, whereas taxes on beer and soda may provide relatively stable revenue bases but require routine indexation to income growth to sustain the public health objective of reducing consumption.Conclusions In Uganda, raising excise taxes on cigarettes is strongly supported by evidence to reduce consumption and generate health gains, which is consistent with WHO recommendations. For beer and soda, while price responsiveness is statistically inconclusive, their positive and significant expenditure elasticities confirm that tax revenues will grow with income. Therefore, policymakers should prioritise immediate cigarette tax increases while routinely indexing beer and soda taxes to inflation and income growth to sustain any potential health objectives, alongside future research to refine price-elasticity estimates for these goods.
Objectives To quantify provider-level variation in musculoskeletal (MSK) health outcomes, consultation experience and opioid prescribing in general practice using a validated case-mix-adjustment model, and to evaluate the feasibility of applying Achievable Benchmark of Care (ABC) and funnel plots to derive performance benchmarks.Design Prospective observational cohort study.Setting 30 general practices across 13 primary care networks within a defined geographical region in England, UK (primary care).Participants 1875 adults aged ≥18 years consulting general practice with non-inflammatory MSK pain between September 2021 and July 2022 who consented to data linkage. Of these, 1317 (70%) completed 3-month follow-up. Patients with inflammatory arthritis were excluded.Interventions None.Primary and secondary outcome measures Primary outcome was 3-month change in Musculoskeletal Health Questionnaire (MSK-HQ; range 0–56, higher scores better) score. Secondary outcomes were patient-reported poor consultation experience and opioid prescribing within 14 days of consultation. Multivariable case-mix models included demographic and clinical variables. Provider-level variation was assessed using funnel plots. ABC methodology defined achievable benchmarks based on top-performing providers.Results Mean unadjusted 3-month MSK-HQ improvement was 4.9 points. After case-mix-adjustment, the weighted mean improvement was 4.8 points, with provider-level adjusted gains ranging from 3.0 to 5.7 points. ABC benchmarks were 5.7 points for MSK-HQ improvement, 4.4% for poor experience and 19.6% for opioid prescribing. Case-mix-adjustment altered provider rankings compared with crude analyses. Funnel plots identified two providers exceeding the 95% control limit for opioid prescribing; no outliers were observed for MSK-HQ.Conclusions Case-mix-adjusted benchmarking of MSK care in general practice is feasible: combining case-mix models, ABC benchmarks and funnel plots offers a transparent framework for provider comparison. The low baseline response rate, which varied between networks, means the variation observed should be interpreted cautiously rather than as an assessment of individual providers.Trial registration number ISRCTN18132064.
Objective(s) To evaluate the first implementation cycle of the cataract screening and surgical programme in Sierra Leone using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework and the Plan-Do-Study-Act approach.Design Mixed-methods implementation evaluation of routine programme data with interviews and focus group discussions.Setting Sierra Leone.Participants Cataract-positive patients identified through community screening.Primary and secondary outcomes Primary outcome includes programme reach and implementation, vision-related quality of life measured. Secondary outcomes included qualitative assessment of implementation barriers and programme adaptations.Results Among 9117 individuals screened, 7738 complete records were analysed, and 1433 cataract surgeries were performed. The programme predominantly reached economically vulnerable populations and mean composite National Eye Institute Visual Function Questionnaire score improved by 17 points following surgery (p<0.001). High patient demand, transportation and road infrastructure barriers, limited workforce and equipment affected implementation and postoperative follow-up. Adaptation included changes to staffing and workflows and plans for decentralised follow-up services.Conclusions High-volume cataract outreach in Sierra Leone substantially improved vision-related quality of life while highlighting the importance of adaptive implementation strategies in resource-constrained settings.
Introduction Antimicrobial resistance poses a major challenge to both public health and economic stability in many countries. In response, antimicrobial stewardship programmes are essential for optimising antibiotic use and reducing antimicrobial resistance, particularly in primary care settings where most antibiotics are prescribed. Kosovo, like many countries, is increasingly affected by the growing threat of antimicrobial resistance and must strengthen its strategies to address this problem. Although national action plans on antimicrobial resistance and stewardship have been completed, there is limited evidence on the economic impact of antimicrobial stewardship interventions in Kosovo, as is the case in many low- and middle-income country contexts. This study thus aims to evaluate the cost-effectiveness of antimicrobial stewardship programme in Kosovo, and the cost of implementing this programme in primary care settings in Kosovo.Methods and analysis First, for the cost-effectiveness component of the study, we will use a quasi-experimental interrupted time series design focusing on patients ≥18 years old diagnosed with upper respiratory tract infections at intervention and control sites in Kosovo’s primary care system, to analyse changes in antibiotic consumption measured in defined daily doses, and estimate the corresponding monetary value to determine cost-effectiveness. Second, we will use a bottom-up costing method to estimate the costs associated with implementing the antimicrobial stewardship programme, including resources required across intervention and control sites. Cost data for both components will be collected from the implementing institutions and the main family medicine centres, serving as the intervention and control sites.Ethics and dissemination The Ethical Committee of the Kosovo Chamber of Medical Doctors approved the protocol of our study (Number: 122/2024). Moreover, the results from this study will be published and disseminated as a peer-reviewed publication.
