Imperial College London

DrSharifIsmail

Faculty of MedicineSchool of Public Health

Honorary Clinical Research Fellow
 
 
 
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Contact

 

sharif.ismail15

 
 
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Location

 

Sir Alexander Fleming BuildingSouth Kensington Campus

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Summary

 

Publications

Publication Type
Year
to

42 results found

Aiano F, Mensah AA, McOwat K, Obi C, Vusirikala A, Powell AA, Flood J, Bosowski J, Letley L, Jones S, Amin-Chowdhury Z, Lacy J, Hayden I, Ismail SA, Ramsay ME, Ladhani SN, Saliba Vet al., 2021, COVID-19 outbreaks following full reopening of primary and secondary schools in England: Cross-sectional national surveillance, November 2020, The Lancet Regional Health - Europe, Vol: 6, Pages: 100120-100120, ISSN: 2666-7762

Journal article

Mensah AA, Sinnathamby M, Zaidi A, Coughlan L, Simmons R, Ismail SA, Ramsay ME, Saliba V, Ladhani SNet al., 2021, SARS-CoV-2 infections in children following the full re-opening of schools and the impact of national lockdown: Prospective, national observational cohort surveillance, July-December 2020, England, JOURNAL OF INFECTION, Vol: 82, Pages: 67-74, ISSN: 0163-4453

Journal article

Moschopoulou E, Deane J, Duncan M, Ismail SA, Moriarty S, Sarker S-J, White P, Korszun Aet al., 2021, Measuring quality of life in people living with and beyond cancer in the UK, Supportive Care in Cancer, Pages: 1-8, ISSN: 0941-4355

PurposeThe aim of this study was to identify the most appropriate measure of quality of life (QoL) for patients living with and beyond cancer.MethodsOne hundred eighty-two people attending cancer clinics in Central London at various stages post-treatment, completed a series of QoL measures: FACT-G, EORTC QLQ-C30 , IOCv2 (positive and negative subscales) and WEMWBS, a wellbeing measure. These measures were chosen as the commonest measures used in previous research. Correlation tests were used to assess the association between scales. Participants were also asked about pertinence and ease of completion.ResultsThere was a significant positive correlation between the four domain scores of the two health-related QoL measures (.32 ≤ r ≤ .72, P < .001), and a significant large negative correlation between these and the negative IOCv2 subscale scores (− .39 ≤ r ≤ − .63, P < .001). There was a significant moderate positive correlation between positive IOCv2 subscale and WEMWBS scores (r = .35, P < .001). However, neither the FACT-G nor the EORTC showed any significant correlation with the positive IOCv2 subscale. Participants rated all measures similarly with regards to pertinence and ease of use.ConclusionThere was little to choose between FACT-G, EORTC, and the negative IOC scales, any of which may be used to measure QoL. However, the two IOCv2 subscales capture unique aspects of QoL compared to the other measures. The IOCv2 can be used to identify those cancer survivors who would benefit from interventions to improve their QoL and to target specific needs thereby providing more holistic and personalised care beyond cancer treatment.

Journal article

Shrotri M, van Schalkwyk MCI, Post N, Eddy D, Huntley C, Leeman D, Rigby S, Williams SV, Bermingham W, Kellam P, Maher J, Shields AM, Amirthalingam G, Peacock SJ, Ismail Set al., 2021, T cell response to SARS-CoV-2 infection in humans: a systematic review, PLoS One, Vol: 16, Pages: 1-21, ISSN: 1932-6203

BackgroundUnderstanding the T cell response to SARS-CoV-2 is critical to vaccine development, epidemiological surveillance and control strategies. This systematic review critically evaluates and synthesises the relevant peer-reviewed and pre-print literature published in recent months.MethodsFor this systematic review, independent keyword-structured literature searches were carried out in MEDLINE, Embase and COVID-19 Primer for studies published from 01/01/2020-26/06/2020. Papers were independently screened by two researchers, with arbitration of disagreements by a third researcher. Data were independently extracted into a pre-designed Excel template and studies critically appraised using a modified version of the MetaQAT tool, with resolution of disagreements by consensus. Findings were narratively synthesised.Results61 articles were included. 55 (90%) studies used observational designs, 50 (82%) involved hospitalised patients with higher acuity illness, and the majority had important limitations. Symptomatic adult COVID-19 cases consistently show peripheral T cell lymphopenia, which positively correlates with increased disease severity, duration of RNA positivity, and non-survival; while asymptomatic and paediatric cases display preserved counts. People with severe or critical disease generally develop more robust, virus-specific T cell responses. T cell memory and effector function has been demonstrated against multiple viral epitopes, and, cross-reactive T cell responses have been demonstrated in unexposed and uninfected adults, but the significance for protection and susceptibility, respectively, remains unclear. Conclusion A complex pattern of T cell response to SARS-CoV-2 infection has been demonstrated, but inferences regarding population level immunity are hampered by significant methodological limitations and heterogeneity between studies, as well as a striking lack of research in asymptomatic or pauci-symptomatic individuals. In contrast to antibody respo

Journal article

Ismail SA, Huntley C, Post N, Rigby S, Shrotri M, Williams SV, Peacock SJet al., 2021, Horses for courses? Assessing the potential value of a surrogate, point-of-care test for SARS-CoV-2 epidemic control, Influenza and Other Respiratory Viruses, Vol: 15, Pages: 3-6, ISSN: 1750-2640

Point‐of‐care tests (POCTs) offer considerable potential for improving clinical and public health management of COVID‐19 by providing timely information to guide decision‐making, but data on real‐world performance are in short supply. Besides SARS‐CoV‐2‐specific tests, there is growing interest in the role of surrogate (non‐specific) tests such as FebriDx, a biochemical POCT which can be used to distinguish viral from bacterial infection in patients with influenza‐like illnesses. This short report assesses what is currently known about FebriDx performance across settings and populations by comparison with some of the more intensively evaluated SARS‐CoV‐2‐specific POCTs. While FebriDx shows some potential in supporting triage for early‐stage infection in acute care settings, this is dependent on SARS‐CoV‐2 being the most likely cause for influenza‐like illnesses, with reduction in discriminatory power when COVID‐19 case numbers are low, and when co‐circulating viral respiratory infections become more prevalent during the autumn and winter. Too little is currently known about its performance in primary care and the community to support use in these contexts, and further evaluation is needed. Reliable SARS CoV2‐specific POCTs—when they become available—are likely to rapidly overtake surrogates as the preferred option given the greater specificity they provide.

Journal article

Post N, Eddy D, Huntley C, van Schalkwyk M, Shrotri M, Leeman D, Rigby S, Williams S, Bermingham W, Kellam P, Maher J, Shields A, Amirthalingam G, Peacock S, Ismail Set al., 2020, Antibody response to SARS-CoV-2 infection in humans: a systematic review, PLoS One, Vol: 15, Pages: 1-27, ISSN: 1932-6203

BackgroundProgress in characterising the humoral immune response to Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) has been rapid but areas of uncertainty persist. Assessment of the full range of evidence generated to date to understand the characteristics of the antibody response, its dynamics over time, its determinants and the immunity it confers will have a range of clinical and policy implications for this novel pathogen. This review comprehensively evaluated evidence describing the antibody response to SARS-CoV-2 published from 01/01/2020-26/06/2020.MethodsSystematic review. Keyword-structured searches were carried out in MEDLINE, Embase and COVID-19 Primer. Articles were independently screened on title, abstract and full text by two researchers, with arbitration of disagreements. Data were double-extracted into a pre-designed template, and studies critically appraised using a modified version of the MetaQAT tool, with resolution of disagreements by consensus. Findings were narratively synthesised. Results150 papers were included. Most studies (113 or 75%) were observational in design, were based wholly or primarily on data from hospitalised patients (108, 72%) and had important methodological limitations. Few considered mild or asymptomatic infection. Antibody dynamics were well described in the acute phase, up to around 3 months from disease onset, but the picture regarding correlates of the antibody response was inconsistent. IgM was consistently detected before IgG in included studies, peaking at weeks 2-5 and declining over a further 3-5 weeks post-symptom onset depending on the patient group; IgG peaked around weeks 3-7 post-symptom onset then plateaued, generally persisting for at least 8 weeks. Neutralising antibodies were detectable within 7-15 days following disease onset, with levels increasing until days 14-22 before levelling and then decreasing, but titres were lower in those with asymptomatic or clinically mild disease. Specific and potent neu

Journal article

Garry S, Abdelmagid N, Baxter L, Roberts N, le Polain de Waroux O, Ismail S, Ratnayake R, Favas C, Lewis E, Checchi Fet al., 2020, Considerations for planning COVID-19 treatment services in humanitarian responses, Conflict and Health, Vol: 14, Pages: 1-11, ISSN: 1752-1505

The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.

Journal article

Ismail SA, Saliba V, Lopez Bernal J, Ramsay ME, Ladhani SNet al., 2020, SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England, The Lancet Infectious Diseases, ISSN: 1473-3099

Journal article

Abbara A, Joseph L, Ismail S, Gunst M, Jarman K, Prior D, Harris Met al., 2020, A qualitative research study which explores humanitarian stakeholders’ views on healthcare access for refugees in Greece, International Journal of Environmental Research and Public Health, Vol: 17, ISSN: 1660-4601

Introduction: As of January 2020, 115,600 refugees remain in Greece; most are Afghani, Iraqi or Syrian nationals. This qualitative research study explores the views of key stakeholders providing healthcare for refugees in Greece between 2015 and 2018. The focus was on identifying key barriers and facilitators to healthcare access for refugees in Greece. Methods: 16 interviewees from humanitarian and international organisations operating in Greece were identified through purposive and snowball sampling. Semi-structured interviews were conducted between March and April 2018. Data were analysed using the Framework Method. Results: Key themes affecting healthcare access included the influence of socio-cultural factors (healthcare expectations, language, gender) and the ability of the Greek health system to respond to existing and evolving demands; these included Greece’s ongoing economic crisis, human resource shortages, weak primary healthcare system, legal barriers and logistics. The evolution of the humanitarian response from emergency to sustained changes to EU funding, coordination and comprehensiveness of services affected healthcare access for refugees. Conclusion: The most noted barriers cited by humanitarian stakeholders to healthcare access for refugees in Greece were socio-cultural and language differences between refugees and healthcare providers and poor coordination among stakeholders. Policies and interventions which address these could improve healthcare access for refugees in Greece with coordination led by the EU.

Journal article

Gheorghe A, Ismail S, Gad M, Chalkidou Ket al., 2020, Capacity for health economics research and practice in Jordan, Lebanon, the occupied Palestinian territories and Turkey: needs assessment and options for development, Health Research Policy and Systems, Vol: 18, ISSN: 1478-4505

Background: Capacity for health economics analysis and research is indispensable for evidence-informed allocations of scarce health resources, however little is known about the experience and capacity strengthening preferences of academics and practitioners in the Eastern Mediterranean region. This study aimed to assess the needs for strengthening health economics capacity in Jordan, Lebanon, the occupied Palestinian territories and Turkey as part of the Research for Health in Conflict in Middle East and North Africa (R4HC-MENA) project.Methods: Bibliometric analysis of health economics outputs combined with an online survey of academic researchers and non-academic practitioners. The bibliometric analysis was based on a literature search conducted across seven databases. Included records were original studies and reviews with an explicit economic outcome related to health, disease or disability; had at least one author in Jordan, Lebanon, Palestine or Turkey; and were published between January 2014 and December 2018. Two types of analyses were conducted using VOSviewer software: keyword co-occurrence; and co-publication networks across countries and organizations. The online survey asked academic researchers, analysts and decision-makers – identified through the bibliometric analysis and regional professional networks – about previous exposure to and preference for capacity development in health economics.Results: Of 15,185 records returned by the literature search, 566 were included in the bibliometric analysis. Organizations in Turkey contributed more than 80% of records and had the broadest and most diverse network of collaborators, nationally and internationally. Only 1% (n=7) studies were collaborations between researchers in two or more different jurisdictions. Cost analysis, cost-effectiveness analysis and health system economics were the main health economics topics across the included studies. Economic evaluation, measuring the economic burden o

Journal article

Post N, Eddy D, Huntley C, van Schalkwyk MCI, Shrotri M, Leeman D, Rigby S, Williams SV, Bermingham WH, Kellam P, Maher J, Shields AM, Amirthalingam G, Peacock SJ, Ismail SAet al., 2020, Antibody response to SARS-CoV-2 infection in humans: a systematic review, Publisher: Cold Spring Harbor Laboratory

Introduction Progress in characterising the humoral immune response to Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) has been rapid but areas of uncertainty persist. This review comprehensively evaluated evidence describing the antibody response to SARS-CoV-2 published from 01/01/2020-26/06/2020.Methods Systematic review. Keyword-structured searches were carried out in MEDLINE, Embase and COVID-19 Primer. Articles were independently screened on title, abstract and full text by two researchers, with arbitration of disagreements. Data were double-extracted into a pre-designed template, and studies critically appraised using a modified version of the MetaQAT tool, with resolution of disagreements by consensus. Findings were narratively synthesised.Results 150 papers were included. Most studies (75%) were observational in design, and included papers were generally of moderate quality based on hospitalised patients. Few considered mild or asymptomatic infection. Antibody dynamics were well described in the acute phase, and up to around 3 months from disease onset, although inconsistencies remain concerning clinical correlates. Development of neutralising antibodies following SARS-CoV-2 infection is typical, although titres may be low. Specific and potent neutralising antibodies have been isolated from convalescent plasma. Cross reactivity but limited cross neutralisation occurs with other HCoVs. Evidence for protective immunity in vivo is limited to small, short-term animal studies, which show promising initial results in the immediate recovery phase.Interpretation Published literature on immune responses to SARS-CoV-2 is of variable quality with considerable heterogeneity with regard to methods, study participants, outcomes measured and assays used. Antibody dynamics have been evaluated thoroughly in the acute phase but longer follow up and a comprehensive assessment of the role of demographic characteristics and disease severity is needed. The role of protective neu

Working paper

Shrotri M, van Schalkwyk M, Post N, Eddy D, Huntley C, Leeman D, Rigby S, Williams S, Bermingham W, Kellam P, Maher J, Shields A, Amirthalingam G, Peacock S, Ismail Set al., 2020, Cellular immune response to SARS-CoV-2 infection in humans: a systematic review, Publisher: Cold Spring Harbor Laboratory

Introduction Understanding the cellular immune response to SARS-CoV-2 is critical to vaccine development, epidemiological surveillance and control strategies. This systematic review critically evaluates and synthesises the relevant peer-reviewed and pre-print literature published in recent months. Methods For this systematic review, independent keyword-structured literature searches were carried out in MEDLINE, Embase and COVID-19 Primer for studies published from 01/01/2020-26/06/2020. Papers were independently screened by two researchers, with arbitration of disagreements by a third researcher. Data were independently extracted into a pre-designed Excel template and studies critically appraised using a modified version of the MetaQAT tool, with resolution of disagreements by consensus. Findings were narratively synthesised. Results 61 articles were included. Almost all studies used observational designs, were hospital-based, and the majority had important limitations. Symptomatic adult COVID-19 cases consistently show peripheral T cell lymphopenia, which positively correlates with increased disease severity, duration of RNA positivity, and non-survival; while asymptomatic and paediatric cases display preserved counts. People with severe or critical disease generally develop more robust, virus-specific T cell responses. T cell memory and effector function has been demonstrated against multiple viral epitopes, and, cross-reactive T cell responses have been demonstrated in unexposed and uninfected adults, but the significance for protection and susceptibility, respectively, remains unclear. Interpretation A complex pattern of T cell response to SARS-CoV-2 infection has been demonstrated, but inferences regarding population level immunity are hampered by significant methodological limitations and heterogeneity between studies. In contrast to antibody responses, population-level surveillance of the cellular response is unlikely to be feasible in the near term. Focuse

Working paper

Sigfrid L, Maskell K, Bannister PG, Ismail SA, Collinson S, Regmi S, Blackmore C, Harriss E, Longuere K-S, Gobat N, Horby P, Clarke M, Carson Get al., 2020, Addressing challenges for clinical research responses to emerging epidemics and pandemics: a scoping review, BMC Medicine, Vol: 18, ISSN: 1741-7015

BACKGROUND: Major infectious disease outbreaks are a constant threat to human health. Clinical research responses to outbreaks generate evidence to improve outcomes and outbreak control. Experiences from previous epidemics have identified multiple challenges to undertaking timely clinical research responses. This scoping review is a systematic appraisal of political, economic, administrative, regulatory, logistical, ethical and social (PEARLES) challenges to clinical research responses to emergency epidemics and solutions identified to address these. METHODS: A scoping review. We searched six databases (MEDLINE, Embase, Global Health, PsycINFO, Scopus and Epistemonikos) for articles published from 2008 to July 2018. We included publications reporting PEARLES challenges to clinical research responses to emerging epidemics and pandemics and solutions identified to address these. Two reviewers screened articles for inclusion, extracted and analysed the data. RESULTS: Of 2678 articles screened, 76 were included. Most presented data relating to the 2014-2016 Ebola virus outbreak or the H1N1 outbreak in 2009. The articles related to clinical research responses in Africa (n = 37), Europe (n = 8), North America (n = 5), Latin America and the Caribbean (n = 3) and Asia (n = 1) and/or globally (n = 22). A wide range of solutions to PEARLES challenges was presented, including a need to strengthen global collaborations and coordination at all levels and develop pre-approved protocols and equitable frameworks, protocols and standards for emergencies. Clinical trial networks and expedited funding and approvals were some solutions implemented. National ownership and community engagement from the outset were a key enabler for delivery. Despite the wide range of recommended solutions, none had been formally evaluated. CONCLUSIONS: To strengthen global preparedness and response to the COVID-19 pandemi

Journal article

Bricknell M, Hinrichs-Krapels S, Ismail S, Sullivan Ret al., 2020, Understanding the structure of a country's health service providers for defence health engagement, BMJ Military Health, ISSN: 2633-3767

There are a variety of structural and systems frameworks for describing the building blocks of country's public health and health systems. In this paper, we propose a conceptual framework for a holistic view of a country's health service providers in order to inform the plan for Defence Health Engagement activities with partner countries. This includes all potential government ministries involved in healthcare provision, the independent, private sector and the non-government organisation/charity sector. The framework provides a visualisation to support the analysis of a country's health services providers. We propose that recognising and analysing the different contributions of all these national health providers is essential for understanding the wider political economy of a nation's health systems. This can inform a plan of Defence Health Engagement for capacity building in crisis response, development and health systems strengthening.

Journal article

Naik Y, Baker P, Ismail SA, Tillmann T, Bash K, Quantz D, Hillier-Brown F, Jayatunga W, Kelly G, Black M, Gopfert A, Roderick P, Barr B, Bambra Cet al., 2019, Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities, BMC Public Health, Vol: 19, ISSN: 1471-2458

Background: The social determinants of health have been widely recognised yet thereremains a lack of clarity regarding what constitute the macro-economic determinants ofhealth and what can be done to address them. An umbrella review of systematicreviews was conducted to identify the evidence for the health and health inequalitiesimpact of population level macroeconomic factors, strategies, policies andinterventions. Methods: Nine databases were searched for systematic reviews meetingthe Database of Abstracts of Reviews of Effects (DARE) criteria using a novelconceptual framework. Studies were assessed for quality using a standardisedinstrument and a narrative overview of the findings is presented Results: The reviewfound a large (n=63) but low quality systematic review-level evidence base. The resultsindicated that action to promote employment and improve working conditions can helpimprove health and reduce gender-based health inequalities. Evidence suggests thatmarket regulation of tobacco, alcohol and food is likely to be effective at improvinghealth and reducing inequalities in health including strong taxation, or restriction ofadvertising and availability. Privatisation of utilities and alcohol sectors, incomeinequality, and economic crises are likely to increase health inequalities. Left of centregovernments and welfare state generosity may have a positive health impact, butevidence on specific welfare interventions is mixed. Trade and trade policies werefound to have a mixed effect. There were no systematic reviews of the health impact ofmonetary policy or of large economic institutions such as central banks and regulatoryorganisations.Conclusions: The results of this study provide a simple yetcomprehensive framework to support policy-makers and practitioners in addressing themacroeconomic determinants of health. Further research is needed in low and middleincome countries and further reviews are needed to summarise evidence in key gapsidentified by this revie

Journal article

Sigfrid L, Bannister PG, Maskell K, Regmi S, Collinson S, Blackmore C, Ismail SA, Harriss E, Longuere K-S, Gobat N, Clarke M, Carson Get al., 2019, Addressing political, economic, administrative, regulatory, logistical, ethical, and social challenges to clinical research responses to emerging epidemics and pandemics: a systematic review, The Lancet, Vol: 394, Pages: S86-S86, ISSN: 0140-6736

Journal article

Honein-AbouHaidar G, Noubani A, El Arnaout N, Ismail S, Nimer H, Menassa M, Coutts AP, Rayes D, Jomaa L, Saleh S, Fouad FMet al., 2019, Correction to: Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis., Conflict and Health, Vol: 13, ISSN: 1752-1505

[This corrects the article DOI: 10.1186/s13031-019-0224-y.].

Journal article

Honein-AbouHaidar G, Noubani A, El Arnaout N, Ismail S, Nimer H, Menassa M, Coutts AP, Rayes D, Jomaa L, Saleh S, Fouad FMet al., 2019, Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis, Conflict and Health, Vol: 13, Pages: 1-11, ISSN: 1752-1505

BackgroundSyrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism.MethodA qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used.ResultsTwenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria.ConclusionOur study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, partic

Journal article

Ismail SA, McCullough A, Guo S, Sharkey A, Harma S, Rutter Pet al., 2019, Gender-related differences in care-seeking behaviour for newborns: a systematic review of the evidence in South Asia, BMJ Global Health, Vol: 4, ISSN: 2059-7908

Introduction Data indicate substantial excess mortality among female neonates in South Asia compared with males. We reviewed evidence on sex and gender differences in care-seeking behaviour for neonates as a driver for this.Methods We conducted a systematic review of literature published between January 1st, 1996 and August 31st, 2016 in Pubmed, Embase, Eldis and Imsear databases, supplemented by grey literature searches. We included observational and experimental studies, and reviews. Two research team members independently screened titles, abstracts and then full texts for inclusion, with disagreements resolved by consensus. Study quality was assessed using National Institute for Health and Care Excellence (NICE) checklists and summary judgements given using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data were extracted into Microsoft Excel.Results Of 614 studies initially identified, 17 studies were included. Low quality evidence across several South Asian countries suggests that care-seeking rates for female neonates are lower than males, especially in households with older female children. Parents are more likely to pay more, and seek care from providers perceived as higher quality, for males than females. Evidence on drivers of these care-seeking behaviours is limited. Care-seeking rates are suboptimal, ranging from 20% to 76% across male and female neonates.Conclusion Higher mortality observed among female neonates in South Asia may be partly explained by differences in care-seeking behaviour, though good quality evidence on drivers for this is lacking. Further research is needed, but policy interventions to improve awareness of causes of neonatal mortality, and work with households with predominantly female children may yield population health benefits. The social, economic and cultural norms that give greater value and preference to boys over girls must also be challenged through the creation of legislation and polic

Journal article

Flanagan S, Kunkel J, Appleby V, Eldridge SE, Ismail S, Moreea S, Griffiths C, Walton R, Pitt M, Salmon A, Madurasinghe V, Barnes E, Simms E, Agarwal K, Foster GRet al., 2019, Case finding and therapy for chronic viral hepatitis in primary care (HepFREE): a cluster-randomised controlled trial, The Lancet Gastroenterology & Hepatology, Vol: 4, Pages: 32-44, ISSN: 2468-1253

BackgroundThe prevalence of viral hepatitis (hepatitis B virus and hepatitis C virus) in migrants is higher than among the general population in many high-income countries. We aimed to determine whether incentivising and supporting primary-care physicians in areas with a high density of migrants increases the numbers of adult migrants screened for viral hepatitis.MethodsHepFREE was a multicentre, open, cluster-randomised controlled trial in general practices in areas of the UK with a high density of migrants (Bradford, Yorkshire, and northeast and southeast London). Participants were adult patients (aged 18 years or older) in primary care, who had been identified as a first or second generation migrant from a high-risk country. General practices were randomly assigned (1:2:2:2:2) to an opportunistic screening (control) group or to one of four targeted screening (interventional) groups: standard (ie, hospital-based) care and a standard invitation letter; standard care and an enhanced invitation letter; community care and a standard invitation letter; or community care and an enhanced invitation letter. In control screening, general practitioners (GPs) were given a teaching session on viral hepatitis and were asked to test all registered migrants. In the intervention, GPs were paid a nominal sum for setting up searches of records, reimbursed for signed consent forms, and supported by a dedicated clinician. Patients who were eligible for testing and tested positive for viral hepatitis in the intervention groups were eligible to enrol in a second embedded trial of community versus hospital based care. The primary outcomes were the proportion of patients eligible for screening, the proportion of those eligible who were sent an invitation letter in the intervention groups, the uptake of viral hepatitis screening (in the intention-to-treat population), the proportion of patients who tested positive for viral hepatitis, the proportion who complied with treatment, and the co

Journal article

Joseph L, Ismail S, Prior D, Gunst M, Jarman K, Harris M, Abbara Aet al., 2018, Barriers to healthcare access for refugees in Greece, Publisher: OXFORD UNIV PRESS, Pages: 407-407, ISSN: 1101-1262

Conference paper

Reed JE, Kaplan H, Ismail S, 2018, A new typology for understanding context: qualitative exploration of the model for understanding success in quality (MUSIQ), BMC Health Services Research, Vol: 18, ISSN: 1472-6963

BackgroundThe importance of contextual factors in influencing quality improvement and implementation (QI&I) initiatives is broadly acknowledged. Existing treatments of context have primarily viewed it as static and distinct from interventions themselves. The objective of this study was to advance understanding of the complex and dynamic interaction between context, intervention, and implementation strategies. Using the Model for Understanding Success in Quality (MUSIQ), we aimed to better understand the roles of, and inter-relationships between, contextual factors within QI&I initiatives.MethodsSecondary analysis was performed on qualitative data collected as part of two studies: (1) an evaluation of a state-wide obstetrical quality improvement (QI) initiative, and (2) a study of the use of Plan-Do-Study-Act cycle method in QI projects. Electronic coding databases from each study were reviewed jointly. Data analysis was initiated deductively using MUSIQ as a template. Codes were added in an inductive manner.ResultsAll original factors in MUSIQ were observed to be important in the QI initiatives studied and new factors were identified. Three distinct types of context were identified; the setting(s) of care in which QI&I takes place (Type 1); the context of the team conducting a specific project (Type 2); and the wider context supporting general QI&I (Type 3). The picture of context emerging from this study is a dynamic one with multiple, closely-linked factors operating at different levels in a system that is constantly changing in response to QI&I initiatives. To capture this complexity, a revised model (MUSIQ v2.0) was created positioning use of structured QI&I approaches as the focal point and demonstrating how context influenced effective use of these approaches, and in turn, how these approaches supported teams in navigating context by adapting interventions to fit local settings.ConclusionsMUSIQ is a useful tool to explore the roles of

Journal article

Ismail SA, 2018, The rocky road to universal health coverage in Egypt: A political economy of health insurance reform from 2005-15, INTERNATIONAL SOCIAL SECURITY REVIEW, Vol: 71, Pages: 79-101, ISSN: 0020-871X

Journal article

Pope I, Ismail S, Bloom B, Jansen G, Burn H, McCoy D, Harris Tet al., 2018, Short-stay admissions at an inner city hospital: a cross-sectional analysis, Emergency Medicine Journal, ISSN: 1472-0205

Journal article

Ismail SA, Cuadros DF, Benova L, 2017, Hepatitis B in Egypt: A cross-sectional analysis of prevalence and risk factors for active infection from a nationwide survey, Liver International, Vol: 37, Pages: 1814-1822, ISSN: 1478-3223

Background & AimsViral hepatitis is a major public health challenge in Egypt but little is known about the epidemiology of the hepatitis B virus (HBV) infection, its geographical distribution, or risk factors for infection in the Egyptian context. This study addresses this deficit using data from a nationally representative survey.MethodsCross‐sectional analysis of data gathered from men and women aged 15‐59 in the Egypt Health Issues Survey (EHIS) 2015, including logistic regression to evaluate the contribution of different factors to risk of HBV infection. This was supplemented by spatial analysis of the distribution of acute or chronic HBV infection at governorate level, and the ecological relationship between HBV and HCV infections.ResultsPopulation HBV prevalence was 1.4% (95% confidence interval [CI] 1.2‐1.6), with a HBV‐HCV co‐infection rate of 0.06%. Spatial analysis showed localisation of HBV infected individuals primarily to urban areas of Upper Egypt (in contrast to HCV for which prevalence is highest in rural Lower Egypt), and those in early middle age (Adjusted Odds Ratio [AOR] 3.32, 95% CI: 1.66‐6.63). HBV positive status among other household members emerged as a powerful driver of infection risk in this analysis (AOR=10.75, 95% CI: 4.98‐23.24).ConclusionSpatial distribution of HBV infection in Egypt differs markedly from HCV and co‐infection rates are low. Within‐household transmissions appear to be particularly important in explaining the persistence of HBV infection in the general population. Prevention strategies should focus on urban Upper Egypt, and particularly those households with documented cases of infection.

Journal article

Pope I, Ismail SA, McCoy D, Harris Tet al., 2017, 20 Risk factors for admission at three, urban emergency departments in england: a cross-sectional analysis of attendances over one month, Emergency Medicine Journal, Vol: 34, Pages: A875-A875, ISSN: 1472-0205

Journal article

Pope I, Burn H, Ismail SA, Harris T, McCoy Det al., 2017, A qualitative study exploring the factors influencing admission to hospital from the emergency department, BMJ Open, Vol: 7, ISSN: 2044-6055

Objective The number of emergency admissions to hospital in England and Wales has risen sharply in recent years and is a matter of concern to clinicians, policy makers and patients alike. However, the factors that influence this decision are poorly understood. We aimed to ascertain how non-clinical factors can affect hospital admission rates.Method We conducted semistructured interviews with 21 participants from three acute hospital trusts. Participants included 11 emergency department (ED) doctors, 3 ED nurses, 3 managers and 4 inpatient doctors. A range of seniority was represented among these roles. Interview questions were developed from key themes identified in a theoretical framework developed by the authors to explain admission decision-making. Interviews were recorded, transcribed and analysed by two independent researchers using framework analysis.Findings Departmental factors such as busyness, time of day and levels of senior support were identified as non-clinical influences on a decision to admit rather than discharge patients. The 4-hour waiting time target, while overall seen as positive, was described as influencing decisions around patient admission, independent of clinical need. Factors external to the hospital such as a patient’s social support and community follow-up were universally considered powerful influences on admission. Lastly, the culture within the ED was described as having a strong influence (either negatively or positively) on the decision to admit patients.Conclusion Multiple factors were identified which go some way to explaining marked variation in admission rates observed between different EDs. Many of these factors require further inquiry through quantitative research in order to understand their influence further.

Journal article

Qirbi N, Ismail SA, 2017, Health system functionality in a low-income country in the midst of conflict: the case of Yemen, Health Policy and Planning, Vol: 32, Pages: 911-922, ISSN: 1460-2237

Background Although the literature on effects of armed conflict on population health is extensive, detailed assessments of effects on public health ‘systems’ are few. This article aims to help address this deficit through the medium of a case study on Yemen, describing health system and health outcome performance prior to the internationalisation of the conflict there in March 2015, before assessing the impact of war on health system functionality since that time.Method Review of peer- and non-peer reviewed literature from 2005 to 2016 from academic sources, multilateral organizations, donors and governmental and non-governmental organizations, augmented by secondary data analysis.Results Despite significant health system weaknesses and structural vulnerabilities pre-conflict, there were important improvements in selected health outcome measures in Yemen up to early 2015 (life expectancy, and infant and maternal mortality, e.g.), partly driven by a fragile health sector that was heavily reliant on out-of-pocket expenditure, and hampered by weak service penetration especially in rural areas. High intensity conflict has resulted in rising mortality and injury rates since March 2015, the first decline in life expectancy and increase in child and maternal mortality in Yemen for some years, and worsening levels of malnutrition. Service delivery has become increasingly challenging in the context of a funding crisis, destruction of health facilities, widespread shortages of essential medicines and equipment across the country, and governance fragmentation.Conclusion Conflict in Yemen has resulted in humanitarian disaster on a wide scale in a short period of time, and crippled an already weak health system. Important areas of uncertainty remain, however, including the scale of health worker flight, and the extent to which alternative providers have stepped in to fill widening service gaps as the conflict has unfolded. Planning for longer-term

Journal article

Ismail SA, Pope I, Bloom B, Catalao R, Green E, Longbottom RE, Jansen G, McCoy D, Harris Tet al., 2017, Risk factors for admission at three urban emergency departments in England: a cross-sectional analysis of attendances over 1 month, BMJ Open, Vol: 7, ISSN: 2044-6055

Objective To investigate factors associated with unscheduled admission following presentation to emergency departments (EDs) at three hospitals in England.Design and setting Cross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (site 1) and two district general hospitals (sites 2 and 3). Variables included patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome. Coding inconsistencies in routine ED data used for this study meant that diagnosis could not be included.Outcome measure The primary outcome for the study was unscheduled admission.Participants All adults aged 16 and older attending the three inner London EDs in December 2013. Data on 19 734 unique patient attendances were gathered.Results Outcome data were available for 19 721 attendances (>99%), of whom 6263 (32%) were admitted to hospital. Site 1 was set as the baseline site for analysis of admission risk. Risk of admission was significantly greater at sites 2 and 3 (adjusted OR (AOR) relative to site 1 for site 2 was 1.89, 95% CI 1.74 to 2.05, p<0.001) and for patients of black or black British ethnicity (AOR 1.29, 1.16 to 1.44, p<0.001). Deprivation was strongly associated with admission. Analysis of departmental and hospital-wide workload pressures gave conflicting results, but proximity to the “4-hour target” (a rule that limits patient stays in EDs to 4 hours in the National Health Service in England) emerged as a strong driver for admission in this analysis (AOR 3.61, 95% CI 3.30 to 3.95, p<0.001).Conclusion This study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED-level and clinician-level behaviour relat

Journal article

Qirbi N, Ismail SA, 2016, Ongoing threat of a large-scale measles outbreak in Yemen, The Lancet Global Health, Vol: 4, Pages: E451-E451, ISSN: 2214-109X

Journal article

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