Jolene Skordis-Worrall
Biographic Data
| ID | 88892 |
|---|---|
| NAME | Jolene Skordis-Worrall |
| GIVEN NAMES | Jolene |
| FAMILY NAME | Skordis-Worrall |
| SIGNATURE | SKORDIS-WORRALL J |
| AFFILIATIONS | University College London |
| ORCID | 0000-0002-8633-0208 |
| VERIFIED | Yes |
| TOTAL WORKS | 41 |
| TOTAL CITATIONS | 76 |
| AUTHOR COUNT | 41 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2011 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 6 |
Economic evaluation
Background: The Nurture Early for Optimal Nutrition (NEON) programme was designed to promote equitable early childhood development by educating mothers of South Asian origin in two boroughs (Newham and Tower Hamlets) in East London on optimal feeding, care, and dental hygiene practices. The study found that the adapted Participatory Learning and Action (PLA) approach was highly acceptable and well-received by participants, with improvements in ma…
Cost-effectiveness of modified fully oral 9-month treatment regimens for rifampicin-resistant tuberculosis in Belarus, Georgia, Kazakhstan and the Republic of Moldova
Introduction Prior to 2020, treatment options for multidrug-resistant tuberculosis (MDR-TB) were limited and typically involved long treatment durations and high financial burdens. In the eastern European and central Asian (EECA) region, traditional inpatient tuberculosis (TB) care models, alongside high MDR-TB rates, escalate nosocomial transmission risks and treatment costs. Modified, fully oral, shorter treatment regimens (mSTR) implemented in…
Estimated cost-savings from integrated care for HIV, diabetes and hypertension in sub-Saharan Africa
Background In a cluster-randomised trial in Uganda and Tanzania, we showed that integrated management, compared with standard vertical care, could achieve a high standard of care for diabetes and hypertension without adversely affecting outcomes for HIV. However, evidence on the value for money of integrated care is needed to inform policy.Objective Our economic evaluation aimed to establish the value for money of integrated care compared with ve…
How the four-day working week could affect health
Designing an evidence-informed package of essential health services for Universal Health Coverage
Liberia developed an evidence-informed package of health services for Universal Health Coverage (UHC) based on the Disease Control Priorities 3 evidence. This paper describes the policy decisions, methods and processes adopted for prioritisation, key features of the package and lessons learnt, with special emphasis on feasibility of implementation. Package design was led by the Ministry of Health. Prioritisation of essential services was based on…
Transferable data exclusivity vouchers are not the solution to the antimicrobial drug development crisis
Access to pharmaceutical products worsened during the COVID-19 pandemic when key developers of active pharmaceutical ingredients and medicinal products prioritised their national markets. These challenges led to a stronger commitment by the European Union (EU) to become more autonomous in developing and providing access to pharmaceutical products for its population.1 In April 2023, the European Commission (EC) proposed a reform of the EU pharma r…
Using costing to facilitate policy making towards Universal Health Coverage
As countries progress towards universal health coverage (UHC), they frequently develop explicit packages of health services compatible with UHC goals. As part of the Disease Control Initiative 3 Country Translation project, a systematic survey instrument was developed and used to review the experience of five low-income and lower-middle-income countries—Afghanistan, Ethiopia, Pakistan, Somalia and Sudan—in estimating the cost of their proposed pa…
Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe
High rates of drug-resistant tuberculosis (DR-TB) continue to threaten public health, especially in Eastern Europe. Costs for treating DR-TB are substantially higher than treating drug-susceptible TB, and higher yet if DR-TB services are delivered in hospital. The WHO recommends that multidrug-resistant (MDR) TB be treated using mainly ambulatory care, shown to have non-inferior health outcomes, however, there has been a delay to transition away …
Economic evaluation of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India
An estimated 2.4 million newborn infants died in 2020, 80% of them in sub-Saharan Africa and South Asia. To achieve the Sustainable Development Target for neonatal mortality reduction, countries with high mortality need to implement evidence-based, cost-effective interventions at scale. Our study aimed to estimate the cost, cost-effectiveness, and benefit-cost ratio of a participatory women’s groups intervention scaled up by the public health sys…
Technical efficiency of national HIV/Aids spending in 78 countries between 2010 and 2018
HIV/AIDS remains a leading global cause of disease burden, especially in low- and middle-income countries (LMICs). In 2020, more than 80% of all people living with HIV (PLHIV) lived in LMICs. While progress has been made in extending coverage of HIV/AIDS services, only 66% of all PLHIV were virally suppressed at the end of 2020. In addition to more resources, the efficiency of spending is key to accelerating progress towards global 2030 targets f…
Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya
There is limited evidence on the cost and cost-effectiveness of cash transfer programmes to improve maternal and child health in Kenya and other sub-Saharan African countries. This article presents the economic evaluation results of the Afya trial, assessing the costs, cost-effectiveness and equity impact of a demand-side financing intervention that promotes utilisation of maternal health services in rural Kenya. The cost of implementing the Afya…
Understanding the effects of nutrition‐sensitive agriculture interventions with participatory videos and women's group meetings on maternal and child nutrition in rural Odisha, India
A trial of three nutrition-sensitive agriculture interventions with participatory videos and women's group meetings in rural Odisha, India, found improvements in maternal and child dietary diversity, limited effects on agricultural production, and no effects on women and children's nutritional status. Our process evaluation explored fidelity, reach, and mechanisms behind interventions' effects. We also examined how context affected implementation…
Factors associated with women’s healthcare decision-making during and after pregnancy in urban slums in Mumbai, India
Exclusion of women from maternal healthcare decision-making threatens the effectiveness of health interventions. Factors such as age, employment, education, and household size need to be considered when designing health interventions targeting new mothers living in challenging conditions, such as urban slums in low- and middle-income countries
Understanding the Lived Experience of Children With Type 1 Diabetes in Kenya
Focusing only on biomedical targets neglects the important role that psychosocial factors play in effective diabetes self-management. This study aims to understand the lived experiences of children with Type 1 Diabetes (T1DM) in Kenya. Children ( n = 15) participated in focus group discussions and photo diary data collection. Focus group discussions and semi-structured interviews were also conducted with caregivers ( n = 14). We describe an adapt…
Exploring the Associations between Early Childhood Development Outcomes and Ecological Country-Level Factors across Low- and Middle-Income Countries
A poor start in life shapes children's development over the life-course. Children from low- and middle-income countries (LMICs) are exposed to low levels of early stimulation, greater socioeconomic deprivation and persistent environmental and health challenges. Nevertheless, little is known about country-specific factors affecting early childhood development (ECD) in LMICs. Using data from 68 LMICs collected as part of the Multiple Indicator Clus…
Relative power
We estimate the effects of antenatal food and cash transfers with women's groups on household allocative behaviour and explore whether these effects are explained by intergenerational bargaining among women. Interventions were tested in randomised-controlled trial in rural Nepal, in a food-insecure context where pregnant women are allocated the least adequate diets. We show households enrolled in a cash transfer intervention allocated pregnant wo…
Participatory learning and action cycles with women's groups to prevent neonatal death in low-resource settings
WHO recommends participatory learning and action cycles with women's groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effective…
Participatory learning and action cycles with women’s groups to prevent neonatal death in low-resource settings
WHO recommends participatory learning and action cycles with women’s groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effective…
A method for measuring spatial effects on socioeconomic inequalities using the concentration index
Our findings suggest that men from lower socioeconomic groups are more likely to receive an HIV test after adjustment for spatial effects. This study develops a novel methodological approach that incorporates estimation of spatial effects into a common approach to equity analysis. We find that a significant component of inequalities in HIV uptake in Malawi driven by non-need factors can be explained by spatial effects. When the spatial model was …
Do Participatory Learning and Action Women’s Groups Alone or Combined with Cash or Food Transfers Expand Women’s Agency in Rural Nepal
Participatory learning and action women's groups (PLA) have proven effective in reducing neonatal mortality in rural, high-mortality settings, but their impacts on women's agency in the household remain unknown. Cash transfer programmes have also long targeted female beneficiaries in the belief that this empowers women. Drawing on data from 1309 pregnant women in a four-arm cluster-randomised controlled trial in Nepal, we found little evidence fo…
Innovating to increase access to diabetes care in Kenya
In the context of the rising prevalence of non-communicable diseases in LMICs, cross-sector approaches to improving access to care are increasingly needed. Public-private partnerships such as the BoP are necessary but not sufficient to ensure access to health care for people with diabetes at the base of the economic pyramid in Kenya
Organising Concepts of 'Women's Empowerment' for Measurement
Findings from a cluster randomised trial of unconditional cash transfers in Niger
Unconditional cash transfers (UCTs) are used as a humanitarian intervention to prevent acute malnutrition, despite a lack of evidence about their effectiveness. In Niger, UCT and supplementary feeding are given during the June-September "lean season," although admissions of malnourished children to feeding programmes may rise from March/April. We hypothesised that earlier initiation of the UCT would reduce the prevalence of global acute malnutrit…
Optima Nutrition
A resource optimization tool can provide important guidance for targeting nutrition investments to achieve greater impact
Revisiting the patriarchal bargain
Although power struggles between daughters-in-law and mothers-in-law in the South Asian household remain an enduring theme of feminist scholarship, current policy discourse on 'women's economic empowerment' in the Global South tends to focus on married women's power over their husband; this neglects intergenerational power dynamics. The aim of this study was to describe and analyze the processes involved in young, married women's negotiations of …
What is a good life? Selecting capabilities to assess women's quality of life in rural Malawi
Organising Concepts of 'Women's Empowerment' for Measurement
Revisiting the patriarchal bargain
Although power struggles between daughters-in-law and mothers-in-law in the South Asian household remain an enduring theme of feminist scholarship, current policy discourse on 'women's economic empowerment' in the Global South tends to focus on married women's power over their husband; this neglects intergenerational power dynamics. The aim of this study was to describe and analyze the processes involved in young, married women's negotiations of …
Validating an Agency-based Tool for Measuring Women's Empowerment in a Complex Public Health Trial in Rural Nepal
Despite the rising popularity of indicators of women's empowerment in global development programmes, little work has been done on the validity of existing measures of such a complex concept. We present a mixed methods validation of the use of the Relative Autonomy Index for measuring Amartya Sen's notion of agency freedom in rural Nepal. Analysis of think-aloud interviews (n = 7) indicated adequate respondent understanding of questionnaire items,…
Development, Validity, and Reliability of the Women’s Capabilities Index
We report the results of a series of validity and reliability tests performed during the development of the Women's Capabilities Index (WCI) in Malawi. The WCI is a multidimensional measure based on Sen's capability framework for assessing women's quality of life. Construct validity was assessed by investigating the expected relationships of the dimensions with key socioeconomic characteristics. The majority of hypothesized associations were foun…
Relative power
We estimate the effects of antenatal food and cash transfers with women's groups on household allocative behaviour and explore whether these effects are explained by intergenerational bargaining among women. Interventions were tested in randomised-controlled trial in rural Nepal, in a food-insecure context where pregnant women are allocated the least adequate diets. We show households enrolled in a cash transfer intervention allocated pregnant wo…
Maternal and neonatal health expenditure in mumbai slums (India)
High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective is to increase institutional deliveries without forcing households deeper into poverty, these inequitie…
Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings
Collecting and analysing cost data for complex public health trials
BACKGROUND: Current guidelines for the conduct of cost-effectiveness analysis (CEA) are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings. OBJECTIVE: This paper reflects on the challenges experienced within our own work and proposes solutio…
Inequity in costs of seeking sexual and reproductive health services in India and Kenya
Highly regressive spending on SRH services highlights the heavier burden borne by the poorest when seeking care in resource-constrained settings such as India and Kenya. The large proportion of service users, particularly in India, relying on money received from family members to finance care seeking suggests that access would be more difficult for those with weak social ties, small social networks or weak bargaining positions within the family -…
Are village health sanitation and nutrition committees fulfilling their roles for decentralised health planning and action? A mixed methods study from rural eastern India
Our study suggests that VHSNCs perform few of their specified functions for decentralized planning and action. If VHSNCs are to be instrumental in improving community health, sanitation and nutrition, they need education, mobilisation and monitoring for formal links with the wider health system
Participatory women’s groups and counselling through home visits to improve child growth in rural eastern India
ISRCTN register 51505201 ; Clinical Trials Registry of India number 2014/06/004664
Highlighting the evidence gap
There is growing evidence of the effectiveness of early childhood interventions to improve the growth and development of children. Although, historically, nutrition and stimulation interventions may have been delivered separately, they are increasingly being tested as a package of early childhood interventions that synergistically improve outcomes over the life course. However, implementation at scale is seldom possible without first considering …
What is a good life? Selecting capabilities to assess women's quality of life in rural Malawi
Socio-economic inequity in HIV testing in Malawi
BACKGROUND: Human immunodeficiency virus (HIV) is a significant contributor to Malawi's burden of disease. Despite a number of studies describing socio-economic differences in HIV prevalence, there is a paucity of evidence on socio-economic inequity in HIV testing in Malawi. OBJECTIVE: To assess horizontal inequity (HI) in HIV testing in Malawi. DESIGN: Data from the Demographic and Health Surveys (DHSs) 2004 and 2010 in Malawi are used for the a…
Recognizing the importance of chronic disease in driving healthcare expenditure in Tanzania
BACKGROUND: Despite the growing chronic disease burden in low- and middle-income countries, there are significant gaps in our understanding of the financial impact of these illnesses on households. As countries make progress towards universal health coverage, specific information is needed about how chronic disease care drives health expenditure over time, and how this spending differs from spending on acute disease care. METHODS: A 19-year panel…
Addressing the double-burden of diabetes and tuberculosis
BACKGROUND: The incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals. Kyrgyzstan is a priority country for tuberculosis control and has a 5% prevalence of diabetes in adults, with many health system challenges for both conditions. METHODS: Patient exit interviews collected data on demographic and socio-economic cha…
Somos iguales? Using a structural violence framework to understand gender and health inequities from an intersectional perspective in the Peruvian Amazon
BACKGROUND: In the Peruvian Amazon, historical events of colonization and political marginalization intersect with identities of ethnicity, class and geography in the construction of gender and health inequities. Gender-based inequalities can manifest in poor health outcomes via discriminatory practices, healthcare system imbalances, inequities in health research, and differential exposures and vulnerabilities to diseases. Structural violence is …
Experiences in running a complex electronic data capture system using mobile phones in a large-scale population trial in southern Nepal
The increasing availability and capabilities of mobile phones make them a feasible means of data collection. Electronic Data Capture (EDC) systems have been used widely for public health monitoring and surveillance activities, but documentation of their use in complicated research studies requiring multiple systems is limited. This paper shares our experiences of designing and implementing a complex multi-component EDC system for a community-base…
Can voluntary pooled procurement reduce the price of antiretroviral drugs? a case study of Efavirenz
PURPOSE: : A number of strategies have aimed to assist countries in procuring antiretroviral therapy (ARV) at lower prices. In 2009, as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) commenced a voluntary pooled procurement scheme, however, the impact of the scheme on ARV prices remains uncertain. This study aims to estimate the effect of VPP on drug prices using Efavirenz as a case study. METHODS: This analysis uses WHO Global p…
Validating an Agency-based Tool for Measuring Women's Empowerment in a Complex Public Health Trial in Rural Nepal
Despite the rising popularity of indicators of women's empowerment in global development programmes, little work has been done on the validity of existing measures of such a complex concept. We present a mixed methods validation of the use of the Relative Autonomy Index for measuring Amartya Sen's notion of agency freedom in rural Nepal. Analysis of think-aloud interviews (n = 7) indicated adequate respondent understanding of questionnaire items,…
Findings from a cluster randomised trial of unconditional cash transfers in Niger
Unconditional cash transfers (UCTs) are used as a humanitarian intervention to prevent acute malnutrition, despite a lack of evidence about their effectiveness. In Niger, UCT and supplementary feeding are given during the June-September "lean season," although admissions of malnourished children to feeding programmes may rise from March/April. We hypothesised that earlier initiation of the UCT would reduce the prevalence of global acute malnutrit…
Optima Nutrition
A resource optimization tool can provide important guidance for targeting nutrition investments to achieve greater impact
Revisiting the patriarchal bargain
Although power struggles between daughters-in-law and mothers-in-law in the South Asian household remain an enduring theme of feminist scholarship, current policy discourse on 'women's economic empowerment' in the Global South tends to focus on married women's power over their husband; this neglects intergenerational power dynamics. The aim of this study was to describe and analyze the processes involved in young, married women's negotiations of …
Development, Validity, and Reliability of the Women’s Capabilities Index
We report the results of a series of validity and reliability tests performed during the development of the Women's Capabilities Index (WCI) in Malawi. The WCI is a multidimensional measure based on Sen's capability framework for assessing women's quality of life. Construct validity was assessed by investigating the expected relationships of the dimensions with key socioeconomic characteristics. The majority of hypothesized associations were foun…
Do Participatory Learning and Action Women’s Groups Alone or Combined with Cash or Food Transfers Expand Women’s Agency in Rural Nepal
Participatory learning and action women's groups (PLA) have proven effective in reducing neonatal mortality in rural, high-mortality settings, but their impacts on women's agency in the household remain unknown. Cash transfer programmes have also long targeted female beneficiaries in the belief that this empowers women. Drawing on data from 1309 pregnant women in a four-arm cluster-randomised controlled trial in Nepal, we found little evidence fo…
Innovating to increase access to diabetes care in Kenya
In the context of the rising prevalence of non-communicable diseases in LMICs, cross-sector approaches to improving access to care are increasingly needed. Public-private partnerships such as the BoP are necessary but not sufficient to ensure access to health care for people with diabetes at the base of the economic pyramid in Kenya
Organising Concepts of 'Women's Empowerment' for Measurement
A method for measuring spatial effects on socioeconomic inequalities using the concentration index
Our findings suggest that men from lower socioeconomic groups are more likely to receive an HIV test after adjustment for spatial effects. This study develops a novel methodological approach that incorporates estimation of spatial effects into a common approach to equity analysis. We find that a significant component of inequalities in HIV uptake in Malawi driven by non-need factors can be explained by spatial effects. When the spatial model was …
Exploring the Associations between Early Childhood Development Outcomes and Ecological Country-Level Factors across Low- and Middle-Income Countries
A poor start in life shapes children's development over the life-course. Children from low- and middle-income countries (LMICs) are exposed to low levels of early stimulation, greater socioeconomic deprivation and persistent environmental and health challenges. Nevertheless, little is known about country-specific factors affecting early childhood development (ECD) in LMICs. Using data from 68 LMICs collected as part of the Multiple Indicator Clus…
Relative power
We estimate the effects of antenatal food and cash transfers with women's groups on household allocative behaviour and explore whether these effects are explained by intergenerational bargaining among women. Interventions were tested in randomised-controlled trial in rural Nepal, in a food-insecure context where pregnant women are allocated the least adequate diets. We show households enrolled in a cash transfer intervention allocated pregnant wo…
Medicine (29 works) · Economics (24 works) · Economic growth (20 works) · Environmental health (19 works) · Global Maternal and Child Health (19 works) · Nursing (16 works) · Business (13 works) · Child Nutrition and Water Access (13 works) · Psychology (11 works) · Public health (11 works)