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Bapolisi WA, Makelele J, Ferrari G, Kono-Tange L, Bisimwa G, Schindler C, Merten S. Engaging men in women's empowerment: impact of a complex gender transformative intervention on household socio-economic and health outcomes in the eastern democratic republic of the Congo using a longitudinal survey. BMC Public Health 2024; 24:443. [PMID: 38347559 PMCID: PMC10863082 DOI: 10.1186/s12889-024-17717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In the Democratic Republic of the Congo, women in (peri-)urban areas are commonly engaged in small trade, which allows them to meet the basic needs of their families. Microsaving approaches are a low-risk option to obtain financing for economic activities. A project combining men's sensitization on gender equity and women's empowerment through village savings and loan associations were implemented in North and South Kivu to raise the household economic level. OBJECTIVE This study assessed how involving men in gender equity affects women's health and socio-economic outcomes, including food security. METHODS A cohort study was conducted with 1812 women at the baseline; out of them 1055 were retrieved at the follow-up. Baseline data collection took place from May to December 2017 and the follow-up from July 2018 to January 2019. To identify socio-economic changes and changes of gender relations, linear and logistic regressions were run. RESULTS Results showed that the household income improved with intervention (coefficient = 0.327; p = 0.002), while the capacity to pay high bills without contracting debts decreased (coefficient = 0.927; p = 0.001). We did not find enough statistically significant evidence of the influence of the intervention on skilled birth attendance (coefficient = 0.943; p = 0.135), or family planning use (coefficient = 0.216; p = 0.435) nor women's participation in the decision-making (coefficient = 0.033; p = 0.227) nor on couple's cohesion (coefficient = 0.024; p = 0.431). Food insecurity levels decreased over time regardless of being in the intervention or control area. CONCLUSION Empowering women while sensitizing men on gender aspects improves financial well-being (income). Time, security, and strong politics of government recognizing and framing the approach are still needed to maximize the benefit of such projects on social factors such as women's participation in decision-making and social cohesion.
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Affiliation(s)
- Wyvine Ansima Bapolisi
- Université Catholique de Bukavu, Democratic Republic of the Congo, Bukavu, Sud-Kivu, Democratic Republic of the Congo.
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Jean Makelele
- CARE International, Goma, Democratic Republic of the Congo
| | - Giovanfrancesco Ferrari
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Ghislain Bisimwa
- Université Catholique de Bukavu, Democratic Republic of the Congo, Bukavu, Sud-Kivu, Democratic Republic of the Congo
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Mbanga E, Joachim C, Ilyas O, John R, Rweyemamu L, Mtenga S, Mhalu G, Nanai A, Kileo N, Kessi M, Iriya N, Mapunda M, Phori P, Kirigia D, Valentine N, Told M, Marwa A, Yoti Z. Process of developing the National Health in All Policies Framework to address social determinants of health in Tanzania Mainland: lessons learned, 2018 - 2022. Pan Afr Med J 2023; 45:4. [PMID: 37538361 PMCID: PMC10395109 DOI: 10.11604/pamj.supp.2023.45.1.39693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction social determinants of health (SDH) are the non-medical factors that contribute to various infectious and non-infectious diseases in Tanzania. Studies suggest that SDH account for 30-55% of health outcomes globally. Most SDH are outside the mandate of the health sector; hence, multi-sectoral collaboration through Health in All Policies (HiAP) is critical. Health in All Policies looks at public policies across sectors that consider health implications of decisions, seek synergies, use resources and avoid harmful health impacts to improve population health and health equity. This paper demonstrates lessons learned from the process of developing National HiAP Framework in Tanzania Mainland to address SDH. It is expected that countries will be able to learn and adopt what deems fit in their context as they address SDH to improve population health. Methods different methods were used to promote multi-sectoral collaboration in addressing SDH through HiAP. They included consultations with Prime Minister's Office (PMO) as the coordinator of Government business for their buy-in. High-level advocacy meetings of Directors of Policy and Planning and Permanent Secretaries from sectoral ministries were conducted to move forward the HiAP agenda. Capacity building was provided for sectoral Ministries to understand HiAP concept and SDH. Interministerial collaboration meetings were convened to bring sectors together to identify SDH issues and key areas for inter-sectoral collaboration and develop National HiAP Framework to address SDH. Health in All Policies Secretariat coordinates the HiAP activities. Results it has been noted that almost every sectoral ministry has a health component in its policy which contributes to the Tanzanian population's health. In this regard, every sectoral ministry has a role to play in addressing SDH for sustainable development. Political will is key in moving forward the HiAP agenda. The role of PMO is significant to ensure inter-sectoral collaboration. Achieving the national and Sustainable Development Goals require strong collaboration among sectors and stakeholder coordination at all levels through HiAP. Conclusion implementing HiAP is a win-win situation. It enhances inter-sectoral collaboration, benefiting each sector to achieve its health-related strategic indicators and ultimately achieve national and global goals.
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Affiliation(s)
- Edward Mbanga
- Ministry of Health, Tanzania Mainland, Dodoma, Tanzania
| | | | - Omar Ilyas
- Prime Minister’s Office, Dodoma, Tanzania
| | - Raynold John
- Ministry of Health, Tanzania Mainland, Dodoma, Tanzania
| | | | - Sally Mtenga
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Mhalu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Alphoncina Nanai
- World Health Organization, Country Office, Dar es Salaam, Tanzania
| | - Neema Kileo
- World Health Organization, Country Office, Dar es Salaam, Tanzania
| | - Mary Kessi
- Ministry of Health, Tanzania Mainland, Dodoma, Tanzania
| | - Nemes Iriya
- World Health Organization, Country Office, Dar es Salaam, Tanzania
| | | | - Peter Phori
- World Health Organization, Regional Office for Africa, Brazaville, Congo
| | - Doris Kirigia
- World Health Organization, Regional Office for Africa, Brazaville, Congo
| | | | - Michaela Told
- World Health Organization, Headquarters, Geneva, Switzerland
| | | | - Zabulon Yoti
- World Health Organization, Country Office, Dar es Salaam, Tanzania
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Bapolisi WA, Bisimwa G, Merten S. Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey. BMJ Open 2023; 13:e061564. [PMID: 36764708 PMCID: PMC9923293 DOI: 10.1136/bmjopen-2022-061564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP. DESIGN Longitudinal study. SETTING A community-based approach was used to investigate FP use in the North and South-Kivu regions. PARTICIPANTS Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up. PRIMARY AND SECONDARY OUTCOMES FP use and intention to use FP. RESULTS The mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (β=-0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052). CONCLUSION TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.
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Affiliation(s)
- Wyvine Ansima Bapolisi
- Epidemiology, University of Basel Faculty of Science, Basel, Switzerland
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Catholic University of Bukavu, Bukavu, South-Kivu, Congo (the Democratic Republic of the)
| | - Sonja Merten
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Gumani MA. Police interventions in victims’ encounters of intimate partner violence in a rural setting. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221086379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the most frequently experienced types of violent crime in South African rural communities is interpersonal violence, which includes intimate partner violence. Rural policing is among the vital forms of intervention required to manage such incidents. This article employs a qualitative interpretative phenomenological analysis approach, to describe and interpret police members’ experiences of policing victims’ encounters of intimate partner violence in the rural Vhembe district in Limpopo. Fifteen police members, from the two South African Police Service’s subprogrammes: Visible Policing and Detective Service were sampled through purposive sampling. Unstructured open-ended interviews, field notes, diaries, and follow-up telephone interviews were used as data-collection methods. Data were analysed in accordance with the interpretative phenomenological analysis guidelines. The findings show that intimate partner violence in matrimonial and intimate relationships is common in this district; that it manifests as physical, emotional, sexual violence, and controlling behaviour and affects women, men, children, and the victims’ next-of-kin, with men mostly being the perpetrators. Paradoxes on the home front and cultural customs shape how the incidents are handled in the district communities and also determine the implementation of policing of the incidents leading to incident-focussed and evasive intervention strategies. The findings have implications for police training, further research, collaborative community stakeholder workshops, and setting up intimate partner violence community capacity-building centres.
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Chetty-Makkan CM, Grund JM, Muchiri E, Price MA, Latka MH, Charalambous S. High risk sexual behaviours associated with traditional beliefs about gender roles among men interested in medical male circumcision in South Africa. AIDS Res Ther 2021; 18:33. [PMID: 34158082 PMCID: PMC8220767 DOI: 10.1186/s12981-021-00359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Beliefs about gender roles and high-risk sexual behaviours underlie the human immunodeficiency virus (HIV) epidemic in South Africa. Yet, there is limited information on the relationships between beliefs about gender roles and risky sexual behaviours. Few studies have explored the association between beliefs about gender roles, high risk sexual behaviour, and health-seeking behaviour among men. METHODS We investigated associations between gender beliefs (dichotomised as traditional or progressive) and high-risk sexual behaviour among South African men presenting for medical male circumcision (Apr 2014 to Nov 2015). RESULTS Of 2792 enrolled men, 47.4% reported traditional gender beliefs. Participant ages ranged between 18-46 years (median age 26 years; interquartile range, 21-31 years). Most participants had at least one sex partner over the last 12 months (68.2%). Younger men (18-24 years old vs. 25-46 years old) (odds ratio [OR], 1.5 [95% confidence interval (CI) 1.0-2.0]), those with multiple partners ([OR], 1.5 (CI) 1.3-1.8]) and participants unsure of their last partner's HIV status (OR, 1.4 [95% CI 1.1-1.7]) were more likely to have traditional beliefs on gender roles. CONCLUSION Young men with traditional beliefs on gender roles may be more likely to engage in high-risk sexual behaviour and could be good candidates for HIV prevention programmes. N = 206 (max 350) Trial registration Name of registry: Clinicaltrials.gov; Trial registration number: NCT02352961; Date of registration: 30 January 2015 "Retrospectively registered"; URL of trial registry record: https://www.clinicaltrials.gov/.
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Affiliation(s)
- Candice M. Chetty-Makkan
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
| | - Jonathan M. Grund
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Evans Muchiri
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, South Africa
| | - Matt A. Price
- IAVI, New York, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Mary H. Latka
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Thapa R, Yang Y, Nget M. Perceptions of Sexual Infidelity in Rural Cambodia: A Qualitative Study of Adolescent Men. Am J Mens Health 2019; 13:1557988319848576. [PMID: 31055984 PMCID: PMC6505243 DOI: 10.1177/1557988319848576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
Sexual infidelity plays a significant role in the high rate of spousal transmission of HIV in Cambodia. The sexual beliefs and attitudes of a person begin in childhood and are developed through multiple chains in early adolescence, affecting his or her future sexual behavior and future incidence of HIV. A deeper understanding of the perspectives of adolescents regarding infidelity is critical to effective HIV prevention efforts during adulthood. Using a descriptive qualitative approach, this study explored the perceptions of male adolescents regarding male infidelity. Through the thematic analysis method, themes and subcategories were developed from the responses of 48 male high school students from three provinces. Majority of the participants ( n = 33) were found to have liberal attitudes not only toward male infidelity but also toward the high possibility of their own future infidelity ( n = 14). Almost 45% ( n = 21) of the participants explained that men would fulfill their sexual desires outside, such as in karaoke, when their wives are unable to have sex with them. Participants believed it annoying for men to disclose their extramarital activities to their wives. The study concluded that the participants hold accepting perceptions about infidelity; they are part of the HIV problem and must be part of the solution. Educators and counselors need to deliver age-appropriate, scientifically correct, and culturally relevant messages about sexual health and HIV prevention to growing adolescents.
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Affiliation(s)
- Roshna Thapa
- School of Nursing, Research Institute of
Nursing Science, Chonbuk National University, Jeonju, Baekje-daero, Republic of
Korea
| | - Youngran Yang
- School of Nursing, Research Institute of
Nursing Science, Chonbuk National University, Jeonju, Baekje-daero, Republic of
Korea
| | - Manndy Nget
- School of Nursing, Thammasat University,
Bangkok, Thailand
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