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Denis-Robichaud J, Hindmarch S, Nswal NN, Mutabazi JC, D'Astous M, Gangbè M, Osborn A, Zarowsky C, Rees EE, Carabin H. One Health communication channels: a qualitative case study of swine influenza in Canada in 2020. BMC Public Health 2024; 24:964. [PMID: 38580942 PMCID: PMC10996129 DOI: 10.1186/s12889-024-18460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND With increased attention to the importance of integrating the One Health approach into zoonotic disease surveillance and response, a greater understanding of the mechanisms to support effective communication and information sharing across animal and human health sectors is needed. The objectives of this qualitative case study were to describe the communication channels used between human and animal health stakeholders and to identify the elements that have enabled the integration of the One Health approach. METHODS We combined documentary research with interviews with fifteen stakeholders to map the communication channels used in human and swine influenza surveillance in Alberta, Canada, as well as in the response to a human case of H1N2v in 2020. A thematic analysis of the interviews was also used to identify the barriers and facilitators to communication among stakeholders from the animal and human health sectors. RESULTS When a human case of swine influenza emerged, the response led by the provincial Chief Medical Officer of Health involved players at various levels of government and in the human and animal health sectors. The collaboration of public and animal health laboratories and of the swine sector, in addition to the information available through the surveillance systems in place, was swift and effective. Elements identified as enabling smooth communication between the human and animal health systems included preexisting relationships between the various stakeholders, a relationship of trust between them (e.g., the swine sector and their perception of government structures), the presence of stakeholders acting as permanent liaisons between the ministries of health and agriculture, and stakeholders' understanding of the importance of the One Health approach. CONCLUSIONS Information flows through formal and informal channels and both structural and relational features that can support rapid and effective communication in infectious disease surveillance and outbreak response.
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Affiliation(s)
- José Denis-Robichaud
- Université de Montréal, QC, Montréal, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique, Saint-Hyacinthe, QC, Canada
| | | | - Nancy N Nswal
- Université de Montréal, QC, Montréal, Canada
- Centre de Recherche en Santé Publique, QC, Montréal, Canada
| | | | - Mireille D'Astous
- Université de Montréal, QC, Montréal, Canada
- Centre de Recherche en Santé Publique, QC, Montréal, Canada
| | - Marcellin Gangbè
- Public Health Agency of Canada, QC, Saint-Hyacinthe, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique, Saint-Hyacinthe, QC, Canada
| | - Andrea Osborn
- Canadian Food Inspection Agency, BC, Parksville, Canada
| | - Christina Zarowsky
- Université de Montréal, QC, Montréal, Canada
- Centre de Recherche en Santé Publique, QC, Montréal, Canada
| | - Erin E Rees
- Université de Montréal, QC, Montréal, Canada
- Public Health Agency of Canada, QC, Saint-Hyacinthe, Canada
- Centre de Recherche en Santé Publique, QC, Montréal, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique, Saint-Hyacinthe, QC, Canada
| | - Hélène Carabin
- Université de Montréal, QC, Montréal, Canada.
- Centre de Recherche en Santé Publique, QC, Montréal, Canada.
- Groupe de recherche en épidémiologie des zoonoses et santé publique, Saint-Hyacinthe, QC, Canada.
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Djiofack Kentsop HB, Zarowsky C, Von Oettingen JE. Type 1 diabetes care delivery in Yaoundé, Cameroon: Social and political representations. Afr J Prim Health Care Fam Med 2024; 16:e1-e16. [PMID: 38572859 PMCID: PMC11019050 DOI: 10.4102/phcfm.v16i1.4229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 02/04/2024] [Accepted: 02/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Increasing chronic diseases challenges the health systems of low- and middle-income countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges. AIM We examined social representations of patients' roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families. SETTING The study was conducted in Yaoundé, Cameroon. METHODS Eighty-two individuals were included in the study. The authors conducted semi-structured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients 'parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused non-governmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics. RESULTS Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families. CONCLUSION Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care.Contribution: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.
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Affiliation(s)
- Hervé B Djiofack Kentsop
- Department of Social and Preventive Medicine, Faculty of Public Health, University of Montreal, Montreal, Canada; Public Health Research Center, Faculty of Public Health, University of Montreal, Montreal, Canada; and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal.
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Michaelsen S, Jordan SP, Zarowsky C, Koski A. Challenges to the Provision of Services for Sexual and Intimate Partner Violence in Canada During the COVID-19 Pandemic: Results of a Nationwide Web-Based Survey. Violence Against Women 2024:10778012241228286. [PMID: 38295351 DOI: 10.1177/10778012241228286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
The COVID-19 pandemic increased women's vulnerability to intimate partner and sexual violence (IPV/SV), as well as challenging organizations' ability to respond. This research is based on a 2021 nationwide survey about the impacts of COVID-19 on IPV/SV services across Canada. Nationwide, organizations adopted several measures to reduce the risk of COVID-19 transmission, including scaling back services, reducing or stopping their volunteers, and reducing the number of in-shelter clients. Organizations detailed several financial challenges including increased costs and cancelation of fundraising events. Organizations also reported many staffing challenges, from increased workloads to staff leaves of absence due to childcare responsibilities, mental health reasons, or contracting COVID-19. Policies ensuring adequate financial support to IPV/SV services in nonemergency times could help minimize disruption to service delivery during crisis situations.
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Affiliation(s)
- Sonia Michaelsen
- École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Sonia Parra Jordan
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Christina Zarowsky
- École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Alissa Koski
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
- Department of Equity, Ethics, and Policy, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
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Norris SA, Zarowsky C, Murphy K, Ware LJ, Lombard C, Matjila M, Chivese T, Muhwava LS, Mutabazi JC, Harbron J, Fairall LR, Lambert E, Levitt N. Integrated health system intervention aimed at reducing type 2 diabetes risk in women after gestational diabetes in South Africa (IINDIAGO): a randomised controlled trial protocol. BMJ Open 2024; 14:e073316. [PMID: 38195169 PMCID: PMC10806811 DOI: 10.1136/bmjopen-2023-073316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION South Africa has a high prevalence of gestational diabetes mellitus (GDM; 15%) and many of these women (48%) progress to type 2 diabetes mellitus (T2DM) within 5 years post partum. A significant proportion (47%) of the women are not aware of their diabetes status after the index pregnancy, which may be in part to low postnatal diabetes screening rates. Therefore, we aim to evaluate a intervention that reduces the subsequent risk of developing T2DM among women with recent GDM. Our objectives are fourfold: (1) compare the completion of the nationally recommended 6-week postpartum oral glucose tolerance test (OGTT) between intervention and control groups; (2) compare the diabetes risk reduction between control and intervention groups at 12 months' post partum; (3) assess the process of implementation; and (4) assess the cost-effectiveness of the proposed intervention package. METHODS AND ANALYSES Convergent parallel mixed-methods study with the main component being a pragmatic, 2-arm individually randomised controlled trial, which will be carried out at five major referral centres and up to 26 well-baby clinics in the Western Cape and Gauteng provinces of South Africa. Participants (n=370) with GDM (with no prior history of either type 1 or type 2 diabetes) will be recruited into the study at 24-36 weeks' gestational age, at which stage first data collection will take place. Subsequent data collection will take place at 6-8 weeks after delivery and again at 12 months. The primary outcome for the trial is twofold: first, the completion of the recommended 2-hour OGTT at the well-baby clinics 6-8 weeks post partum, and second, a composite diabetes risk reduction indicator at 12 months. Process evaluation will assess fidelity, acceptability, and dose of the intervention. ETHICS AND DISSEMINATION Ethics approval has been granted from University of Cape Town (829/2016), University of the Witwatersrand, Johannesburg (M170228), University of Stellenbosch (N17/04/032) and the University of Montreal (2019-794). The results of the trial will be disseminated through publication in peer-reviewed journals and presentations to key South African Government stakeholders and health service providers. PROTOCOL VERSION 1 December 2022 (version #2). Any protocol amendments will be communicated to investigators, Human Ethics Research Committees, trial participants, and trial registries. TRIAL REGISTRATION NUMBER PAN African Clinical Trials Registry (https://pactr.samrc.ac.za) on 11 June 2018 (identifier PACTR201805003336174).
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Affiliation(s)
- Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Zarowsky
- School of Public Health, University of Montreal, Montreal, Québec, Canada
| | - Katherine Murphy
- Faculty of Health Science, Department of Medicine, University of Cape Town, Rondebosch, South Africa
| | - Lisa Jayne Ware
- SAMRC Developmental Pathways for Health Research Unit, Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Mushi Matjila
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Jean Claude Mutabazi
- Médecine sociale et préventive-Option: Santé Mondiale, University of Montreal, Montreal, Québec, Canada
| | | | | | | | - Naomi Levitt
- Department of Medicine, University of Cape Town, Rondebosch, South Africa
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Murphy K, Berk J, Muhwava-Mbabala L, Booley S, Harbron J, Ware L, Norris S, Zarowsky C, Lambert EV, Levitt NS. Using the COM-B model and Behaviour Change Wheel to develop a theory and evidence-based intervention for women with gestational diabetes (IINDIAGO). BMC Public Health 2023; 23:894. [PMID: 37189143 DOI: 10.1186/s12889-023-15586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/02/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND In South Africa, the prevalence of gestational diabetes (GDM) is growing, concomitant with the dramatically increasing prevalence of overweight/obesity among women. There is an urgent need to develop tailored interventions to support women with GDM to mitigate pregnancy risks and to prevent progression to type 2 diabetes post-partum. The IINDIAGO study aims to develop and evaluate an intervention for disadvantaged GDM women attending three large, public-sector hospitals for antenatal care in Cape Town and Soweto, SA. This paper offers a detailed description of the development of a theory-based behaviour change intervention, prior to its preliminary testing for feasibility and efficacy in the health system. METHODS The Behaviour Change Wheel (BCW) and the COM-B model of behaviour change were used to guide the development of the IINDIAGO intervention. This framework provides a systematic, step-by-step process, starting with a behavioural analysis of the problem and making a diagnosis of what needs to change, and then linking this to intervention functions and behaviour change techniques to bring about the desired result. Findings from primary formative research with women with GDM and healthcare providers were a key source of information for this process. RESULTS Key objectives of our planned intervention were 1) to address women's evident need for information and psychosocial support by positioning peer counsellors and a diabetes nurse in the GDM antenatal clinic, and 2) to offer accessible and convenient post-partum screening and counselling for sustained behaviour change among women with GDM by integrating follow-up into the routine immunisation programme at the Well Baby clinic. The peer counsellors and the diabetes nurse were trained in patient-centred, motivational counselling methods. CONCLUSIONS This paper offers a rich description and analysis of designing a complex intervention tailored to the challenging contexts of urban South Africa. The BCW was a valuable tool to use in designing our intervention and tailoring its content and format to our target population and local setting. It provided a robust and transparent theoretical foundation on which to develop our intervention, assisted us in making the hypothesised pathways for behaviour change explicit and enabled us to describe the intervention in standardised, precisely defined terms. Using such tools can contribute to improving rigour in the design of behavioural change interventions. TRIAL REGISTRATION First registered on 20/04/2018, Pan African Clinical Trials Registry (PACTR): PACTR201805003336174.
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Affiliation(s)
- Katherine Murphy
- Department of Medicine, Chronic Disease Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa.
| | - Jamie Berk
- Department of Medicine, Chronic Disease Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa
| | - Lorrein Muhwava-Mbabala
- Department of Medicine, Chronic Disease Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa
| | - Sharmilah Booley
- Department of Human Biology, Division of Human Nutrition, University of Cape Town, Cape Town, South Africa
| | - Janetta Harbron
- Department of Human Biology, Division of Human Nutrition, University of Cape Town, Cape Town, South Africa
| | - Lisa Ware
- Department of Paediatrics, MRC/WITS Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Shane Norris
- Department of Paediatrics, MRC/WITS Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Christina Zarowsky
- Public Health Research Centre (CReSP - Centre de recherche en santé publique de l'Université de Montréal et du CIUSSS de Centre-Sud de Montréal), Montreal, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Estelle V Lambert
- Department of Human Biology, Division of Physiological Sciences, Faculty of Health Sciences, Research Centre for Health Through Physical Activity, Lifestyle and Sport (HPALS), University of Cape Town, Cape Town, South Africa
| | - Naomi S Levitt
- Department of Medicine, Chronic Disease Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa
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Denis-Robichaud J, Mutabazi JC, D'Astous M, Nswal N, Osborn A, Hindmarch S, Zarowsky C, Rees E, Carabin H. 465 - Étude des canaux de communication « Une Seule Santé » lors d'un cas humain d'Influenza porcin. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Michaelsen S, Nombro E, Djiofack H, Ferlatte O, Vissandjee B, Zarowsky C. Looking at COVID-19 effects on intimate partner and sexual violence organizations in Canada through a feminist political economy lens: a qualitative study. Can J Public Health 2022; 113:867-877. [PMID: 35896942 PMCID: PMC9330954 DOI: 10.17269/s41997-022-00673-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Intimate partner violence and sexual violence organizations such as women's shelters play a crucial role in advancing gender equality in Canada. COVID-19 has challenged how such organizations operate. This study explored how intimate partner violence and sexual violence organizations in Canada have been affected by COVID-19 and the consequences on service delivery. METHODS We interviewed 17 frontline and management staff from intimate partner violence and sexual violence organizations and programs across Canada, and analyzed the data using thematic analysis and applying a feminist political economy lens. RESULTS We identified the following themes: (1) Adapting; (2) Struggling financially; (3) Resourcefulness; (4) Troubles connecting; (5) Narrowing scope of work; and (6) Burden of care. CONCLUSION A feminist political economy framework considers the gendered impact of the pandemic and related measures on the workforce. Both the pandemic and measures to control it have affected intimate partner violence and sexual violence organizations in Canada, the staff working in these organizations, and the quality of relationships between staff and clients. Intimate partner and sexual violence organizations in Canada have been chronically underfunded and their predominantly female staff underpaid, affecting their ability to meet the needs of women. The onset of COVID-19 not only worsened these issues but converged with a shift in focus to more pandemic-related tasks, further limiting the scope and reach of organizations. Whether the adaptations, innovations, and perseverance demonstrated by such organizations and staff can tip the balance in favour of more equitable policy and outcomes remains to be seen.
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Affiliation(s)
- Sonia Michaelsen
- École de Santé Publique, Université de Montréal, Montréal, Québec Canada ,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec Canada
| | - Elisabeth Nombro
- Faculty of Education, University of New Brunswick, Fredericton, New Brunswick Canada
| | - Hervé Djiofack
- École de Santé Publique, Université de Montréal, Montréal, Québec Canada ,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec Canada
| | - Olivier Ferlatte
- École de Santé Publique, Université de Montréal, Montréal, Québec Canada ,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec Canada
| | - Bilkis Vissandjee
- École de Santé Publique, Université de Montréal, Montréal, Québec Canada ,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec Canada
| | - Christina Zarowsky
- École de Santé Publique, Université de Montréal, Montréal, Québec Canada ,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec Canada
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Mac-Seing M, Ochola E, Ogwang M, Zinszer K, Zarowsky C. Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors' Perspectives in Post-Conflict Northern Uganda. Int J Health Policy Manag 2022; 11:1187-1196. [PMID: 33906334 PMCID: PMC9808201 DOI: 10.34172/ijhpm.2021.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/28/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors' perceptions of existing pro-disability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities. METHODS Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people's organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers. RESULTS We identified four main themes: (1) legislation and policy implementation was fraught with numerous technical and financial challenges, coupled with lack of prioritisation of disability issues; (2) people with disabilities experienced multiple physical, attitudinal, communication, and structural barriers to access and use SRH services; (3) the conflict was perceived to have persisting impacts on the access to services; and (4) policy actors recommended concrete solutions to reduce health inequities faced by people with disabilities. CONCLUSION This study provides substantial evidence of the multilayered disadvantages people with disabilities face when using SRH services and the difficulty of implementing disability-focused policy in Uganda. Informed by an intersectionality approach, policy actors were able to identify concrete solutions and recommendations beyond the identification of problems. These recommendations can be acted upon in a practical road map to remove different types of barriers in the access to SRH services by people with disabilities, irrespective of their geographic location in Uganda.
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Affiliation(s)
- Muriel Mac-Seing
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
| | | | - Martin Ogwang
- Institutional Direction Department, St-Mary’s Hospital, Lacor, Uganda
| | - Kate Zinszer
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
| | - Christina Zarowsky
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
- School of Public Health, University of Western Cape, Bellville, South Africa
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Michaelsen S, Djiofack H, Nombro E, Ferlatte O, Vissandjée B, Zarowsky C. Service provider perspectives on how COVID-19 and pandemic restrictions have affected intimate partner and sexual violence survivors in Canada: a qualitative study. BMC Womens Health 2022; 22:111. [PMID: 35410209 PMCID: PMC8996227 DOI: 10.1186/s12905-022-01683-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The COVID-19 pandemic may increase risk of intimate partner and sexual violence and make relevant services less accessible. This study explored the perspectives of intimate partner and sexual violence workers across Canada on how the COVID-19 pandemic has affected the survivors with whom they work. Methods Using a qualitative descriptive design, we interviewed 17 management and frontline staff of organizations supporting survivors of intimate partner and sexual violence across Canada. Results: We identified 4 themes that describe the impacts of COVID-19 on intimate partner and sexual violence survivors, from the perspective of service providers: (1) No escape; (2) Isolation; (3) Tough decisions; and (4) Heightened vulnerability. These narrative findings are presented first, followed by an analysis within a social determinants of health framework. Interpreting our findings against such a framework revealed a complex interplay of social determinants, notably social support, access to services, and poverty, that produced several challenges for intimate partner and sexual violence survivors during COVID-19. Conclusion According to service providers, intimate partner and sexual violence survivors in Canada faced several challenges during the pandemic, including reduced ability to escape their situations, increased isolation, increasingly complex decisions, and heightened vulnerability. Our findings demonstrate the critical need to adopt a broader, more holistic approach in tackling intimate partner and sexual violence by also addressing socioeconomic issues such as poverty and marginalization. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01683-4.
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Affiliation(s)
- Sonia Michaelsen
- École de Santé Publique, Université de Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada. .,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada.
| | - Hervé Djiofack
- École de Santé Publique, Université de Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada.,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada
| | - Elisabeth Nombro
- Faculty of Education, University of New Brunswick, 10 MacKay Drive, Marshall d'Avray Hall, Room 227, P.O. Box 4400, Fredericton, NB, E3B 5A3, Canada
| | - Olivier Ferlatte
- École de Santé Publique, Université de Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada.,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada
| | - Bilkis Vissandjée
- École de Santé Publique, Université de Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada.,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada
| | - Christina Zarowsky
- École de Santé Publique, Université de Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada.,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 Park Ave, Montreal, QC, H3N 1X9, Canada
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Mac-Seing M, Zarowsky C, Yuan M, Zinszer K. Disability and sexual and reproductive health service utilisation in Uganda: an intersectional analysis of demographic and health surveys between 2006 and 2016. BMC Public Health 2022; 22:438. [PMID: 35246094 PMCID: PMC8897881 DOI: 10.1186/s12889-022-12708-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background The United Nations through universal health coverage, including sexual and reproductive health (SRH), pledges to include all people, leaving no one behind. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social identities and health determinants reveal a complex pattern in SRH service use. Framed within a larger mixed methods study conducted in Uganda, we examined how disability, among other key social determinants of health (SDH), was associated with the use of SRH services. Methods We analysed data from repeated cross-sectional national surveys, the Uganda Demographic and Health Surveys (DHS) of 2006, 2011, and 2016. The three outcomes of interest were antenatal care visits, HIV testing, and modern contraception use. Our main exposure of interest was the type of disability, classified according to six functional dimensions: seeing, hearing, walking/climbing steps, remembering/concentrating, communicating, and self-care. We performed descriptive and multivariable logistic regression analyses, which controlled for covariates such as survey year, sex, age, place of residence, education, and wealth index. Interaction terms between disability and other factors such as sex, education, and wealth index were explored. Regression analyses were informed by an intersectionality framework to highlight social and health disparities within groups. Results From 2006 to 2016, 15.5-18.5% of study participants lived with some form of disability. Over the same period, the overall prevalence of at least four antenatal care visits increased from 48.3 to 61.0%, while overall HIV testing prevalence rose from 30.8 to 92.4% and the overall prevalence of modern contraception use increased from 18.6 to 34.2%. The DHS year, highest education level attained, and wealth index were the most consistent determinants of SRH service utilisation. People with different types of disabilities did not have the same SRH use patterns. Interactions between disability type and wealth index were associated with neither HIV testing nor the use of modern contraception. Women who were wealthy with hearing difficulty (Odds Ratio (OR) = 0.15, 95%CI 0.03 – 0.87) or with communication difficulty (OR = 0.17, 95%CI 0.03 – 0.82) had lower odds of having had optimal antenatal care visits compared to women without disabilities who were poorer. Conclusion This study provided evidence that SRH service use prevalence increased over time in Uganda and highlights the importance of studying SRH and the different disability types when examining SDH. The SDH are pivotal to the attainment of universal health coverage, including SRH services, for all people irrespective of their social identities.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada. .,Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.,School of Public Health, University of Western Cape, Bellville, South Africa
| | - Mengru Yuan
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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11
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Delesalle L, Sadoine ML, Mediouni S, Denis-Robichaud J, Zinszer K, Zarowsky C, Aenishaenslin C, Carabin H. How are large-scale One Health initiatives targeting infectious diseases and antimicrobial resistance evaluated? A scoping review. One Health 2022; 14:100380. [PMID: 35386427 PMCID: PMC8978269 DOI: 10.1016/j.onehlt.2022.100380] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
While One Health initiatives are gaining in popularity, it is unclear if and how they are evaluated when implementation at scale is intended. The main purpose of this scoping review was to describe how One Health initiatives targeting infectious diseases and antimicrobial resistance at a large scale are evaluated. Secondary objectives included identifying the main facilitators and barriers to the implementation and success of these initiatives, and how their impacts were assessed. Twenty-three studies evaluating One Health initiatives were eligible. Most studies included the human (n = 22) and animal (n = 15) sectors; only four included the environment sector. The types of evaluated initiative (non-exclusive) included governance (n = 5), knowledge (n = 6), protection (n = 17), promotion (n = 16), prevention (n = 9), care (n = 8), advocacy (n = 10) and capacity (n = 10). Studies used normative (n = 4) and evaluative (n = 20) approaches to assess the One Health initiatives, the latter including impact (n = 19), implementation (n = 8), and performance (n = 7) analyses. Structural and economic, social, political, communication and coordination-related factors, as well as ontological factors, were identified as both facilitators and barriers for successful One Health initiatives. These results identified a wide range of evaluation methods and indicators used to demonstrate One Health's added values, strengths, and limitations: the inherent complexity of the One Health approach leads to the use of multiple types of evaluation. The strengths and remaining gaps in the evaluation of such initiative highlight the relevance of comprehensive, mixed-method, context-sensitive evaluation frameworks to inform and support the implementation of One Health initiatives by stakeholders in different governance settings. Studies evaluating One Health initiatives were scarce. Only One Health initiatives related to infectious diseases were evaluated. Evaluations were mainly conducted using quantitative approaches. Involvement of the community was identified as a major facilitator.
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Affiliation(s)
- Léa Delesalle
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | - Margaux L. Sadoine
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Sarah Mediouni
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | | | - Kate Zinszer
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Christina Zarowsky
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Cécile Aenishaenslin
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | - Hélène Carabin
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
- Corresponding author at: Faculté de Médecine Vétérinaire, 3200 rue Sicotte, Saint-Hyacinthe J2S 2M2, Québec, Canada.
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Yarmoshuk AN, Abomo P, Fitzgerald N, Cole DC, Fontanet A, Adeola HA, Zarowsky C, Pulford J. A mapping of health education institutions and programs in the WHO African Region. AAS Open Res 2021. [DOI: 10.12688/aasopenres.13320.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Information on health education institutions is required for planning, implementing and monitoring human resources for health strategies. Details on the number, type and distribution of medical and health science programs offered by African higher education institutions remains scattered. Methods: We merged and updated datasets of health professional and post-graduate programs to develop a mapping of health education institutions covering the World Health Organization African Region as of 2021. Results: Nine hundred and nine (909) institutions were identified in the 47 countries. Together they offered 1,157 health professional programs (235 medicine, 718 nursing, 77 public health and 146 pharmacy) and 1,674 post-graduate programs (42 certificates, 1,152 Master’s and 480 PhDs). Regionally, East Africa had the most countries with multiple academic health science centres - institutions offering medical degrees and at least one other health professional program. Among countries, South Africa had the most institutions and post-graduate programs with 182 and 596, respectfully. A further five countries had between 53-105 institutions, 12 countries had between 10 and 37 institutions, and 28 countries had between one and eight institutions. One country had no institution. Countries with the largest populations and gross domestic products had significantly more health education institutions and produced more scientific research (ANOVA testing). Discussion: We envision an online database being made available in a visually attractive, user-friendly, open access format that nationally, registered institutions can add to and update. This would serve the needs of trainees, administrators, planners and researchers alike and support the World Health Organization’s Global strategy on human resources for health: workforce 2030.
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13
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Mac-Seing M, Ringuette L, Zinszer K, Godard B, Zarowsky C. How to navigate the application of ethics norms in global health research: reflections based on qualitative research conducted with people with disabilities in Uganda. BMC Med Ethics 2021; 22:140. [PMID: 34663292 PMCID: PMC8521956 DOI: 10.1186/s12910-021-00710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As Canadian global health researchers who conducted a qualitative study with adults with and without disabilities in Uganda, we obtained ethics approval from four institutional research ethics boards (two in Canada and two in Uganda). In Canada, research ethics boards and researchers follow the research ethics norms of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2), and the National Guidelines for Research Involving Humans as Research Participants of Uganda (NGRU) in Uganda. The preparation and implementation of this qualitative research raised specific ethical issues related to research participant privacy and the importance of availability and management of financial resources. MAIN BODY Our field experience highlights three main issues for reflection. First, we demonstrate that, in a global health research context, methodological and logistic adjustments were necessary throughout the research implementation process to ensure the protection of study participants' privacy, especially that of people with disabilities, despite having followed the prescribed Canadian and Ugandan ethics norms. Data collection and management plans were adapted iteratively based on local realities. Second, securing financial support as a key aspect of financial management was critical to ensure privacy through disability-sensitive data collection strategies. Without adequate funding, the recruitment of research participants based on disability type, sex, and region or the hiring of local sign language interpreters would not have been possible. Third, although the TCPS2 and NGRU underscore the significance of participants' privacy, none of these normative documents clearly express this issue in the context of global health research and disability, nor broadly discuss the ethical issue related to financial availability and management. CONCLUSIONS Conducting research in resource limited settings and with study participants with different needs calls for a nuanced and respectful implementation of research ethics in a global health context. We recommend a greater integration in both the TCPS2 and NGRU of global health research, disability, and responsible conduct of research. This integration should also be accompanied by adequate training which can further guide researchers, be they senior, junior, or students, and funding agencies.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
| | - Louise Ringuette
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Laboratoire Transformation Numérique en Santé, Montreal, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Béatrice Godard
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
- Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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14
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Mac-Seing M, Zinszer K, Eryong B, Ajok E, Ferlatte O, Zarowsky C. The intersectional jeopardy of disability, gender and sexual and reproductive health: experiences and recommendations of women and men with disabilities in Northern Uganda. Sex Reprod Health Matters 2021; 28:1772654. [PMID: 32449504 PMCID: PMC7887920 DOI: 10.1080/26410397.2020.1772654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The 2030 Sustainable Development Goals committed to "Leave No One Behind" regardless of social identity. While access to sexual and reproductive health (SRH) services has improved globally, people with disabilities continue to face enormous barriers to SRH, infringing on their SRH rights (SRHR). Uganda adopted pro-disability legislation to promote the rights of people with disabilities. Despite these legal instruments, SRHR of people with disabilities continue to be violated and denied. To address this, we sought to understand and document how people with disabilities perceive the relationships between their use of SRH services, legislation, and health policy in three districts of the post-conflict Northern region of Uganda. Through an intersectionality-informed analysis, we interviewed 32 women and men with different types of impairments (physical, sensory and mental) and conducted two focus groups with 12 hearing and non-hearing disabled people as well as non-participant observations at seven health facilities. We found that disabled people's access to SHR services is shaped by the intersections of gender, disability, and violence, and that individuals with disabilities experienced discrimination across both private-not-for-profit and public health facilities. They also encountered numerous physical, attitudinal, and communication accessibility barriers. Despite policy implementation challenges, people with disabilities expected to exercise their rights and made concrete multi-level recommendations to redress situations of inequity and disadvantages in SRH service utilisation. Intersectionality revealed blind spots in policy implementation and service utilisation gaps. Universal health coverage can be operationalised in actionable measures where its universality meets with social justice.
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Affiliation(s)
- Muriel Mac-Seing
- PhD Candidate, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Kate Zinszer
- Associate Professor, Department of Social and Preventive Medicine, School of PublicHealth, Université de Montréal, Montreal, Canada; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | | | - Emma Ajok
- Independent Researcher, Gulu, Uganda
| | - Olivier Ferlatte
- Associate Professor, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Christina Zarowsky
- Full Professor, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada; University of the Western Cape, Bellville, South Africa
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15
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McLaren L, Masuda J, Smylie J, Zarowsky C. Unpacking vulnerability: towards language that advances understanding and resolution of social inequities in public health. Can J Public Health 2021; 111:1-3. [PMID: 31994015 DOI: 10.17269/s41997-019-00288-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Janet Smylie
- University of Toronto and St. Michael's Hospital, Toronto, ON, Canada
| | - Christina Zarowsky
- Université de Montréal, Montréal, QC, Canada.,University of the Western Cape, Cape Town, South Africa
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Belaid L, Atim P, Ochola E, Omara B, Atim E, Ogwang M, Bayo P, Oola J, Okello IW, Sarmiento I, Rojas-Rozo L, Zinszer K, Zarowsky C, Andersson N. Community views on short birth interval in Northern Uganda: a participatory grounded theory. Reprod Health 2021; 18:88. [PMID: 33910570 PMCID: PMC8080315 DOI: 10.1186/s12978-021-01144-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda.
Methods Gendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing.
Results Women, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands’ consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives.
Conclusions The economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women’s capacity to practice child spacing.
Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01144-5. The evidence on what increases birth spacing remains limited. This study explored community views on influences on short birth interval to promote a culturally safe child spacing in Northern Uganda. A participatory research process began by collating perspectives of causes of short birth intervals through fuzzy cognitive mapping. Focus group discussions clarified concepts emerging from the fuzzy cognitive mapping exercise. Fieldworkers administered a household survey to quantify reproductive health outcomes. In deliberative dialogue sessions involving women and their communities, shared and discussed these results and suggested potential actions to promote culturally safe child spacing. Women, men, and youth showed clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice, however, as women feel they are unable to exercise child spacing. Women who use contraceptives without their husbands’ consent risk losing financial and social resources and are likely to face intra-partner violence. Women were not comfortable with contraceptive methods and reported experiencing side effects. The deliberative dialogues suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives.
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Affiliation(s)
- Loubna Belaid
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada.
| | - Pamela Atim
- Department of Public Health, Gulu University, Laroo Division, Gulu Municipality 166, Gulu, Uganda
| | | | - Bruno Omara
- Gulu University, Gulu Municipality 166, Gulu, Uganda
| | | | - Martin Ogwang
- St Mary's Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | - Pontius Bayo
- St Mary's Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | | | | | - Ivan Sarmiento
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Laura Rojas-Rozo
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Kate Zinszer
- University of Montreal, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | | | - Neil Andersson
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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17
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Belaid L, Atim P, Atim E, Ochola E, Ogwang M, Bayo P, Oola J, Wonyima Okello I, Sarmiento I, Rojas-Rozo L, Zinszer K, Zarowsky C, Andersson N. Communities and service providers address access to perinatal care in postconflict Northern Uganda: socialising evidence for participatory action. Fam Med Community Health 2021; 9:fmch-2020-000610. [PMID: 33731319 PMCID: PMC7978070 DOI: 10.1136/fmch-2020-000610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives Describe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda. Study design Mixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process. Setting Three parishes in Nwoya district in the Gulu region, Northern Uganda. Participants Purposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes. Results Stakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall. They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign. Conclusion Participatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.
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Affiliation(s)
- Loubna Belaid
- CIET/ PRAM Family Medicine, McGill University, Montreal, Québec, Canada
| | - Pamela Atim
- Public Health, Gulu University, Gulu, Uganda
| | - Eunice Atim
- Maternal and child health, Nwoya Health District, Nwoya, Uganda
| | | | | | | | - Janet Oola
- Maternal and child health, Nwoya Health District, Nwoya, Uganda
| | | | - Ivan Sarmiento
- Family Medicine, McGill University, Montreal, Québec, Canada
| | | | - Kate Zinszer
- Preventive and social medicine, University of Montreal, Montreal, Québec, Canada
| | - Christina Zarowsky
- Preventive and social medicine, University of Montreal, Montreal, Québec, Canada
| | - Neil Andersson
- CIET/ PRAM Family Medicine, McGill University, Montreal, Québec, Canada.,Universidad Autónoma de Guerrero, Centro de Investigación de Enfermedades Tropicales, Acapulco, Mexico
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Oga-Omenka C, Tseja-Akinrin A, Boffa J, Heitkamp P, Pai M, Zarowsky C. Commentary: Lessons from the COVID-19 global health response to inform TB case finding. Healthc (Amst) 2021; 9:100487. [PMID: 33607520 PMCID: PMC7580683 DOI: 10.1016/j.hjdsi.2020.100487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has emerged as a serious threat to global public health, demanding urgent action and causing unprecedented worldwide change in a short space of time. This disease has devastated economies, infringed on individual freedoms, and taken an unprecedented toll on healthcare systems worldwide. As of 1 April 2020, over a million cases of COVID-19 have been reported in 204 countries and territories, resulting in more than 51,000 deaths. Yet, against the backdrop of the COVID-19 pandemic, lies an older, insidious disease with a much greater mortality. Tuberculosis (TB) is the leading cause of death by a single infectious agent and remains a potent threat to millions of people around the world. We discuss the differences between the two pandemics at present, consider the potential impact of COVID-19 on TB case management, and explore the opportunities that the COVID-19 response presents for advancing TB prevention and control now and in future.
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Affiliation(s)
- Charity Oga-Omenka
- École de Santé Publique de l'Université de Montréal (ESPUM), Canada; McGill International TB Center, Montreal, Canada; Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Canada.
| | | | - Jody Boffa
- McGill International TB Center, Montreal, Canada; Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Petra Heitkamp
- McGill International TB Center, Montreal, Canada; TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | - Madhukar Pai
- McGill International TB Center, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Christina Zarowsky
- École de Santé Publique de l'Université de Montréal (ESPUM), Canada; Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Canada; School of Public Health, University of the Western Cape, Bellville South Africa, South Africa
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19
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Oga-Omenka C, Wakdet L, Menzies D, Zarowsky C. A qualitative meta-synthesis of facilitators and barriers to tuberculosis diagnosis and treatment in Nigeria. BMC Public Health 2021; 21:279. [PMID: 33535990 PMCID: PMC7860048 DOI: 10.1186/s12889-021-10173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Despite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most of these numbers. Nigeria ranks 6th in the world for TB burden, with an estimated 4.3% multi-drug resistance in new cases. However, the country had one of the lowest case detection rates, estimated at 24% of incident cases in 2018 - well below the WHO STOP TB target of 84%. This rate highlights the need to understand contextual issues influencing tuberculosis management in Nigeria. Our synthesis was aimed at synthesizing qualitative evidence on factors influencing TB care in Nigeria. Methods A three-stage thematic meta-synthesis of qualitative studies was used to identify barriers and facilitators to tuberculosis case finding and treatment in Nigeria. A search of eleven databases was conducted. The date of publication was limited to 2006 to June 2020. We analyzed articles using a three-stage process, resulting in coding, descriptive subthemes and analytical themes. Results Our final synthesis of 10 articles resulted in several categories including community and family involvement, education and knowledge, attitudes and stigma, alternative care options, health system factors (including coverage and human resource), gender, and direct and indirect cost of care. These were grouped into three major themes: individual factors; interpersonal influences; and health system factors. Conclusion Case finding and treatment for TB in Nigeria currently depends more on individual patients presenting voluntarily to the hospital for care, necessitating an understanding of patient behaviors towards TB diagnosis and treatment. Our synthesis has identified several related factors that shape patients’ behavior towards TB management at individual, community and health system levels that can inform future interventions.
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Affiliation(s)
- Charity Oga-Omenka
- School of Public Health of the University of Montreal (ESPUM), Montreal, Canada. .,Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Montreal, Canada. .,McGill University International TB Centre, Montreal, Quebec, Canada.
| | | | - Dick Menzies
- McGill University International TB Centre, Montreal, Quebec, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Christina Zarowsky
- School of Public Health of the University of Montreal (ESPUM), Montreal, Canada.,Centre de Recherche en Santé Publique, Université de Montréal (CReSP), Montreal, Canada.,School of Public Health, University of the Western Cape, Cape Town, South Africa
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20
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Mutabazi JC, Enok Bonong PR, Trottier H, Ware LJ, Norris SA, Murphy K, Levitt N, Zarowsky C. Integrating gestational diabetes and type 2 diabetes care into primary health care: Lessons from prevention of mother-to-child transmission of HIV in South Africa - A mixed methods study. PLoS One 2021; 16:e0245229. [PMID: 33481855 PMCID: PMC7822503 DOI: 10.1371/journal.pone.0245229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background Implementation of the programmes for the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) into antenatal care over the last three decades could inform implementation of interventions for other health challenges such as gestational diabetes mellitus (GDM). This study assessed PMTCT outcomes, and how GDM screening, care, and type 2 diabetes (T2DM) prevention were integrated into PMTCT in Western Cape (WC), South Africa. Methods A convergent mixed methods and triangulation design were used. Content and thematic analysis of PMTCT-related policy documents and of 30 semi-structured interviews with HIV/PMTCT experts, health care workers and women under PMTC diagnosed with GDM complement quantitative longitudinal analysis of PMTCT implementation indicators across the WC for 2012–2017. Results Provincial PMTCT and Post Natal Care (PNC) documents emphasized the importance of PMTCT, but GDM screening and T2DM prevention were not covered. Data on women with both HIV and GDM were not available and GDM screening was not integrated into PMTCT. Women who attended HIV counselling and testing annually increased at 17.8% (95% CI: 12.9% - 22.0%), while women who delivered under PMTCT increased at 3.1% (95% CI: 0.6% - 5.9%) annually in the WC. All 30 respondents favour integrating GDM screening and T2DM prevention initiatives into PMTCT. Conclusion PMTCT programmes have not yet integrated GDM care. However, Western Cape PMTCT integration experience suggests that antenatal GDM screening and post-partum initiatives for preventing or delaying T2DM can be successfully integrated into PMTCT and primary care.
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Affiliation(s)
- Jean Claude Mutabazi
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Canada
- Centre de Recherche du Centre Hospitalier de l’Universitaire Sainte Justine, Montréal, QC, Canada
- * E-mail:
| | - Pascal Roland Enok Bonong
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l’Universitaire Sainte Justine, Montréal, QC, Canada
| | - Helen Trottier
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l’Universitaire Sainte Justine, Montréal, QC, Canada
| | - Lisa Jayne Ware
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Katherine Murphy
- Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western Cape, South Africa
| | - Naomi Levitt
- Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, Western Cape, South Africa
| | - Christina Zarowsky
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Canada
- School of Public Health, University of the Western Cape, Bellville, South Africa
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21
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Belaid L, Ochola E, Bayo P, Alii GW, Ogwang M, Greco D, Zarowsky C. Exploring the impact of a community participatory intervention on women's capability: a qualitative study in Gulu Northern Uganda. BMC Womens Health 2021; 21:28. [PMID: 33461541 PMCID: PMC7812725 DOI: 10.1186/s12905-020-01170-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
Background Community participatory interventions mobilizing women of childbearing age are an effective strategy to promote maternal and child health. In 2017, we implemented this strategy in Gulu Northern Uganda. This study explored the perceived impact of this approach on women's capability. Methods We conducted a qualitative study based on three data collection methods: 14 in-depth individual interviews with participating women of childbearing age, five focus group discussions with female facilitators, and document analysis. We used the Sen capability approach as a conceptual framework and undertook a thematic analysis. Results Women adopted safe and healthy behaviors for themselves and their children. They were also able to respond to some of their family's financial needs. They reported a reduction in domestic violence and in mistreatment towards their children. The facilitators perceived improved communication skills, networking, self-confidence, and an increase in their social status. Nevertheless, the women still faced unfreedoms that deprived them of living the life they wanted to lead. These unfreedoms are related to their lack of access to economic opportunities and socio-cultural norms underlying gender inequalities. Conclusion To expand women's freedoms, we need more collective political actions to tackle gender inequalities and need to question the values underlying women's social status.
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Affiliation(s)
- Loubna Belaid
- Family Medicine Department, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, Canada.
| | | | - Pontius Bayo
- St. Mary's Lacor Hospital, P.O. Box 180, Gulu, Uganda
| | | | - Martin Ogwang
- St. Mary's Lacor Hospital, P.O. Box 180, Gulu, Uganda
| | - Donato Greco
- International Prevention Research Institute, Allée Claude Debussy, 69130, Écully, Lyon, France
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22
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Oga-Omenka C, Bada F, Agbaje A, Dakum P, Menzies D, Zarowsky C. Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes. Int J Equity Health 2020; 19:221. [PMID: 33302956 PMCID: PMC7731779 DOI: 10.1186/s12939-020-01342-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/01/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Persistent low rates of case notification and treatment coverage reflect that accessing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge, even though it is provided free of charge to patients. Equity in health access requires availability of comparable, appropriate services to all, based on needs, and irrespective of socio-demographic characteristics. Our study aimed to identify the reasons for Nigeria’s low rates of case-finding and treatment for DR-TB. To achieve this, we analyzed elements that facilitate or hinder equitable access for different groups of patients within the current health system to support DR-TB management in Nigeria. Methods We conducted documentary review of guidelines and workers manuals, as well as 57 qualitative interviews, including 10 focus group discussions, with a total of 127 participants, in Nigeria. Between August and November 2017, we interviewed patients who were on treatment, their treatment supporter, and providers in Ogun and Plateau States, as well as program managers in Benue and Abuja. We adapted and used Levesque’s patient-centered access to care framework to analyze DR-TB policy documents and interview data. Results Thematic analysis revealed inequitable access to DR-TB care for some patient socio-demographic groups. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Health system factors including positive provider attitudes and financial support provided to the patients facilitated equity and ease of access. However, limited coverage and the absence of patients’ access rights protection and considerations in the treatment guidelines and workers manuals likely hampered access. Conclusion In the context of Nigeria’s low case-finding and treatment coverage, applying an equity of access framework was necessary to highlight gaps in care. Differing social contexts of patients adversely affected their access to DR-TB care. We identified several strengths in DR-TB care delivery, including the current financial support that should be sustained. Our findings highlight the need for government’s commitment and continued interventions.
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Affiliation(s)
- Charity Oga-Omenka
- The School of Public Health of the University of Montreal (ÉSPUM), 7101, Parc avenue, 3rd floor, Montreal, Quebec, H3N 1X9, Canada. .,Centre de recherche en santé publique, Université de Montréal (CReSP), Montreal, Canada. .,McGill University International TB Centre, Montreal, Quebec, Canada.
| | - Florence Bada
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Aderonke Agbaje
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Patrick Dakum
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Dick Menzies
- McGill University International TB Centre, Montreal, Quebec, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Christina Zarowsky
- The School of Public Health of the University of Montreal (ÉSPUM), 7101, Parc avenue, 3rd floor, Montreal, Quebec, H3N 1X9, Canada.,Centre de recherche en santé publique, Université de Montréal (CReSP), Montreal, Canada.,School of Public Health, University of the Western Cape, Cape Town, South Africa
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23
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Smylie J, Marsden N, Star L, Gahagan J, Zarowsky C, Mykhalovskiy E, Masuda J, Potvin L. Requirement for Meaningful Engagement of First Nations, Inuit, Métis, and Indigenous Peoples in Publications About Them. Can J Public Health 2020; 111:826-830. [PMID: 33289057 DOI: 10.17269/s41997-020-00450-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Janet Smylie
- CJPH Senior Editor, Toronto, ON, Canada. .,Tier 1 Canada Research Chair in Generative Health Services for Indigenous Populations in Canada and Director of Well Living House, St. Michael's Hospital, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Namaste Marsden
- First Nations Health Authority, West Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Leona Star
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, MB, Canada
| | | | - Christina Zarowsky
- CJPH Senior Editor, Montreal, QC, Canada.,Département de médicine sociale et préventive, École de Santé Publique, Université de Montréal, Montreal, QC, Canada.,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Eric Mykhalovskiy
- CJPH Senior Editor, Toronto, ON, Canada.,Department of Sociology, York University, Toronto, ON, Canada
| | - Jeff Masuda
- CJPH Senior Editor, Kingston, ON, Canada.,Canada Research Chair in Environmental Health Equity, School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Louise Potvin
- CJPH Editor-in-Chief, Montreal, QC, Canada.,School of Public Health, University of Montreal, Montreal, QC, Canada
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24
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Ruckert A, Zinszer K, Zarowsky C, Labonté R, Carabin H. What role for One Health in the COVID-19 pandemic? Can J Public Health 2020; 111:641-644. [PMID: 32909226 PMCID: PMC7480204 DOI: 10.17269/s41997-020-00409-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/23/2020] [Indexed: 01/02/2023]
Abstract
This commentary discusses the contributions that One Health (OH) principles can make in improving the global response to the COVID-19 pandemic. We highlight four areas where the application of OH has the potential to significantly improve the governance of infectious diseases in general, and of COVID-19 in particular. First, more integrated surveillance infrastructure and monitoring of the occurrence of infectious diseases in both humans and animals can facilitate the detection of new infectious agents sharing similar genotypes across species and the monitoring of the spatio-temporal spread of such infections. This knowledge can guide public and animal health officials in their response measures. Second, application of the OH approach can improve coordination and active collaboration among stakeholders representing apparently incompatible domains. Third, the OH approach highlights the need for an effective institutional landscape, facilitating adequate regulation of hotspots for transmission of infectious agents among animals and humans, such as live animal markets. And finally, OH thinking emphasizes the need for equitable solutions to infectious disease challenges, suggesting that policy response mechanisms and interventions need to be reflective of the disproportionate disease burdens borne by vulnerable and marginalized populations, or by persons providing health care and other essential services to those sick.
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Affiliation(s)
- Arne Ruckert
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 3Z7, Canada.
| | - Kate Zinszer
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, H3N 1X9, Canada
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, H3N 1X9, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 3Z7, Canada
| | - Hélène Carabin
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, J2S 2M2, Canada
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25
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Mac-Seing M, Zinszer K, Oga Omenka C, de Beaudrap P, Mehrabi F, Zarowsky C. Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review. Glob Health Promot 2020; 27:97-106. [PMID: 32748728 PMCID: PMC7750661 DOI: 10.1177/1757975920941435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Twenty-five years ago, the International Conference on Population and
Development highlighted the need to address sexual and reproductive
health (SRH) rights on a global scale. The sub-Saharan Africa region
continues to have the highest levels of maternal mortality and HIV,
primarily affecting the most vulnerable populations. Recognising the
critical role of policy in understanding population health, we
conducted a systematic review of original primary research which
examined the relationships between equity-focused legislation and
policy and the utilisation of SRH services by vulnerable populations
in sub-Saharan Africa. We searched nine bibliographic databases for
relevant articles published between 1994 and 2019. Thirty-two studies,
conducted in 14 sub-Saharan African countries, met the inclusion
criteria. They focused on maternal health service utilisation, either
through specific fee reduction/removal policies, or through healthcare
reforms and insurance schemes to increase SRH service utilisation.
Findings across most of the studies showed that health-related
legislation and policy promoted an increase in service utilisation,
over time, especially for antenatal care, skilled birth attendance and
facility-based delivery. However, social health inequalities persisted
among subgroups of women. Neither the reviewed studies nor the
policies specifically addressed youth, people living with HIV and
people with disabilities. In the era of the sustainable development
goals, addressing health inequities in the context of social
determinants of health becomes unavoidable. Systematic and rigorous
quantitative and qualitative research, including longitudinal policy
evaluation, is required to understand the complex relationships
between policy addressing upstream social determinants of health and
health service utilisation.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
- Muriel Mac-Seing, Department of
Social and Preventive Medicine, School of Public Health, Université de
Montréal, and Centre de recherche en santé publique, Université de
Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, 7101, Parc
avenue, 3rd floor, Montreal, Quebec, H3N 1X9, Canada.
| | - Kate Zinszer
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Charity Oga Omenka
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Pierre de Beaudrap
- Centre Population et Développement
(CEPED), Institut de recherche pour le développement, Paris, France
| | - Fereshteh Mehrabi
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
- Department of Health Management,
Evaluation and Health Policy, School of Public Health, Université de
Montréal, Montreal, Canada
| | - Christina Zarowsky
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
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26
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Oga-Omenka C, Tseja-Akinrin A, Sen P, Mac-Seing M, Agbaje A, Menzies D, Zarowsky C. Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review. BMJ Glob Health 2020; 5:e002280. [PMID: 32616481 PMCID: PMC7333807 DOI: 10.1136/bmjgh-2019-002280] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care. METHODS Using an integrative design, we reviewed and narratively synthesised qualitative, quantitative and mixed-methods studies from nine electronic databases: Medline, Global Health, CINAHL, EMBASE, Scopus, Web of Science, International Journal of Tuberculosis and Lung Disease, PubMed and Google Scholar (January 2006 to June 2019). RESULTS Of 3181 original studies identified, 55 full texts were screened, and 29 retained. The studies included were from 6 countries, mostly South Africa. Barriers and facilitators to DR-TB care were identified at the health system and patient levels. Predominant health system barriers were laboratory operational issues, provider knowledge and attitudes and information management. Facilitators included GeneXpert MTB/RIF (Xpert) diagnosis and decentralisation of services. At the patient level, predominant barriers were patients being lost to follow-up or dying due to lengthy diagnostic and treatment delays, negative public sector care perceptions, family, work or school commitments and using private sector care. Some patient-level facilitators were HIV positivity and having more symptoms. CONCLUSION Case detection and treatment for DR -TB in SSA currently relies on individual patients presenting voluntarily to the hospital for care. Specific interventions targeting identified barriers may improve rates and timeliness of detection and treatment.
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Affiliation(s)
- Charity Oga-Omenka
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
| | | | - Paulami Sen
- McGill International TB Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Muriel Mac-Seing
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
| | | | - Dick Menzies
- McGill International TB Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Christina Zarowsky
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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27
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Mutabazi JC, Gray C, Muhwava L, Trottier H, Ware LJ, Norris S, Murphy K, Levitt N, Zarowsky C. Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study. BMC Health Serv Res 2020; 20:582. [PMID: 32586318 PMCID: PMC7318762 DOI: 10.1186/s12913-020-05381-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background Integrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing primary health care (PHC) services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. This study explored the perspectives of both experts or key informants and frontline health workers (FHCWs) in South Africa on PMTCT integration into PHC in the context of post-AIDS denialism using a Complex Adaptive Systems framework. Methods A total of 20 in-depth semi-structured interviews were conducted; 10 with experts including national and international health systems and HIV/PMTCT policy makers and researchers, and 10 FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis. Results Experts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programmes into PHC following its initial rollout as a stand-alone programme in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructural issues (e.g., lack of rooms, small spaces) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to polymerase-chain reaction (PCR) testing and immunisation. Conclusions Despite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT in PHC, especially postpartum. The results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.
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Affiliation(s)
- Jean Claude Mutabazi
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada. .,Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, H3L 1M3, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, QC, H3T 1C5,, Canada.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Lorrein Muhwava
- Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, J Floor, Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, Western Cape, South Africa
| | - Helen Trottier
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada.,Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, QC, H3T 1C5,, Canada
| | - Lisa Jayne Ware
- Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, 26 Chris Hani Road, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - Shane Norris
- Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, 26 Chris Hani Road, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - Katherine Murphy
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Naomi Levitt
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Christina Zarowsky
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada.,Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, H3L 1M3, Canada.,School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville 7535, Cape Town, Western Cape, South Africa
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Bayo P, Belaid L, Tahir EO, Ochola E, Dimiti A, Greco D, Zarowsky C. "Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing": institutional delivery and postnatal care in Torit County, South Sudan: a mixed method study. BMC Pregnancy Childbirth 2020; 20:250. [PMID: 32345240 PMCID: PMC7189725 DOI: 10.1186/s12884-020-02910-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 03/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background South Sudan has one of the highest maternal mortality ratios in the world, at 789 deaths per 100,000 live births. The majority of these deaths are due to complications during labor and delivery. Institutional delivery under the care of skilled attendants is a proven, effective intervention to avert some deaths. The aim was to determine the prevalence and explore the factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan. Methods A convergent parallel mixed method design combined a community survey among women who had delivered in the previous 12 months selected through a multistage sampling technique (n = 418) with an exploratory descriptive qualitative study. Interviews (n = 19) were conducted with policymakers, staff from non-governmental organizations and health workers. Focus group discussions (n = 12) were conducted among men and women within the communities. Bivariate and multivariate logistic regression were conducted to determine independent factors associated with institutional delivery. Thematic analysis was undertaken for the qualitative data. Results Of 418 participants who had delivered in the previous 12 months, 27.7% had institutional deliveries and 22.5% attended postnatal care at least once within 42 days following delivery. Four or more antenatal care visits increased institutional delivery 5 times (p < 0.001). The participants who had an institutional delivery were younger (mean age 23.3 years old) than those who had home deliveries (mean age 25.6 years). Any previous payments made for delivery in the health facility doubled the risk of home delivery (p = 0.021). Women were more likely to plan and prepare for home delivery than for institutional delivery and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health staff and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. Unofficial payments such as soap and sweets were reported as routine expectations and another major barrier to institutional delivery. Conclusion Interventions to stop unofficial payments and discrimination based on socio-economic status and to increase access to ANC, delivery services and PNC are needed.
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Affiliation(s)
- Pontius Bayo
- Department of Obstetrics and Gynecology, Torit State Hospital, Torit, South Sudan.
| | - Loubna Belaid
- Department of family medicine, McGill University, Montreal, Canada
| | | | - Emmanuel Ochola
- Department of public health, St, Mary's Hospital Lacor, Gulu, Uganda
| | | | - Donato Greco
- School of public health, University of Rome, Rome, Italy
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Muhwava LS, Murphy K, Zarowsky C, Levitt N. Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting. PLoS One 2019; 14:e0225431. [PMID: 31765431 PMCID: PMC6876752 DOI: 10.1371/journal.pone.0225431] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background Lifestyle change can reduce the risk of developing type 2 diabetes among women with prior gestational diabetes mellitus (GDM). While understanding women’s lived experiences and views around GDM is critical to the development of behaviour change interventions to reduce this risk, few studies have addressed this issue in low- and middle- income countries. The aim of the study was to explore women’s lived experiences of GDM and the feasibility of sustained lifestyle modification after GDM in a low-income setting. Methods This was a descriptive qualitative study on the lived experiences of women with prior GDM, who received antenatal care at a public sector tertiary hospital in Cape Town, South Africa. Nine focus groups and five in-depth interviews were conducted with a total of thirty-five women. Data were analysed using content analysis and the COM-B (Capabilities, Opportunities, Motivations and Behaviour) model to identify factors influencing lifestyle change during and beyond the GDM pregnancy. Results The results suggest that the COM-B model’s concepts of capability (knowledge and skills for behaviour change), opportunity (resources for dietary change and physical activity) and motivation (perception of future diabetes risk) are relevant to lifestyle change among GDM women in South Africa. The results will contribute to the design of a postpartum health system intervention for women with recent GDM. Conclusion Our findings highlight the need for health services to improve counselling and education for women with GDM in South Africa. Support from family and health professionals is essential for women to achieve lifestyle change. The experience of GDM imposed a significant psychological burden on women, which affected motivation for lifestyle change. To achieve long-term lifestyle change, behaviour interventions for women with prior GDM need to address their capability, opportunity and motivation for lifestyle change during and beyond pregnancy.
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Affiliation(s)
- Lorrein Shamiso Muhwava
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
- * E-mail:
| | - Katherine Murphy
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
| | - Christina Zarowsky
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
- University of Montreal, Hospital Research Centre and University of Montreal School of Public Health, Montreal, Canada
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Naomi Levitt
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
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Yarmoshuk AN, Cole DC, Guantai AN, Mwangu M, Zarowsky C. The international partner universities of East African health professional programmes: why do they do it and what do they value? Global Health 2019; 15:37. [PMID: 31174554 PMCID: PMC6555909 DOI: 10.1186/s12992-019-0477-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background Globalization and funding imperatives drive many universities to internationalize through global health programmes. University-based global health researchers, advocates and programmes often stress the importance of addressing health inequity through partnerships. However, empirical exploration of perspectives on why universities engage in these partnerships and the benefits of them is limited. Objective To analyse who in international partner universities initiated the partnerships with four East African universities, why the partnerships were initiated, and what the international partners value about the partnerships. Methods Fifty-nine key informants from 26 international universities partnering with four East African universities in medicine, nursing and/or public health participated in individual in-depth interviews. Transcripts were analysed thematically. We then applied Burton Clark’s framework of “entrepreneurial” universities characterized by an “academic heartland”, “expanded development periphery”, “managerial core” and “expanded funding base”, developed to examine how European universities respond to the forces of globalization, to interpret the data through a global health lens. Results Partnerships that were of interest to universities’ “academic heartland” - research and education - were of greatest interest to many international partners, especially research intensive universities. Some universities established and placed coordination of their global health activities within units consistent with an expanded development periphery. These units were sometimes useful for helping to establish and support global health partnerships. Success in developing and sustaining the global health partnerships required some degree of support from a strengthened steering or managerial core. Diversified funding in the form of third-stream funding, was found to be essential to sustain partnerships. Social responsibility was also identified as a key ethos required to unite the multiple elements in some universities and sustain global health partnerships. Conclusion Universities are complex entities. Various elements determine why a specific university entered a specific international partnership and what benefits it accrues. Ultimately, integration of the various elements is required to grow and sustain partnerships potentially through embracing social responsibility as a common value.
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Affiliation(s)
- Aaron N Yarmoshuk
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Mughwira Mwangu
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christina Zarowsky
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,CR-CHUM/ESPUM, Université de Montréal, Montréal, Canada
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Oga-Omenka C, Zarowsky C, Agbaje A, Kuye J, Menzies D. Rates and timeliness of treatment initiation among drug-resistant tuberculosis patients in Nigeria- A retrospective cohort study. PLoS One 2019; 14:e0215542. [PMID: 31022228 PMCID: PMC6483179 DOI: 10.1371/journal.pone.0215542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/03/2019] [Indexed: 12/05/2022] Open
Abstract
Background There were an estimated 580,000 new cases of multidrug/rifampicin resistant TB (DR-TB) in 2015, and only 20% were initiated on treatment. This study explored health system and patient factors associated with initiation and timeliness of treatment among DR-TB patients in Nigeria, ranked 4th globally for estimated TB cases in 2015. Methods A retrospective cohort study using 2015 diagnosis and treatment data from the Nigerian TB program electronic records examined “treatment ever received” (yes/no) and “treatment within 30 days” (yes/no). We compared health system and patient characteristics using binomial logistic regression, while controlling for confounders. Results Of 996 patients diagnosed nationwide in 2015 (aged 0–87 years, median 34), 47.8% were never treated. Of those treated (n = 520), 51.2% were treated within the 30 days prescribed in the National treatment guideline. Healthcare facility locations were significantly associated with ever receiving treatment and timely treatment. Predictors of timely treatment at the national level also included level of care and patient treatment history. The South-West zone, where DR-TB programs started, showed overall better access to DR-TB healthcare. Conclusions Healthcare facility geographic locations were significantly associated with treatment initiation and timeliness. Significant regional differences in access to DR-TB care in Nigeria persist, reflecting uneven contexts for national DR-TB treatment rollout.
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Affiliation(s)
- Charity Oga-Omenka
- School of Public Health of the University of Montreal (ESPUM), Montreal, Canada
- Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Canada
- * E-mail:
| | - Christina Zarowsky
- School of Public Health of the University of Montreal (ESPUM), Montreal, Canada
- Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Canada
| | | | - Joseph Kuye
- National TB and Leprosy Control Program, Federal Ministry of Health, Abuja, Nigeria
| | - Dick Menzies
- McGill University International TB Centre, Montreal, Quebec, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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Sanga ES, Mukumbang FC, Mushi AK, Lerebo W, Zarowsky C. Understanding factors influencing linkage to HIV care in a rural setting, Mbeya, Tanzania: qualitative findings of a mixed methods study. BMC Public Health 2019; 19:383. [PMID: 30953503 PMCID: PMC6451278 DOI: 10.1186/s12889-019-6691-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In remote rural Tanzania, the rate of linkage into HIV care was estimated at 28% in 2014. This study explored facilitators and barriers to linkage to HIV care at individual/patient, health care provider, health system, and contextual levels to inform eventual design of interventions to improve linkage to HIV care. METHODS We conducted a descriptive qualitative study nested in a cohort study of 1012 newly diagnosed HIV-positive individuals in Mbeya region between August 2014 and July 2015. We conducted 8 focus group discussions and 10 in-depth interviews with recently diagnosed HIV-positive individuals and 20 individual interviews with healthcare providers. Transcripts were analyzed inductively using thematic content analysis. The emergent themes were then deductively fitted into the four level ecological model. RESULTS We identified multiple factors influencing linkage to care. HIV status disclosure, support from family/relatives and having symptoms of disease were reported to facilitate linkage at the individual level. Fear of stigma, lack of disclosure, denial and being asymptomatic, belief in witchcraft and spiritual beliefs were barriers identified at individual's level. At providers' level; support and good patient-staff relationship facilitated linkage, while negative attitudes and abusive language were reported barriers to successful linkage. Clear referral procedures and well-organized clinic procedures were system-level facilitators, whereas poorly organized clinic procedures and visit schedules, overcrowding, long waiting times and lack of resources were reported barriers. Distance and transport costs to HIV care centers were important contextual factors influencing linkage to care. CONCLUSION Linkage to HIV care is an important step towards proper management of HIV. We found that access and linkage to care are influenced positively and negatively at all levels, however, the individual-level and health system-level factors were most prominent in this setting. Interventions must address issues around stigma, denial and inadequate awareness of the value of early linkage to care, and improve the capacity of HIV treatment/care clinics to implement quality care, particularly in light of adopting the 'Test and Treat' model of HIV treatment and care recommended by the World Health Organization.
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Affiliation(s)
- Erica S Sanga
- NIMR-Mwanza Medical Research Centre, P.O Box 1462, Mwanza, Tanzania. .,School of Public Health- University of Western Cape, Cape Town, South Africa. .,NIMR-Mwanza Medical Research Centre (MMRC), Mbeya, Tanzania.
| | - Ferdinand C Mukumbang
- School of Public Health- University of Western Cape, Cape Town, South Africa.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Adiel K Mushi
- National Institute for Medical Research (NIMR), London, England
| | - Wondwossen Lerebo
- School of Public Health- University of Western Cape, Cape Town, South Africa.,School of Public Health, Mekelle University, Makelle, Ethiopia
| | - Christina Zarowsky
- School of Public Health- University of Western Cape, Cape Town, South Africa.,University of Montreal Hospital Research Centre and School of Public Health, Universite de Montreal, Montreal, Canada
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Mutabazi JC, Werfalli MM, Rawat A, Musa E, Norris SA, Murphy K, Trottier H, Levitt N, Zarowsky C. Integrated management of type 2 diabetes and gestational diabetes within multi-morbidity conditions in Africa: a systematic review protocol. BMJ Open 2019; 9:e023684. [PMID: 30862631 PMCID: PMC6429749 DOI: 10.1136/bmjopen-2018-023684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Multi-morbidity, defined as the co-existence of more than one chronic condition in one person, has been increasing due to comorbid non-communicable and infectious chronic diseases (CNCICDs). Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) incidences within the CNCICDs conditions are increasing and overwhelming already weak and under-resourced healthcare systems in Africa. There is then an urgent need for the integrated management of CNCICDs. We aim to review the integrated management of T2D and GDM within multi-morbidity conditions in Africa. METHODS Studies that have assessed the integrated management of T2D and GDM within multi-morbidity conditions in Africa will be considered based on the Population, Intervention, Comparator and Outcome method: population (adult diagnosed with T2D and GDM, who also have other diseases, non-communicable diseases (NCDs) and infectious, in public primary and secondary healthcare facilities in Africa); Intervention (integrated management of T2D and GDM, also suffering from other diseases in Africa), Comparator (Unintegrated management of T2D and GDM in Africa) and Outcomes (integrated management of T2D and GDM in Africa). The following databases Cochrane Library, MEDLINE, PubMed and SCOPUS, the WHO International Clinical Trials Registry Platform, among others will be searched. Two reviewers (JCM and MW) will independently screen, select eligible studies and extract data. Discrepancies will be resolved by consensus or by a discussion with the third author (AR). Quality of included studies will be assessed using both the newly developed tool, 'the Cochrane Collaboration Risk of Bias Tool' and 'Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I)". A narrative synthesis of extracted data and meta-analysis, if necessary will be conducted and then reported according to the preferred reporting items for systematic review and meta-analysis. ETHICS CONSIDERATION AND DISSEMINATION By only using the published data, there is no ethics approval required for this study. This systematic review will be included in JCM's PhD thesis and its findings will also be disseminated through peer-reviewed publication and conference presentation. PROSPERO REGISTRATION NUMBER CRD42016046630.
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Affiliation(s)
- Jean Claude Mutabazi
- Département de Médecine Sociale et Préventive - Santé Mondiale, École de Santé Publique, Université de Montréal, Montréal, Quebec, Canada
- École de santé publique, Université de Montréal, Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montreal, Quebec, Canada
| | - Mahmoud M Werfalli
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, South Africa
| | - Angeli Rawat
- School of Population and Public Health, University of British Colombia, Vancouver, British Columbia, Canada
| | - Ezekiel Musa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Cape Town, South Africa
| | - Shane A Norris
- Department of Medicine, Faculty of Health Science, University of Cape Town, Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Cape Town, South Africa
- Paediatrics and Child Health, University of Witwatersrand, Johannesburg, South Africa
| | - Katherine Murphy
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Cape Town, South Africa
| | - Helen Trottier
- Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, Quebec, Canada
| | - Naomi Levitt
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Cape Town, South Africa
| | - Christina Zarowsky
- École de santé publique, Université de Montréal, Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montreal, Quebec, Canada
- Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montréal, Quebec, Canada
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Shamu S, Shamu P, Zarowsky C, Temmerman M, Shefer T, Abrahams N. Does a history of sexual and physical childhood abuse contribute to HIV infection risk in adulthood? A study among post-natal women in Harare, Zimbabwe. PLoS One 2019; 14:e0198866. [PMID: 30608938 PMCID: PMC6319705 DOI: 10.1371/journal.pone.0198866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/14/2018] [Indexed: 12/01/2022] Open
Abstract
Background Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women. Methods A cross sectional survey was conducted among 2042 postnatal women (mean age = 26y) attending six public primary health care clinics in Harare, Zimbabwe within 6 weeks post-delivery. Clinic records were reviewed for mother’s antenatal HIV status. Participants were interviewed about childhood abuse including physical or sexual abuse before 15 years of age, forced first sex before 16, HIV risk factors such as age difference at first sex before age 16. Multivariate analyses assessed the associations between mother’s HIV status and child physical and sexual abuse while controlling for confounding variables. Results More than one in four (26.6%) reported abuse before the age of 15: 14.6% physical abuse and 9.1% sexual abuse,14.3% reported forced first sex and 9.0% first sex before 16 with someone 5+ years older. Fifteen percent of women tested HIV positive during the recent antenatal care visit. In multivariate analysis, childhood physical abuse (aOR 3.30 95%CI 1.58–6.90), sexual abuse (3.18 95%CI: 1.64–6.19), forced first sex (aOR 1.42, 95%CI: 1.00–2.02), and 5+ years age difference with first sex partner (aOR 1.66 95%CI 1.09–2.53) were independently associated with HIV infection. Conclusion This study highlights that child physical and/or sexual abuse may increase risk for HIV acquisition. Further research is needed to assess the pathways to HIV acquisition from childhood to adulthood. Prevention of child abuse must form part of the HIV prevention agenda in Sub-Saharan Africa.
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Affiliation(s)
- Simukai Shamu
- Health Systems Strengthening Division, Foundation for Professional Development, Pretoria, South Africa
- School of Public Health, University of the Western Cape, Belville, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Patience Shamu
- Wits Reproductive Health Research Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Zarowsky
- School of Public Health, University of the Western Cape, Belville, South Africa
- University of Montreal Hospital Research Centre, Montreal, Canada
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Obstetrics and Gynaecology, Agha Khan University, Nairobi, Kenya
| | - Tamara Shefer
- Department of Women and Gender Studies, University of the Western Cape, Belville, South Africa
| | - Naeemah Abrahams
- School of Public Health, University of the Western Cape, Belville, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
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Lembani M, de Pinho H, Delobelle P, Zarowsky C, Mathole T, Ager A. Understanding key drivers of performance in the provision of maternal health services in eastern cape, South Africa: a systems analysis using group model building. BMC Health Serv Res 2018; 18:912. [PMID: 30497460 PMCID: PMC6267091 DOI: 10.1186/s12913-018-3726-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background The Eastern Cape Province reports among the poorest health service indicators in South Africa with some of its districts standing out as worst performing as regards maternal health indicators. To understand key drivers and outcomes of this underperformance and to explore whether a participatory analysis could deepen action-oriented understanding among stakeholders, a study was conducted in one of the chronically poorly performing districts. Methods The study used a systems analysis approach to understand the drivers and outcomes affecting maternal health in the district in order to identify key leverage points for addressing the situation. The approach included semi-structured interviews with a total of 24 individuals consisting health system managers at various levels, health facility staff and patients. This was followed by a participatory group model building exercise with 23 key stakeholders to analyze system factors and their interrelationships affecting maternal health in the district using rich pictures and interrelationship diagraphs (IRDs) and finally the development of causal loop diagrams (CLDs). Results The stakeholders were able to unpack the complex ways in which factors were interrelated in contributing to poor maternal health performance and identified the feedback loops which resulted in the situation being intractable, suggesting strategies for sustainable improvement. Quality of leadership was shown to have a pervasive influence on overall system performance by linking to numerous factors and feedback loops, including staff motivation and capacity building. Staff motivation was linked to quality of care in turn influencing patient attendance and feeding back into staff motivation through its impact on workload. Without attention to workload, patient waiting times and satisfaction, the impact of improved leadership and staff support on staff competence and attitudes would be diminished. Conclusion Understanding the complex interrelationships of factors in the health system is key to identifying workable solutions especially in the context of chronic health systems challenges. Systems modelling using group model building methods can be an efficient means of supporting stakeholders to recognize valuable resources within the context of a dysfunctional system to strengthen systems performance.
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Affiliation(s)
- Martina Lembani
- School of Public Health, University of the Western Cape, Private Bag X17, Bellville, Cape Town, 7535, South Africa.
| | - Helen de Pinho
- Mailman School of Public Health, Columbia University, New York, USA
| | - Peter Delobelle
- School of Public Health, University of the Western Cape, Private Bag X17, Bellville, Cape Town, 7535, South Africa
| | - Christina Zarowsky
- School of Public Health, University of the Western Cape, Private Bag X17, Bellville, Cape Town, 7535, South Africa.,University of Montreal Hospital Research Centre and School of Public Health, University of Montreal, Montreal, Canada
| | - Thubelihle Mathole
- School of Public Health, University of the Western Cape, Private Bag X17, Bellville, Cape Town, 7535, South Africa
| | - Alastair Ager
- Mailman School of Public Health, Columbia University, New York, USA.,Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK
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Sanga ES, Mukumbang FC, Mushi AK, Olomi W, Lerebo W, Zarowsky C. Processes and dynamics of linkage to care from mobile/outreach and facility-based HIV testing models in hard-to-reach settings in rural Tanzania. Qualitative findings of a mixed methods study. AIDS Res Ther 2018; 15:21. [PMID: 30458874 DOI: 10.1186/s12981-018-0209-8n.pag-n.pag] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/08/2018] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Like other countries, Tanzania instituted mobile and outreach testing approaches to address low HIV testing rates at health facilities and enhance linkage to care. Available evidence from hard-to-reach rural settings of Mbeya region, Tanzania suggests that clients testing HIV+ at facility-based sites are more likely to link to care, and to link sooner, than those testing at mobile sites. This paper (1) describes the populations accessing HIV testing at mobile/outreach and facility-based testing sites, and (2) compares processes and dynamics from testing to linkage to care between these two testing models from the same study context. METHODS An explanatory sequential mixed-method study (a) reviewed records of all clients (n = 11,773) testing at 8 mobile and 8 facility-based testing sites over 6 months; (b), reviewed guidelines; (c) observed HIV testing sites (n = 10) and Care and Treatment Centers (CTCs) (n = 8); (d) applied questionnaires at 0, 3 and 6 months to a cohort of 1012 HIV newly-diagnosed clients from the 16 sites; and (e) conducted focus group discussions (n = 8) and in-depth qualitative interviews with cohort members (n = 10) and health care providers (n = 20). RESULTS More clients tested at mobile/outreach than facility-based sites (56% vs 44% of 11,733, p < 0.001). Mobile site clients were more likely to be younger and male (p < 0.001). More clients testing at facility sites were HIV positive (21.5% vs. 7.9% of 11,733, p < 0.001). All sites in both testing models adhered to national HIV testing and care guidelines. Staff at mobile sites showed more proactive efforts to support linkage to care, and clients report favouring the confidentiality of mobile sites to avoid stigma. Clients who tested at mobile/outreach sites faced longer delays and waiting times at treatment sites (CTCs). CONCLUSIONS Rural mobile/outreach HIV testing sites reach more people than facility based sites but they reach a different clientèle which is less likely to be HIV +ve and appears to be less "linkage-ready". Despite more proactive care and confidentiality at mobile sites, linkage to care is worse than for clients who tested at facility-based sites. Our findings highlight a combination of (a) patient-level factors, including stigma; and (b) well-established procedures and routines for each step between testing and initiation of treatment in facility-based sites. Long waiting times at treatment sites are a further barrier that must be addressed.
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Affiliation(s)
- Erica S Sanga
- NIMR-Mwanza Medical Research Centre (MMRC), Mwanza, Tanzania.
- School of Public Health, University of Western Cape, Cape Town, South Africa.
- NIMR-Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania.
| | - Ferdinand C Mukumbang
- School of Public Health, University of Western Cape, Cape Town, South Africa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Adiel K Mushi
- National Institute for Medical Research (NIMR), Dar-es-Salaam, Tanzania
| | | | - Wondwossen Lerebo
- School of Public Health, University of Western Cape, Cape Town, South Africa
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Christina Zarowsky
- School of Public Health, University of Western Cape, Cape Town, South Africa
- University of Montreal Hospital Research Centre and School of Public Health, Université de Montréal, Montreal, Canada
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Mathole T, Lembani M, Jackson D, Zarowsky C, Bijlmakers L, Sanders D. Leadership and the functioning of maternal health services in two rural district hospitals in South Africa. Health Policy Plan 2018; 33:ii5-ii15. [PMID: 30053038 PMCID: PMC6037108 DOI: 10.1093/heapol/czx174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/02/2022] Open
Abstract
Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hospitals. In ongoing research, leadership emerged as one of the key health systems factors affecting the performance of maternal health services at facility level. This article reports on a subsequent case study undertaken to examine leadership practices and the functioning of maternal health services in two resource-limited hospitals with disparate maternal health outcomes. An exploratory mixed-methods case study was undertaken with the two rural district hospitals as the units of analysis. The hospitals were purposively selected based on their maternal health outcomes: one reported good maternal health outcomes (pseudonym: Chisomo) and the other had poor outcomes (pseudonym: Tinyade). Comparative data were collected through a facility survey, non-participant observation of management and perinatal meetings, record reviews and interviews with hospital leadership, staff and patients to elicit information about leadership practices including supervision, communication and teamwork. Descriptive and thematic data analysis was undertaken. The two hospitals had similar infrastructure and equipment. Hospital managers at Chisomo used their innovation and entrepreneurial skills to improve quality of care, and leadership style was described as supportive, friendly, approachable but 'firm'. They also undertook frequent and supportive supervisory meetings. Each department at Chisomo developed its own action plan and used data to monitor their actions. Good performers were acknowledged in group meetings. Staff in this facility were motivated and patients were happy about the quality of services. The situation was different at Tinyade hospital. Participants described the leadership style of their senior managers as authoritarian. Managers were rarely available in the office and did not hold regular meetings, leading to poor communication across teams and poor coordination to address resource constraints. This demotivated the staff. The differences in leadership style, structures, processes and work culture affected teamwork, managerial supervision and support. The study demonstrates how leadership styles and practices influence maternal health care services in resource limited hospitals. Supportive leadership manifested itself in the form of focused efforts to build teamwork, enhance entrepreneurship and in management systems that are geared to improving maternal care.
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Affiliation(s)
- T Mathole
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - M Lembani
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - D Jackson
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - C Zarowsky
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
- University of Montreal Hospital Research Centre (CR-CHUM), 850, rue St-Denis, Montreal (Québec) Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal 7101 av du Parc, Ste, Montreal, Québec H3N 1X9 Canada
| | - L Bijlmakers
- Radboud University Medical Centre, Radboud Institute for Health Sciences (RIHS), Geert Grooteplein-Noord 21 EZ Nijmegen, The Netherlands and
| | - D Sanders
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
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Muhwava LS, Murphy K, Zarowsky C, Levitt N. Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa - a qualitative study. BMC Health Serv Res 2018; 18:349. [PMID: 29747657 PMCID: PMC5946476 DOI: 10.1186/s12913-018-3175-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/01/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders' perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant's first year of life. METHODS Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa's two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures. RESULTS The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers. CONCLUSION Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.
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Affiliation(s)
- Lorrein Shamiso Muhwava
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
| | - Katherine Murphy
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
| | - Christina Zarowsky
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
- University of Montreal, Hospital Research Centre and University of Montreal School of Public Health, Montreal, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Naomi Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa (CDIA), Cape Town, South Africa
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Shamu S, Munjanja S, Zarowsky C, Shamu P, Temmerman M, Abrahams N. Intimate partner violence, forced first sex and adverse pregnancy outcomes in a sample of Zimbabwean women accessing maternal and child health care. BMC Public Health 2018; 18:595. [PMID: 29724216 PMCID: PMC5934870 DOI: 10.1186/s12889-018-5464-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes. Methods A cross sectional study was conducted with 2042 women aged 15–49 years attending postnatal care at six clinics in Harare, Zimbabwe, 2011. Women were interviewed on IPV while maternal and newborn health data were abstracted from clinic records. We conducted logistic regression models to assess the relationship between forced first sex (FFS), IPV (lifetime, in the last 12 months and during pregnancy) and maternal and newborn health outcomes. Results Of the recent pregnancies 27.6% were not planned, 50.9% booked (registered for antenatal care) late and 5.6% never booked. A history of miscarriage was reported by 11.5%, and newborn death by 9.4% of the 2042 women while 8.6% of recent livebirths were low birth weight (LBW) babies. High prevalence of emotional (63,9%, 40.3%, 43.8%), physical (37.3%, 21.3%, 15.8%) and sexual (51.7%, 35.6%, 38.8%) IPV ever, 12 months before and during pregnancy were reported respectively. 15.7% reported forced first sex (FFS). Each form of lifetime IPV (emotional, physical, sexual, physical/sexual) was associated with a history of miscarrying (aOR ranges: 1.26–1.38), newborn death (aOR ranges: 1.13–2.05), and any negative maternal and newborn health outcome in their lifetime (aOR ranges: 1.32–1.55). FFS was associated with a history of a negative outcome (newborn death, miscarriage, stillbirth) (aOR1.45 95%CI: 1.06–1.98). IPV in the last 12 months before pregnancy was associated with unplanned pregnancy (aOR ranges 1.31–2.02) and booking late for antenatal care. Sexual IPV (aOR 2.09 CI1.31–3.34) and sexual/physical IPV (aOR2.13, 95%CI: 1.32–3.42) were associated with never booking for antenatal care. Only emotional IPV during pregnancy was associated with low birth weight (aOR1.78 95%CI1.26–2.52) in the recent pregnancy and any recent pregnancy negative outcomes including LBW, premature baby, emergency caesarean section (aOR1.38,95%CI:1.03–1.83). Conclusions Forced first sex (FFS) and intimate partner violence (IPV) are associated with adverse maternal and newborn health outcomes. Strengthening primary and secondary violence prevention is required to improve pregnancy-related outcomes.
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Affiliation(s)
- Simukai Shamu
- Foundation for Professional Development, 173 Mary Road, The Willows, Pretoria, 0184, South Africa. .,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Stephen Munjanja
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Christina Zarowsky
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.,School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
| | - Patience Shamu
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, 9000, Ghent, Belgium
| | - Naeemah Abrahams
- School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.,Gender and Health Research Unit, Medical Research Council, Cape Town, South Africa
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Yarmoshuk AN, Guantai AN, Mwangu M, Cole DC, Zarowsky C. What Makes International Global Health University Partnerships Higher-Value? An Examination of Partnership Types and Activities Favoured at Four East African Universities. Ann Glob Health 2018; 84:139-150. [PMID: 30873772 PMCID: PMC6748237 DOI: 10.29024/aogh.20] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are many interuniversity global health partnerships with African universities. Representatives of these partnerships often claim partnership success in published works, yet critical, contextualized, and comparative assessments of international, cross-border partnerships are few. OBJECTIVE The objectives of this paper are to describe partnerships characterized as higher-value for building the capacity of four East African universities and identify why they are considered so by these universities. METHODS Forty-two senior representatives of four universities in East Africa described the value of their partnerships. A rating system was developed to classify the value of the 125 international partnerships they identified, as the perceived value of some partnerships varied significantly between representatives within the same university. An additional 88 respondents from the four universities and 59 respondents from 25 of the international partner universities provided further perspectives on the partnerships identified. All interviews were transcribed and analysed in relation to the classification and emergent themes. FINDINGS Thirty-one (25%) of the partnerships were perceived as higher-value, 41 (33%) medium-value, and 53 (42%) lower-value for building the capacity of the four focus universities. Thirteen (42%) of the higher-value partnerships were over 20 years old, while 8 (26%) were between 3 and 5 years old. New international partners were able to leapfrog some of the development phases of partnerships by coordinating with existing international partners and/or by building on the activities of or filling gaps in older partnerships. Higher-valued partnerships supported PhD obtainment, the development of new programmes and pedagogies, international trainee learning experiences, and infrastructure development. The financial and prestige value of partnerships were important but did not supersede other factors such as fit with strategic needs, the development of enduring results, dependability and reciprocity. Support of research or service delivery were also considered valuable but, unless education components were also included, the results were deemed unlikely to last. CONCLUSION International partnerships prioritizing the needs of the focus university, supporting it in increasing its long-term capacity and best ensuring that capacity benefits realized favour the focus university are valued most. How best to achieve this so all partners still benefit sufficiently requires further exploration.
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Affiliation(s)
| | | | | | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, CA
| | - Christina Zarowsky
- School of Public Health, University of the Western Cape, ZA.,CR-CHUM/ESPUM, Université de Montréal, CA
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Abstract
INTRODUCTION Reproductive health remains a major global health issue. People with disabilities face additional discrimination and barriers to access which need to be better understood. To contribute to future interventions, we examined the intersections between gender and disability related to reproductive health in sub-Saharan Africa in the qualitative literature. METHODS We conducted a meta-synthesis, using a taxonomic analysis. An inductive and iterative approach was adopted to allow exploration of new and emergent semantic variations in themes. NVivo 11 Plus was used to code themes. RESULTS Ten qualitative studies from six sub-Saharan African countries were analysed. Two main thematic areas emerged from the analysis: 1) gendered roles of people with disabilities are programmed by sociocultural normativity, including perceptions about sexuality. They are exacerbated by the hegemony of ableism and influenced by the type of reproductive health issues experienced by people with disabilities; and 2) experiences of disability in interaction with a reproductive health issue are exacerbated by the type of disability, influenced by the type of barriers to access, and perceived differently depending upon the actors involved. DISCUSSION The intersections between gender and disability embodied by people with disabilities are multiple and complex. Not only do imposed gendered roles influence the lives of people with disabilities, but their experiences of disability are also intricately linked to gender. An intersectional analysis is proposed as a useful support to developing future perspectives.
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Mutabazi JC, Zarowsky C, Trottier H. The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review. Public Health Rev 2017; 38:28. [PMID: 29450099 PMCID: PMC5809942 DOI: 10.1186/s40985-017-0072-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The global scale-up of Prevention of mother-to-child transmission (PMTCT) services is credited for a 52% worldwide decline in new HIV infections among children between 2001 and 2012. However, the epidemic continues to challenge maternal and paediatric HIV control efforts in Sub Saharan Africa (SSA), with repercussions on other health services beyond those directly addressing HIV and AIDS. This systematised narrative review describes the effects of PMTCT programs on other health care services and the implications for improving health systems in SSA as reported in the existing articles and scientific literature. The following objectives framed our review:To describe the effects of PMTCT on health care services and systems in SSA and assess whether the PMTCT has strengthened or weakened health systems in SSATo describe the integration of PMTCT and its extent within broader programs and health systems. METHODS Articles published in English and French over the period 1st January 2007 (the year of publication of WHO/UNICEF guidelines on global scale-up of the PMTCT) to 31 November 2016 on PMTCT programs in SSA were sought through searches of electronic databases (Medline and Google Scholar). Articles describing the impact (positive and negative effects) of PMTCT on other health care services and those describing its integration in health systems in SSA were eligible for inclusion. We assessed 6223 potential papers, reviewed 225, and included 57. RESULTS The majority of selected articles offered arguments for increased health services utilisation, notably of ante-natal care, and some evidence of beneficial synergies between PMTCT programs and other health services especially maternal health care, STI prevention and early childhood immunisation. Positive and negative impact of PMTCT on other health care services and health systems are suggested in thirty-two studies while twenty-five papers recommend more integration and synergies. However, the empirical evidence of impact of PMTCT integration on broader health systems is scarce. Underlying health system challenges such as weak physical and human resource infrastructure and poor working conditions, as well as social and economic barriers to accessing health services, affect both PMTCT and the health services with which PMTCT interacts. CONCLUSIONS PMTCT services increase to some extent the availability, accessibility and utilisation of antenatal care and services beyond HIV care. Vertical PMTCT programs work, when well-funded and well-managed, despite poorly functioning health systems. The beneficial synergies between PMTCT and other services are widely suggested, but there is a lack of large-scale evidence of this.
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Affiliation(s)
- Jean Claude Mutabazi
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7 Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Tour Saint-Antoine, 3rd Floor, Room: S03.516, 900, Rue St-Denis, Montreal, QC H2X 0A9 Canada
| | - Christina Zarowsky
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7 Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Tour Saint-Antoine, 3rd Floor, Room: S03.516, 900, Rue St-Denis, Montreal, QC H2X 0A9 Canada
- School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville, 7535 South Africa
| | - Helen Trottier
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7 Canada
- Centre de Recherche du Centre Hospitalier de l’Universitaire Sainte Justine, Montréal, QC H3T 1C5 Canada
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Kuate Defo B, Mbanya JC, Tardif JC, Ekundayo O, Perreault S, Potvin L, Cote R, Kengne AP, Choukem SP, Assah F, Kingue S, Richard L, Pongou R, Frohlich K, Saji J, Fournier P, Sobngwi E, Ridde V, Dubé MP, De Denus S, Mbacham W, Lafrance JP, Nsagha DS, Mampuya W, Dzudie A, Cloutier L, Zarowsky C, Tanya A, Ndom P, Hatem M, Rey E, Roy L, Borgès Da Silva R, Dagenais C, Todem D, Weladji R, Mbanya D, Emami E, Njoumemi Z, Monnais L, Dubois CA. Diagnosis, Prevalence, Awareness, Treatment, Prevention, and Control of Hypertension in Cameroon: Protocol for a Systematic Review and Meta-Analysis of Clinic-Based and Community-Based Studies. JMIR Res Protoc 2017; 6:e102. [PMID: 28554882 PMCID: PMC5468543 DOI: 10.2196/resprot.7807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 12/27/2022] Open
Abstract
Background Hypertension holds a unique place in population health and health care because it is the leading cause of cardiovascular disease and the most common noncommunicable condition seen in primary care worldwide. Without effective prevention and control, raised blood pressure significantly increases the risk of stroke, myocardial infarction, chronic kidney disease, heart failure, dementia, renal failure, and blindness. There is an urgent need for stakeholders—including individuals and families—across the health system, researchers, and decision makers to work collaboratively for improving prevention, screening and detection, diagnosis and evaluation, awareness, treatment and medication adherence, management, and control for people with or at high risk for hypertension. Meeting this need will help reduce the burden of hypertension-related disease, prevent complications, and reduce the need for hospitalization, costly interventions, and premature deaths. Objective This review aims to synthesize evidence on the epidemiological landscape and control of hypertension in Cameroon, and to identify elements that could potentially inform interventions to combat hypertension in this setting and elsewhere in sub-Saharan Africa. Methods The full search process will involve several steps, including selecting relevant databases, keywords, and Medical Subject Headings (MeSH); searching for relevant studies from the selected databases; searching OpenGrey and the Grey Literature Report for gray literature; hand searching in Google Scholar; and soliciting missed publications (if any) from relevant authors. We will select qualitative, quantitative, or mixed-methods studies with data on the epidemiology and control of hypertension in Cameroon. We will include published literature in French or English from electronic databases up to December 31, 2016, and involving adults aged 18 years or older. Both facility and population-based studies on hypertension will be included. Two reviewers of the team will independently search, screen, extract data, and assess the quality of selected studies using suitable tools. Selected studies will be analyzed by narrative synthesis, meta-analysis, or both, depending on the nature of the data retrieved in line with the review objectives. Results This review is part of an ongoing research program on disease prevention and control in the context of the dual burden of communicable and noncommunicable diseases in Africa. The first results are expected in 2017. Conclusions This review will provide a comprehensive assessment of the burden of hypertension and control measures that have been designed and implemented in Cameroon. Findings will form the knowledge base relevant to stakeholders across the health system and researchers who are involved in hypertension prevention and control in the community and clinic settings in Cameroon, as a yardstick for similar African countries. Trial Registration PROSPERO registration number: CRD42017054950; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42017054950 (Archived by WebCite at http://www.webcitation.org/6qYSjt9Jc)
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Affiliation(s)
- Barthelemy Kuate Defo
- Department of Social and Preventive Medicine, Department of Demography and Public Health Research Institute, Université de Montréal, Montreal, QC, Canada
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | - Olugbemiga Ekundayo
- Department of Public Health and Health Administration, College of Health Science and Public Health, Eastern Washington University, Spokane, WA, United States
| | - Sylvie Perreault
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada
| | - Louise Potvin
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Robert Cote
- Departments of Neurology, Neurosurgery and Medicine, McGill University, Montreal, QC, Canada
| | | | - Simeon Pierre Choukem
- Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Felix Assah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Samuel Kingue
- Department of Cardiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Lucie Richard
- Faculté des sciences infirmières, Université de Montréal, Montreal, QC, Canada
| | - Roland Pongou
- Department of Economics, University of Ottawa, Ottawa, ON, Canada
| | - Katherine Frohlich
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jude Saji
- Public Health Research Institute, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Pierre Fournier
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Eugene Sobngwi
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Valery Ridde
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Simon De Denus
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Wilfred Mbacham
- Department of Biochemistry and Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Jean-Philippe Lafrance
- Faculté de médecine et Faculté de pharmacologie, Université de Montréal, Montreal, QC, Canada
| | - Dickson Shey Nsagha
- Department of Public Health Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Warner Mampuya
- Faculté de Médecine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anastase Dzudie
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Lyne Cloutier
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Agatha Tanya
- College of Technology, University of Bamenda, Bamenda, Cameroon
| | - Paul Ndom
- Department of Oncology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Marie Hatem
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Evelyne Rey
- Faculty of Medicine and CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Louise Roy
- Service de néphrologie (CHUM-Saint-Luc) & Faculté de médecine, Université de Montréal, Montreal, QC, Canada
| | | | - Christian Dagenais
- Département de psychologie, Université de Montréal, Montreal, QC, Canada
| | - David Todem
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States
| | - Robert Weladji
- Department of Biology, Concordia University, Montreal, QC, Canada
| | - Dora Mbanya
- Department of Haematology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Elham Emami
- Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Zakariaou Njoumemi
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Laurence Monnais
- Département d'histoire, Université de Montréal, Montreal, QC, Canada
| | - Carl-Ardy Dubois
- Faculté des sciences infirmières, Université de Montréal, Montreal, QC, Canada
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Sanga ES, Lerebo W, Mushi AK, Clowes P, Olomi W, Maboko L, Zarowsky C. Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study. BMJ Open 2017; 7:e013733. [PMID: 28404611 PMCID: PMC5541440 DOI: 10.1136/bmjopen-2016-013733] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/18/2017] [Accepted: 02/27/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Linkage to care is the bridge between HIV testing and HIV treatment, care and support. In Tanzania, mobile testing aims to address historically low testing rates. Linkage to care was reported at 14% in 2009 and 28% in 2014. The study compares linkage to care of HIV-positive individuals tested at mobile/outreach versus public health facility-based services within the first 6 months of HIV diagnosis. SETTING Rural communities in four districts of Mbeya Region, Tanzania. PARTICIPANTS A total of 1012 newly diagnosed HIV-positive adults from 16 testing facilities were enrolled into a two-armed cohort and followed for 6 months between August 2014 and July 2015. 840 (83%) participants completed the study. MAIN OUTCOME MEASURES We compared the ratios and time variance in linkage to care using the Kaplan-Meier estimator and Log rank tests. Cox proportional hazards regression models to evaluate factors associated with time variance in linkage. RESULTS At the end of 6 months, 78% of all respondents had linked into care, with differences across testing models. 84% (CI 81% to 87%, n=512) of individuals tested at facility-based site were linked to care compared to 69% (CI 65% to 74%, n=281) of individuals tested at mobile/outreach. The median time to linkage was 1 day (IQR: 1-7.5) for facility-based site and 6 days (IQR: 3-11) for mobile/outreach sites. Participants tested at facility-based site were 78% more likely to link than those tested at mobile/outreach when other variables were controlled (AHR=1.78; 95% CI 1.52 to 2.07). HIV status disclosure to family/relatives was significantly associated with linkage to care (AHR=2.64; 95% CI 2.05 to 3.39). CONCLUSIONS Linkage to care after testing HIV positive in rural Tanzania has increased markedly since 2014, across testing models. Individuals tested at facility-based sites linked in significantly higher proportion and modestly sooner than mobile/outreach tested individuals. Mobile/outreach testing models bring HIV testing services closer to people. Strategies to improve linkage from mobile/outreach models are needed.
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Affiliation(s)
- Erica Samson Sanga
- NIMR-Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Wondwossen Lerebo
- School of Public Health, University of Western Cape, Cape Town, South Africa
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Adiel K Mushi
- National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Petra Clowes
- NIMR-Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | | | - Leonard Maboko
- NIMR-Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania
| | - Christina Zarowsky
- School of Public Health, University of Western Cape, Cape Town, South Africa
- University of Montreal Hospital Research Centre and School of Public Health, Université de Montréal, Montreal, Quebec, Canada
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Yarmoshuk AN, Guantai AN, Mwangu M, Cole DC, Zarowsky C. Mapping International University Partnerships Identified by East African Universities as Strengthening Their Medicine, Nursing, and Public Health Programs. Ann Glob Health 2017; 82:665-677.e2. [PMID: 28283117 DOI: 10.1016/j.aogh.2016.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND International university partnerships are recommended for increasing the capacity of sub-Saharan African universities. Many publications describe individual partnerships and projects, and tools are available for guiding collaborations, but systematic mappings of the basic, common characteristics of partnerships are scarce. OBJECTIVE To document and categorize the international interuniversity partnerships deemed significant to building the capacity of medicine, nursing, and public health programs of 4 East African universities. METHODS Two universities in Kenya and 2 in Tanzania were purposefully selected. Key informant interviews, conducted with 42 senior representatives of the 4 universities, identified partnerships they considered significant for increasing the capacity of their institutions' medicine, nursing, and public health programs in education, research, or service. Interviews were transcribed and analyzed. Partners were classified by country of origin and corresponding international groupings, duration, programs, and academic health science components. FINDINGS One hundred twenty-nine university-to-university partnerships from 23 countries were identified. Each university reported between 25 and 36 international university partners. Seventy-four percent of partnerships were with universities in high-income countries, 15% in low- and middle-income countries, and 11% with consortia. Seventy percent included medicine, 37% nursing, and 45% public health; 15% included all 3 programs. Ninety-two percent included an education component, 47% research, and 24% service; 12% included all 3 components. CONCLUSIONS This study confirms the rapid growth of interuniversity cross-border health partnerships this century. It also finds, however, that there is a pool of established international partnerships from numerous countries at each university. Most partnerships that seek to strengthen universities in East Africa should likely ensure they have a significant education component. Universities should make more systematic information about past and existing partnerships available publicly.
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Affiliation(s)
| | | | - Mughwira Mwangu
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Christina Zarowsky
- University of the Western Cape, Cape Town, South Africa; CR-CHUM/ESPUM, Université de Montréal, Montreal, Québec
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Zarowsky C, Haddad S, O'Hearn S, Belaid L, Fregonese F. Strengthening systems and scholarship for global health - and public health. Can J Public Health 2016; 107:e339-e341. [PMID: 28026694 PMCID: PMC6972318 DOI: 10.17269/cjph.107.5986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 06/06/2023]
Abstract
No abstract available.
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Affiliation(s)
- Christina Zarowsky
- Senior Editor, CJPH, Université de Montréal; HSR2016 Programme Co-Chair.
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Van der Wal R, Hatem M, Lynn Z, Zarowsky C. Transitioning into democracy: what contextual barriers and facilitators
do auxiliary midwives perceive in Myanmar’s first point-of-care mHealth
project? Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Potvin L, Zarowsky C. A window on the world. Can J Public Health 2016; 106:e460-e461. [PMID: 26986901 PMCID: PMC6972330 DOI: 10.17269/cjph.106.5500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Louise Potvin
- Editor in Chief, CJPH, School of Public Health, University of Montreal.
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Shamu S, Zarowsky C, Roelens K, Temmerman M, Abrahams N. High-frequency intimate partner violence during pregnancy, postnatal depression and suicidal tendencies in Harare, Zimbabwe. Gen Hosp Psychiatry 2016; 38:109-14. [PMID: 26607330 DOI: 10.1016/j.genhosppsych.2015.10.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Intimate partner violence (IPV) is a common form of violence experienced by pregnant women and is believed to have adverse mental health effects postnatally. This study investigated the association of postnatal depression (PND) and suicidal ideation with emotional, physical and sexual IPV experienced by women during pregnancy. METHODS Data were collected from 842 women interviewed postnatally in six postnatal clinics in Harare, Zimbabwe. We used the World Health Organization versions of IPV and Centre for Epidemiological Studies - Depression Scale measures to assess IPV and PND respectively. We derived a violence severity variable and combined forms of IPV variables from IPV questions. Logistic regression was used to analyse data whilst controlling for past mental health and IPV experiences. RESULTS One in five women [21.4% (95% CI 18.6-24.2)] met the diagnostic criteria for PND symptomatology whilst 21.6% (95% CI 18.8-24.4) reported postpartum suicide thoughts and 4% (95% CI 2.7-5.4) reported suicide attempts. Two thirds (65.4%) reported any form of IPV. Although individual forms of severe IPV were associated with PND, stronger associations were found between PND and severe emotional IPV or severe combined forms of IPV. Suicidal ideation was associated with emotional IPV. Other forms of IPV, except when combined with emotional IPV, were not individually associated with suicidal ideation. CONCLUSION Emotional IPV during pregnancy negatively affects women's mental health in the postnatal period. Clinicians and researchers should include it in their conceptualisation of violence and health. Further research must look at possible indirect relationships between sexual and physical IPV on mental health.
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Affiliation(s)
- Simukai Shamu
- Gender and Health Research Unit, Medical Research Council, 7505 Tygerberg, South Africa; School of Public Health, University of the Western Cape, 7535 Bellville, South Africa; Foundation for Professional Development, 0184 Pretoria, South Africa.
| | - Christina Zarowsky
- School of Public Health, University of the Western Cape, 7535 Bellville, South Africa; University of Montreal Hospital Research Centre, Montreal, QC, Canada H2X 0A9
| | - Kristien Roelens
- International Centre for Reproductive Health, Ghent University, 9000 Ghent, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, 9000 Ghent, Belgium
| | - Naeemah Abrahams
- Gender and Health Research Unit, Medical Research Council, 7505 Tygerberg, South Africa; School of Public Health, University of the Western Cape, 7535 Bellville, South Africa
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