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Sokemawu Freeman AY, Ganizani A, Mwale AC, Manda IK, Chitete J, Phiri G, Stambuli B, Chimulambe E, Koslengar M, Kimambo NR, Bita A, Apolot RR, Mponda H, Mungwira RG, Chapotera G, Yur CT, Yatich NJ, Totah T, Mantchombe F, Chamla DD, Olu OO. Analyses of drinking water quality during a protracted cholera epidemic in Malawi - a cross-sectional study of key physicochemical and microbiological parameters. J Water Health 2024; 22:510-521. [PMID: 38557567 DOI: 10.2166/wh.2024.283] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024]
Abstract
Anecdotal evidence and available literature indicated that contaminated water played a major role in spreading the prolonged cholera epidemic in Malawi from 2022 to 2023. This study assessed drinking water quality in 17 cholera-affected Malawi districts from February to April 2023. Six hundred and thirty-three records were analysed. The median counts/100 ml for thermotolerant coliform was 98 (interquartile range (IQR): 4-100) and that for Escherichia coli was 0 (IQR: 0-9). The drinking water in all (except one) districts was contaminated by thermotolerant coliform, while six districts had their drinking water sources contaminated by E. coli. The percentage of contaminated drinking water sources was significantly higher in shallow unprotected wells (80.0% for E. coli and 95.0% for thermotolerant coliform) and in households (55.8% for E. coli and 86.0% for thermotolerant coliform). Logistic regression showed that household water has three times more risk of being contaminated by E. coli and two and a half times more risk of being contaminated by thermotolerant coliform compared to other water sources. This study demonstrated widespread contamination of drinking water sources during a cholera epidemic in Malawi, which may be the plausible reason for the protracted nature of the epidemic.
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Affiliation(s)
| | | | | | | | | | - Gift Phiri
- Ministry of Water and Sanitation, Lilongwe, Malawi
| | | | | | | | | | - Alisa Bita
- World Health Organization Country Office, Lilongwe, Malawi
| | | | - Hamid Mponda
- World Health Organization Country Office, Lilongwe, Malawi
| | | | | | - Chol Thabo Yur
- World Health Organization Emergency Preparedness and Response Hub, Nairobi, Kenya
| | | | - Terence Totah
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Freddie Mantchombe
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Dick Damas Chamla
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olushayo Oluseun Olu
- World Health Organization Regional Office for Africa, Brazzaville, Congo E-mail:
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Apolot RR, Kaddu SS, Evers ES, Debashish P, Mowla SMN, Ahmed S, Das A, Bhuiyan ATMRH, Rahman MM, Barua A, Maina AGK, Sultan M, Nyawara M, Willet V, Von Harbou K. Infection prevention and control for COVID-19 response in the Rohingya refugee camps in Bangladesh: an intra-action review. Int J Equity Health 2023; 22:111. [PMID: 37277825 PMCID: PMC10241551 DOI: 10.1186/s12939-023-01926-2] [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: 08/10/2022] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Infection Prevention and Control (IPC) is critical in controlling the COVID-19 pandemic and is one of the pillars of the WHO COVID-19 Strategic Preparedness and Response Plan 2020. We conducted an Intra-Action Review (IAR) of IPC response efforts to the COVID-19 pandemic in Cox's Bazar, Bangladesh, to identify best practices, challenges, and recommendations for improvement of the current and future responses. METHODS We conducted two meetings with 54 participants purposively selected from different organizations and agencies involved in the frontline implementation of IPC in Cox's Bazar district, Bangladesh. We used the IPC trigger questions from the WHO country COVID-19 IAR: trigger question database to guide the discussions. Meeting notes and transcripts were then analyzed manually using content analysis, and results were presented in text and quotes. RESULTS Best practices included: assessments, a response plan, a working group, trainings, early case identification and isolation, hand hygiene in Health Facilities (HFs), monitoring and feedback, general masking in HFs, supportive supervision, design, infrastructure and environmental controls in Severe Acute Respiratory Infection Isolation and Treatment Centers (SARI ITCs) and HFs and waste management. Challenges included: frequent breakdown of incinerators, limited PPE supply, inconsistent adherence to IPC, lack of availability of uniforms for health workers, in particular cultural and gender appropriate uniforms and Personal Protective Equipment (PPE). Recommendations from the IAR were: (1) to promote the institutionalization of IPC, programs in HFs (2) establishment of IPC monitoring mechanisms in all HCFs, (3) strengthening IPC education and training in health care facilities, and (4) strengthen public health and social measures in communities. CONCLUSION Establishing IPC programmes that include monitoring and continuous training are critical in promoting consistent and adaptive IPC practices. Response to a pandemic crisis combined with concurrent emergencies, such as protracted displacement of populations with many diverse actors, can only be successful with highly coordinated planning, leadership, resource mobilization, and close supervision.
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Affiliation(s)
| | - Simon Ssentamu Kaddu
- World Health Organization, Cox’s Bazar Emergency Sub Office, Cox’s Bazar, Bangladesh
| | - Egmond Samir Evers
- World Health Organization, Cox’s Bazar Emergency Sub Office, Cox’s Bazar, Bangladesh
| | - Paul Debashish
- World Health Organization, Cox’s Bazar Emergency Sub Office, Cox’s Bazar, Bangladesh
| | - S. M. Niaz Mowla
- World Health Organization, Cox’s Bazar Emergency Sub Office, Cox’s Bazar, Bangladesh
| | - Sabbir Ahmed
- World Health Organization, Cox’s Bazar Emergency Sub Office, Cox’s Bazar, Bangladesh
| | - Aritra Das
- Food for the Hungry/Medical Teams International, Cox’s Bazar, Bangladesh
| | | | | | - Anupam Barua
- Cox’s Bazar Medical College, Cox’s Bazar, Bangladesh
| | | | - Murad Sultan
- World Health Organization, Bangladesh Country Office, Dhaka, Bangladesh
| | - Marsela Nyawara
- International Organization for Migration (IOM), Cox’s Bazar Sub Office, Cox’s Bazar, Bangladesh
| | - Victoria Willet
- World Health Organization, WHO Health Emergencies (WHE) Programme, Geneva, Switzerland
| | - Kai Von Harbou
- World Health Organization, Cox’s Bazar Emergency Sub Office, Cox’s Bazar, Bangladesh
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Ekirapa-Kiracho E, De Broucker G, Ssebagereka A, Mutebi A, Apolot RR, Patenaude B, Constenla D. The economic burden of pneumonia in children under five in Uganda. Vaccine X 2021; 8:100095. [PMID: 34036262 PMCID: PMC8135046 DOI: 10.1016/j.jvacx.2021.100095] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/07/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There were about 138 million new episodes of pneumonia and 0.9 million deaths globally in 2015. In Uganda, pneumonia was the fourth leading cause of death in children under five years of age in 2017-18. However, the economic burden of pneumonia, particularly for households and caregivers, is poorly documented. AIM To estimate the costs associated with an episode of pneumonia from the household, government, and societal perspectives. METHODS We selected 48 healthcare facilities from the public and private sector across all care levels (primary, secondary, and tertiary), based on the number of pneumonia episodes reported for 2015-16. Adult caregivers of children with pneumonia diagnosis at discharge were selected. Using an ingredient-based approach, we collected cost and utilization data from administrative databases, medical records, and patient caregiver surveys. Household costs included direct medical and non-medical costs, as well as indirect costs estimated through a human capital approach. All costs are presented in 2018 U.S. dollars. RESULTS The treatment of pneumonia puts a substantial economic burden on households. The average societal cost per episode of pneumonia across all sectors and types of visits was $42; hospitalized episodes costed an average of $62 per episode, while episodes only requiring ambulatory care was $16 per episode. Public healthcare facilities covered $12 and $7 on average per hospitalized or ambulatory episode, respectively. Caregivers using the public system faced lower out-of-pocket payments, evaluated at $17, than those who used private for-profit ($21) and not-for-profit ($50) for hospitalized care. For ambulatory care, out-of-pocket payments amounted to $8, $18, and $9 for public, private for-profit, and not-for-profit healthcare facilities, respectively. About 39% of households experienced catastrophic health expenditures due to out-of-pocket payments related to the treatment of pneumonia.
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Affiliation(s)
| | - Gatien De Broucker
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
| | | | | | | | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
| | - Dagna Constenla
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
- GlaxoSmithKline Plc., Panama City, Panama
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Kiracho EE, Aanyu C, Apolot RR, Kiwanuka SN, Paina L. Designing for Scale and taking scale to account: lessons from a community score card project in Uganda. Int J Equity Health 2021; 20:31. [PMID: 33430877 PMCID: PMC7802338 DOI: 10.1186/s12939-020-01367-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Planning for the implementation of community scorecards (CSC) is an important, though seldom documented process. Makerere University School of Public Health (MakSPH) and Future Health Systems Consortium set out to develop and test a sustainable and scalable CSC model. This paper documents the process of planning and adapting the design of the CSC, incorporating key domains of the scalable model such as embeddedness, legitimacy, feasibility and ownership, challenges encountered in this process and how they were mitigated. METHODS The CSC intervention comprised of five rounds of scoring in five sub counties and one town council of Kibuku district. Data was drawn from ten focus group discussions, seven key informant interviews with local and sub national leaders, and one reflection meeting with the project team from MakSPH. More data was abstracted from notes of six quarterly stakeholder meetings and six quarterly project meetings. Data was analyzed using a thematic approach, drawing constructs outlined in the project's theory of change. RESULTS Embeddedness, legitimacy and ownership were promoted through aligning the model with existing processes and systems as well as the meaningful and strategic involvement of stakeholders and leaders at local and sub national level. The challenges encountered included limited technical capacity of stakeholders facilitating the CSC, poor functionality of existing community engagement platforms, and difficulty in promoting community participation without financial incentives. However, these challenges were mitigated through adjustments to the intervention design based on the feedback received. CONCLUSION Governments seeking to scale up CSCs and to take scale to account should keenly adapt existing models to the local implementation context with strategic and meaningful involvement of key legitimate local and sub national leaders in decision making during the design and implementation process. However, they should watch out for elite capture and develop mitigating strategies. Social accountability practitioners should document their planning and adaptive design efforts to share good practices and lessons learned. Enhancing local capacity to implement CSCs should be ensured through use of existing local structures and provision of technical support by external or local partners familiar with the skill until the local partners are competent.
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Affiliation(s)
- Elizabeth Ekirapa Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Christine Aanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Rebecca Racheal Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Suzanne Namusoke Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 21205 Baltimore, MD United States of America
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Ssebagereka A, Apolot RR, Nyachwo EB, Ekirapa-Kiracho E. Estimating the cost of implementing a facility and community score card for maternal and newborn care service delivery in a rural district in Uganda. Int J Equity Health 2021; 20:2. [PMID: 33386074 PMCID: PMC7777411 DOI: 10.1186/s12939-020-01335-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/25/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION This paper aimed at estimating the resources required to implement a community Score Card by a typical rural district health team in Uganda, as a mechanism for fostering accountability, utilization and quality of maternal and child healthcare service. METHODS This costing analysis was done from the payer's perspective using the ingredients approach over five quarterly rounds of scoring between 2017 and 2018. Expenditure data was obtained from project records, entered and analyzed in Microsoft excel. Two scale-up scenarios, scenario one (considered cost inputs by the MakSPH research teams) and scenario two (considering cost inputs based on contextual knowledge from district implementing teams), were simulated to better understand the cost implications of integrating the Community Score Card (CSC) into a district health system. RESULTS The total and average cost of implementing CSC for five quarterly rounds over a period of 18 months were USD 59,962 and USD 11,992 per round of scoring, respectively. Considering the six sub-counties (including one Town Council) in Kibuku district that were included in this analysis, the average cost of implementating the CSC in each sub-county was USD 1998 per scoring round. Scaling-up of the intervention across the entire district (included 22 sub-counties) under the first scenario would cost a total of USD 19,003 per scoring round. Under the second scaleup scenario, the cost would be lower at USD 7116. The total annual cost of scaling CSC in the entire district would be USD 76,012 under scenario one compared to USD 28,465 under scenario two. The main cost drivers identified were transportation costs, coordination and supervision costs, and technical support to supplement local implementers. CONCLUSION Our analysis suggests that it is financially feasible to implement and scale-up the CSC initiative, as an accountability tool for enhancing service delivery. However, the CSC design and approach needs to be embedded within local systems and implemented in collaboration with existing stakeholders so as to optimise costs. A comprehensive economic analysis of the costs associated with transportation, involvement of the district teams in coordination, supervision as well as provision of technical support is necessary to determine the cost-effectiveness of the CSC approach.
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Affiliation(s)
- Anthony Ssebagereka
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
| | - Rebecca Racheal Apolot
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
| | - Evelyne Baelvina Nyachwo
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
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De Broucker G, Ssebagereka A, Apolot RR, Aloysius M, Ekirapa Kiracho E, Patenaude B, Constenla D. The economic burden of measles in children under five in Uganda. Vaccine X 2020; 6:100077. [PMID: 33073228 PMCID: PMC7548439 DOI: 10.1016/j.jvacx.2020.100077] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
Measles costed over $135,627 in societal costs for 2018, incl. $59,357 to households. Ugandan caregivers faced $44 in economic costs incl. $23 in out-of-pocket payments. Measles deepens the inequalities in access to healthcare in the population.
Background There is very limited evidence about the economic cost of measles in low-income countries. We estimated the cost of treating measles in Uganda from a societal perspective. Methods We conducted an incidence-based cost-of-illness study in Uganda. We surveyed the facility staff, recording hospital-related expenditures for measles patients. We interviewed caregivers of children with measles at 48 selected healthcare facilities. We conducted phone interviews with caregivers 7–14 days post-discharge to capture additional out-of-pocket expenses and time costs. Results From a societal perspective, a hospitalized and an ambulatory episode of measles cost 2018 US$ 60 and $15, respectively. The government spent on average $12 and $5 per hospitalized and ambulatory episode of measles. Including both public and private facilities, caregivers incurred approximately $44 in economic costs, including $23 in out-of-pocket expenses. In 2018, 2614 cases of measles were confirmed, resulting in $135,627 in societal costs, including $59,357 in economic costs to Ugandan households. Conclusion This cost-of-illness study is the first to use empirical methods to quantify the economic burden of measles in a low-income country. Information related to the cost of treating measles is important for guiding decisions related to changes in measles control and prevention.
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Affiliation(s)
- Gatien De Broucker
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
| | | | | | | | | | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States
| | - Dagna Constenla
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, United States.,GlaxoSmithKline Plc., Panama City, Panama
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Kiracho EE, Namuhani N, Apolot RR, Aanyu C, Mutebi A, Tetui M, Kiwanuka SN, Ayen FA, Mwesige D, Bumbha A, Paina L, Peters DH. Influence of community scorecards on maternal and newborn health service delivery and utilization. Int J Equity Health 2020; 19:145. [PMID: 33131498 PMCID: PMC7604954 DOI: 10.1186/s12939-020-01184-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The community score card (CSC) is a participatory monitoring and evaluation tool that has been employed to strengthen the mutual accountability of health system and community actors. In this paper we describe the influence of the CSC on selected maternal and newborn service delivery and utilization indicators. METHODS This was a mixed methods study that used both quantitative and qualitative data collection methods. It was implemented in five sub-counties and one town council in Kibuku district in Uganda. Data was collected through 17 key informant interviews and 10 focus group discussions as well as CSC scoring and stakeholder meeting reports. The repeated measures ANOVA test was used to test for statistical significance. Qualitative data was analyzed manually using content analysis. The analysis about the change pathways was guided by the Wild and Harris dimensions of change framework. RESULTS There was an overall improvement in the common indicators across sub-counties in the project area between the 1st and 5th round scores. Almost all the red scores had changed to green or yellow by round five except for availability of drugs and mothers attending Antenatal care (ANC) in the first trimester. There were statistically significant differences in mean scores for men escorting their wives for ante natal care (ANC) (F(4,20) = 5.45, P = 0.01), availability of midwives (F(4,16) =5.77, P < 0.01), availability of delivery beds (F(4,12) =9.00, P < 0.01) and mothers delivering from traditional birth attendants (TBAs), F(4,16) = 3.86, p = 0.02). The qualitative findings suggest that strengthening of citizens' demand, availability of resources through collaborative problem solving, increased awareness about targeted maternal health services and increased top down performance pressure contributed to positive changes as perceived by community members and their leaders. CONCLUSIONS AND RECOMMENDATIONS The community score cards created opportunities for community leaders and communities to work together to identify innovative ways of dealing with the health service delivery and utilization challenges that they face. Local leaders should encourage the availability of safe spaces for dialogue between communities, health workers and leaders where performance and utilization challenges can be identified and solutions proposed and implemented jointly.
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Affiliation(s)
- Elizabeth Ekirapa Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Noel Namuhani
- Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Rebecca Racheal Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Christine Aanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Aloysuis Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Suzanne N. Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Faith Adong Ayen
- District Health Service, Kibuku Local Government, P.O Box 150, Mbale, Uganda
| | - Dennis Mwesige
- District Health Service, Kibuku Local Government, P.O Box 150, Mbale, Uganda
| | - Ahmed Bumbha
- District Health Service, Kibuku Local Government, P.O Box 150, Mbale, Uganda
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - David H. Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Ganle JK, Apolot RR, Rugoho T, Sumankuuro J. 'They are my future': childbearing desires and motivations among women with disabilities in Ghana - implications for reproductive healthcare. Reprod Health 2020; 17:151. [PMID: 33023601 PMCID: PMC7539488 DOI: 10.1186/s12978-020-01000-y] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has highlighted widespread public mis/perceptions that portray women with disabilities (WWDs) as asexual, less likely to marry, and often not interested in childbearing. However, evidence from high-income settings shows that many WWDs are sexually active and do have or want to have children. Notwithstanding this, very few studies have focused on understanding childbearing desires and motivations among WWDs in low-income settings. This qualitative research explored childbearing desires and motivations among WWDs in Ghana. METHODS A cross-sectional qualitative study was conducted with WWDs aged 18-49 years in Northern Ghana. The distribution of participants by disability types were as follows: physical disability/impairment (n = 37); visual impairment (n = 11); speech and hearing impairment (n = 14); epilepsy (n = ten); and albinism (n = five). A pre-tested open-ended thematic topic guide was designed and used to conduct in-depth interviews. Interviews were tape-recorded and later transcribed for analysis. Transcripts were coded using QSR NVivo 11 software. Thematic content analysis techniques were used to analyse and present the data. RESULTS Nearly all the WWDs interviewed were sexually active, desiring to have children, and intended to have as many children as they could support. Strong desire to experience the joy of motherhood; fear of social insecurity; fear of old age economic insecurity; desire to challenge stigma and negative stereotypes about disability, sexuality and motherhood; and desire for self-actualisation, were key motivations for childbearing. CONCLUSION Our findings challenge existing negative public perceptions about the status of WWDs in relation to sexuality, childbearing and motherhood. More importantly, our findings suggest that if the Sustainable Development Goals related to universal access to sexual and reproductive healthcare are to be attained, WWDs must be targeted with quality sexual and reproductive healthcare information and services.
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Affiliation(s)
- John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, P.O. Box LG 13, Accra, Ghana. .,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, 7600, South Africa.
| | - Rebecca Racheal Apolot
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Tafadzwa Rugoho
- Department of Development Studies, Great Zimbabwe University, Masvingo, Zimbabwe
| | - Joshua Sumankuuro
- School of Community Health, Faculty of Science, Charles Sturt University, Bathurst, New South Wales, Australia
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Aanyu C, Kadobera D, Apolot RR, Kisakye AN, Nsubuga P, Bazeyo W, Ddamulira JB. Prevalence, knowledge and practices of shisha smoking among youth in Kampala City, Uganda. Pan Afr Med J 2019; 32:61. [PMID: 31223353 PMCID: PMC6560999 DOI: 10.11604/pamj.2019.32.61.15184] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION globally tobacco use kills more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030. Though perceived as safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking yet, this practice has gained popularity especially among youths globally. We assessed shisha smoking and factors associated with shisha smoking to support public health interventions. METHODS a cross-sectional study was conducted among 663 systematically selected youths aged between 18-30 years attending bars in two divisions of Kampala city Uganda. Data was analyzed using Stata version 12 and logistic regression model run to establish factors independently associated with shisha smoking. RESULTS we found that 458 (86.4%) youths had low knowledge of the health effects of shisha and 193 (36.4%) smoked shisha. Majority of the respondents, 184 (97.4%) smoked flavoured and sweetened tobacco, 69 (36.5%) smoked on a weekly basis, 163 (86.2%) smoked in the company of friends, 162 (85.7%) shared shisha pipes. Factors associated with shisha smoking include smoking cigarettes adjusted odds ratio [aOR]: 5.91, 95% Confidence Interval (CI): 3.86-9.05); positive attitude (aOR: 3.89, 95% CI: 2.50-6.05); urban residence (aOR: 3.98, 95% CI: 1.99-8.00) and older age [25-30 years] (aOR: 2.13, 95% CI: 1.37-3.22). CONCLUSION the prevalence of shisha smoking is high with three in ten youths smoking shisha yet their knowledge about the health effects associated with shisha smoking was low. Shisha smoking ban should be implemented in all bars in Kampala as stated by the newly enacted tobacco law.
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Affiliation(s)
- Christine Aanyu
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Angela Nakanwagi Kisakye
- Makerere University School of Public Health, Kampala, Uganda
- African Field Epidemiology Network, Kampala, Uganda
| | | | - William Bazeyo
- Makerere University School of Public Health, Kampala, Uganda
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Aanyu C, Apolot RR, Bagonza J. Smoke free policy in bars and restaurants in Kampala: a cross sectional study. Tob Induc Dis 2018. [DOI: 10.18332/tid/84313] [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: 11/24/2022] Open
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