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Regmi S, Bertone MP, Shrestha P, Sapkota S, Arjyal A, Martineau T, Raven J, Witter S, Baral S. Understanding health system resilience in responding to COVID-19 pandemic: experiences and lessons from an evolving context of federalization in Nepal. BMC Health Serv Res 2024; 24:428. [PMID: 38575933 PMCID: PMC10996157 DOI: 10.1186/s12913-024-10755-0] [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: 05/11/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has tested the resilience capacities of health systems worldwide and highlighted the need to understand the concept, pathways, and elements of resilience in different country contexts. In this study, we assessed the health system response to COVID-19 in Nepal and examined the processes of policy formulation, communication, and implementation at the three tiers of government, including the dynamic interactions between tiers. Nepal was experiencing the early stages of federalization reform when COVID-19 pandemic hit the country, and clarity in roles and capacity to implement functions were the prevailing challenges, especially among the subnational governments. METHODS We adopted a cross-sectional exploratory design, using mixed methods. We conducted a desk-based review of all policy documents introduced in response to COVID-19 from January to December 2020, and collected qualitative data through 22 key informant interviews at three tiers of government, during January-March 2021. Two municipalities were purposively selected for data collection in Lumbini province. Our analysis is based on a resilience framework that has been developed by our research project, ReBUILD for Resilience, which helps to understand pathways to health system resilience through absorption, adaptation and transformation. RESULTS In the newly established federal structure, the existing emergency response structure and plans were utilized, which were yet to be tested in the decentralized system. The federal government effectively led the policy formulation process, but with minimal engagement of sub-national governments. Local governments could not demonstrate resilience capacities due to the novelty of the federal system and their consequent lack of experience, confusion on roles, insufficient management capacity and governance structures at local level, which was further aggravated by the limited availability of human, technical and financial resources. CONCLUSIONS The study findings emphasize the importance of strong and flexible governance structures and strengthened capacity of subnational governments to effectively manage pandemics. The study elaborates on the key areas and pathways that contribute to the resilience capacities of health systems from the experience of Nepal. We draw out lessons that can be applied to other fragile and shock-prone settings.
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Affiliation(s)
| | - Maria Paola Bertone
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | | | | | | | - Tim Martineau
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Parajuli A, Garbovan L, Bhattarai B, Arjyal A, Baral S, Cooke P, Latham S, Barrington DJ, Mitchell J, King R. Exploring community insights on antimicrobial resistance in Nepal: a formative qualitative study. BMC Health Serv Res 2024; 24:57. [PMID: 38212733 PMCID: PMC10782613 DOI: 10.1186/s12913-023-10470-2] [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: 04/24/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is the process by which microbes evolve mechanisms to survive the medicines designed to destroy them i.e. antimicrobials (AMs). Despite being a natural process, AMR is being hastened by the abuse of AMs. In context of Nepal, there is limited information on drivers of AMR and barriers in addressing it from a community perspective. This study explores the local language and terminology used around AMs in the community, commonly used AMs and reasons for their usage, how these AMs are sourced, and the perceived barriers to addressing AMR via One Health approach. METHODS A phenomenological study design was utilized with applied qualitative research theoretically framed as pragmatism. Twelve in-depth interviews and informal discussions with a One Health focus, were purposively conducted with wide range of stakeholders and community resident of Kapilvastu municipality of Nepal during April 2022. The acquired data was analyzed manually via a thematic framework approach. The study obtained ethical approval from ethical review board of Nepal Health Research Council and University of Leeds. RESULTS Nepali and Awadhi languages does not have specific words for AMs or AMR, which is understandable by the community people. Rather, community use full explanatory sentences. People use AMs but have incomplete knowledge about them and they have their own local words for these medicines. The knowledge and usage of AMs across human and animal health is impacted by socio-structural factors, limited Government regulation, inadequate supply of AMs in local government health facilities and the presence of various unregulated health providers that co-exist within the health system. Novel ideas such as the use of visual and smart technology, for instance mobile phones and social media exposure, can enable access to information about AMs and AMR. CONCLUSION This study shows that terminology that is understandable by the community referring to AMs and AMR in Nepali and Awadhi languages does not exist, but full explanatory sentences and colloquial names are used. Despite regular utilisation, communities have incomplete knowledge regarding AMs. Since, knowledge alone cannot improve behaviour, behavioural interventions are required to address AMR via community engagement to co-produce their own solutions. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | - Lidis Garbovan
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | | | | | | | - Paul Cooke
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Sophia Latham
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Chester High Road, Neston, Liverpool, CH64 7TE, UK
| | - Dani J Barrington
- School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western, 6009, Australia
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
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Baral S, Uprety AB, Kshetri R. Serum Uric Acid to Creatinine Ratio with Estimated Glomerular Filtration Rate in Type 2 Diabetes Patients. J Nepal Health Res Counc 2023; 21:271-276. [PMID: 38196220 DOI: 10.33314/jnhrc.v21i02.4565] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Diabetes mellitus is a metabolic disorder associated with cardiovascular and renal complications. The serum uric acid to creatinine ratio and estimated glomerular filtration rate are important markers used to assess kidney function in patients with type 2 diabetes. This study aimed to find the correlation between serum uric acid to creatinine ratio and estimated glomerular filtration rate to various parameters among the diabetes patients. METHODS It is an observational hospital-based, cross-sectional study. Patients with a diagnosis of diabetes for three years or more duration were selected. This study designed to serum uric acid to creatinine ratio with estimated glomerular filtration rate and its relationship with other biochemical parameters. The Modification of Diet in Renal Disease formula was used to calculate estimated glomerular filtration rate (eGFR). eGFR (mL/min∙1.73 m2) = 186 × (Scr) -1.154 × (age) - 0.203 × (0.742 female). Low eGFR was defined as eGFR<60 mL/min∙1.73 m2. The data were analyzed by SPSS version 20. Mean values of different variables, standard deviations and p-values were calculated. RESULTS Mean serum uric acid to creatinine ratio was 6.09±1.71 and elevated among 49.1%. Mean blood urea and serum creatinine levels were 28.0±10.72 and 1.01±0.18, respectively. There was a significant positive correlation between eGFR and serum uric acid : serum creatinine ( r = 0.246, p = 0.007) in this study. CONCLUSIONS The serum uric acid to creatinine ratio can serve as an early marker for renal injury, showing a positive correlation with estimated glomerular filtration rate (eGFR). Monitoring serum uric acid to creatinine ratio levels alongside eGFR can assistance in the identification and management of kidney damage in its early stages.
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Affiliation(s)
- Sushil Baral
- Department of Internal Medicine, National Academy of Medical Sciences, Bir hospital,Kathmandu,Nepal
| | - Ananta Bhakta Uprety
- Department of Internal Medicine, National Academy of Medical Sciences, Bir hospital,Kathmandu,Nepal
| | - Rupesh Kshetri
- University of Iowa Hospitals and Clinics, Iowa City, USA
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Mitchell J, Hawkings H, Latham S, Fieroze F, Arjyal A, Barrington DJ, Baral S, Saify MB, Cooke P, Hamade P, Huque R, Parajuli A, Siddiki AZ, King R. Addressing antimicrobial resistance through community engagement: a framework for developing contextually relevant and impactful behaviour change interventions. JAC Antimicrob Resist 2023; 5:dlad124. [PMID: 38021035 PMCID: PMC10673675 DOI: 10.1093/jacamr/dlad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Community engagement (CE) interventions often explore and promote behaviour change around a specific challenge. Suggestions for behaviour change should be co-produced in partnership with the community. To facilitate this, it is essential that the intervention includes key content that unpacks the challenge of interest via multiple sources of knowledge. However, where community lived experience and academic evidence appear misaligned, tensions can appear within the co-production dynamic of CE. This is specifically so within the context of antimicrobial resistance (AMR) where ideal behaviours are often superseded by what is practical or possible in a particular community context. Methods Here we describe a framework for the equitable development of contextually appropriate, clearly evidenced behavioural objectives for CE interventions. This framework explores different sources of knowledge on AMR, including the potentially competing views of different stakeholders. Findings The framework allows key content on AMR to be selected based upon academic evidence, contextual appropriateness and fit to the chosen CE approach. A case study of the framework in action exemplifies how the framework is applicable to a range of contexts, CE approaches and One Health topics beyond just AMR. Conclusions Within CE interventions, academic evidence is crucial to develop well-informed key content. However, this formative work should also involve community members, ensuring that their contextual knowledge is valued. The type of CE approach also needs careful consideration because methodological constraints may limit the breadth and depth of information that can be delivered within an intervention, and thus the scope of key content.
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Affiliation(s)
- Jessica Mitchell
- Nuffield Centre for International Health and Development, Leeds Institute for Health Sciences, Faculty of Medicine and Health, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Helen Hawkings
- Malaria Consortium, The Green House 244-254 Cambridge Heath Rd, London EC2 9DA, UK
| | - Sophia Latham
- Department of Livestock and One Health, Institute of Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK
| | - Fariza Fieroze
- ARK Foundation, Suite C3 & C4, House 06, Road 109, Gulshan-2, Dhaka 1212, Bangladesh
| | | | - Dani Jennifer Barrington
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Western Australia
| | | | - Md Badruddin Saify
- ARK Foundation, Suite C3 & C4, House 06, Road 109, Gulshan-2, Dhaka 1212, Bangladesh
| | - Paul Cooke
- Faculty of Arts and Humanities, Centre for World Cinemas and Digital Cultures, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Prudence Hamade
- Malaria Consortium, The Green House 244-254 Cambridge Heath Rd, London EC2 9DA, UK
| | - Rumana Huque
- ARK Foundation, Suite C3 & C4, House 06, Road 109, Gulshan-2, Dhaka 1212, Bangladesh
| | | | - Amam Zonaed Siddiki
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Rebecca King
- Nuffield Centre for International Health and Development, Leeds Institute for Health Sciences, Faculty of Medicine and Health, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
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Mitchell J, Arjyal A, Baral S, Barrington D, Cooke P, Fieroze F, Huque R, Hamade P, Hawkings H, Jones N, Latham S, Parajuli A, Saify MB, King R. Co-designing community-based interventions to tackle antimicrobial resistance (AMR): what to include and why. BMC Res Notes 2023; 16:290. [PMID: 37875996 PMCID: PMC10598890 DOI: 10.1186/s13104-023-06449-1] [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: 05/18/2023] [Accepted: 07/31/2023] [Indexed: 10/26/2023] Open
Abstract
Antimicrobial resistance (AMR) is a social and biological problem. Although resistance to antimicrobials is a natural phenomenon, many human behaviors are increasing the pressure on microbes to develop resistance which is resulting in many commonly used treatments becoming ineffective. These behaviors include unregulated use of antimicrobial medicines, pesticides and agricultural chemicals, the disposal of heavy metals and other pollutants into the environment, and human-induced climatic change. Addressing AMR thus calls for changes in the behaviors which drive resistance. Community engagement for antimicrobial resistance (CE4AMR) is an international and interdisciplinary network focused on tackling behavioural drivers of AMR at community level. Since 2019 this network has worked within Low-Middle Income Countries (LMICs), predominantly within Southeast Asia, to tackle behavioral drivers of AMR can be mitigated through bottom-up solutions championed by local people. This commentary presents seven Key Concepts identified from across the CE4AMR portfolio as integral to tackling AMR. We suggest it be used to guide future interventions aimed at addressing AMR via social, participatory, and behavior-change approaches.
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Affiliation(s)
- Jessica Mitchell
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Woodhouse, Leeds, LS2 9JT, UK.
| | | | | | - Dani Barrington
- University of Western Australia, School of Population and Global Health, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Paul Cooke
- Centre for World Cinema and Digital Cultures, Faculty of Arts and Humanities, University of Leeds, Woodhouse, Leeds, LS2 9JT, UK
| | | | | | - Prudence Hamade
- Malaria Consortium, The Green House 244-254 Cambridge Heath Rd, London, EC2 9DA, UK
| | - Helen Hawkings
- Malaria Consortium, The Green House 244-254 Cambridge Heath Rd, London, EC2 9DA, UK
| | - Nichola Jones
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Woodhouse, Leeds, LS2 9JT, UK
| | - Sophia Latham
- Department of Livestock and One Health, Institute of Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | | | | | - Rebecca King
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Woodhouse, Leeds, LS2 9JT, UK
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Morrison J, Giri R, James P, Arjyal A, Kharel C, Saville N, Baral S, Hillman S, Harris-Fry H. Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study. Br J Nutr 2023; 130:211-220. [PMID: 36205216 PMCID: PMC10277664 DOI: 10.1017/s0007114522003208] [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: 07/25/2022] [Revised: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Anaemia in pregnancy is a persistent health problem in Nepal and could be reduced through nutrition counselling and strengthened iron folic acid supplementation programmes. We analysed 24-hour diet recall data from 846 pregnant women in rural plains Nepal, using linear programming to identify the potential for optimised food-based strategies to increase iron adequacy. We then conducted qualitative research to analyse how anaemia was defined and recognised, how families used food-based strategies to address anaemia, and the acceptability of optimised food-based strategies. We did 16 interviews of recently pregnant mothers, three focus group discussions with fathers, three focus group discussions with mothers-in-law and four interviews with key informants. Dietary analyses showed optimised diets did not achieve 100 % of recommended iron intakes, but iron intakes could be doubled by increasing intakes of green leaves, egg and meat. Families sought to address anaemia through food-based strategies but were often unable to because of the perceived expense of providing an 'energy-giving' diet. Some foods were avoided because of religious or cultural taboos, or because they were low status and could evoke social consequences if eaten. There is a need for counselling to offer affordable ways for families to optimise iron adequacy. The participation of communities in tailoring advice to ensure cultural relevance and alignment with local norms is necessary to enable its effectiveness.
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Affiliation(s)
- Joanna Morrison
- UCL Institute for Global Health, 30 Guilford Street, LondonWC1N 1EH, UK
| | - Romi Giri
- Herd International, Thapathali, Kathmandu, Nepal
| | - Philip James
- London School of Hygiene and Tropical Medicine, Keppel St, LondonWC1E 7HT, UK
| | | | | | - Naomi Saville
- UCL Institute for Global Health, 30 Guilford Street, LondonWC1N 1EH, UK
| | - Sushil Baral
- Herd International, Thapathali, Kathmandu, Nepal
| | - Sara Hillman
- UCL Institute for Women’s Health, 74 Huntley Street, LondonWC1E 6AU, UK
| | - Helen Harris-Fry
- London School of Hygiene and Tropical Medicine, Keppel St, LondonWC1E 7HT, UK
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Mitchell J, Cooke P, Arjyal A, Baral S, Jones N, Garbovan L, King R. Exploring the potential for children to act on antimicrobial resistance in Nepal: Valuable insights from secondary analysis of qualitative data. PLoS One 2023; 18:e0285882. [PMID: 37267313 PMCID: PMC10237405 DOI: 10.1371/journal.pone.0285882] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023] Open
Abstract
This study explores the perceived roles of children in antimicrobial resistance (AMR) in two sites across Nepal. AMR is a global challenge and underpinned by many complex behavioural drivers including how antimicrobial medicines are sourced and used. Because of this social dynamic, several research groups are using community engagement (CE) approaches to understand AMR at community level. However, most data negate the importance of children in behaviours linked to, and potentially driving AMR. In this study, authors apply secondary analysis methods to 10 transcripts representing the views of 23 adults engaged in an AMR-focused film-making project. By focusing on participants' reference to children, we reveal that antimicrobial usage and adherence to health providers' messages can be influenced by the age of the patient. Secondly that children are involved in some of the behaviours which are known to drive antimicrobial resistance such as purchasing over-the-counter antibiotic drugs. Finally, community members discuss that, with careful creation of resources, AMR could be meaningfully presented in educational settings with a view to children acting as agents of change around AMR-driving behaviours. Findings suggest that age-inclusive community engagement projects could be effective in tackling AMR at community level in Nepal and other low resource settings.
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Affiliation(s)
- Jessica Mitchell
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Leeds, United Kingdom
| | - Paul Cooke
- Centre for World Cinema and Digital Cultures, Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| | | | | | - Nichola Jones
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Leeds, United Kingdom
| | - Lidis Garbovan
- Centre for World Cinema and Digital Cultures, Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| | - Rebecca King
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Leeds, United Kingdom
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Baral S, McCartney G. Health inequalities: responding to the challenge. Public Health 2023; 219:165-166. [PMID: 37248159 DOI: 10.1016/j.puhe.2023.04.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- S Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, 21205, USA
| | - G McCartney
- School of Social and Political Sciences, University, of Glasgow, Glasgow, G12 8QQ, UK.
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Affiliation(s)
- Brynne Gilmore
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | | | | | - Nuhu Omeiza Yaqub
- Department of Maternal, Newborn, Child, Adolescent Health, and Ageing, World Health Organization, Geneva, Switzerland
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Thapaliya B, Yadav SK, Bhattarai S, Giri S, Sapkota S, Arjyal A, Harris-Fry H, Saville N, Hillman S, Baral S, Morrison J. Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic. PLoS One 2023; 18:e0284796. [PMID: 37093841 PMCID: PMC10124848 DOI: 10.1371/journal.pone.0284796] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/07/2023] [Indexed: 04/25/2023] Open
Abstract
The COVID-19 pandemic affected access to antenatal care in low and middle-income countries where anaemia in pregnancy is prevalent. We analyse how health workers provided antenatal care and the factors affecting access to antenatal care during the COVID-19 pandemic in Kapilvastu district in the western plains of Nepal. We used qualitative and quantitative methodologies, conducting eight semi-structured interviews with health workers who provided antenatal care during the pandemic, and a questionnaire containing open and closed questions with 52 female community health volunteers. Antenatal care was severely disrupted during the pandemic. Health workers had to find ways to provide care with insufficient personal protective equipment and guidance whilst facing extreme levels of stigmatisation which prevented them from providing outreach services. Pregnant women were fearful or unable to visit health institutions during the pandemic because of COVID-19 control measures. Pre-pandemic and during the pandemic health workers tried to contact pregnant and postpartum women and families over the phone, but this was challenging because of limited access to phones, and required pregnant women to make at least one antenatal care visit to give their phone number. The pandemic prevented new pregnancies from being registered, and therefore the possibilities to provide services over the phone for these pregnancies were limited. To reach the most marginalised during a pandemic or other health emergency, health volunteers and households need to exchange phone numbers, enabling proactive monitoring and care-seeking. Strengthening procurement and coordination between the municipal, provincial, and federal levels of government is needed to ensure adequacy of antenatal supplies, such as iron folic acid tablets, in health emergencies. Community engagement is important to ensure women and families are aware of the need to access antenatal care and iron folic acid, and to address stigmatisation of health workers.
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Affiliation(s)
| | | | | | | | | | | | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Naomi Saville
- UCL Institute for Global Health 30 Guilford Street, London, United Kingdom
| | - Sara Hillman
- UCL Institute for Women’s Health Room 237c Medical School Building, London, United Kingdom
| | | | - Joanna Morrison
- UCL Institute for Global Health 30 Guilford Street, London, United Kingdom
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Perrin H, Shannon K, Lowik AJ, Rich A, Baral S, Braschel M, Deering K. Access to and quality of care for sexual and gender minority women living with HIV in Metro Vancouver, Canada: Results from a longitudinal cohort study. Womens Health (Lond) 2023; 19:17455057231205677. [PMID: 38116643 PMCID: PMC10676058 DOI: 10.1177/17455057231205677] [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] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND While scarce, literature suggests that women at the intersection of HIV status and gender and/or sexual minority identities experience heightened social and health disparities within health care systems. OBJECTIVES This study examines the association between sexual and/or gender minority identities and: (1) experiences of poor treatment by health professionals and (2) being unable to access health services among a cohort of women living with HIV in Metro Vancouver, Canada. DESIGN Data were drawn from a longitudinal community-based cohort of women living with HIV (Sexual Health and HIV/AIDS Women's Longitudinal Needs Assessment). METHODS We examined associations between sexual and/or gender minority identities and the two outcomes. We drew on explanatory variables to measure sexual minority and gender minority identities independently and a combined variable measuring sexual and/or gender minority identities. The associations between each of these three variables and each outcome were analysed using bivariate and multivariable logistic regression models with generalized estimating equations for repeated measures over time. Adjusted odds ratios and 95% confidence intervals are reported. RESULTS The study sample included 1460 observations on 315 participants over 4.5 years (September 2014 to February 2019). Overall, 125 (39.7%) reported poor treatment by health professionals and 102 (32.4%) reported being unable to access health care services when needed at least once over the study period. A total of 110 (34.9%) of participants reported sexual and/or gender minority identities, 106 (33.7%) reporting sexual minority identities, with 29 (9.2%) reporting gender minority identities. In multivariable analysis, adjusting for confounders, sexual minority identities, and combined sexual and/or gender minority identities were significantly associated with increased odds of experiencing poor treatment by health professionals (sexual minority adjusted odds ratio = 1.39 (0.94-2.05); sexual and/or gender minority adjusted odds ratio = 1.48 (1.00-2.18)) and being unable to access health services (sexual minority adjusted odds ratio = 1.89 (1.20-2.97); sexual and/or gender minority adjusted odds ratio = 1.91 (1.23-2.98)). In multivariable analysis, gender minority identities were not significantly associated with increased odds of experiencing poor treatment by health professionals (gender minority adjusted odds ratio = 1.38; 95% CI = 0.76-2.52) and being unable to access health services (gender minority adjusted odds ratio = 1.72; 95% CI = 0.89-3.31) possibly due to low sample size among women with gender minority identities. CONCLUSION Our findings suggest the need for access to inclusive, affirming, trauma-informed health care services tailored specifically for and by women living with HIV with sexual and/or gender minority identities.
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Affiliation(s)
- H Perrin
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - K Shannon
- Centre for Gender & Sexual Health Equity (CGSHE), The University of British Columbia, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - AJ Lowik
- Centre for Gender & Sexual Health Equity (CGSHE), The University of British Columbia, Vancouver, BC, Canada
| | - A Rich
- Centre for Gender & Sexual Health Equity (CGSHE), The University of British Columbia, Vancouver, BC, Canada
- Department of Social Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Braschel
- Centre for Gender & Sexual Health Equity (CGSHE), The University of British Columbia, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - K Deering
- Centre for Gender & Sexual Health Equity (CGSHE), The University of British Columbia, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Okonkwo N, Rwema JOT, Lyons C, Liestman B, Nyombayire J, Olawore O, Nsanzimana S, Mugwaneza P, Kagaba A, Sullivan P, Allen S, Karita E, Baral S. The Relationship Between Sexual Behavior Stigma and Depression Among Men Who have Sex with Men and Transgender Women in Kigali, Rwanda: a Cross-sectional Study. Int J Ment Health Addict 2022; 20:3228-3243. [PMID: 36532817 PMCID: PMC9754158 DOI: 10.1007/s11469-021-00699-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/27/2022] Open
Abstract
To evaluate the role of sexual behavior stigma as a determinant of depressive symptoms among men who have sex with men (MSM) and transgender women (TGW) in Kigali, Rwanda. MSM/TGW aged ≥18 years were recruited using respondent-driven sampling (RDS) between March-August, 2018. Mental health was assessed using the Patient Health Questionnaire (PHQ-9). Sexual behavior stigma from friends and family, healthcare workers, and community members was assessed using a validated instrument. Multinomial logistic regression models were used to determine the association between sexual behavior stigma and depressive symptoms and depression. Secondary analyses further compared depression and depressive symptoms among MSM and TGW. Among the 736 participants included, 14% (106/736) identified as TGW. Depression 8.9% (RDS-adjusted, 7.6%; 95% CI, 4.6-10.6) and mild/moderate symptoms of depression 26.4% (RDS-adjusted, 24.1%; 95% CI, 19.4-28.7) were common and higher among TGW compared to MSM (p < 0.001). Anticipated (41%), perceived (36%), and enacted (45%) stigmas were highly prevalent, and were also significantly higher among TGW (p < 0.001). In multivariable RDS-adjusted analysis, anticipated (relative risk ratio (RRR), 1.88; 95% CI, 1.11-3.19) and perceived (RRR, 2.06; 95% CI, 1.12-3.79) stigmas were associated with a higher prevalence of depressive symptoms. Anticipated (RRR, 4.78; 95% CI, 1.74-13.13) and enacted (RRR, 3.09; 95% CI, 1.61-5.93) stigmas were also associated with a higher prevalence of depression. In secondary analyses, the significant differences between MSM and TGW were lost after adjusting for stigma. These data demonstrate a high burden of depressive symptoms and depression among MSM/TGW in Kigali. Conceptually, stigma is a likely antecedent of mental health stress among MSM and TGW suggesting the potential utility of scaling up stigma mitigation interventions to improve the quality of life and mental health outcomes among sexual and gender minority communities in Rwanda.
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Affiliation(s)
- N. Okonkwo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - C. Lyons
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - B. Liestman
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | | | - O. Olawore
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
| | - S. Nsanzimana
- Rwanda Biomedical Center, HIV and AIDS Division, Kigali, Rwanda
| | - P. Mugwaneza
- Rwanda Biomedical Center, HIV and AIDS Division, Kigali, Rwanda
| | - A. Kagaba
- Health Development Initiative, Kigali, Rwanda
| | - P. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - S. Allen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - E. Karita
- Projet San Francisco, Kigali, Rwanda
| | - S. Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133 Baltimore, MD, 21205, USA
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Mitchell J, Cooke P, Ahorlu C, Arjyal A, Baral S, Carter L, Dasgupta R, Fieroze F, Fonseca-Braga M, Huque R, Lewycka S, Kalpana P, Saxena D, Tomley F, Tsekleves E, Vu Thi Quynh G, King R. Community engagement: The key to tackling Antimicrobial Resistance (AMR) across a One Health context? Glob Public Health 2022; 17:2647-2664. [PMID: 34882505 DOI: 10.1080/17441692.2021.2003839] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 05/21/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
Abstract
Antimicrobial resistance (AMR) is a One Health problem underpinned by complex drivers and behaviours. This is particularly so in low - and middle-income countries (LMICs), where social and systemic factors fuel (mis)use and drive AMR. Behavioural change around antimicrobial use could safeguard both existing and future treatments. However, changing behaviour necessitates engaging with people to understand their experiences. This publication describes a knowledge-exchange cluster of six LMIC-based projects who co-designed and answered a series of research questions around the usage of Community Engagement (CE) within AMR. Findings suggest that CE can facilitate AMR behaviour change, specifically in LMICs, because it is a contextualised approach which supports communities to develop locally meaningful solutions. However, current CE interventions focus on human aspects, and demand-side drivers, of AMR. Our cluster suggests that broader attention should be paid to AMR as a One Health issue. The popularity of mixed methods approaches within existing CE for AMR interventions suggests there is interdisciplinary interest in the uptake of CE. Unfortunately, the specificity and context-dependency of CE can make it difficult to evaluate and scale. Nevertheless, we suggest that in synthesising learnings from CE, we can develop a collective understanding of its scope to tackle AMR across contexts. .
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Affiliation(s)
- Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse, UK
| | - Paul Cooke
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse, UK
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Laura Carter
- School of Geography, University of Leeds, Woodhouse, UK
| | - Rajib Dasgupta
- One Health Poultry Hub, UK
- Centre of Social Medicine & Community Health, Jawaharlal Nehru University, New Delhi, India
| | | | | | | | - Sonia Lewycka
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam
| | - Pachillu Kalpana
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Deepak Saxena
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Fiona Tomley
- One Health Poultry Hub, UK
- Royal Veterinary College, Hatfield, UK
| | | | - Gioa Vu Thi Quynh
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse, UK
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Wallace LJ, Agyepong I, Baral S, Barua D, Das M, Huque R, Joshi D, Mbachu C, Naznin B, Nonvignon J, Ofosu A, Onwujekwe O, Sharma S, Quayyum Z, Ensor T, Elsey H. The Role of the Private Sector in the COVID-19 Pandemic: Experiences From Four Health Systems. Front Public Health 2022; 10:878225. [PMID: 35712320 PMCID: PMC9195628 DOI: 10.3389/fpubh.2022.878225] [Citation(s) in RCA: 3] [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: 02/17/2022] [Accepted: 05/05/2022] [Indexed: 11/21/2022] Open
Abstract
As societies urbanize, their populations have become increasingly dependent on the private sector for essential services. The way the private sector responds to health emergencies such as the COVID-19 pandemic can determine the health and economic wellbeing of urban populations, an effect amplified for poorer communities. Here we present a qualitative document analysis of media reports and policy documents in four low resource settings-Bangladesh, Ghana, Nepal, Nigeria-between January and September 2020. The review focuses on two questions: (i) Who are the private sector actors who have engaged in the COVID-19 first wave response and what was their role?; and (ii) How have national and sub-national governments engaged in, and with, the private sector response and what have been the effects of these engagements? Three main roles of the private sector were identified in the review. (1) Providing resources to support the public health response. (2) Mitigating the financial impact of the pandemic on individuals and businesses. (3) Adjustment of services delivered by the private sector, within and beyond the health sector, to respond to pandemic-related business challenges and opportunities. The findings suggest that a combination of public-private partnerships, contracting, and regulation have been used by governments to influence private sector involvement. Government strategies to engage the private sector developed quickly, reflecting the importance of private services to populations. However, implementation of regulatory responses, especially in the health sector, has often been weak reflecting the difficulty governments have in ensuring affordable, quality private services. Lessons for future pandemics and other health emergencies include the need to ensure that essential non-pandemic health services in the government and non-government sector can continue despite elevated risks, surge capacity to minimize shortages of vital public health supplies is available, and plans are in place to ensure private workplaces remain safe and livelihoods protected.
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Affiliation(s)
- Lauren J Wallace
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Irene Agyepong
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | | | - Mahua Das
- Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Rumana Huque
- Department of Economics, University of Dhaka, and ARK Foundation, Dhaka, Bangladesh
| | | | - Chinyere Mbachu
- Health Policy Research Group, The College of Medicine, University of Nigeria, Enugu Campus, Nsukka, Nigeria
| | - Baby Naznin
- Centre of Excellence for Urban Equity and Health, Brac James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Justice Nonvignon
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Obinna Onwujekwe
- Health Policy Research Group, The College of Medicine, University of Nigeria, Enugu Campus, Nsukka, Nigeria
| | | | - Zahidul Quayyum
- Centre of Excellence for Urban Equity and Health, Brac James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Tim Ensor
- Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Helen Elsey
- Department of Health Sciences, University of York, York, United Kingdom
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15
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Baral S, Pokhrel A, B.K. SK, Kshetri R, Regmi P, Gyawali P. Dyslipidemia among Patients with Ischemic Stroke in the Department of Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:511-516. [PMID: 35690976 PMCID: PMC9275451 DOI: 10.31729/jnma.7491] [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] [Received: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Stroke is a leading cause of morbidity and disability in Asian population. Dyslipidemia is considered a major risk factor for various cardiovascular diseases. The study aimed to find the prevalence of dyslipidemia among patients with ischemic stroke in the Department of Medicine of a tertiary care centre. Methods This is a descriptive cross-sectional study conducted among 150 diagnosed cases of ischemic stroke admitted in the Department of Medicine from 1st October, 2020 to 1st October, 2021. The ethical clearance was taken from the Institutional Review Committee (Reference number: 358/2077/78). Fasting blood samples were collected from the patients, serum lipids were measured and atherogenic indices of plasma were calculated. Demographic, anthropometric and cardiovascular risk factors related data were collected. Data were entered in Microsoft Excel 2010 and analysis was using the Statistical Package for the Social Sciences version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data, and mean and standard deviation for continuous data. Results The prevalence of dyslipidemia among the ischemic stroke patients was 120 (80.00%) (73.60-86.40 at 95% Confidence Interval). High total cholesterol was found in 64 (53.33%) patients, high triglycerides in 70 (58.33%), high low-density lipoprotein cholesterol in 54 (45.00%) and low high-density lipoprotein cholesterol in 51 (42.50%) patients. Conclusions The prevalence of dyslipidemia among ischemic stroke patients was higher than the studies done in similar settings. Keywords dyslipidemia; ischemic stroke; lipid; prevalence.
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Affiliation(s)
- Sushil Baral
- Department of Internal Medicine, National Academy of Medical Science, Bir Hospital, Mahabouddha, Kathmandu, Nepal,Correspondence: Dr Sushil Baral, National Academy of Medical Science, Bir Hospital, Mahabouddha, Kathmandu, Nepal. , Phone: +977-9841371800
| | - Asmita Pokhrel
- Department of Biochemistry, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | | | - Rupesh Kshetri
- University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Prashant Regmi
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Prajwal Gyawali
- School of Health and Medical Sciences, University of Southern Queensland, Queensland, Australia
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16
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Jones N, Mitchell J, Cooke P, Baral S, Arjyal A, Shrestha A, King R. Gender and Antimicrobial Resistance: What Can We Learn From Applying a Gendered Lens to Data Analysis Using a Participatory Arts Case Study? Front Glob Womens Health 2022; 3:745862. [PMID: 35720810 PMCID: PMC9199426 DOI: 10.3389/fgwh.2022.745862] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance (AMR), the natural process by which bacteria become resistant to the medicines used to kill them, is becoming one of the greatest threats to health globally. AMR is accelerating at alarming rates due to behaviors across human, animal, and environmental health sectors as well as governance and policy shortfalls across each sector. Antimicrobial resistant infections occur through the same channels as other infectious diseases and are most common in countries/areas where there is limited access to improved sanitation facilities, reliable healthcare and health education. At the community level, much remains to be understood about the drivers of antimicrobial resistance and how to generate community-led, acceptable solutions. Gender can influence every part of an individual's health experiences; access to knowledge, healthcare facilities, financial resources and paid employment are all heavily gendered and influence behaviors relating to the procurement of antimicrobial and antibiotic agents. This analysis uses data gathered during a participatory video study designed to work with two communities in Nepal to understand drivers of antibiotic mis and over use from the perspective of the communities themselves. Findings reveal that gender impacts upon many aspects of AMR-driving behaviors within this community and stimulate essential discussion as to the importance of gender in future AMR research. This paper places a spotlight on gender in the wider AMR conversation, an area that is currently neglected, and improve our collective knowledge on the drivers of AMR from a gendered perspective.
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Affiliation(s)
- Nichola Jones
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Paul Cooke
- Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| | | | | | | | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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17
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Martineau T, Ozano K, Raven J, Mansour W, Bay F, Nkhoma D, Badr E, Baral S, Regmi S, Caffrey M. Improving health workforce governance: the role of multi-stakeholder coordination mechanisms and human resources for health units in ministries of health. Hum Resour Health 2022; 20:47. [PMID: 35619105 PMCID: PMC9134719 DOI: 10.1186/s12960-022-00742-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/15/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND A cohesive and strategic governance approach is needed to improve the health workforce (HW). To achieve this, the WHO Global Strategy on Human Resources for Health (HRH) promotes mechanisms to coordinate HRH stakeholders, HRH structures and capacity within the health sector to support the development and implementation of a comprehensive HW agenda and regular reporting through WHO's National Health Workforce Accounts (NHWA). METHODS Using an adapted HRH governance framework for guidance and analysis, we explored the existence and operation of HRH coordination mechanisms and HRH structures in Malawi, Nepal, Sudan and additionally from a global perspective through 28 key informant interviews and a review of 165 documents. RESULTS A unified approach is needed for the coordination of stakeholders who support the timely development and oversight of an appropriate costed HRH strategy subsequently implemented and monitored by an HRH unit. Multiple HRH stakeholder coordination mechanisms co-exist, but the broader, embedded mechanisms seemed more likely to support and sustain a comprehensive intersectoral HW agenda. Including all stakeholders is challenging and the private sector and civil society were noted for their absence. The credibility of coordination mechanisms increases participation. Factors contributing to credibility included: high-level leadership, organisational support and the generation and availability of timely HRH data and clear ownership by the ministry of health. HRH units were identified in two study countries and were reported to exist in many countries, but were not necessarily functional. There is a lack of specialist knowledge needed for the planning and management of the HW amongst staff in HRH units or equivalent structures, coupled with high turnover in many countries. Donor support has helped with provision of technical expertise and HRH data systems, though the benefits may not be sustained. CONCLUSION While is it important to monitor the existence of HRH coordination mechanisms and HRH structure through the NHWA, improved 'health workforce literacy' for both stakeholders and operational HRH staff and a deeper understanding of the operation of these functions is needed to strengthen their contribution to HW governance and ultimately, wider health goals.
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Affiliation(s)
- Tim Martineau
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Wesam Mansour
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Fiona Bay
- Friends of Waldorf Education, Stuttgart, Germany
| | | | | | | | | | - Margaret Caffrey
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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18
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Baral S, Baral BK, Sharma P, Shrestha SL. Dried rhododendron flower ingestion presenting with bradycardia and hypotension: a case report. J Med Case Rep 2022; 16:189. [PMID: 35551667 PMCID: PMC9101929 DOI: 10.1186/s13256-022-03413-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Rhododendron toxicity can be a life-threatening situation when manifested; it results in bradycardia and hypotension. Treatment remains challenging when it is complicated with refractory hypotension involving the multiorgan system if not treated early. Case presentation A 33-year-old Magar male presented with history of ingestion of two handfuls of white rhododendron flower. He had ingested the flowers believing that it would help relieve the pain and remove the materials stuck in his food pipe. Symptoms presented included muscular discomfort, dizziness, nausea, palpitation, tingling sensation around the face and lips, difficulty breathing, chest tightness, and difficulty swallowing within 4–5 hours after the ingestion of the dried flower. High-flow oxygen, intravenous fluids, atropine, and other supportive measures were used during the emergency, followed later by transfer to the intensive care unit for further observation. Conclusion The patient was discharged with complete recovery after 2 days of hospital stay. Intentional or accidental ingestion of toxic plants can be severe or even life-threatening. Thus, clinicians should be familiar with local toxic plants with grayanotoxin action.
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Affiliation(s)
- Sushil Baral
- Department of Internal Medicine, Bir hospital, National Academy of Medical Sciences (NAMS), Kathmandu, Nepal. .,Vinayak Hospital and Maternity Home Pvt. Ltd, Kathmandu, Nepal.
| | - Binaya Kumar Baral
- Department of Biochemistry, Nepal Medical College, Jorpati, Kathmandu, Nepal
| | - Pranit Sharma
- Vinayak Hospital and Maternity Home Pvt. Ltd, Kathmandu, Nepal
| | - Surendra Lal Shrestha
- Department of Internal Medicine, Bir hospital, National Academy of Medical Sciences (NAMS), Kathmandu, Nepal.,Vinayak Hospital and Maternity Home Pvt. Ltd, Kathmandu, Nepal
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19
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Baral S. T184 HbA1c and serum uric acid to creatinine ratio: A predictor of kidney diseases in association with estimated glomerular filtration rate in type 2 diabetes patients. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.663] [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]
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Elsey H, Al Azdi Z, Regmi S, Baral S, Fatima R, Fieroze F, Huque R, Karki J, Khan DM, Khan A, Khan Z, Li J, Noor M, Arjyal A, Shrestha P, Ullah S, Siddiqi K. Scaling up tobacco cessation within TB programmes: findings from a multi-country, mixed-methods implementation study. Health Res Policy Syst 2022; 20:43. [PMID: 35436896 PMCID: PMC9014631 DOI: 10.1186/s12961-022-00842-1] [Citation(s) in RCA: 2] [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] [Received: 09/27/2021] [Accepted: 03/22/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brief behavioural support can effectively help tuberculosis (TB) patients quit smoking and improve their outcomes. In collaboration with TB programmes in Bangladesh, Nepal and Pakistan, we evaluated the implementation and scale-up of cessation support using four strategies: (1) brief tobacco cessation intervention, (2) integration of tobacco cessation within routine training, (3) inclusion of tobacco indicators in routine records and (4) embedding research within TB programmes. METHODS We used mixed methods of observation, interviews, questionnaires and routine data. We aimed to understand the extent and facilitators of vertical scale-up (institutionalization) within 59 health facility learning sites in Pakistan, 18 in Nepal and 15 in Bangladesh, and horizontal scale-up (increased coverage beyond learning sites). We observed training and surveyed all 169 TB health workers who were trained, in order to measure changes in their confidence in delivering cessation support. Routine TB data from the learning sites were analysed to assess intervention delivery and use of TB forms revised to report smoking status and cessation support provided. A purposive sample of TB health workers, managers and policy-makers were interviewed (Bangladesh n = 12; Nepal n = 13; Pakistan n = 19). Costs of scale-up were estimated using activity-based cost analysis. RESULTS Routine data indicated that health workers in learning sites asked all TB patients about tobacco use and offered them cessation support. Qualitative data showed use of intervention materials, often with adaptation and partial implementation in busy clinics. Short (1-2 hours) training integrated within existing programmes increased mean confidence in delivering cessation support by 17% (95% CI: 14-20%). A focus on health system changes (reporting, training, supervision) facilitated vertical scale-up. Dissemination of materials beyond learning sites and changes to national reporting forms and training indicated a degree of horizontal scale-up. Embedding research within TB health systems was crucial for horizontal scale-up and required the dynamic use of tactics including alliance-building, engagement in the wider policy process, use of insider researchers and a deep understanding of health system actors and processes. CONCLUSIONS System-level changes within TB programmes may facilitate routine delivery of cessation support to TB patients. These strategies are inexpensive, and with concerted efforts from TB programmes and donors, tobacco cessation can be institutionalized at scale.
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Affiliation(s)
- Helen Elsey
- Department of Health Sciences, University of York, Heslington, Y010 5DD, UK.
| | - Zunayed Al Azdi
- ARK Foundation, Suite C-3, C-4, House # 06, Road # 109, Gulshan-2, Bangladesh
| | | | - Sushil Baral
- HERDi, Prasuti Griha Marg, Kathmandu, 44600, Nepal
| | - Razia Fatima
- Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
| | - Fariza Fieroze
- ARK Foundation, Suite C-3, C-4, House # 06, Road # 109, Gulshan-2, Bangladesh
| | - Rumana Huque
- ARK Foundation, Suite C-3, C-4, House # 06, Road # 109, Gulshan-2, Bangladesh
| | - Jiban Karki
- Department of Health Sciences, University of York, Heslington, Y010 5DD, UK
| | | | - Amina Khan
- The Initiative, Orange Grove Farm, Main Korung Road, Malpur, Bani Gala, Islamabad, Pakistan
| | - Zohaib Khan
- Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, 25100, Khyber Pakhtunkhwa, Pakistan
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, Y010 5DD, UK
| | - Maryam Noor
- The Initiative, Orange Grove Farm, Main Korung Road, Malpur, Bani Gala, Islamabad, Pakistan
| | | | | | - Safat Ullah
- Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, 25100, Khyber Pakhtunkhwa, Pakistan
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, Y010 5DD, UK
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Saville NM, Kharel C, Morrison J, Harris-Fry H, James P, Copas A, Giri S, Arjyal A, Beard BJ, Haghparast-Bidgoli H, Skordis J, Richter A, Baral S, Hillman S. Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women's groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal. Trials 2022; 23:183. [PMID: 35232469 PMCID: PMC8886560 DOI: 10.1186/s13063-022-06043-z] [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: 05/24/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaemia in pregnancy remains prevalent in Nepal and causes severe adverse health outcomes. METHODS This non-blinded cluster-randomised controlled trial in the plains of Nepal has two study arms: (1) Control: routine antenatal care (ANC); (2) Home visiting, iron supplementation, Participatory Learning and Action (PLA) groups, plus routine ANC. Participants, including women in 54 non-contiguous clusters (mean 2582; range 1299-4865 population) in Southern Kapilbastu district, are eligible if they consent to menstrual monitoring, are resident, married, aged 13-49 years and able to respond to questions. After 1-2 missed menses and a positive pregnancy test, consenting women < 20 weeks' gestation, who plan to reside locally for most of the pregnancy, enrol into trial follow-up. Interventions comprise two home-counselling visits (at 12-21 and 22-26 weeks' gestation) with iron folic acid (IFA) supplement dosage tailored to women's haemoglobin concentration, plus monthly PLA women's group meetings using a dialogical problem-solving approach to engage pregnant women and their families. Home visits and PLA meetings will be facilitated by auxiliary nurse midwives. The hypothesis is as follows: Haemoglobin of women at 30 ± 2 weeks' gestation is ≥ 0.4 g/dL higher in the intervention arm than in the control. A sample of 842 women (421 per arm, average 15.6 per cluster) will provide 88% power, assuming SD 1.2, ICC 0.09 and CV of cluster size 0.27. Outcomes are captured at 30 ± 2 weeks gestation. Primary outcome is haemoglobin concentration (g/dL). Secondary outcomes are as follows: anaemia prevalence (%), mid-upper arm circumference (cm), mean probability of micronutrient adequacy (MPA) and number of ANC visits at a health facility. Indicators to assess pathways to impact include number of IFA tablets consumed during pregnancy, intake of energy (kcal/day) and dietary iron (mg/day), a score of bioavailability-enhancing behaviours and recall of one nutrition knowledge indicator. Costs and cost-effectiveness of the intervention will be estimated from a provider perspective. Using constrained randomisation, we allocated clusters to study arms, ensuring similarity with respect to cluster size, ethnicity, religion and distance to a health facility. Analysis is by intention-to-treat at the individual level, using mixed-effects regression. DISCUSSION Findings will inform Nepal government policy on approaches to increase adherence to IFA, improve diets and reduce anaemia in pregnancy. TRIAL REGISTRATION ISRCTN 12272130 .
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Affiliation(s)
- Naomi M Saville
- Institute for Global Health, University College London (UCL), London, UK.
| | | | - Joanna Morrison
- Institute for Global Health, University College London (UCL), London, UK
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Philip James
- Department of Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Andrew Copas
- Institute for Global Health, University College London (UCL), London, UK
| | - Santosh Giri
- HERD International, Thapathali, Kathmandu, Nepal
| | | | | | | | - Jolene Skordis
- Institute for Global Health, University College London (UCL), London, UK
| | - Adam Richter
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sushil Baral
- HERD International, Thapathali, Kathmandu, Nepal.,Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - Sara Hillman
- Institute for Women's Health, University College London (UCL), London, UK
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22
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Mansour W, Arjyal A, Hughes C, Gbaoh ET, Fouad FM, Wurie H, Kyaw HK, Tartaggia J, Hawkins K, Than KK, Kallon LH, Saad MA, Chand O, Win PM, Yamout R, Regmi S, Baral S, Theobald S, Raven J. Health systems resilience in fragile and shock-prone settings through the prism of gender equity and justice: implications for research, policy and practice. Confl Health 2022; 16:7. [PMID: 35189938 PMCID: PMC8860254 DOI: 10.1186/s13031-022-00439-z] [Citation(s) in RCA: 2] [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] [Received: 10/29/2021] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
Fragile and shock-prone settings (FASP) present a critical development challenge, eroding efforts to build healthy, sustainable and equitable societies. Power relations and inequities experienced by people because of social markers, e.g., gender, age, education, ethnicity, and race, intersect leading to poverty and associated health challenges. Concurrent to the growing body of literature exploring the impact of these intersecting axes of inequity in FASP settings, there is a need to identify actions promoting gender, equity, and justice (GEJ). Gender norms that emphasise toxic masculinity, patriarchy, societal control over women and lack of justice are unfortunately common throughout the world and are exacerbated in FASP settings. It is critical that health policies in FASP settings consider GEJ and include strategies that promote progressive changes in power relationships. ReBUILD for Resilience (ReBUILD) focuses on health systems resilience in FASP settings and is underpinned by a conceptual framework that is grounded in a broader view of health systems as complex adaptive systems. The framework identifies links between different capacities and enables identification of feedback loops which can drive or inhibit the emergence and implementation of resilient approaches. We applied the framework to four different country case studies (Lebanon, Myanmar, Nepal and Sierra Leone) to illustrate how it can be inclusive of GEJ concerns, to inform future research and support context responsive recommendations to build equitable and inclusive health systems in FASP settings.
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Affiliation(s)
- Wesam Mansour
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | | | - Emma Tiange Gbaoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Fouad Mohamed Fouad
- Faculty of Health and Sciences, American University in Beirut, Beirut, Lebanon
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | | | | | - Lansana Hassim Kallon
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Maya Abou Saad
- Faculty of Health and Sciences, American University in Beirut, Beirut, Lebanon
| | | | | | - Rouham Yamout
- Faculty of Health and Sciences, American University in Beirut, Beirut, Lebanon
| | | | | | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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23
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Shah M, Baral S, Adhikari RC. Erythrokeratoderma variabilis (EKV) - First Nepalese case documenting GJB3 mutation. Skin Health Dis 2021; 1:e63. [PMID: 35663771 PMCID: PMC9060094 DOI: 10.1002/ski2.63] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 11/28/2022]
Abstract
Erythrokeratoderma Variabilis (EKV) is a rare genodermatosis, characterized by variable erythematous and hyperkeratotic skin lesions. It is most often transmitted in autosomal dominant manner (AD). Casual mutations were found in the GJB3 and GJB4 genes encoding connexins 31 and 30.3, respectively. We report a 7-year-old girl with multiple dusky red and brown skin lesions on face, buttock, both arms and legs. This diagnosis was made on the basis of clinical and histological findings and further genetic analysis detected a G > C transition at position 125 of the coding sequence, which replaces arginine with a proline at residue 42 of the protein (R42P). Here, we report a first case of Nepalese patient with EKV resulting from the GJB3 mutation.
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Affiliation(s)
- M. Shah
- Department of DermatologyAnandaban HospitalThe Leprosy Mission NepalLalitpurNepal
| | - S. Baral
- Department of DermatologyAnandaban HospitalThe Leprosy Mission NepalLalitpurNepal
- Department of PathologyAnandaban HospitalThe Leprosy Mission NepalLalitpurNepal
| | - R. C. Adhikari
- Department of PathologyInstitute of MedicineMaharajgunj Medical CampusTribhuvan UniversityKathmanduNepal
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24
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Baral S, BK SK, kshetri R. Study of Triglyceride Glucose Index and Total Cholesterol/HDLc for Assessment of Cardiovascular Outcomes in Patients with Diabetes and Hypertension. Am Heart J 2021. [DOI: 10.1016/j.ahj.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Kayastha R, Mueller S, Yadav P, Kelman I, Boscor A, Saville N, Arjyal A, Baral S, Fordham M, Hearn G, Kostkova P. Do Women in Nepal Like Playing a Mobile Game? MANTRA: A Mobile Gamified App for Improving Healthcare Seeking Behavior in Rural Nepal. Front Public Health 2021; 9:645837. [PMID: 34805057 PMCID: PMC8603420 DOI: 10.3389/fpubh.2021.645837] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
In Low and Middle Income Countries (LMIC), one of the causes of maternal and child mortality is a lack of medical knowledge and consequently the inability to seek timely healthcare. Mobile health (mHealth) technology is gradually becoming a universal intervention platform across the globe due to ubiquity of mobile phones and network coverage. MANTRA is a novel mHealth intervention developed to tackle maternal and child health issues through a serious mobile game app in rural Nepal, which demonstrated a statistically significant knowledge improvement in rural women. This paper explores the perceptions and usability of the MANTRA app amongst rural women and Female Community Health Volunteers (FCHVs) in Nepal. Despite the challenges of a target user group with limited educational levels and low smartphone experience, all participants viewed the MANTRA app with approval and enthusiasm. They were willing to engage further with the mHealth intervention and to share their experience and knowledge with fellow community members. Participants also showed an increase in awareness of danger signs enabling them to make better informed health decisions in the future. FCHVs viewed the app as a validation tool providing and support for greater impact of their efforts in rural Nepal. Growing mobile ownership, network coverage and availability of smartphones along with acceptance of the prototype MANTRA app in rural communities suggest encouraging prospects for mHealth interventions to be incorporated in the national health infrastructure in Nepal and other LMICs.
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Affiliation(s)
- Rachya Kayastha
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Sonja Mueller
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Punam Yadav
- Centre for Gender and Disaster, Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Ilan Kelman
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Andrei Boscor
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Naomi Saville
- Institute for Global Health, University College London, London, United Kingdom
| | - Abriti Arjyal
- Health Research and Social Development Forum (HERD International), Kathmandu, Nepal
| | - Sushil Baral
- Health Research and Social Development Forum (HERD International), Kathmandu, Nepal
| | | | - Gareth Hearn
- Centre for Gender and Disaster, Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
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26
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Morrison J, Giri R, Arjyal A, Kharel C, Harris‐Fry H, James P, Baral S, Saville N, Hillman S. Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study. Matern Child Nutr 2021; 17 Suppl 1:e13170. [PMID: 34241951 PMCID: PMC8269150 DOI: 10.1111/mcn.13170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/01/2022]
Abstract
Maternal anaemia prevalence in low-income countries is unacceptably high. Our research explored the individual-, family- and community-level factors affecting antenatal care uptake, iron folic acid (IFA) intake and consumption of micronutrient-rich diets among pregnant women in the plains of Nepal. We discuss how these findings informed the development of a home visit and community mobilisation intervention to reduce anaemia in pregnancy. We used a qualitative methodology informed by the socio-ecological framework, conducting semi-structured interviews with recently pregnant women and key informants, and focus group discussions with mothers-in-law and fathers. We found that harmful gender norms restricted women's access to nutrient-rich food, restricted their mobility and access to antenatal care. These norms also restricted fathers' role to that of the provider, as opposed to the caregiver. Pregnant women, mothers-in-law and fathers lacked awareness about iron-rich foods and how to manage the side effects of IFA. Fathers lacked trust in government health facilities affecting access to care and trust in the efficacy of IFA. Our research informed interventions by (1) informing the development of intervention tools and training; (2) informing the intervention focus to engaging mothers-in-law and men to enable behaviour change; and (3) demonstrating the need to work in synergy across individual, family and community levels to address power and positionality, gender norms, trust in health services and harmful norms. Participatory groups and home visits will enable the development and implementation of feasible and acceptable strategies to address family and contextual issues generating knowledge and an enabling environment for behaviour change.
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Affiliation(s)
- Joanna Morrison
- UCL Institute for Global HealthUniversity College LondonLondonUK
| | | | | | | | - Helen Harris‐Fry
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Philip James
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Naomi Saville
- UCL Institute for Global HealthUniversity College LondonLondonUK
| | - Sara Hillman
- UCL Institute for Women's HealthUniversity College LondonLondonUK
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27
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Thomson DR, Bhattarai R, Khanal S, Manandhar S, Dhungel R, Gajurel S, Hicks JP, Duc DM, Ferdoush J, Ferdous T, Urmy NJ, Shawon RA, Long KQ, Poudel AN, Cartwright C, Wallace H, Ensor T, Baral S, Mashreky S, Huque R, Van Minh H, Elsey H. Addressing Unintentional Exclusion of Vulnerable and Mobile Households in Traditional Surveys in Kathmandu, Dhaka, and Hanoi: a Mixed-Methods Feasibility Study. J Urban Health 2021; 98:111-129. [PMID: 33108601 PMCID: PMC7873174 DOI: 10.1007/s11524-020-00485-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 10/27/2022]
Abstract
The methods used in low- and middle-income countries' (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanization and urbanization of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi and summarize feasibility of our innovative methods in terms of time, cost, skill requirements, and experiences. We used descriptive statistics and regression techniques to compare respondent characteristics in samples drawn with innovative versus standard survey designs and household definitions, adjusting for sample probability weights and clustering. Feasibility of innovative methods was evaluated using a thematic framework analysis of focus group discussions with survey field staff, and via survey planner budgets. We found that a common household definition excluded single adults (46.9%) and migrant-headed households (6.7%), as well as non-married (8.5%), unemployed (10.5%), disabled (9.3%), and studying adults (14.3%). Further, standard two-stage sampling resulted in fewer single adult and non-family households than an innovative area-microcensus design; however, two-stage sampling resulted in more tent and shack dwellers. Our survey innovations provided good value for money, and field staff experiences were neutral or positive. Staff recommended streamlining field tools and pairing technical and survey content experts during fieldwork. This evidence of exclusion of vulnerable and mobile urban populations in LMIC household surveys is deeply concerning and underscores the need to modernize survey methods and practices.
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Affiliation(s)
- Dana R Thomson
- Department of Demography and Social Statistics, University of Southampton, Highfield Campus Building 58, Southampton, SO17 1BJ, UK.
| | | | - Sudeepa Khanal
- Health Research and Social Development Forum-International, Kathmandu, Nepal
| | - Shraddha Manandhar
- Health Research and Social Development Forum-International, Kathmandu, Nepal
| | - Rajeev Dhungel
- Health Research and Social Development Forum-International, Kathmandu, Nepal
| | - Subash Gajurel
- Health Research and Social Development Forum-International, Kathmandu, Nepal
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | | | - Junnatul Ferdoush
- Centre for Injury Prevention and Research - Bangladesh, Dhaka, Bangladesh
| | - Tarana Ferdous
- Advancement through Research and Knowledge Foundation, Dhaka, Bangladesh
| | - Nushrat Jahan Urmy
- Centre for Injury Prevention and Research - Bangladesh, Dhaka, Bangladesh
| | - Riffat Ara Shawon
- Centre for Injury Prevention and Research - Bangladesh, Dhaka, Bangladesh
| | | | - Ak Narayan Poudel
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Chris Cartwright
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Hilary Wallace
- School of Medicine, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Sushil Baral
- Health Research and Social Development Forum-International, Kathmandu, Nepal
| | - Saidur Mashreky
- Centre for Injury Prevention and Research - Bangladesh, Dhaka, Bangladesh
| | - Rumana Huque
- Advancement through Research and Knowledge Foundation, Dhaka, Bangladesh
| | | | - Helen Elsey
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
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28
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Mueller S, Soriano D, Boscor A, Saville NM, Arjyal A, Baral S, Fordham M, Hearn G, Kayastha R, Kostkova P. MANTRA: Improving Knowledge of Maternal Health, Neonatal Health, and Geohazards in Women in Rural Nepal Using a Mobile Serious Game. Front Public Health 2020; 8:584375. [PMID: 33363082 PMCID: PMC7759478 DOI: 10.3389/fpubh.2020.584375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/17/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
Serious games, conveying educational knowledge rather than merely entertainment, are a rapidly expanding research domain for cutting-edge educational technology. Digital interventions like serious games are great opportunities to overcome challenges in low-and-middle-income countries that limit access to health information, such as social barriers like low-literacy and gender. MANTRA: Increasing maternal and child health resilience before, during and after disasters using mobile technology in Nepal takes on these challenges with a novel digital health intervention; a serious mobile game aimed at vulnerable low-literacy female audiences in rural Nepal. The serious game teaches 28 learning objectives of danger signs in geohazards, maternal, and neonatal health to improve knowledge and self-assessment of common conditions and risks to inform healthcare-seeking behavior. Evaluations consisted of recruiting 35 end users to participate in a pre-test assessment, playing the game, post-test assessment, and focus groups to elicit qualitative feedback. Assessments analyzed knowledge gain in two ways; by learning objective with McNemar tests for each learning objective, and by participant scores with paired t-tests of overall scores and by module. Results of assessments of knowledge gain by learning objective (McNemar tests) indicate participants had sufficient prior knowledge to correctly interpret and respond to 26% of pictograms (coded AA), which is a desirable result although without the possibility of improvement through the intervention. The geohazard module had greatest impact as 16% of responses showed knowledge gain (coded BA). The two most successful learning objectives showing statistically significant positive change were evidence of rockfalls and small cracks in the ground (p = < 0.05). Assessment of knowledge gain by participant scores (paired t-tests) showed the 35 participants averaged a 7.7 point improvement (p < 0.001) in the assessment (28 learning objectives). Average change in knowledge of subdivided module scores (each module normalized to 100 points for comparison) was greatest in the geohazard module (9.5 points, p < 0.001), then maternal health (7.4 points, p = 0.0067), and neonatal health (6.0 points, p = 0.013). This evaluation demonstrated that carefully designed digital health interventions with pictograms co-authored by experts and users can teach complex health and geohazard situations. Significant knowledge gain was demonstrated for several learning objectives while those with non-significant or negative change will be re-designed to effectively convey information.
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Affiliation(s)
- Sonja Mueller
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom.,Institute for Risk and Disaster Reduction Centre for Digital Public Health in Emergencies (dPHE), University College London, London, United Kingdom
| | - Delphine Soriano
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom.,Institute for Risk and Disaster Reduction Centre for Digital Public Health in Emergencies (dPHE), University College London, London, United Kingdom
| | - Andrei Boscor
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom.,Institute for Risk and Disaster Reduction Centre for Digital Public Health in Emergencies (dPHE), University College London, London, United Kingdom
| | - Naomi M Saville
- Institute for Global Health, University College London, London, United Kingdom
| | - Abriti Arjyal
- Health Research and Social Development Forum, Kathmandu, Nepal
| | - Sushil Baral
- Health Research and Social Development Forum, Kathmandu, Nepal
| | - Maureen Fordham
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom.,Institute for Risk and Disaster Reduction Centre for Gender and Disaster, University College London, London, United Kingdom
| | | | - Rachya Kayastha
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom.,Institute for Global Health, University College London, London, United Kingdom
| | - Patty Kostkova
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom.,Institute for Risk and Disaster Reduction Centre for Digital Public Health in Emergencies (dPHE), University College London, London, United Kingdom
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29
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Rawal LB, Kharel C, Yadav UN, Kanda K, Biswas T, Vandelanotte C, Baral S, Abdullah AS. Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study. BMJ Open 2020; 10:e040350. [PMID: 33318116 PMCID: PMC7737104 DOI: 10.1136/bmjopen-2020-040350] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/21/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal. DESIGN We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders' consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically. SETTING Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level. PARTICIPANTS We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6). RESULTS The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation. CONCLUSION Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW's capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.
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Affiliation(s)
- Lal B Rawal
- School of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, NSW, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia
- Translational Health Research Institute (THRI) and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | | | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kie Kanda
- School of Nursing and Midwifery, Western Sydney University, Australia, Sydney, New South Wales, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | | | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu 215347, China, Kunsan, China
- School of Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, USA
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30
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Mueller S, Soriano D, Boscor A, Saville N, Arjyal A, Baral S, Fordham M, Hearn G, Le Masson V, Kayastha R, Kostkova P. MANTRA: development and localization of a mobile educational health game targeting low literacy players in low and middle income countries. BMC Public Health 2020; 20:1171. [PMID: 32723317 PMCID: PMC7385876 DOI: 10.1186/s12889-020-09246-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/30/2019] [Accepted: 07/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile technology is increasingly important for delivering public health interventions to remote populations. This research study developed, piloted, and assessed a serious game for mobile devices that teaches geohazard, maternal, and neonatal health messages. This unique mHealth intervention aimed at low-literacy audiences in low resource settings is part of the Maternal and Neonatal Technologies in Rural Areas (MANTRA) project: Increasing maternal and child health resilience before, during, and after disasters using mobile technology in Nepal. METHODS The serious game was developed through a co-creation process between London and Kathmandu based researchers by email and video-calling, and face-to-face with local stakeholders in Nepal. The process identified core needs, developed appropriate pictograms and mechanics, and tailored the pilot serious game to the local cultural context. Evaluations and feedback from end users took place in rural villages and suburban Kathmandu in Province Three. Field evaluation sessions used mixed methods. Researchers observed game play and held focus group discussions to elicit qualitative feedback and understand engagement, motivation, and usability, and conducted a paired pre- and post-game knowledge assessment. RESULTS The MANTRA serious game is contextualized to rural Nepal. The game teaches 28 learning objectives in three modules: maternal health, neonatal health, and geohazards, through picture matching with immediate audio and visual feedback. User feedback from focus groups demonstrated high engagement, motivation, and usability of the game. CONCLUSIONS This MANTRA study is a unique mHealth intervention of a serious game to teach core health and geohazards messages to low-literacy audiences in rural Nepal. Although the mobile game is tailored for this specific context, the developmental process and insights could be transferable to the development of other games-based interventions and contextualized for any part of the world. Successfully targeting this low-literacy and illiterate audience makes the MANTRA development process the first of its kind and a novel research endeavor with potential for widespread impact and adoption following further game development. TRIAL REGISTRATION This project was approved by the University College London Ethics Committee in London, United Kingdom [10547/001], and the Nepal Health Research Council in Kathmandu, Nepal [Reg. No. 105/2017]. All participants provided informed written consent.
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Affiliation(s)
- Sonja Mueller
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK.
- Centre for Digital Public Health in Emergencies (dPHE), University College London, Gower Street, London, WC1E 6BT, UK.
| | - Delphine Soriano
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Centre for Digital Public Health in Emergencies (dPHE), University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrei Boscor
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Centre for Digital Public Health in Emergencies (dPHE), University College London, Gower Street, London, WC1E 6BT, UK
| | - Naomi Saville
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Abriti Arjyal
- Health Research and Social Development Forum, Prasuti Griha Marg, Kathmandu, 44600, Nepal
| | - Sushil Baral
- Health Research and Social Development Forum, Prasuti Griha Marg, Kathmandu, 44600, Nepal
| | - Maureen Fordham
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Centre for Gender and Disaster, University College London, Gower Street, London, WC1E 6BT, UK
| | | | - Virginie Le Masson
- Overseas Development Institute, 203 Blackfriars Road, London, SE1 8NJ, UK
| | - Rachya Kayastha
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Patty Kostkova
- Institute for Risk and Disaster Reduction, University College London, Gower Street, London, WC1E 6BT, UK
- Centre for Digital Public Health in Emergencies (dPHE), University College London, Gower Street, London, WC1E 6BT, UK
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Marston C, Arjyal A, Maskey S, Regmi S, Baral S. Using qualitative evaluation components to help understand context: case study of a family planning intervention with female community health volunteers (FCHVs) in Nepal. BMC Health Serv Res 2020; 20:685. [PMID: 32703196 PMCID: PMC7379347 DOI: 10.1186/s12913-020-05466-1] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/25/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Evaluations of health interventions are increasingly concerned with measuring or accounting for 'context'. How to do this is still subject to debate and testing, and is particularly important in the case of family planning where outcomes will inevitably be influenced by contextual factors as well as any intervention effects. We conducted an evaluation of an intervention where female community health volunteers (FCHVs) in Nepal were trained to provide better interpersonal communication on family planning. We included a context-orientated qualitative component to the evaluation. Here, we discuss the evaluation findings, specifically focusing on what was added by attending to the context. We explore and illustrate important dimensions of context that may also be relevant in future evaluation work. METHODS The evaluation used a mixed methods approach, with a qualitative component which included in-depth interviews with women of reproductive age, FCHVs, and family planning service providers. We conducted iterative, thematic analysis. RESULTS The life-history fertility and contraception narratives generated from the in-depth interviews contextualised the intervention, yielding nuanced data on contraceptive choices, needs, and areas for future action. For instance, it highlighted how women generally knew about effective contraceptive methods and were willing to use them: information was not a major barrier. Barriers instead included reports of providers refusing service when women were not in the fifth day of their menstrual cycle when this was unnecessary. Privacy and secrecy were important to some women, and risked being undermined by information sharing between FCHVs and health services. The qualitative component also revealed unanticipated positive effects of our own evaluation strategies: using referral slips seemed to make it easier for women to access contraception. CONCLUSIONS Life history narratives collected via in-depth interviews helped us understand pathways from intervention to effect from the user point of view without narrowly focusing only on the intervention, highlighting possible areas for action that would otherwise have been missed. By attending to context in a nuanced way in evaluations, we can build a body of evidence that not only informs future interventions within that context, but also builds better knowledge of contextual factors likely to be important elsewhere.
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Affiliation(s)
- Cicely Marston
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | | | | | | | - Sushil Baral
- HERD International, Thapathali, Kathmandu, Nepal
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Khatri GK, Tran TD, Baral S, Fisher J. Experiences of an earthquake during pregnancy, antenatal mental health and infants' birthweight in Bhaktapur District, Nepal, 2015: a population-based cohort study. BMC Pregnancy Childbirth 2020; 20:414. [PMID: 32689955 PMCID: PMC7370411 DOI: 10.1186/s12884-020-03086-5] [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: 07/10/2018] [Accepted: 07/02/2020] [Indexed: 01/10/2023] Open
Abstract
Background Infant birthweight is an important public health indicator that is a proxy of maternal and baby’s health. Earthquakes can cause acute distress, but can also contribute to chronic stress through long-term disruptions to social, economic and domestic circumstances. The aims of this study were to examine the direct effect of earthquake experiences on the birthweight of infants of women who experienced the 2015 Nepal Earthquakes during pregnancy and whether mental health mediated this relationship. Methods This is a prospective, population-based cohort study. Pregnant women in Bhaktapur District, Nepal who had experienced the 2015 earthquakes after conception were recruited. Baseline data were collected in structured individual interviews. Follow up was a short telephone interview two weeks after the baby’s birth. Infant birthweight recorded on the hospital-issued birth certificate. The direct effect of earthquake experiences on birthweight and the indirect effect via antenatal common mental disorders (CMDs) were tested using Sobel tests simultaneously. Results In total 497/498 women contributed baseline data and 469 (94.4%) women also provided the birth weight of their infants. In total 6% of infants had low birth weight (< 2.5 kg). The earthquake experiences did not have a significant direct effect on birthweight (p = 0.116). However, the effect of earthquake experiences had a significant indirect effect on infant birthweight via CMDs. When 15 covariates were controlled, women who had moderate to severe earthquake experiences had an increase of 1.58 scores of antenatal CMD symptoms that resulted in their babies being 20.50 g lighter than those who had low earthquake experiences (p = 0.026). Conclusions The findings from this study indicate that the relationship is mediated by the mental health of women during pregnancy. Data demonstrate that the mental health of women who are pregnant should be prioritised in post-disaster management not only because of the burden experienced by women but also because of the risk for the growth and development of their babies.
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Affiliation(s)
- Goma Kumari Khatri
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
| | - Thach Duc Tran
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | | | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
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Källander K, Ward C, Smith H, Bhattarai R, KC A, Timsina D, Lamichhane B, Maurel A, Ram Shrestha P, Baral S, McWhorter C, LaBarre P, de Cola MA, Baker K. Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal. Acta Paediatr 2020; 109:1207-1220. [PMID: 31762072 PMCID: PMC7318335 DOI: 10.1111/apa.15108] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 01/03/2023]
Abstract
AIM Pneumonia is the leading cause of child death after the neonatal period, resulting from late care seeking and inappropriate treatment. Diagnosis involves counting respiratory rate (RR); however, RR counting remains challenging for health workers and miscounting, and misclassification of RR is common. We evaluated the usability of a new automated RR counter, the Philips Children's Respiratory Monitor (ChARM), to Female Community Health Volunteers (FCHVs), and its acceptability to FCHVs and caregivers in Nepal. METHODS A cross-sectional study was conducted in Jumla district, Nepal. About 133 FCHVs were observed between September and December 2018 when using ChARM during 517 sick child consultations, 264 after training and 253 after 2 months of routine use of ChARM. Acceptability of the ChARM was explored using semi-structured interviews. RESULTS FCHV adherence to guidelines after 2 months of using ChARM routinely was 52.8% (95% CI 46.6-58.9). The qualitative findings suggest that ChARM is acceptable to FCHVs and caregivers; however, capacity constraints such as older age and low literacy and impacted device usability were mentioned. CONCLUSION Further research on the performance, cost-effectiveness and implementation feasibility of this device is recommended, especially among low-literate CHWs.
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Affiliation(s)
- Karin Källander
- Malaria Consortium London UK
- Programme Division Health Section UNICEF New York NY USA
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
| | | | | | | | - Ashish KC
- Health & Nutrition Section UNICEF Nepal Kathmandu Nepal
- Department of Women's and Children's Health International Maternal and Child Health (IMCH) Uppsala University Uppsala Sweden
| | | | - Bikash Lamichhane
- Department of Health Services Ministry of Health & Population Kathmandu Nepal
| | | | | | | | - Cindy McWhorter
- UNICEF Supply DivisionProduct Innovation CentreCopenhagen Denmark
| | - Paul LaBarre
- UNICEF Supply DivisionProduct Innovation CentreCopenhagen Denmark
| | | | - Kevin Baker
- Malaria Consortium London UK
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
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Ensor T, Bhattarai R, Manandhar S, Poudel AN, Dhungel R, Baral S, Hicks JP, Thomson D, Elsey H. From Rags to Riches: Assessing poverty and vulnerability in urban Nepal. PLoS One 2020; 15:e0226646. [PMID: 32023251 PMCID: PMC7001899 DOI: 10.1371/journal.pone.0226646] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/01/2019] [Indexed: 12/16/2022] Open
Abstract
Urbanisation brings with it rapid socio-economic change with volatile livelihoods and unstable ownership of assets. Yet, current measures of wealth are based predominantly on static livelihoods found in rural areas. We sought to assess the extent to which seven common measures of wealth appropriately capture vulnerability to poverty in urban areas. We then sought to develop a measure that captures the characteristics of one urban area in Nepal. We collected and analysed data from 1,180 households collected during a survey conducted between November 2017 and January 2018 and designed to be representative of the Kathmandu valley. A separate survey of a sub set of households was conducted using participatory qualitative methods in slum and non-slum neighbourhoods. A series of currently used indices of deprivation were calculated from questionnaire data. We used bivariate statistical methods to examine the association between each index and identify characteristics of poor and non-poor. Qualitative data was used to identify characteristics of poverty from the perspective of urban poor communities which were used to construct an Urban Poverty Index that combined asset and consumption focused context specific measures of poverty that could be proxied by easily measured indicators as assessed through multivariate modelling. We found a strong but not perfect association between each measure of poverty. There was disagreement when comparing the consumption and deprivation index on the classification of 19% of the sample. Choice of short-term monetary and longer-term capital approaches accounted for much of the difference. Those who reported migrating due to economic necessity were most likely to be categorised as poor. A combined index was developed to capture these dimension of poverty and understand urban vulnerability. A second version of the index was constructed that can be computed using a smaller range of variables to identify those in poverty. Current measures may hide important aspects of urban poverty. Those who migrate out of economic necessity are particularly vulnerable. A composite index of socioeconomic status helps to capture the complex nature of economic vulnerability.
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Affiliation(s)
- Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, England, United Kingdom
- * E-mail:
| | | | | | - Ak Narayan Poudel
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, England, United Kingdom
| | | | | | - Joseph P. Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, England, United Kingdom
| | - Dana Thomson
- Social Statistics, University of Southampton, Southampton, England, United Kingdom
| | - Helen Elsey
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, England, United Kingdom
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Mitchell J, Cooke P, Baral S, Bull N, Stones C, Tsekleves E, Verdezoto N, Arjyal A, Giri R, Shrestha A, King R. The values and principles underpinning community engagement approaches to tackling antimicrobial resistance (AMR). Glob Health Action 2019; 12:1837484. [PMID: 33198604 PMCID: PMC7682730 DOI: 10.1080/16549716.2020.1837484] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/13/2020] [Indexed: 11/06/2022] Open
Abstract
This paper presents seven values underpinning the application of Community Engagement (CE) approaches to the One Health challenge of antimicrobial resistance (AMR) developed during an international workshop in June 2019. We define a value as a quality or standard which a CE project is aiming for, whilst a principle is an objective which underpins the value and facilitates its achievement. The values of Clarity, Creativity, (being) Evidence-led, Equity, Interdisciplinarity, Sustainability and Flexibility were identified by a network of 40 researchers and practitioners who utilise CE approaches to tackle complex One Health challenges including, but not limited to, AMR. We present our understanding of these seven values and their underlying principles as a flexible tool designed to support stakeholders within CE for AMR projects. We include practical guidance on working toward each value, plus case studies of the values in action within existing AMR interventions. Finally, we consider the extent to which CE approaches are appropriate to tackle AMR challenges. We reflect on these in relation to the tool, and current literature for both CE and AMR research. Authors and co-producers anticipate this tool being used to scene-set, road map and trouble shoot the development, implementation, and evaluation of CE projects to address AMR and other One Health challenges. However, the tool is not prescriptive but responsive to the context and needs of the community, opening opportunity to build a truly collaborative and community-centred approach to AMR research.
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Affiliation(s)
- Jessica Mitchell
- Centre for World Cinemas and Digital Cultures, Faculty of Arts, Humanities and Cultures, University of Leeds, Woodhouse, UK
- University of Leeds, Woodhouse, UK
- Nuffield Centre for International Health and Development, Worsley Building University of Leeds, Woodhouse, England
| | - Paul Cooke
- Centre for World Cinemas and Digital Cultures, Faculty of Arts, Humanities and Cultures, University of Leeds, Woodhouse, UK
- University of Leeds, Woodhouse, UK
| | - Sushil Baral
- University of Leeds, Woodhouse, UK
- HERD International, Kathmandu, Nepal
| | - Naomi Bull
- University of Leeds, Woodhouse, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Stones
- University of Leeds, Woodhouse, UK
- School of Design, University of Leeds, Woodhouse, UK
| | - Emmanuel Tsekleves
- University of Leeds, Woodhouse, UK
- ImaginationLancaster, LICA, Lancaster University, Lancaster, UK
| | - Nervo Verdezoto
- University of Leeds, Woodhouse, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Abriti Arjyal
- University of Leeds, Woodhouse, UK
- HERD International, Kathmandu, Nepal
| | - Romi Giri
- University of Leeds, Woodhouse, UK
- HERD International, Kathmandu, Nepal
| | - Ashim Shrestha
- University of Leeds, Woodhouse, UK
- HERD International, Kathmandu, Nepal
| | - Rebecca King
- University of Leeds, Woodhouse, UK
- Nuffield Centre for International Health and Development, Worsley Building University of Leeds, Woodhouse, England
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Mirzoev T, Poudel AN, Gissing S, Doan TTD, Ferdous T, Regmi S, Duong MD, Baral S, Chand O, Huque R, Hoang VM, Elsey H. Is evidence-informed urban health planning a myth or reality? Lessons from a qualitative assessment in three Asian cities. Health Policy Plan 2019; 34:773-783. [PMID: 31603206 PMCID: PMC6913712 DOI: 10.1093/heapol/czz097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Accepted: 08/25/2019] [Indexed: 11/23/2022] Open
Abstract
City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself. We collected qualitative data between August 2017 and October 2018 using: in-depth interviews with key actors, document review and observations of planning events. Framework approach guided the data analysis. Health is one of competing priorities with multiple plans being produced within each city, using combinations of top-down, bottom-up and fragmented planning approaches. Mostly data from government information systems are used, which were perceived as good quality though often omits the urban poor and migrants. Key common influences on data use include constrained resources and limitations of current planning approaches, alongside data duplication and limited co-ordination within Dhaka's pluralistic system, limited opportunities for data use in Hanoi and inadequate and incomplete data in Pokhara. City governments have the potential to act as a hub for multi-sectoral planning. Our results highlight the tensions this brings, with health receiving less attention than other sector priorities. A key emerging issue is that data on the most marginalized urban poor and migrants are largely unavailable. Feasible improvements to evidence-informed urban health planning include increasing availability and quality of data particularly on the urban poor, aligning different planning processes, introducing clearer mechanisms for data use, working within the current systemic opportunities and enhancing participation of local communities in urban health planning.
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Affiliation(s)
- Tolib Mirzoev
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Ak Narayan Poudel
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Stefanie Gissing
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Thi Thuy Duong Doan
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Tarana Ferdous
- ARK Foundation, C4, House 6, Road 109, Gulshan 2, Dhaka-1212, Bangladesh
| | - Shophika Regmi
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Minh Duc Duong
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Sushil Baral
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Obindra Chand
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Rumana Huque
- ARK Foundation, C4, House 6, Road 109, Gulshan 2, Dhaka-1212, Bangladesh
| | - Van Minh Hoang
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Helen Elsey
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
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Boeckmann M, Noor M, Zahid R, Firoze F, Shresthra P, Khanal S, Regmi S, Baral S, Elsey H. Lessons from the field: Gender roles and researcher reflexivity in smoking cessation in South Asia. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In South Asia, dual epidemics of smoking and tuberculosis (TB) have contributed to a high burden of lung disease. To address these health risks, the TB & Tobacco study uses the TB diagnosis as a teachable moment and implements a behaviour support counselling intervention, conducted by TB health workers, for patients in Bangladesh, Nepal and Pakistan. In this region, smoking tobacco is perceived as problematic for women, and being confronted with questions on smoking from a health professional may be uncomfortable for men and women. Anticipating these challenges, we incorporated gender sensitivity into training of health workers.
Methods
During implementation of the cessation support in routine TB care, a process evaluation assessed interactions between participants and the intervention through interviews with health workers and patients with TB participating in the cessation program. This presentation focusses on a retrospective self-reflection on how we conceptualized gender roles based on prior research, and how research findings partially challenged these assumptions.
Findings
While parts of our interview findings point towards smoking as a stigmatized practice for women and some men in South Asia as expected, several male and female respondents across socio-economic and geographical spheres contradicted this assumption. We discovered that health workers’ self-efficacy and perceived smoking stigma among health workers influenced whether they discussed smoking with women or minors. Many patients, on the other hand, told us that they were interested in receiving help to cure their TB and were willing to talk to about smoking with their health workers and their family members.
Conclusions
Patients in this study were more open to talking about smoking than anticipated. When including gender sensitivity into the standard training for health workers, we should be careful not to increase doubts in health workers about addressing smoking with women.
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Affiliation(s)
- M Boeckmann
- Department of Environment and Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
- Department of Health Sciences, University of York, York, UK
| | - M Noor
- The Inititative, Islamabad, Pakistan
| | - R Zahid
- The Inititative, Islamabad, Pakistan
| | - F Firoze
- ARK Foundation, Dhaka, Bangladesh
| | | | | | - S Regmi
- HERD International, Kathmandu, Nepal
| | - S Baral
- HERD International, Kathmandu, Nepal
| | - H Elsey
- Department of Health Sciences, University of York, York, UK
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Mueller S, Soriano D, Boscor A, Saville NM, Arjyal A, Baral S, Fordham M, Hearn GJ, Kayastha R, Kostkova P. MANTRA: a serious game improving knowledge of maternal and neonatal health and geohazards in Nepal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mobile technology is increasingly important for delivering public health interventions to remote populations. This research study developed, piloted, and assessed a serious game for mobile devices that teaches geohazard, maternal, and neonatal health messages. This unique mHealth intervention aimed at low-literacy audiences in low resource settings is part of the Maternal and Neonatal Technologies in Rural Areas (MANTRA) project: Increasing maternal and child health resilience before, during, and after disasters using mobile technology in Nepal. Specifically, we assess impact of the serious game to improve knowledge gain in our target audience.
Methods
Co-creation with the MANTRA team and local stakeholders in Nepal identified core needs, developed appropriate pictograms and mechanics, and tailored the pilot game to the local cultural context. Through picture matching with immediate audio and visual feedback, the game teaches 28 learning objectives in three modules: maternal health, neonatal health, and geohazards. To assess the game, 35 participants were recruited in Kathmandu and villages in Kavre district. Sessions consisted of pre-test assessment, playing the game, post-test assessment, and a focus group to elicit qualitative feedback.
Results
The knowledge assessment quantified knowledge gain. Overall, the group averaged a normalized 6.8 point improvement (p = 0.000022). Change in the geohazard module was 9.5 points (p = 0.001), followed by maternal health (7.4 points, p = 0.007), and neonatal health (4.3 points, p = 0.83). Four learning objectives had statistically significant change (p < 0.05). Feedback demonstrated high engagement, motivation, and usability of the game.
Conclusions
This MANTRA study is a unique mhealth intervention of a serious game to teach core health and hazards messages to low-literacy audiences in rural Nepal. The pilot intervention demonstrated statistically significant knowledge improvement among participants.
Key messages
The pilot MANTRA mobile serious game intervention is a novel idea, to bring public health knowledge to difficult to reach vulnerable populations, including often ignored illiterate audiences. The pilot MANTRA mobile serious game intervention demonstrated a statistically significant knowledge improvement of geohazard, maternal, and neonatal health learning objectives among participants.
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Affiliation(s)
- S Mueller
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - D Soriano
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - A Boscor
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - N M Saville
- Institute for Global Health, University College London, London, UK
| | - A Arjyal
- Health Research and Social Development, Kathmandu, Nepal
| | - S Baral
- Health Research and Social Development, Kathmandu, Nepal
| | - M Fordham
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - G J Hearn
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - R Kayastha
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - P Kostkova
- Institute for Risk and Disaster Reduction, University College London, London, UK
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Baral S, Hamal AB, BK SK, Gupta S, Sigdel M, Mandal LP. Assessment of lipid abnormalities and Cardiovascular Risk indices in Type 2 Diabetes Mellitus. Asian J Med Sci 2019. [DOI: 10.3126/ajms.v10i6.25337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Incidence of cardiovascular events is increased to two to four times among diabetic patients when compared with non-diabetic. Dyslipidaemia in diabetes is major risk factor for cardiovascular events. Atherogenic indices have been used as major laboratory measures in clinical practice to assess cardiovascular risk. Recent studies, have shown that non-high-density lipoprotein cholesterol and other atherogenic indices is like or better than LDL-C alone in the prediction of CVD incidence and mortality.
Aim and Objectives: The aim of this study is to assess the lipid abnormalities with cardiovascular risk using atherogenic coefficient (Ac), Cardiac Risk Ratio (TC/HDLc and LDLc/HDLc), TG/HDLc and Non- HDL in diabetes patients.
Materials and Methods: A cross-sectional descriptive study conducted at Bir hospital (tertiary care center) Nepal. Patients diagnosed as diabetes with age 30 years or above were selected in this study during a period of 1 yr.
Results: The mean age of the patients enrolled was 55.08±1.11 (34-81) year with male (52 %) to female (48%) ratio is 1.08:1. In this study the mean Non HDLc was 165.24±43.40 mg/dl (65-323) and AC was 4.0±1.09. The finding of AC was slightly higher in female compare to male i.e mean ±S.D 4.07±1.31 and 3.94±1.15. This study show the strong correlation of Non HDLc with total cholesterol (r=.990, p=0.000), LDLc(r=.602,p=0.000),TG (r=.411,p=0.000), LDLc/HDLc (r=.580,p=0.000),TC/HDLc ((r=.866,p=0.000), TG/HDLc (r=.390,p=0.000) and AC (p=0.866).
Conclusion: The association between abnormal lipid levels and cardiovascular risk is evident among patients with diabetes mellitus. In this study there is the correlation with FBS, Non HDL-c cholesterol, Cardio risk ratio, TG/HDLc, Atherogenic coefficient. Hence Non-HDL cholesterol and Atherogenic indices proves to be more sensitive and a better predictor of cardiovascular events in diabetes patients.
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Wang Y, Comins CA, Mulu A, Abebe SA, Belete K, Balcha TT, Baral S, Schwartz SR. Correction to: Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia. AIDS Behav 2019; 23:194. [PMID: 31542878 DOI: 10.1007/s10461-019-02674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The article "Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia" written by Y. Wang, C. A. Comins, A. Mulu, S. A. Abebe, K. Belete, T. T. Balcha, S. Baral, S. R. Schwartz, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 27th May 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 19th September 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
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Affiliation(s)
- Y Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St E7003, Baltimore, MD, 21231, USA
| | - C A Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St E7003, Baltimore, MD, 21231, USA.
| | - A Mulu
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - S A Abebe
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - K Belete
- United States Agency for International Development, Addis Ababa, Ethiopia
| | - T T Balcha
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - S Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St E7003, Baltimore, MD, 21231, USA
| | - S R Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St E7003, Baltimore, MD, 21231, USA
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Elsey H, Agyepong I, Huque R, Quayyem Z, Baral S, Ebenso B, Kharel C, Shawon RA, Onwujekwe O, Uzochukwu B, Nonvignon J, Aryeetey GC, Kane S, Ensor T, Mirzoev T. Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries. BMJ Glob Health 2019; 4:e001501. [PMID: 31297245 PMCID: PMC6577312 DOI: 10.1136/bmjgh-2019-001501] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/26/2019] [Accepted: 05/18/2019] [Indexed: 11/29/2022] Open
Abstract
The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the 'urban advantage', the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations.
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Affiliation(s)
- Helen Elsey
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Irene Agyepong
- Research and Development Division, Ghana Health Service, Accra, Greater Accra Region, Ghana
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Zahidul Quayyem
- Centre of Excellence for Urban Equity and Health, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | | | - Riffat Ara Shawon
- Public Health Research, Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
| | - Obinna Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine, Universiy of Nigeria, Enugu, Nigeria
| | - Justice Nonvignon
- School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | | | - Sumit Kane
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Ensor
- Nuffield Centre for Health, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Baral S. Association of HbA1c, serum uric acid and non HDL cholesterol in type 2 diabetes patients. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.572] [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: 11/27/2022]
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Baral S, Subedi HN, Paudel P, Chand PB, Shrestha MP, McCullough A, Raven J, Theobald S, Martineau T, Elsey H. Implementation research to assess a health workers performance-based management system in Nepal. Acta Paediatr 2018; 107 Suppl 471:24-34. [PMID: 30570792 DOI: 10.1111/apa.14406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/17/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
Abstract
AIM To test and refine a performance-based management system to improve health worker performance in Nepal. METHODS A mixed-methods implementation research in three districts. The study assessed health workers' job satisfaction at the start and end of the study. Qualitative techniques were used to document processes, and routine health service data were analysed to measure outcomes. RESULTS Job satisfaction significantly increased in six of nine key areas, and the proportion of staff absenteeism significantly declined in the study districts. It demonstrated an increase in immunisation coverage, the proportion of women who had a first antenatal check-up also having a fourth check-up and the proportion of childbirth in a health facility. The greatest perceived strengths of the system were its robust approach to performance planning and evaluation, supportive supervision, outcome-based job descriptions and a transparent reward system. A functional health facility environment, leadership and community engagement support successful implementation. CONCLUSION The performance-based management system has the potential to increase health workers' job satisfaction, and it offers a tool to link facility-wide human resource management. A collaborative approach, ownership and commitment of the health system are critical to success. Considering the Nepal context, a management system that demonstrates a positive improvement has potential for improved health care delivery.
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Affiliation(s)
- S Baral
- HERD International; Kathmandu Nepal
| | - HN Subedi
- Health Research and Social Development Forum; Kathmandu Nepal
| | - P Paudel
- HERD International; Kathmandu Nepal
| | - PB Chand
- Ministry of Health (Nepal); Kathmandu Nepal
| | | | - A McCullough
- South West Public Health Speciality Training Programme; Bristol UK
| | - J Raven
- Liverpool School of Tropical Medicine; Liverpool UK
| | - S Theobald
- Liverpool School of Tropical Medicine; Liverpool UK
| | - T Martineau
- Liverpool School of Tropical Medicine; Liverpool UK
| | - H Elsey
- Nuffield Centre for International Health and Development; University of Leeds; Leeds UK
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Elsey H, Poudel AN, Ensor T, Mirzoev T, Newell JN, Hicks JP, Cartwright C, Wong D, Tait C, Baral S, Bhattarai R, Khanal S, Dhungel R, Gajurel S, Manandhar S, Mashreky S, Ferdoush J, Huque R, Ferdous T, Nasreen S, Van Minh H, Duc DM, Ngoc B, Thomson D, Wallace H. Improving household surveys and use of data to address health inequities in three Asian cities: protocol for the Surveys for Urban Equity (SUE) mixed methods and feasibility study. BMJ Open 2018; 8:e024182. [PMID: 30478123 PMCID: PMC6254496 DOI: 10.1136/bmjopen-2018-024182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/07/2018] [Accepted: 10/02/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION As rapid urbanisation transforms the sociodemographic structures within cities, standard survey methods, which have remained unchanged for many years, under-represent the urban poorest. This leads to an overly positive picture of urban health, distorting appropriate allocation of resources between rural and urban and within urban areas. Here, we present a protocol for our study which (i) tests novel methods to improve representation of urban populations in household surveys and measure mental health and injuries, (ii) explores urban poverty and compares measures of poverty and 'slumness' and (iii) works with city authorities to understand, and potentially improve, utilisation of data on urban health for planning more equitable services. METHODS AND ANALYSIS We will conduct household surveys in Kathmandu, Hanoi and Dhaka to test novel methods: (i) gridded population sampling; (ii) enumeration using open-access online maps and (iii) one-stage versus two-stage cluster sampling. We will test reliability of an observational tool to categorise neighbourhoods as slum areas. Within the survey, we will assess the appropriateness of a short set of questions to measure depression and injuries. Questionnaire data will also be used to compare asset-based, consumption-based and income-based measures of poverty. Participatory methods will identify perceptions of wealth in two communities in each city. The analysis will combine quantitative and qualitative findings to recommend appropriate measures of poverty in urban areas. We will conduct qualitative interviews and establish communities of practice with government staff in each city on use of data for planning. Framework approach will be used to analyse qualitative data allowing comparison across city settings. ETHICS AND DISSEMINATION Ethical approvals have been granted by ethics committees from the UK, Nepal, Bangladesh and Vietnam. Findings will be disseminated through conference papers, peer-reviewed open access articles and workshops with policy-makers and survey experts in Kathmandu, Hanoi and Dhaka.
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Affiliation(s)
- Helen Elsey
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ak Narayan Poudel
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tim Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - James Nicholas Newell
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Christopher Cartwright
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Wong
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Caroline Tait
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sushil Baral
- Health Research and Social Development Forum—International, Kathmandu, Nepal
| | | | - Sudeepa Khanal
- Health Research and Social Development Forum—International, Kathmandu, Nepal
| | - Rajeev Dhungel
- Health Research and Social Development Forum—International, Kathmandu, Nepal
| | - Subash Gajurel
- Health Research and Social Development Forum—International, Kathmandu, Nepal
| | | | - Saidur Mashreky
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Junnatul Ferdoush
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Rumana Huque
- Advancement through Research and Knowledge (ARK Foundation), Dhaka, Bangladesh
| | - Tarana Ferdous
- Advancement through Research and Knowledge (ARK Foundation), Dhaka, Bangladesh
| | - Shammi Nasreen
- Advancement through Research and Knowledge (ARK Foundation), Dhaka, Bangladesh
| | - Hoang Van Minh
- Centre for Population Health Sciences, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
| | - Duong Minh Duc
- Centre for Population Health Sciences, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
| | - Bao Ngoc
- Centre for Population Health Sciences, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
| | - Dana Thomson
- Flowminder Foundation, Stockholm, Sweden
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
- Department of Social Statistics, University of Southampton, Southampton, UK
| | - Hilary Wallace
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
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Pavlovski B, Frishchikj J, Baral S, Olawore O, Atanasova S, Windle M, Antikj D, Holtzman M, Penaloza DA. Community based approaches to enhance access to health for Roma in Macedonia. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Pavlovski
- Association for Emancipation, Solidarity and Equality of Women - ESE, Skopje, Macedonia
| | - J Frishchikj
- Association for Emancipation, Solidarity and Equality of Women - ESE, Skopje, Macedonia
| | - S Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - O Olawore
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - S Atanasova
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - M Windle
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - D Antikj
- Association for Emancipation, Solidarity and Equality of Women - ESE, Skopje, Macedonia
| | - M Holtzman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Raven J, Baral S, Wurie H, Witter S, Samai M, Paudel P, Subedi HN, Martineau T, Elsey H, Theobald S. What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal. Health Res Policy Syst 2018; 16:6. [PMID: 29415738 PMCID: PMC5804047 DOI: 10.1186/s12961-018-0285-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health workers are critical to the performance of health systems; yet, evidence about their coping strategies and support needs during and post crisis is lacking. There is very limited discussion about how research teams should respond when unexpected crises occur during on-going research. This paper critically presents the approaches and findings of two health systems research projects that explored and evaluated health worker performance and were adapted during crises, and provides lessons learnt on re-orientating research when the unexpected occurs. METHODS Health systems research was adapted post crisis to assess health workers' experiences and coping strategies. Qualitative in-depth interviews were conducted with 14 health workers in a heavily affected earthquake district in Nepal and 25 frontline health workers in four districts in Ebola-affected Sierra Leone. All data were transcribed and analysed using the framework approach, which included developing coding frameworks for each study, applying the frameworks, developing charts and describing the themes. A second layer of analysis included analysis across the two contexts, whereas a third layer involved the research teams reflecting on the approaches used to adapt the research during these crises and what was learned as individuals and research teams. RESULTS In Sierra Leone, health workers were heavily stigmatised by the epidemic, leading to a breakdown of trust. Coping strategies included finding renewed purpose in continuing to serve their community, peer and family support (in some cases), and religion. In Nepal, individual determination, a sense of responsibility to the community and professional duty compelled staff to stay or return to their workplace. The research teams had trusting relationships with policy-makers and practitioners, which brought credibility and legitimacy to the change of research direction as well as the relationships to maximise the opportunity for findings to inform practice. CONCLUSIONS In both contexts, health workers demonstrated considerable resilience in continuing to provide services despite limited support. Embedded researchers and institutions are arguably best placed to navigate emerging ethical and social justice challenges and are strategically positioned to support the co-production of knowledge and ensure research findings have impact.
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Affiliation(s)
- Joanna Raven
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - Sushil Baral
- Health Research and Social Development Forum, Kathmandu, Nepal
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sophie Witter
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Pravin Paudel
- Health Research and Social Development Forum, Kathmandu, Nepal
| | - Hom Nath Subedi
- Health Research and Social Development Forum, Kathmandu, Nepal
| | - Tim Martineau
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen Elsey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sally Theobald
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Baral S, Adhikari A, Khanal R, Malla Y, Kunwar R, Basnyat B, Gauli K, Acharya RP. Invasion of alien plant species and their impact on different ecosystems of Panchase Area, Nepal. ACTA ACUST UNITED AC 2017. [DOI: 10.3126/banko.v27i1.18547] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aggressiveness of invasive alien plant species has been amidst the changing climate, which has necessitated further research in this area. The impact of invasive alien plant species in the Panchase area of Nepal was assessed through the forest resource assessment and other methodologies such as, household survey, group discussion, direct field observation, participatory cluster mapping, quadrat sampling, laboratory analysis, and GIS mapping. A total of nine major invasive species, in which Ageratum houstonianum and Ageratina adenophora were found spread throughout the ecosystem. The invasion was fueled by anthropogenic disturbances such as leaving the agricultural lands, fallow and degradation of habitat. As a consequence, native species such as Artemisia indica and Urtica dioica were outcompeted mostly in the fringes of fallow lands, agricultural lands and in the disturbed sites. The intrusion was, however, less in the forest area, implying that community-managed dense canopy forests are less susceptible to invasion and routine management can offset the negative effects of invasion. Even though many negative consequences of the invasion were observed in the study sites, the possibility of the economically exploiting the biomass of invasive alien plant species for generating income locally was noticed.Banko Janakari, Vol. 27, No. 1, page: 31-42
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Khanal S, Baral S, Shrestha P, Puri M, Kandel S, Lamichanne B, Elsey H, Brouwer M, Goel S, Chinnakali P. Yield of intensified tuberculosis case-finding activities using Xpert(®) MTB/RIF among risk groups in Nepal. Public Health Action 2016; 6:136-41. [PMID: 27358808 DOI: 10.5588/pha.16.0015] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/12/2016] [Indexed: 11/10/2022] Open
Abstract
SETTING Twenty-two districts of Nepal, where intensified case-finding (ICF) activities for tuberculosis (TB) were implemented among risk groups under the TB REACH initiative in collaboration with the National TB Programme from July 2013 to November 2015. OBJECTIVES To assess the yield of TB screening using an algorithm with smear microscopy followed by Xpert(®) MTB/RIF. DESIGN A descriptive study using routinely collected data. RESULTS Of 145 679 individuals screened, 28 574 (19.6%) had presumptive TB; 1239 (4.3%) of these were diagnosed with TB and 1195 (96%) were initiated on anti-tuberculosis treatment. The yield of screening was highest among people living with the human immunodeficiency virus (PLHIV) (6.1%), followed by household contacts (3.5%) and urban slum dwellers (0.5%). Among other risk groups, such as prisoners, factory workers, refugees and individuals with diabetes, the yield was less than 0.5%. The number needed to screen to diagnose an active TB case was 17 for PLHIV, 29 for household contacts and 197 for urban slum dwellers. Of 11 525 patients from ICF and the routine programme, 112 (1%) were diagnosed with multidrug-resistant TB. CONCLUSION There was a substantial yield of TB cases among risk groups such as PLHIV and household contacts. Although the yield in urban slum dwellers was found to be moderate, some intervention should nonetheless be targeted because of the large population and poor access to care in this group.
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Affiliation(s)
- S Khanal
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - S Baral
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - P Shrestha
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - M Puri
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - S Kandel
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - B Lamichanne
- National Tuberculosis Centre, Thimi, Bhaktapur, Nepal
| | - H Elsey
- Nuffield Centre for International Health and Development, Leeds Institute of Health Science, Leeds, UK
| | - M Brouwer
- PHTB Consult, Tilburg, The Netherlands
| | - S Goel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Chinnakali
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Marston C, Hinton R, Kean S, Baral S, Ahuja A, Costello A, Portela A. Community participation for transformative action on women's, children's and adolescents' health. Bull World Health Organ 2016; 94:376-82. [PMID: 27152056 PMCID: PMC4857226 DOI: 10.2471/blt.15.168492] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 11/27/2022] Open
Abstract
The Global strategy for women’s, children’s and adolescents’ health (2016–2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals.
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Affiliation(s)
- Cicely Marston
- London School of Hygiene & Tropical Medicine, London, England
| | - Rachael Hinton
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | - Stuart Kean
- World Vision International, Milton Keynes, England
| | - Sushil Baral
- Health Research and Social Development Forum (HERD), Kathmandu, Nepal
| | - Arti Ahuja
- Department of Health and Family Welfare, Government of Odisha, Bhubaneswar, India
| | - Anthony Costello
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Anayda Portela
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Stromdahl S, Hickson F, Pharris A, Sabido M, Baral S, Thorson A. A systematic review of evidence to inform HIV prevention interventions among men who have sex with men in Europe. ACTA ACUST UNITED AC 2015; 20. [PMID: 25953133 DOI: 10.2807/1560-7917.es2015.20.15.21096] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An estimated 42% of all newly diagnosed HIV cases in Europe in 2013 were transmitted during sex between men. This review was performed to identify and describe studies evaluating the efficacy and effectiveness of HIV prevention interventions among men who have sex with men (MSM), in relation to implementation data from European settings. A systematic search was performed individually for 24 interventions.Data were extracted from studies including efficacy or implementation data from European settings,appraised for efficacy, implementation and plausibility, and assigned a grade (1-4) according to the Highest Attainable Standard of Evidence (HASTE)framework. Four interventions (condom use, peer outreach,peer-led groups, and using universal coverage of antiretroviral treatment and treatment as prevention)were assigned the highest HASTE grade, 1. Another four interventions were assigned 2a for probable recommendation, including voluntary counseling and testing for HIV, using condom-compatible lubricant,using post-exposure prophylaxis, and individual counselling for MSM living with HIV. In addition, seven interventions were assigned a grade of 2b, for possible recommendation. Encouragingly, 15 interventions were graded to be strongly, probably or possibly recommended.In the relatively resource-rich European setting, there is an opportunity to provide global leadership with regard to the regional scale-up of comprehensive HIV prevention interventions for MSM.
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Affiliation(s)
- S Stromdahl
- Department of Public Health Sciences, Karolinska Institutet, Sweden
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