Global Public Health最新文献

This study centres the voices of providers currently working with the child and adolescent population to analyse social and structural factors that facilitate or impede access and service utilisation among children and adolescents. We conducted semistructured interviews with 15 psychological health care providers across 4 metropolitan cities in India. Thematic analysis was guided by an immersion-crystallization study design. Following this modified grounded theory approach, structural stigma emerged as a salient factor. Participant narratives revealed interconnecting forms of stigma encountered by adolescents. There was a preference for therapy over pharmacological interventions. Providers indicate the need for institutional and policy support for schools to promote mental health and well-being among children. Training lay counsellors, and initiating tele-mental health services in a large-scale manner could be effective ways to distribute caseloads and reach vulnerable populations without access to high-quality mental healthcare in their geographic vicinity.

The displaced Rohingya population residing in Cox's Bazar, Bangladesh, must navigate their reproductive lives in this fragile context. This study examines the knowledge, attitudes and use of menstrual regulation/pregnancy termination services in four displaced persons' camps to understand women's engagement with these services and barriers to safe services using Bandura's social cognitive theory. We conducted a household, community-based survey with women of reproductive age in 2022 (n = 1173). Ninety-two percent of respondents knew that health facilities provide pregnancy terminations, yet knowledge about when access is permissible is incomplete. Only one-third knew that this service could be provided 11-12 weeks after last menstrual period, with most respondents believing that the cutoff was earlier. The respondents believed that menstrual regulation was provided only under certain conditions, and 99% stated that a husband's consent should be required for a woman to end a pregnancy (always or sometimes). One in five respondents (n = 223) knew someone who had ended a pregnancy since arriving in the camps. While knowledge about and support for pregnancy termination services are high, there is room for improvement in education about the conditions under which it can be accessed. The results fill a knowledge gap regarding the acceptability and use of pregnancy termination in the Bangladesh camps of displaced Rohingya.

The COVID-19 pandemic profoundly impacted Indigenous populations worldwide, extending far beyond the biomedical outcomes of disease and mortality. This study explores the experiences of a Quechua-speaking Indigenous community on Amantaní Island, Peru, through a critical medical anthropology lens. Employing a participatory approach, we engaged with community members to explore the multifaceted impacts of COVID-19 on their health and wellbeing. Local facilitators used participatory methods to collect qualitative data from 10 men and 8 women during 2-day gender-segregated workshops within a larger four-year research study. The data were analysed thematically. Our findings reveal that COVID-19 intensified economic instability, social isolation, and educational disparities in Amantaní, with significant impacts on wellbeing. The interruption of tourism, a primary income source, caused severe financial hardship, while lockdowns disrupted social cohesion and access to services. Despite these challenges, the Amantaní communities implemented autonomous coping strategies: reviving ancestral practices such as bartering, developing new income-generating activities, and leveraging social networks for support. This study underscores the importance of addressing the structural determinants of health and integrating Indigenous knowledge systems into public health strategies. By highlighting pre-existing systemic inequities and community strengths, we advocate for equity-driven pandemic preparedness and response, emphasising the need for culturally competent healthcare and inclusive policymaking.

This study explores the perceptions of adolescents (10-19 years) and youth (20-24) toward sexual violence in Senegal and Ghana, their attitudes, and expected behaviors when witnessing such violence. The purpose of this paper is to add to the emerging literature on context-specific, gendered, and age-related norms surrounding sexual violence. Using a mixed-method approach, this study combined a survey (n = 1425) with semi-structured interviews, focus group discussions and photovoice with adolescents and youth. Results show that youth felt better informed than adolescents (71% vs. 31% in Ghana, p < 0.001; 68% vs. 57% in Senegal, p < 0.001). In Senegal, many believed sexual violence should not be openly discussed. Both countries showed evidence of normalization and victim-blaming influenced by socio-cultural practices. Youth in both countries were more willing to report violence but also showed more acceptance of intimate partner violence. The findings suggest that attitudes towards sexual violence are associated with contextual factors and community norms. Despite normalization, there seems to be potential for attitude change and better reporting. Programs should engage adolescents early, focusing on awareness, empowerment, and challenging victim-blaming while respecting cultural contexts.

South Africa is a critical hotspot in the global fight against sexual violence and HIV. We report on the development of Schools Championing Safe South Africa, a behavioural intervention that engages adolescent boys and their peers to identify and address misperceived norms related to these epidemics within the school setting. A social norms survey conducted among 1,431 students aged 13-19 at 3 high schools guided the development of intervention content. The survey captured self-reported and perceived peer sexual violence and HIV norms and behaviours. Analyses identified major misalignment (>20%) between perceived peer behaviours/norms and actual behaviours/norms. Perpetration of unwanted sexual petting, oral, vaginal, and anal sex was high: 61%, 53%, 53%, and 44% among boys, and 42%, 26%, 20%, and 18% among girls. We identified underestimation of peer support for bystander intervention, overestimation of peer acceptance of gender-based violence, and underestimation of the extent to which peers would believe a survivor. No misalignment between self and peer HIV risk behaviours were identified. Gaps between actual and perceived behaviours/norms are important targets to correct in a behavioural intervention. Given the interconnected risk factors associated with sexual violence and HIV, addressing them together presents a crucial opportunity to maximize prevention efforts.

This paper examines how shifting global health agendas focused on controlling the global HIV epidemic shape responsibilities among health system actors within a national HIV response. Focusing on South Africa-the country with the largest number of people living with HIV in the world-I examine two moments where such responsibilities were negotiated. First, the shift from a largely donor-funded programme to one of full government ownership, highlighting the tensions between donor and government implementers in this moment of change. Second, the shift in HIV treatment guidelines from eligibility based on disease progression to a 'treat all' approach in which all people living with HIV are immediately eligible for treatment. Drawing on ethnographic research conducted within South African HIV implementing organisations between 2011 and 2019, I explore how diverse health systems actors responded to evolving treatment landscapes and broader HIV agendas. I explain their actions, often out of sync with global HIV agendas, not as resistance, but as logical responses to constrained realities in context. The analysis demonstrates that as responsibility continues to shift amid declining external funding, prioritising embedded, context-specific knowledge will be essential for enabling pragmatic, locally tailored programme transitions and sustaining epidemic control.

Non-communicable diseases, driven by cardiovascular conditions and hypertension, account for 75% of global deaths. Hypertension affects 36% of adults in Africa, exceeding the global average of 33%. Rural areas show lower diagnosis and control rates, increasing risks of stroke and early mortality. Evidence of primary health care (PHC) interventions for hypertension in these regions are limited. This scoping review analysed data from seven databases to examine hypertension-focused PHC interventions in rural Africa. Guided by the TIDieR checklist, interventions were mapped across the hypertension care cascade to develop an implementation framework. Thirty-two publications were included, revealing limited use of explicit programme theories, inconsistent outcome reporting and poor fidelity assessment. Only a few studies involved community members or health care providers in co-design. Decentralized PHC management featured in 41% of studies, with 79% adopting a nurse-management model supported by community health workers. Fewer than two-thirds addressed all stages of the hypertension care cascade. Findings underscore the promise of decentralized, nurse-led, team-based models for hypertension control Future interventions should embed clear programme theories, standardized outcomes, co-production, and strong monitoring and evaluation systems. This resulting framework supports PHC teams in implementing hypertension services from screening through long-term control in rural African contexts.

Intimate partner violence (IPV) is a pervasive global health issue. Social norms supporting male dominance are key determinants of IPV. While targeting social norms is crucial for prevention, most intervention evaluations focus only on direct beneficiaries, overlooking diffusion effects to non-participants. This study used social network analysis to assess the diffusion effects of an IPV prevention intervention in Nepal. The participants included social network members (alters) of intervention beneficiaries (egos) across 13 communities in Nawalpur District (N = 258). Data were collected at baseline and midline (at the completion of the core curriculum). Using propensity score-adjusted GEE regression models for difference-in-difference estimates, we assessed intervention effects diffusion to alters of direct beneficiaries and alters of other participants compared to control participants' alters. The results showed both types of alters experienced significant increases in positive injunctive norms compared to control alters. Similar diffusion patterns were observed for financial decision-making, relationship quality and alcohol abuse. The effects diminished in low-closeness ego-alter pairs but remained significant in high-closeness relationships. Our study suggests that diffusion is an important change mechanism in IPV interventions, particularly for normative change, though effects vary depending on the outcome type and relationship closeness between participants and their social network members.

Two common consequences among persons with a physical health condition are internalised stigma associated with the physical illness and depression. Increased awareness and knowledge of both concepts might help professionals to better diagnose and deploy interventions that best suit the needs of people who experience these phenomena. Therefore, this study aimed to investigate to what extent and how internalised stigma and depression overlap. A Delphi study was conducted to create understanding and build consensus among experts. Over three survey rounds, experts in the field of stigma and depression (n = 24) were asked to determine whether signs/behaviours, symptoms/experiences, external factors and strategies or interventions were associated with internalised stigma, depression or both. Consensus was reached that internalised stigma and depression are common consequences of physical health conditions and are two separate but overlapping phenomena. The main difference between both were external factors, such as environmental (e.g. weather-driven mood fluctuations), or therapeutic (e.g. medication) aspects of depression. This study highlights the importance of raising awareness among professionals that internalised stigma and depression can co-occur, and that strategies and interventions are available for both. Improved awareness will lead to care that is more suitable to the individual's needs, therewith improving quality of life.

Despite the growing demand for assisted reproductive technologies (ART), access across Sub-Saharan Africa, remains limited, with only 21 countries offering such services. This qualitative study explores the perspectives of 20 healthcare practitioners in Zimbabwe and South Africa on the systemic barriers to effective ART provision. South Africa emerges as a regional leader with advanced facilities and strong training capacity, whereas Zimbabwe faces significant challenges, including limited infrastructure and inadequate professional development. Both countries, grapple with restricted funding and minimal government investment in infertility care, despite South Africa hosting three publicly funded ART clinics within its university hospital system. Four key themes were identified: (1) The Financial Burden of ART and Clinician Efforts to Facilitate Access for disadvantaged couples; (2) Lack of Government Investment and the Need for Fertility Training Infrastructure (3) Fertility Treatment: A Privilege of Urban Access and (4) Absence of Policy and Regulation in ART Practices. Public health-policies in Africa must prioritise infertility, ensuring equitable access to treatment. This requires government investment in health systems, local expertise, and regulatory frameworks. Framing infertility care within a public health and human rights agenda is crucial for dismantling stigma, addressing structural biases, and promoting reproductive justice through universal access to treatment.