Global Public Health最新文献

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.

Stewardship of antibiotic medicines will likely play a key role in curtailing the rise of antimicrobial resistance (AMR) globally. In East Africa, drug sellers are a critical group for interventions because they often dispense without prescription and violate regulations designed to facilitate antibiotic stewardship. Currently, measures to tackle regulatory avoidance are often rooted in individuated cognitive-behavioural approaches that label sellers' actions as 'irrational'. This study, part of a larger interdisciplinary investigation of AMR drivers in East Africa, conducted in-depth interviews [n = 105] with drug sellers in Kenya, Tanzania and Uganda to explore sellers' accounts of their own behaviours. Its findings seem contradictory; sellers are aware of regulations and express a desire to comply, yet confirm non-compliance is common. The paper's contribution is to demonstrate that such behaviour is 'situationally rational' when contextualised within a broader socio-material assemblage of unenforced regulation, fierce market competition, relational customer interactions and professional commitment to communities in resource-poor healthcare settings. The paper concludes that an understanding of the structural and relational dynamics driving current behaviours is a necessary precondition for the design of new interventions bringing professional and commercial motivations into closer alignment, something which could make antibiotic stewardship situationally rational for sellers and customers alike.

Antimicrobial resistance (AMR) education has been highlighted in both global and national policies as essential for societal efforts to address AMR, with calls for interdisciplinary and intersectoral One Health approaches that involve actors throughout society, including conventional and traditional medical practitioners. While a key aim of AMR education is to reduce the infection burden and antimicrobial use, the potential to integrate these medical practices remains largely unexplored. This paper aims to explore conventional medical practitioners' perspectives on the opportunities and challenges of integrating traditional and conventional medicine to reduce antimicrobial use through infection prevention and alternative treatments as part of AMR education efforts. Using participatory research workshop methods, data from workshops at two Zimbabwean hospitals with health practitioners are presented. The results detail workshop participants' discussions regarding the challenges of misunderstandings and lack of scientific validation and the opportunities for collaboration based on mutual respect, education and training and legitimisation between the two medical practices for health practice integration. The paper contribution includes how community and patient centred AMR educational approaches can be a foundation for integration, highlighting how health care interventions and community empowerment can go hand in hand towards more resilient and culturally relevant AMR educational efforts focusing on prevention.