Global Public Health最新文献

The economic, social and health impacts of the COVID-19 pandemic varied across population groups. This study aimed to provide a comprehensive view of the effects of socioeconomic constraints on sex workers' agency during the COVID-19 pandemic in Tunisia, using the analytical framework of intersectionality. We performed a thematic content analysis of semi-structured interviews conducted with sex workers (n = 19). Results highlighted the heavy burden of socioeconomic constraints on their agency, and specifically on their decision to continue sex work or not during the pandemic. The fact that there were fewer clients during the pandemic led to greater economic precarity, especially among mothers. Furthermore, interviewees - mostly cisgender male sex workers with same-sex practices - reported increased violence and discrimination by clients and the police. Participants also experienced difficulties accessing health care for themselves and for their children, including access to COVID-19 vaccination. This was especially true for women with a low educational level. Finally, sex workers' mental health was also strongly affected by the pandemic. Findings highlights the role of various intersecting socioeconomic conditions and structural vulnerabilities on sex workers' experience of the COVID-19 pandemic in Tunisia, in terms of health and their capacity to negotiate agency.

This study investigates how different forms of social capital influence the health literacy of community-dwelling older adults. Semi-structured interviews were conducted with 24 older adults aged 65 and above living in Hong Kong. Thematic analysis technique was employed to analyse the data. The findings showed that both structural and cognitive forms of social capital were available to most of the older adults. However, some struggled to access common forms of social capital, such as bonding and expressed distrust in their neighbours. Some respondents demonstrated sufficient health literacy (e.g. seeking a second medical opinion), while others had limited health literacy (e.g. difficulties seeking advice during medical consultations). The influence of social capital on older adults' health literacy was evident in four areas: (1) social capital and access to health information; (2) managing infodemic and evaluating healthcare information; (3) social capital and quality of healthcare; and (4) adverse influence of social capital for health literacy and health-related outcomes. Health literacy can impel older adults towards healthy ageing, and its reinforcement can be strengthened by incorporating various forms of social capital. This is because the health literacy of older adults is fundamentally tied to social interactions.

This qualitative study examined factors influencing Central American fathers' views and behaviours on the HPV vaccine for their 11-17-year-old children, aiming to identify barriers and facilitators to vaccination in this underrepresented group. Semi-structured interviews were conducted with 23 fathers (mean age = 44.2, SD = 8.2) from El Salvador, Guatemala, and Honduras (91.3% foreign-born, average U.S. residency = 18.1 years). About 70% were married or living with a partner, and nearly half (47.8%) had less than a high school education. Most had one child aged 11-17, with 70% of children born in the U.S. Findings revealed gaps in fathers' knowledge about HPV, its cancer-preventive benefits, and vaccine safety concerns. Cultural factors and gendered views on vaccination were prevalent. Around 33% of fathers reported that their children received an HPV vaccine recommendation, and all initiated vaccination. Fathers preferred receiving vaccine information from healthcare providers, highlighting their critical role in decision-making. Findings highlight the need for culturally tailored health promotion strategies aimed at Central American immigrant fathers. Public health campaigns should directly address vaccine safety concerns, incorporate cultural values, and emphasise the importance of informed decision-making, and engage healthcare providers to boost HPV vaccine uptake and reduce vaccine hesitancy in this population.

In the face of the COVID-19 pandemic, there have been renewed calls for more equitable vaccine access. These calls have in turn resulted in interventions to increase vaccine manufacturing capacity as one of the key interventions to address global vaccine access. However, skill gaps in manufacturing capacity point out the critical need for technology transfer and more open science. The World Health Organization-instituted mRNA hub in South Africa has been positioned as an initiative to facilitate technology transfer for building and leveraging vaccine manufacturing capacity in low and middle income countries. Our case study examines the activities of the mRNA vaccine hub, highlighting challenges that can stifle the long-term goals of equitable vaccine production if left unaddressed. The findings suggest that for technology transfer to be effective, there must be sufficient institutional commitment, adequate funding that is fit for purpose, clear terms and an enabling legal and socio-economic environment.

This article examines the history of population health surveillance in modern Africa, considering the Demographic and Health Survey (DHS) programme as a bridge between twentieth and twenty-first century epidemiology. Tracing this tradition of surveillance from pre-war Britain, through its extension into the British Empire, and its subsequent employment in post-colonial demography, this article makes two related arguments. The first, that surveys like the DHS complement and encourage economic logics in medicine. Focussing initially on questions of human capital, cross-sectional surveys have tended to promote and promise efficiency in terms of medical research and interventions, thereby reducing the need for extensive and expensive infrastructure. In Africa, this utility has meant that cross-sectional surveillance gained particular traction in the context of colonisation and again following the widespread implementation of Structural Adjustment Programmes from the early 1980s. The second argument takes that the collection of demographic and social data means that these surveys represent a unique form of surveillance medicine, one which encourages associations between illness, family, and society at large. Epidemiology drawn from these data promotes this pathologisation of population, binding the epistemology of contemporary Global Health to old ideas, and siting subaltern families and communities as a prime locus of disease.

The narrative framings of partnerships and interventions in global health shed light on actors' conceptualisations of international development. Ideas of equity and justice in North-South partnerships are increasingly centred in international development and global health policy approaches. However, the extent to which these are evident within practice requires further investigation. This paper critically examines published work from health actors based in Scotland conducted within low - and middle-income countries (LMICs), under a Scottish government policy context currently promoted as engaging in a novel approach to international development. The paper uses a scoping review to analyse Scottish actors' engagement and framing of global health interventions and partnerships with LMIC actors. A majority of the texts discussed Scottish-affiliated global health partnerships and/or interventions in the Malawian medical education and clinical medicine context and focused on capacity building and knowledge transfer. Authors of included documents characterised the 'Scottish approach' to partnership as rejecting the traditional donor-aid model and championing ideas of collaboration, reciprocity and equity in partnership. Yet simultaneously, most works described partnerships that positioned Scottish actors as the sources of expertise with partner country actors as beneficiaries, replicating the donor-recipient aid model. Additionally, the framing of partnership activities frequently deployed historical narrative frames.

Vaccinating health care workers (HCWs) is a common way to prevent influenza-related infection, transmission to patients and absenteeism of HCWs. In India, influenza contributes to 130,000 deaths per year, yet vaccination uptake of HCWs is low. Fifteen percent of the HCWs received one or more vaccinations in 5 years. This study explored the social context of influenza vaccine uptake among HCWs, including physicians, nurses and medical students at a teaching hospital in Mysuru, South India, to generate insights to inform influenza vaccination campaigns targeting HCWs. Qualitative methods, including in-depth interviews with HCWs and structured observations at various departments of the hospital were applied. The results indicate that influenza vaccination uptake among HCWs is low due to personal factors related to little perceived personal threat, emphasis on other prevention techniques to avoid transmission, cost of the vaccine and needle anxiety. Besides, institutional factors, absence of recommendations from superiors and lack of promotion campaigns contribute to low uptake. In conclusion, HCW vaccination education and promotion regarding diminishing personal and transmission risk of the influenza virus, uniform vaccination guidelines and strategies to improve access including for those who are burdened by the cost of the vaccine are suggested.

Displaced communities face risks to quality of life and health, such as poverty, crowded living conditions, exposure to environmental contaminants, and poor access to healthcare, highlighting areas for research on the challenges they endure. However, these communities are routinely subject to extractive research practices with little regard to local participation or sustainability. To facilitate better research, there is a need for tools and frameworks that enable more effective, ethical and equitable research. In this paper, we synthesise and compare eleven research guidelines and frameworks addressing research conducted in displaced and vulnerable populations with the goal of assessing utility and applicability of frameworks for displaced populations. Overall, we found that the level of detail varied between documents, and that while many frameworks were based on expert discussion, few were co-created with community input. Additionally, the frameworks often failed to address nuances between different displaced populations in key aspects of ethics and research. Moreover, in practice, the frameworks were not widely utilised for research in settings of forced displacement. Based on our analyses, we identify recommendations to improve current and future frameworks, including adding context and community feedback, increasing flexibility and adaptability in research practices, and generating strategies to promote framework uptake.