Global Public Health最新文献

Transfers between health facilities for postpartum women living with HIV are associated with disengagement from care. In South Africa, women must transfer from integrated antenatal/HIV care to general HIV services post-delivery. Thereafter, women transfer frequently e.g. due to geographic mobility. To explore barriers to transfer, we conducted in-depth interviews >2 years post-delivery in 28 participants in a trial comparing postpartum HIV care at primary health care (PHC) antiretroviral therapy (ART) facilities versus a differentiated service delivery model, the adherence clubs, which are the predominant model implemented in South Africa. Data were thematically analysed using inductive and deductive approaches. Women lacked information including where they could transfer to and transfer processes. Continuity mechanisms were affected when women transferred silently i.e. without informing facilities or obtaining referral letters. Silent transfers often occurred due to poor relationships with healthcare workers and were managed inconsistently. Fear of disclosure to family and community stigma led to transfers from local PHC ART facilities to facilities further away affecting accessibility. Mobility and the postpartum period presented unique challenges requiring specific attention. Information regarding long-term care options and transfer processes, ongoing counselling regarding disclosure and social support, and increased health system flexibility are required.

A growing body of evidence has shown the effects of poor preconception health on adverse pregnancy outcomes and, subsequently, maternal and child morbidity and mortality. However, the cost of poor preconception health remains relatively unexplored. Using the case of Nigeria, this study provides the first estimate of the disease and economic burden of poor preconception health at a country level. Using data from international databases and the scientific literature, the study used a cost-of-illness approach to quantify the foregone productivity and direct healthcare costs resulting from six preconception risk factors (adolescent pregnancy, short birth interval, overweight and obesity, intimate partner violence, female genital mutilation, folate deficiency). The results indicate that 6.7% of maternal deaths, 10.9% of perinatal deaths, and 10.5% of late neonatal deaths were attributable to the selected preconception risk factors in 2020. The economic burden of poor preconception health in Nigeria was estimated at US$ 3.3 billion in 2020, of which over 90% was generated by premature mortality. If prevalence rates remain constant, total economic losses could amount to US$ 46.2 billion by 2035. This analysis paves the way for further studies investigating the economic costs and benefits of preconception interventions and policies in low and middle-income countries.

As part of the strategy by the local municipal government to improve health services in Lurwaryizo community in Mbhashe Local Municipality in Eastern Cape province of South Africa, an investigation of the current healthcare delivery available to the community was implemented. A qualitative study using Focused Group Discussions (FGDs) on 12 recently trained Community Health Workers (CHWs), Community members in the 8 villages of the area, and 15 Traditional Medical Practitioners (TMPs), and an interview with the nurse who runs the only health center in the area was carried out. Our findings indicate that the overall healthcare delivery in the area is poor due to health manpower shortages and that CHWs and TMPs are currently indispensable to providing primary health care in the community. Compensation of CHWs is a major issue although their services were valued by their supervisor at the only health clinic. The involvement of local community participation in determining healthcare priorities will aid improved healthcare delivery, as well as more effective use of TMPs and CHWs. Recommendations for improving health in the community were also provided such as provision of health promotion services by CHWs and creating a cross-referral system with the formal health system for TMPs.

There is increased awareness of the gendered impacts of outbreaks, including an exacerbation of violence against women and disruptions to essential health service delivery for women. However, there is limited understanding of women's own experiences of deciding to use the health system after experiencing violence in settings affected by major emergent outbreaks like Ebola and COVID-19. Drawing on data from 37 in-depth interviews and 4 focus group discussions conducted in Sierra Leone we described survivors' help-seeking pathways and interactions with the health system. Deciding to seek help and selecting a source of support was dependant on how 'unacceptable' the type of violence was, women's needs (be they for physical, psychological or social trauma) and the risk versus benefit anticipated in accessing support. Informal providers such as local mediators were often the first place that survivors sought help. Pre-existing challenges around access and poor-quality service provision were exacerbated by the outbreaks. Fear of infection, quarantine and widespread distrust of the Ebola response shaped women's help-seeking especially if symptoms like bleeding could resemble the virus. Our findings support the need to re-orientate towards survivor-defined interventions that are flexible in providing a wider range of support choices.

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

Media reporting greatly influences the civilians' mentality, which further exacerbates or mitigates outbreaks of infectious diseases, prolongs or shortens the pandemic process. Adopting corpus linguistic methods and Discursive news values analysis (DNVA) framework, this study examined the news values through key words, naming strategies and photographs in monkeypox-themed news reporting in Spanish and the US media, to analyse how they constructed the monkeypox pandemic in their news reporting, sold it to the public and exacerbated the pandemic in the two societies. The results show that the Spanish media constructed the monkeypox pandemic predominantly as an international medical event, distancing the monkeypox pandemic from the Spanish indigenous context and depriving the domestic audiences from the sense of urgency to take prevention actions. On the other hand, the US media mainly packaged the monkeypox pandemic as a political event which isolated this public health crisis from the life of the common people and hindered the US citizens' understanding of the requisite medical information about the monkeypox virus. It is concluded that the lack of indigenous focus of the Spanish media, and the excessively politicised focus of the US media are important factors that lead to the exacerbation of the monkeypox epidemic.

Background: There is limited evidence on how to engage health workers as advocates in preventing female genital mutilation (FGM). This study assesses the feasibility, acceptability, appropriateness and impact of a person-centered communication (PCC) approach for FGM prevention among antenatal care (ANC) providers in Guinea, Kenya and Somalia.

Methods: Between August 2020 and September 2021, a cluster randomised trial was conducted in 180 ANC clinics in three countries testing an intervention on PCC for FGM prevention. A process evaluation was embedded, comprising in-depth interviews (IDIs) with 18 ANC providers and 18 ANC clients. A qualitative thematic analysis was conducted, guided by themes identified a priori and/or that emerged from the data.

Results: ANC providers and clients agreed that the ANC context was a feasible, acceptable and appropriate entry point for FGM prevention counselling. ANC clients were satisfied with how FGM-related information was communicated by providers and viewed them as trusted and effective communicators. Respondents suggested training reinforcement, targeting other cadres of health workers and applying this approach at different service delivery points in health facilities and in the community to increase sustainability and impact.

Conclusion: These findings can inform the scale up this FGM prevention approach in high prevalence countries.

This special issue aims to help fill two critical gaps in the growing literature as well as in practice. First, to bring together scholars and practitioners from around the world who develop, practice, review, and question structural competency with the aim of promoting a dialogue with related approaches, such as Latin American Social Medicine, Collective Health, and others, which have been key in diverse geographical and social settings. Second, to contribute to expanding structural competency beyond clinical medicine to include other health-related areas such as social work, global health, public health practice, epidemiological research, health policy, community organisation and beyond. This conceptual expansion is currently taking place in structural competency, and we hope that this volume will help to raise awareness and reinforce what is already happening. In sum, this collection of articles puts structural competency more rigorously and actively in conversation with different geographic, political, social, and professional contexts worldwide. We hope this conversation sparks further development in scholarly, political and community movements for social and health justice.

To explore the narrowing of the concept of 'global' in global health, this article traces how Latin America has held a place of both privilege and power as well as marginalisation in the field. We employ a modified extended case method to examine how Latin America has been 'seen' and 'heard' in understandings of global health, underscoring the region's shifting role as a key site for research and practice in 'tropical medicine' from the mid-nineteenth century through World War II, to a major player and recipient of development assistance throughout the 'international health' era after World War II until the late twentieth century, to a region progressively marginalised within 'global health' since the mid-1980s/1990s. We argue that the progressive marginalisation of Latin America and Southern theory has not only hurt health equity and services, but also demonstrates the fundamental flaws in contemporary 'global' thinking. The narrowing of global health constitutes coloniality of power, with Northern institutions largely defining priority regions and epistemic approaches to health globally, thus impoverishing the field from the intellectual resources, political experience, and wisdom of Latin America's long traditions of social medicine and collective health.

We explored women's narratives about their experiences as victim-survivors of multiple forms of armed conflict violence and intimate partner violence (IPV) in Colombia and examined pathways that clarify the relationships between these two types of violence. Thematic analysis of 47 interviews identified connections that explain how armed conflict influences IPV at all levels of the socio-ecology. At the societal level, armed conflict events amplified patriarchal notions and intensified men's expressions of hypermasculinity through violence. At the community level, rules imposed by armed groups excused IPV if women did not comply with their traditional gender roles as wives and caretakers. At the relationship level, husbands/partners blamed victim-survivors of sexual violence perpetrated by armed groups, which intensified IPV situations. At the individual level, the armed conflict generated high levels of stress that contributed to increasing IPV. Results highlight the need to recognise armed conflict as an IPV risk factor that penetrates multiple socio-ecological domains. Post-conflict societies should consider the effects of the armed conflict on family dynamics and intimate partner relationships. Interventions should be developed to deconstruct hyper-militarised masculinity identities and traditional gender roles as an integral part of peace efforts.