International Health最新文献

Background: Effective disability inclusion in education requires that teachers and others in the education system have access to accurate and reliable information about children's disabilities. Washington Group (WG) tools are increasingly used in low- and middle-income countries, however, the feasibility and accuracy of such tools is poorly understood. The aim of this study was to assess the feasibility of using WG tools to assess functional difficulty (FD) in children in rural Sierra Leone and to examine the prevalence of FD.

Methods: Class teachers in eight schools completed an FD assessment for each child on their class register using either the WG Short Set (WG-SS) or Child Functioning Module-Teacher Version (CFM-TV). Teacher experiences with the tools were explored during focus group discussions. The prevalence of FD was explored using descriptive statistics.

Results: Teachers found both tools broadly feasible, although there was some concern with the length and complexity of the CFM-TV. A total of 30 teachers used the WG-SS to assess 1346 children ages 5-17 y; 1.1% were reported to have FD. A total of 35 teachers used the CFM-TV to assess 1738 children; 14.9% were reported to have FD.

Conclusions: The use of WG tools by teachers is feasible for generating data on children's FD and potentially valuable for effective disability inclusion.

Background: There is limited evidence about the prevalence of and factors associated with stigmatizing attitudes in the context of severe visual impairment in sub-Saharan Africa. We assessed baseline prevalence and factors associated with stigma among adults undergoing eligibility screening for cataract surgery in northern Mozambique.

Methods: This was an analysis of baseline data from an ongoing cohort study. Participants were adult patients diagnosed with operable cataracts between April and December 2023 at eight district hospitals in Nampula province. Prior to final assessment for surgery by an eye care professional, participants were assessed for experiences of stigma and discrimination using an adapted existing scale measuring internalized and experienced stigma in the context of vision impairment. We used multivariate logistic regression to assess correlates of stigmatizing attitudes and behaviours.

Results: Of 927 participants, 59% (546/927) reported at least one stigmatizing attitude: internalized stigma (54%) and experienced stigma from others in the community (37%). Adjusting for all factors examined, patients with poor self-rated general health were more likely to report both internalised stigma (odds ratio (OR] 3.34 (95% confidence interval {CI} 1.90 to 5.88], p<0.001) and experienced stigma (OR 2.52 [95% CI 1.45 to 4.38], p<0.01). Several other health-related factors, including self-rated general health, perceived difficulty in seeing, objective visual acuity and vision-related quality of life were strongly associated with both internalised and experienced stigma.

Conclusions: Stigma experiences were common among persons diagnosed with severe vision impairment in rural Mozambique and were associated with poor self-rated general health. These findings may help inform the development of tailored behavioural change interventions and support to visually impaired people about dealing with stigma.

Background: Female Genital Schistosomiasis (FGS) is a neglected gynaecological condition that arises from chronic complications of schistosomiasis infection. It is estimated to affect 56 million women and girls in sub-Saharan Africa. In Nigeria, the burden of FGS is largely unknown, and many cases of FGS are misdiagnosed due to poor levels of awareness among health workers.

Methods: Using a cross-sectional study design, we investigated the prevalence of FGS and its associated risk factors among reproductive-aged women in 15 schistosomiasis hotspot communities in Ondo and Kebbi States of Nigeria. A questionnaire-based survey was conducted with community members to explore their sociodemographic characteristics and reported urogenital symptoms. Urine samples were collected to investigate presence of haematuria and Schistosoma haematobium eggs. Visual examination by colposcopy was also conducted among sexually active participants to determine their FGS status.

Results: Five hundred and sixty-one (561) females were visually examined, with FGS prevalence estimated at 41.4% (95% C.I: 37.3 to 45.5). Age, marital status, educational attainment and state of residence were significantly associated (P < 0.05) with positive visual FGS diagnosis. Other factors such as surface water source, reported signs of blood in urine and presence of S. haematobium eggs in urine were associated risks for FGS.

Conclusion: FGS is a huge burden in schistosomiasis endemic areas of Nigeria. There is need for community-wide interventions to address and manage FGS, and integration of FGS into other sexual and reproductive health programmes.

The persistent conflict in Sudan has worsened the impacts of the prolonged droughts, destroying crops and livestock and severely undermining people's means of survival. Furthermore, the scarcity of water and fertile land has increased competition over resources between communities, further displacing populations. This displacement leads to worsening the crisis, straining resources, spreading disease and overwhelming healthcare. For instance, rainfall, which is one of the most devastating climate changes, can reach up to 427.70 mm in one city. Consequently, Sudan confronts widespread famine threats, while ongoing hostilities significantly restrict humanitarian organizations' ability to provide assistance. Effective solutions must focus on strengthening community resilience through strategic investments, comprehensive emergency preparedness, environmentally sustainable practices and sustained peace-building initiatives that would generate substantial benefits for human welfare and economic development.

Background: In Ethiopia, despite a decline in abortion-related mortality over the past decade, substantial challenges persist in ensuring universal safe abortion access. The lived experiences of women who underwent abortion are not well understood in Ethiopia. Thus, this study aimed to explore the lived experiences of women who underwent safe abortions in eastern Ethiopia.

Methods: The study was conducted in Harari Region and Dire Dawa admiration using a descriptive phenomenological approach among 14 purposively selected women from Public health facilities. Data was collected through In-depth interviews using an interview guide. Verbatim transcription and translation of the recorded interviews were done. Finally, thematic analysis was conducted using Open Code 4.03 software.

Results: Five major themes were emerged after analysis. Facilitators of abortion, Barriers to accessing safe abortion services, the need to keep abortion secret, religious perspectives, and Beliefs regarding the health impacts of abortion were the identified major themes.

Conclusions: This study reveals that women seek abortion for various reasons and experience many challenges after abortion, but most of these reasons are not supported by Ethiopian's current abortion law. As a result, they encounter numerous obstacles when trying to obtain safe abortion services.

Background: In Ethiopia, chronic hepatitis B virus (HBV) prevalence is high (∼6%) and infant vaccination targets are unmet. We assessed HBV vaccination uptake and associations with parental sociodemographic and obstetric factors among children (aged 12-36 months) in Ethiopia.

Methods: We utilised the 2016 Ethiopian Demographic and Health Survey. We included a weighted sample of 3,855 children (aged 12-36 month) to assess HBV vaccination coverage level (none, incomplete, and complete) and its spatial distribution. Additionally, we identified associated factors of HBV vaccination coverage level using ordinal logistic regression.

Results: Overall, 51.2% of children received complete HBV vaccination, with wide regional variation. Older maternal age (adjusted odds ratio (AOR)=1.05, 95% confidence interval (CI): 1.02-1.07), better maternal education level (mean AOR=1.66-2.08), higher household wealth quantile (mean AOR=1.51-2.32), distance to a healthcare facility not a big problem (AOR=1.54, 95% CI: 1.25-1.89), and complete maternal continuum care utilisation (AOR=2.59, 95% CI: 1.25-5.30) were positively associated with HBV vaccination coverage, while higher number of children in the household (AOR=0.86, 95% CI: 0.79-0.92) was negatively associated.

Conclusions: HBV vaccination coverage falls below World Health Organization (WHO) targets in Ethiopia and has substantial regional variation. Targeted vaccination campaigns for mothers in lower socioeconomic groups and larger families may improve vaccination coverage.

The aim of this scoping review was to explore how patient-centred care (PCC) is being measured in healthcare settings in sub-Saharan Africa (SSA) and to examine the psychometric performance of reported measurement instruments for PCC. Medline, Web of Science, EMBASE and Global Health databases were searched for articles published from 1990 to 22 September 2024. Search was updated on 30th December 2024. The keywords 'patient-centred care', 'patient experience', 'measurement' and 'psychometric property' were used. Studies were included if they reported on the development, validation, evaluation or psychometric properties of tools used for measuring PCC. Of the 302 articles retrieved, 36, including 31 unique instruments, met the inclusion criteria. Eight instruments were locally developed in SSA. A total of 26 studies were conducted either in South Africa, Nigeria or Ethiopia. Twenty-two studies (60%) were conducted in hospital settings. Psychometric evaluation was either incomplete or not done at all. Locally developed instruments had better psychometric performance compared with instruments developed in the Global North. Although various instruments have been used to measure PCC in SSA, most of them only measure its subcomponents in specific patient populations. Comprehensive measures of PCC, developed and evaluated in SSA for psychometric properties, are needed.

Over the past 2 decades, Uganda's climate policies have steadily evolved, with several frameworks and legislative measures enacted. However, the explicit consideration of health impacts remains limited, with gaps in ministerial coordination, undefined health targets, insufficient funding and limited community engagement. This commentary examines current governmental strategies through a health lens, assessing how health impacts, mitigation and adaptation measures are addressed-and identifying opportunities to better integrate health into climate policies. Progress could be strengthened by improving ministerial coordination, setting explicit health targets, increasing funding, enhancing preparedness for extreme events such as floods, droughts and extreme heat, as well as climate-sensitive health outcomes through meaningful community engagement. We also identify priority research needs: developing practical health indicators, investigating the knowledge and training of health workers and assessing effective methods for community engagement and policy evaluation. Our findings highlight the need for a clear, actionable research agenda to guide policymakers and to enhance health system resilience and climate policy effectiveness in Uganda.

Background: From a public health standpoint, there is merit in determining the levels of Escherichia coli in drinking water, but surveillance datasets often report censored values that may hinder traditional statistical analysis. This study aims to identify sociodemographic factors associated with the presence of E. coli in household drinking water in Bangladesh using Bayesian models for censored data, utilizing data from 6069 households in the Multiple Indicator Cluster Survey 2019.

Methods: In terms of censoring, we considered two different Bayesian regression strategies: Bayesian Tobit Poisson regression and Bayesian Censored Generalized Poisson regression.

Results: The Bayesian Censored Generalized Poisson regression model was identified as the optimal model for analyzing household fecal contamination. Regression analysis revealed significant associations between household E. coli levels and various factors including division, livestock ownership, location of water sources, treatment of drinking water, household head education, wealth index, source of drinking water, place of handwashing and toilet facility. Households using tube wells had lower E. coli levels than those using other sources. Furthermore, households using pit latrines had 1.03 times higher contamination levels than those using flush latrines.

Conclusions: Levels of fecal contamination in household water in Bangladesh were alarming. Our findings underscore the need for targeted policy interventions in specific population segments to address household fecal contamination, highlighting the link between sociodemographic and environmental factors with E. coli levels in drinking water.