{"title":"Closing the gap in maternal health access and quality through targeted investments in low-resource settings","authors":"Mopelola Lauretta Ajegbile","doi":"10.29392/001c.88917","DOIUrl":"https://doi.org/10.29392/001c.88917","url":null,"abstract":"","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135858813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Berthaume, Spencert Barnes, Shehan Hettiaratchy, Jon C Clasper, Ahilakumar Kumar, Gitanjali Sathiadas, Jeya Ganeshamoorthy
Background When dealing in global health, it is crucial to have a comprehensive understanding of community demographics and needs. From 1983-2009, a 26-year ethnic civil conflict devastated Sri Lanka, disproportionately affecting people living in the north and creating a large amputee population. Here, we use routinely collected prosthetic and orthotic data to investigate the composition of the amputee community in northern Sri Lanka. Methods The Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) was established in 1987 and has been the only centre consistently providing prosthetic, orthotic, and non-orthopaedic services in northern Sri Lanka spanning during and after the civil war. In 2004, with the help of the charity Motivation, they established an electronic patient database, which records and maintains information on the JJCDR’s patients. An anonymized copy of the JJCDR database was obtained in November 2018. Summative statistics and temporal trends in patient data were investigated. Results 3,665 unique patients registered with the JJCDR from 1986-2018 (2,605 male, 1,060 female). Individuals ranged from 0-90 years old, with a mean/median age of 34.76/32 years old. Key findings include: (i) 93.0% patients with amputation site recorded were lower limb amputees, with 74.3% being transtibial amputees; (ii) The majority of patients with cause of amputation recorded had war-related amputations (61.2%); (iii) diabetes was the highest cause for non-war-related amputations (18.3%); (iv) war-related amputations have ceased, while diabetic amputations are on the rise; and (v) peak recorded financial costs due to prosthetic and orthotic (P&O) creation/maintenance occurred in 2013, 4 years after the war ended. Conclusions These analyses provide crucial insight into the P&O population in northern Sri Lanka, including distribution and frequency for causes/sites of amputations, temporal patterns in causes of amputations, and costs to a P&O centre due to device creation and maintenance. This database and analysis provide invaluable insight into the P&O cohort in northern Sri Lanka, and a unique insight into the P&O needs of a post-conflict LMIC from the perspective of a P&O centre.
{"title":"Demographic, medical, and financial statistics from the Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) database, 1987-2018: a prosthetics, orthotics, and mobility clinic in northern Sri Lanka","authors":"Michael Berthaume, Spencert Barnes, Shehan Hettiaratchy, Jon C Clasper, Ahilakumar Kumar, Gitanjali Sathiadas, Jeya Ganeshamoorthy","doi":"10.29392/001c.88105","DOIUrl":"https://doi.org/10.29392/001c.88105","url":null,"abstract":"Background When dealing in global health, it is crucial to have a comprehensive understanding of community demographics and needs. From 1983-2009, a 26-year ethnic civil conflict devastated Sri Lanka, disproportionately affecting people living in the north and creating a large amputee population. Here, we use routinely collected prosthetic and orthotic data to investigate the composition of the amputee community in northern Sri Lanka. Methods The Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) was established in 1987 and has been the only centre consistently providing prosthetic, orthotic, and non-orthopaedic services in northern Sri Lanka spanning during and after the civil war. In 2004, with the help of the charity Motivation, they established an electronic patient database, which records and maintains information on the JJCDR’s patients. An anonymized copy of the JJCDR database was obtained in November 2018. Summative statistics and temporal trends in patient data were investigated. Results 3,665 unique patients registered with the JJCDR from 1986-2018 (2,605 male, 1,060 female). Individuals ranged from 0-90 years old, with a mean/median age of 34.76/32 years old. Key findings include: (i) 93.0% patients with amputation site recorded were lower limb amputees, with 74.3% being transtibial amputees; (ii) The majority of patients with cause of amputation recorded had war-related amputations (61.2%); (iii) diabetes was the highest cause for non-war-related amputations (18.3%); (iv) war-related amputations have ceased, while diabetic amputations are on the rise; and (v) peak recorded financial costs due to prosthetic and orthotic (P&O) creation/maintenance occurred in 2013, 4 years after the war ended. Conclusions These analyses provide crucial insight into the P&O population in northern Sri Lanka, including distribution and frequency for causes/sites of amputations, temporal patterns in causes of amputations, and costs to a P&O centre due to device creation and maintenance. This database and analysis provide invaluable insight into the P&O cohort in northern Sri Lanka, and a unique insight into the P&O needs of a post-conflict LMIC from the perspective of a P&O centre.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136064027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eze D Ukah, Emmanuel S Oguntade, Damilare M Oladimeji
Background Diabetes mellitus (DM) is a disorder of metabolism in which an absolute or relative deficiency of insulin results in hyperglycemia leading to acute and chronic complications. Over the years, the issue of incidences of DM in different regions of the globe has become a huge public health problem, especially in cases of patients with comorbidity conditions. These conditions have made the treatment and management of DM extremely difficult, especially in sub-Saharan Africa, where there are weak health systems. Methods This study was a retrospective study based on the record review of 162 patients receiving care at Federal Medical Centre, Jabi Abuja. Using the electronic medical records, key variables of interest were extracted, and the effects of comorbid conditions on Type 2 Diabetes Mellitus (T2DM) were determined. Results The summary results revealed that the incidence of T2DM was approximately 107(66.1%) had T2DM, while about 159 (98.2%) out of the 162 patients with one or more other diseases had T2DM. There were more female patients, 97(59.9%) with cases of DM than male patients. Patients aged 40-69 years have more prevalence cases of DM (73.5%), with those engaging in businesses or trading common in this category (29.63%). Most of these patients had Hypertension as a comorbid condition 110(67.9). The results based on the logistic model showed that patients with concordant comorbid conditions are 2.11 times more likely to develop T2DM. The Bayesian logistic regression model revealed a positive association between gender and comorbidity; the male patients were 1.65 times more likely to develop comorbidity, and patients with a smoking history were 1.56 times more likely to develop comorbidity. T2DM was not associated with systolic blood pressure. Conclusions This present study provides elaborate details on incidences of DM and associated comorbidity conditions in the study area and its environs. A Bayesian model seems to be more accurate than conventional logistic regression based on the present findings. This, in turn, could be used to formulate health policies geared towards effective management, control and prevention of DM of any kind and community sensitization on DM in Nigeria.
{"title":"Factors associated with type 2 diabetes mellitus comorbidity among adult patients: a retrospective clinical audit of a medical centre in Abuja, Nigeria","authors":"Eze D Ukah, Emmanuel S Oguntade, Damilare M Oladimeji","doi":"10.29392/001c.88106","DOIUrl":"https://doi.org/10.29392/001c.88106","url":null,"abstract":"Background Diabetes mellitus (DM) is a disorder of metabolism in which an absolute or relative deficiency of insulin results in hyperglycemia leading to acute and chronic complications. Over the years, the issue of incidences of DM in different regions of the globe has become a huge public health problem, especially in cases of patients with comorbidity conditions. These conditions have made the treatment and management of DM extremely difficult, especially in sub-Saharan Africa, where there are weak health systems. Methods This study was a retrospective study based on the record review of 162 patients receiving care at Federal Medical Centre, Jabi Abuja. Using the electronic medical records, key variables of interest were extracted, and the effects of comorbid conditions on Type 2 Diabetes Mellitus (T2DM) were determined. Results The summary results revealed that the incidence of T2DM was approximately 107(66.1%) had T2DM, while about 159 (98.2%) out of the 162 patients with one or more other diseases had T2DM. There were more female patients, 97(59.9%) with cases of DM than male patients. Patients aged 40-69 years have more prevalence cases of DM (73.5%), with those engaging in businesses or trading common in this category (29.63%). Most of these patients had Hypertension as a comorbid condition 110(67.9). The results based on the logistic model showed that patients with concordant comorbid conditions are 2.11 times more likely to develop T2DM. The Bayesian logistic regression model revealed a positive association between gender and comorbidity; the male patients were 1.65 times more likely to develop comorbidity, and patients with a smoking history were 1.56 times more likely to develop comorbidity. T2DM was not associated with systolic blood pressure. Conclusions This present study provides elaborate details on incidences of DM and associated comorbidity conditions in the study area and its environs. A Bayesian model seems to be more accurate than conventional logistic regression based on the present findings. This, in turn, could be used to formulate health policies geared towards effective management, control and prevention of DM of any kind and community sensitization on DM in Nigeria.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136294333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The 2018-2020 Ebola epidemic in the eastern Democratic Republic of Congo caused 3,481 infections and 2,299 deaths. The broader impact on health system utilization and health outcomes remains unclear. Methods From January to March 2020, a cross-sectional survey was administered to 3,631 households in Ebola-affected and non-affected health zones in North Kivu province to collect data on health behaviors and health status. Using linear models, we tested for associations between residence in an Ebola zone and multiple outcomes. Additionally, administrative data from 56 health facilities in Ebola zones was used to test for statistically significant changes in medical procedures (e.g. Cesarean sections) and disease rates before and during the epidemic. Results Comparing before the epidemic to during, we found no difference in monthly mean procedures per facility: measles vaccinations -58 (95% confidence interval, CI = -140, 24); Cesarean sections 1.4 (95% CI = -0.8, 3.6); laparotomy 0.2 (95% CI = -0.5, 0.9); open fractures 0.0 (95% CI = -0.1, 0.1); appendectomy 0.0 (95% CI = -0.3, 0.3); inguinal hernia 0.3 (95% CI = 0.0, 0.7). Households in Ebola zones were 16 percentage points (pp) (95% CI = 11, 21) more likely to report going to the hospital more often than normal because of free access, reported fewer measles vaccinations (-10pp 95% CI = -14, -5), and less willingness to vaccinate children (-6pp; 95% CI = -9, -3). However, administrative data showed no change in vaccination before and during Ebola in Ebola zones. Households in Ebola zones were 14pp less likely to report that a child had experienced measles (95% CI = -18, -11) and 8pp less likely to report that a child had experienced diarrhea (95% CI = -12, -4) since 1 Jan 2017. However, administrative data showed no change in either, comparing before-Ebola to during-Ebola in Ebola zones (difference in monthly mean procedures per facility: measles 5.6 (95% CI = -0.8, 12.0); diarrhea 41 (95% CI = -63, 145). Conclusions The Ebola epidemic did not have large effects on health system utilization or health outcomes (other than Ebola virus disease). This suggests that the Congolese and international response successfully maintained health system capacity during the epidemic.
2018-2020年刚果民主共和国东部的埃博拉疫情造成3481人感染，2299人死亡。对卫生系统利用和卫生结果的更广泛影响仍不清楚。方法2020年1月至3月，对北基伍省埃博拉疫区和非疫区的3631户家庭进行横断面调查，收集健康行为和健康状况数据。使用线性模型，我们测试了居住在埃博拉地区与多个结果之间的关联。此外，利用来自埃博拉疫区56个卫生设施的行政数据，检测在疫情发生之前和期间医疗程序(如剖宫产)和发病率方面的统计显著变化。结果:与流行前和流行期间相比，我们发现每个设施的月平均程序没有差异:麻疹疫苗接种-58(95%置信区间，CI = -140, 24);剖宫产1.4 (95% CI = -0.8, 3.6);剖腹手术0.2 (95% CI = -0.5, 0.9);开放性骨折0.0 (95% CI = -0.1, 0.1);阑尾切除术0.0 (95% CI = -0.3, 0.3);腹股沟疝0.3 (95% CI = 0.0, 0.7)。埃博拉疫区的家庭报告说，由于免费就医，比正常情况下更经常去医院的可能性增加了16个百分点(95% CI = 11,21)，报告说麻疹疫苗接种较少(-10个百分点，95% CI = -14， -5)，并且不太愿意为儿童接种疫苗(-6个百分点;95% ci = -9， -3)。然而，行政数据显示，埃博拉疫区在埃博拉之前和期间的疫苗接种情况没有变化。自2017年1月1日以来，埃博拉疫区的家庭报告儿童患麻疹的可能性降低了14% (95% CI = -18， -11)，报告儿童患腹泻的可能性降低了8% (95% CI = -12， -4)。然而，在埃博拉疫区，将埃博拉前与埃博拉期间进行比较，行政数据显示两者都没有变化(每个设施的月平均程序差异:麻疹5.6 (95% CI = -0.8, 12.0);腹泻41 (95% CI = - 63,145)。结论埃博拉疫情对卫生系统的利用或健康结果没有太大影响(埃博拉病毒病除外)。这表明，刚果和国际应对措施在疫情期间成功地维持了卫生系统的能力。
{"title":"Impact of the 2018-2020 Democratic Republic of Congo Ebola epidemic on health system utilization and health outcomes","authors":"John P. Quattrochi, Luc Malemo, Rachel Niehuus","doi":"10.29392/001c.88108","DOIUrl":"https://doi.org/10.29392/001c.88108","url":null,"abstract":"Background The 2018-2020 Ebola epidemic in the eastern Democratic Republic of Congo caused 3,481 infections and 2,299 deaths. The broader impact on health system utilization and health outcomes remains unclear. Methods From January to March 2020, a cross-sectional survey was administered to 3,631 households in Ebola-affected and non-affected health zones in North Kivu province to collect data on health behaviors and health status. Using linear models, we tested for associations between residence in an Ebola zone and multiple outcomes. Additionally, administrative data from 56 health facilities in Ebola zones was used to test for statistically significant changes in medical procedures (e.g. Cesarean sections) and disease rates before and during the epidemic. Results Comparing before the epidemic to during, we found no difference in monthly mean procedures per facility: measles vaccinations -58 (95% confidence interval, CI = -140, 24); Cesarean sections 1.4 (95% CI = -0.8, 3.6); laparotomy 0.2 (95% CI = -0.5, 0.9); open fractures 0.0 (95% CI = -0.1, 0.1); appendectomy 0.0 (95% CI = -0.3, 0.3); inguinal hernia 0.3 (95% CI = 0.0, 0.7). Households in Ebola zones were 16 percentage points (pp) (95% CI = 11, 21) more likely to report going to the hospital more often than normal because of free access, reported fewer measles vaccinations (-10pp 95% CI = -14, -5), and less willingness to vaccinate children (-6pp; 95% CI = -9, -3). However, administrative data showed no change in vaccination before and during Ebola in Ebola zones. Households in Ebola zones were 14pp less likely to report that a child had experienced measles (95% CI = -18, -11) and 8pp less likely to report that a child had experienced diarrhea (95% CI = -12, -4) since 1 Jan 2017. However, administrative data showed no change in either, comparing before-Ebola to during-Ebola in Ebola zones (difference in monthly mean procedures per facility: measles 5.6 (95% CI = -0.8, 12.0); diarrhea 41 (95% CI = -63, 145). Conclusions The Ebola epidemic did not have large effects on health system utilization or health outcomes (other than Ebola virus disease). This suggests that the Congolese and international response successfully maintained health system capacity during the epidemic.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136352454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lundi-Anne Omam, Kelli O’Laughlin, Tine Van Bortel, Iko Musa, Gallus Fung, Nicolas Tendongfor, Zara Wudiri, Mohammed Ngubdo Hassan, Alain Metuge, Yanu Pride, Rosalind Parkes-Ratanshi
The protracted conflict in the North West and South West regions of Cameroon, and the North East states of Nigeria, has led to the closure of 29% and 26% of the health facilities, respectively. This has caused the displacement of over 2.21 million persons internally and 350,000 returnees in both countries. In turn, this has created a massive gap in service delivery, prompting humanitarian organisations and the government to use different models of primary health care delivery to affected communities. As part of a larger study, we developed and piloted the interview guides for the qualitative arm of the project since we found none exist for conflict-affected countries to orientate how to navigate the complexities of conducting quality qualitative research in fragile and challenging operating environments. Piloting interviews is important for the reliability of the interview guides to obtain good quality data from interviews. We present an eight-step process for piloting qualitative studies in multiple conflict-affected settings. These includes the development of interview guides, expert consultation, translation of interview guides, risk assessment/mobilisation, recruitment of participants, piloting interviews, modifying interview guides, reflecting on the process and reporting the pilot results.
{"title":"Refinement pathway for quality research interview guides: an 8-step process to refine a protocol for a complex multi-country humanitarian study","authors":"Lundi-Anne Omam, Kelli O’Laughlin, Tine Van Bortel, Iko Musa, Gallus Fung, Nicolas Tendongfor, Zara Wudiri, Mohammed Ngubdo Hassan, Alain Metuge, Yanu Pride, Rosalind Parkes-Ratanshi","doi":"10.29392/001c.87858","DOIUrl":"https://doi.org/10.29392/001c.87858","url":null,"abstract":"The protracted conflict in the North West and South West regions of Cameroon, and the North East states of Nigeria, has led to the closure of 29% and 26% of the health facilities, respectively. This has caused the displacement of over 2.21 million persons internally and 350,000 returnees in both countries. In turn, this has created a massive gap in service delivery, prompting humanitarian organisations and the government to use different models of primary health care delivery to affected communities. As part of a larger study, we developed and piloted the interview guides for the qualitative arm of the project since we found none exist for conflict-affected countries to orientate how to navigate the complexities of conducting quality qualitative research in fragile and challenging operating environments. Piloting interviews is important for the reliability of the interview guides to obtain good quality data from interviews. We present an eight-step process for piloting qualitative studies in multiple conflict-affected settings. These includes the development of interview guides, expert consultation, translation of interview guides, risk assessment/mobilisation, recruitment of participants, piloting interviews, modifying interview guides, reflecting on the process and reporting the pilot results.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135592433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amani I Kikula, Aline Semaan, Belinda Balandya, Naku K Makoko, Andrea B Pembe, José L Peñalvo, Lenka Beňová
Background The prevalence of people who are overweight or obese is increasing globally, especially in low- and middle-income countries. High body mass index (BMI) among women of reproductive age is a risk factor for various adverse reproductive and pregnancy outcomes. This study aims to describe trends over time in the distribution of BMI among Tanzanian women of reproductive age intending to conceive between 2004/5 and 2015/16, and identify factors associated with high BMI. Methods We used data on 20,819 women of reproductive age (15-49 years) intending to conceive who participated in the Tanzania Demographic and Health Surveys in 2004/5, 2010 and 2015/16. We estimated the prevalence of high BMI (being overweight [≥25 to <30 kg/m 2 ] and obesity [≥30kg/m 2 ) and trends in the prevalence of high BMI across the three surveys. Using survey-weighted multivariable logistic regression, we used the most recent 2015/16 survey data to identify factors associated with high BMI. Results Median BMI increased from 21.7kg/m 2 (inter-quartile range, IQR=19.9-24.1 kg/m 2 ) in 2004/5 to 22.0 kg/m 2 (IQR=20.0-24.8 kg/m 2 ) in 2010 to 22.7 kg/m 2 (IQR=20.4-26.0 kg/m 2 ) in 2015/16. The prevalence of overweight women increased from 11.1% in 2004/5 to 15.8% in 2015 (P <0.001). The prevalence of obesity increased from 3.1% in 2004/5 to 8.0% in 2015/16 (P<0.001). Women in the highest wealth quintile had higher odds (adjusted odds ratio, aOR= 4.5; 95%CI 3.4-6.3, P<0.001) of high BMI than women in the lowest quintile. The odds of high BMI were about four times greater (aOR=3.9; 95%CI=2.9-5.4, P<0.001) for women 40-44 years compared to 20–24-year-olds. Women in the high-paying occupations had greater odds of high BMI than those working in agriculture (aOR=1.5; 95% CI=1.1-2.2, P=0.002). Women residing in the Southern zone had 1.9 (95%CI=1.5-2.5, P<0.001) greater odds of high BMI than Lake zone residents. Conclusions In Tanzania, high BMI affects almost 1 in 4 women of reproductive age who intend to conceive. This contributes to the burden of poor maternal and reproductive health outcomes. We recommend developing and implementing health-system strategies for addressing high BMI, tailored to the modifiable risk factors identified among women of reproductive age.
{"title":"Increasing prevalence of overweight and obesity among Tanzanian women of reproductive age intending to conceive: evidence from three Demographic Health Surveys, 2004-2016","authors":"Amani I Kikula, Aline Semaan, Belinda Balandya, Naku K Makoko, Andrea B Pembe, José L Peñalvo, Lenka Beňová","doi":"10.29392/001c.87443","DOIUrl":"https://doi.org/10.29392/001c.87443","url":null,"abstract":"Background The prevalence of people who are overweight or obese is increasing globally, especially in low- and middle-income countries. High body mass index (BMI) among women of reproductive age is a risk factor for various adverse reproductive and pregnancy outcomes. This study aims to describe trends over time in the distribution of BMI among Tanzanian women of reproductive age intending to conceive between 2004/5 and 2015/16, and identify factors associated with high BMI. Methods We used data on 20,819 women of reproductive age (15-49 years) intending to conceive who participated in the Tanzania Demographic and Health Surveys in 2004/5, 2010 and 2015/16. We estimated the prevalence of high BMI (being overweight [≥25 to <30 kg/m 2 ] and obesity [≥30kg/m 2 ) and trends in the prevalence of high BMI across the three surveys. Using survey-weighted multivariable logistic regression, we used the most recent 2015/16 survey data to identify factors associated with high BMI. Results Median BMI increased from 21.7kg/m 2 (inter-quartile range, IQR=19.9-24.1 kg/m 2 ) in 2004/5 to 22.0 kg/m 2 (IQR=20.0-24.8 kg/m 2 ) in 2010 to 22.7 kg/m 2 (IQR=20.4-26.0 kg/m 2 ) in 2015/16. The prevalence of overweight women increased from 11.1% in 2004/5 to 15.8% in 2015 (P <0.001). The prevalence of obesity increased from 3.1% in 2004/5 to 8.0% in 2015/16 (P<0.001). Women in the highest wealth quintile had higher odds (adjusted odds ratio, aOR= 4.5; 95%CI 3.4-6.3, P<0.001) of high BMI than women in the lowest quintile. The odds of high BMI were about four times greater (aOR=3.9; 95%CI=2.9-5.4, P<0.001) for women 40-44 years compared to 20–24-year-olds. Women in the high-paying occupations had greater odds of high BMI than those working in agriculture (aOR=1.5; 95% CI=1.1-2.2, P=0.002). Women residing in the Southern zone had 1.9 (95%CI=1.5-2.5, P<0.001) greater odds of high BMI than Lake zone residents. Conclusions In Tanzania, high BMI affects almost 1 in 4 women of reproductive age who intend to conceive. This contributes to the burden of poor maternal and reproductive health outcomes. We recommend developing and implementing health-system strategies for addressing high BMI, tailored to the modifiable risk factors identified among women of reproductive age.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135592635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Nigeria developed a National Task Shifting and Sharing Policy due to protracted inequitable distribution of health workers, especially at the primary level of care, and the low stock and production rate of skilled health workforce. Following the development of Nigeria’s task shifting and sharing policy and strategy, implementation was promulgated at various levels, with States adopting and implementing the national policy. However, the policy environment for task shifting and sharing varies widely. Consequently, evidence on barriers to and factors promoting successful implementation are inconclusive. Hence, strategies for improving implementation are needed. The evidence from this study can inform the scale-up and strengthening of implementation approaches as Nigeria strives to achieve the national goals, universal health coverage and sustainable development goals. Methods An explorative, descriptive research study approach was applied with 20 key informant interviews conducted to explore the perception of policymakers on barriers and promoters of task shifting and sharing in Nigeria. In addition, strategies for improving task shifting and sharing implementation were explored. Results The barriers to effective implementation of task shifting ad sharing from our study were the persistent shortage of health workers, inter-cadre rivalry, perceived sub-optimal capacity of the beneficiary cadres, and lack of adequate equipment for delivery of needed services. The factors promoting the implementation of task shifting and sharing were the availability of adapted policies, the political will of the health sector leadership, acceptance of task shifting and sharing implementation by health workers, and the implementation of actions to improve knowledge and skills of health workers to implement shifted or shared tasks by various actors. The strategies to improve future task shifting and sharing implementation include improving staffing levels, scaling up training and periodic retraining, mentoring and supportive supervision, and improving the, use and dissemination of evidence generated. Conclusions Several factors influence the implementation of task shifting and sharing. Hence the identification and implementation of relevant strategies are pertinent in achieving set objectives and national goals. In policy and practice, therefore, a proactive exploration of the contextual understanding, barriers to implementation, enablers and learning from the performance of similar interventions is pertinent in shaping strategies for translating evidence to practice through an implementation framework. This should be done in collaboration with stakeholders to foster acceptance and participation.
{"title":"Barriers, promoters, and strategies for improving task shifting and task sharing implementation in Nigeria: qualitative perspectives of policymakers","authors":"Sunny C Okoroafor, Christmal Dela Christmals","doi":"10.29392/001c.88110","DOIUrl":"https://doi.org/10.29392/001c.88110","url":null,"abstract":"Background Nigeria developed a National Task Shifting and Sharing Policy due to protracted inequitable distribution of health workers, especially at the primary level of care, and the low stock and production rate of skilled health workforce. Following the development of Nigeria’s task shifting and sharing policy and strategy, implementation was promulgated at various levels, with States adopting and implementing the national policy. However, the policy environment for task shifting and sharing varies widely. Consequently, evidence on barriers to and factors promoting successful implementation are inconclusive. Hence, strategies for improving implementation are needed. The evidence from this study can inform the scale-up and strengthening of implementation approaches as Nigeria strives to achieve the national goals, universal health coverage and sustainable development goals. Methods An explorative, descriptive research study approach was applied with 20 key informant interviews conducted to explore the perception of policymakers on barriers and promoters of task shifting and sharing in Nigeria. In addition, strategies for improving task shifting and sharing implementation were explored. Results The barriers to effective implementation of task shifting ad sharing from our study were the persistent shortage of health workers, inter-cadre rivalry, perceived sub-optimal capacity of the beneficiary cadres, and lack of adequate equipment for delivery of needed services. The factors promoting the implementation of task shifting and sharing were the availability of adapted policies, the political will of the health sector leadership, acceptance of task shifting and sharing implementation by health workers, and the implementation of actions to improve knowledge and skills of health workers to implement shifted or shared tasks by various actors. The strategies to improve future task shifting and sharing implementation include improving staffing levels, scaling up training and periodic retraining, mentoring and supportive supervision, and improving the, use and dissemination of evidence generated. Conclusions Several factors influence the implementation of task shifting and sharing. Hence the identification and implementation of relevant strategies are pertinent in achieving set objectives and national goals. In policy and practice, therefore, a proactive exploration of the contextual understanding, barriers to implementation, enablers and learning from the performance of similar interventions is pertinent in shaping strategies for translating evidence to practice through an implementation framework. This should be done in collaboration with stakeholders to foster acceptance and participation.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135592642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Faith Nawagi, Ian Guyton Munabi, Andre Vyt, Sarah Kiguli, Aloysius Gonzaga Mubuuke
Background Faculty perspectives are key drivers of learning during international electives (IEs). However, in Africa, there is limited literature on these perspectives on interprofessional education and collaborative practice (IPECP) during IEs. Therefore, this study explored faculty perspectives toward IPECP within an international elective context from selected African institutions. Methods This was an exploratory qualitative study. The study participants included faculty from four health professional training universities in Africa. Thematic analysis was used to analyze the data. Common codes were identified and grouped to create subthemes and major themes. Results Four themes were identified: (i) The importance of IPECP during IEs, (ii) Approaches to IPECP during IEs, (iii) Perceived key barriers, and (iv) Perceived institutional support for IPECP during IEs. Most of the participants perceived IEs as a platform that can be used to cultivate IPECP with a multicultural perspective while promoting cross-border partnerships to advance health care. Suggested teaching approaches included case studies, joint clinical ward rounds, and simulations, among others, with an openness to having an online, blended, or physical mode of delivery. A framework to guide the implementation of IPECP during IEs was considered important, and most participants thought that their institutions had the infrastructure to support IPECP-IEs. Conclusions Faculty reported enabling perspectives of IPECP during IEs, emphasizing the need for a framework to guide and structure implementation. IPECP-IEs were perceived as a unique platform to cultivate IPECP skills with a multicultural component.
{"title":"An exploration of faculty perspectives towards interprofessional education and collaborative practice during international electives in health professions training institutions in Africa","authors":"Faith Nawagi, Ian Guyton Munabi, Andre Vyt, Sarah Kiguli, Aloysius Gonzaga Mubuuke","doi":"10.29392/001c.88103","DOIUrl":"https://doi.org/10.29392/001c.88103","url":null,"abstract":"Background Faculty perspectives are key drivers of learning during international electives (IEs). However, in Africa, there is limited literature on these perspectives on interprofessional education and collaborative practice (IPECP) during IEs. Therefore, this study explored faculty perspectives toward IPECP within an international elective context from selected African institutions. Methods This was an exploratory qualitative study. The study participants included faculty from four health professional training universities in Africa. Thematic analysis was used to analyze the data. Common codes were identified and grouped to create subthemes and major themes. Results Four themes were identified: (i) The importance of IPECP during IEs, (ii) Approaches to IPECP during IEs, (iii) Perceived key barriers, and (iv) Perceived institutional support for IPECP during IEs. Most of the participants perceived IEs as a platform that can be used to cultivate IPECP with a multicultural perspective while promoting cross-border partnerships to advance health care. Suggested teaching approaches included case studies, joint clinical ward rounds, and simulations, among others, with an openness to having an online, blended, or physical mode of delivery. A framework to guide the implementation of IPECP during IEs was considered important, and most participants thought that their institutions had the infrastructure to support IPECP-IEs. Conclusions Faculty reported enabling perspectives of IPECP during IEs, emphasizing the need for a framework to guide and structure implementation. IPECP-IEs were perceived as a unique platform to cultivate IPECP skills with a multicultural component.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135548092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The emergence of COVID-19 disrupted several global health partnerships, with people unable to travel, meetings and conferences cancelled, and many forced to work remotely. The aim of this study was to explore the impact of COVID-19 on global health partnerships learning from the activities of the Division of Tropical and Humanitarian Medicine (DTHM) at the Geneva University Hospitals (HUG). Methods Five members of the DTHM team as well as five local partners from ongoing projects within the DTHM in Bosnia-Herzegovina, Kyrgyzstan, Nepal, Peru and Ukraine were interviewed. A qualitative approach was chosen employing an interpretive approach using Grounded Theory involving the application of inductive reasoning for the analysis. Results Interviewees describe both positive and negative impacts of COVID-19 for the existing partnerships. The use of on-site visits was disrupted and replaced by extra remote monitoring. Digital tools enabled the continuity of interactions ensuring that the partnership could continue to operate. Online tools allowed access to a wider audience and advantages with regards to time, cost and the environment. However, going online was unable to fully replace human interactions and exchanges which are core components of any partnership. Conclusions COVID-19 resulted in the DTHM and its partners needing to redefine and improve how partnerships were established and maintained. This change in how partnerships operated and adapted during the pandemic will require ongoing assessment to see the long-term impact of these changes in the ways partnerships function in a post-COVID-19 environment.
{"title":"Global health partnerships in the time of COVID-19: redefining the way we work","authors":"Marina Giachino, François Chappuis, David Beran","doi":"10.29392/001c.87860","DOIUrl":"https://doi.org/10.29392/001c.87860","url":null,"abstract":"Background The emergence of COVID-19 disrupted several global health partnerships, with people unable to travel, meetings and conferences cancelled, and many forced to work remotely. The aim of this study was to explore the impact of COVID-19 on global health partnerships learning from the activities of the Division of Tropical and Humanitarian Medicine (DTHM) at the Geneva University Hospitals (HUG). Methods Five members of the DTHM team as well as five local partners from ongoing projects within the DTHM in Bosnia-Herzegovina, Kyrgyzstan, Nepal, Peru and Ukraine were interviewed. A qualitative approach was chosen employing an interpretive approach using Grounded Theory involving the application of inductive reasoning for the analysis. Results Interviewees describe both positive and negative impacts of COVID-19 for the existing partnerships. The use of on-site visits was disrupted and replaced by extra remote monitoring. Digital tools enabled the continuity of interactions ensuring that the partnership could continue to operate. Online tools allowed access to a wider audience and advantages with regards to time, cost and the environment. However, going online was unable to fully replace human interactions and exchanges which are core components of any partnership. Conclusions COVID-19 resulted in the DTHM and its partners needing to redefine and improve how partnerships were established and maintained. This change in how partnerships operated and adapted during the pandemic will require ongoing assessment to see the long-term impact of these changes in the ways partnerships function in a post-COVID-19 environment.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136235327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Issuing fitness certificates to South African mine workers with early and mild silicosis to continue risk work underground is a public health concern. This article draws on the view of solidarity to contend this practice. We employed a normative ethics approach and the concept of solidarity in African ‘Ubuntu’ philosophy to report and reflect on the public health implications of silica dust exposure among South African miners. We argued that since silicosis is irreversible, incurable, and could be progressive, leading to death, thus, issuing certificates of fitness to individuals who have early and mild silicosis, in many ways, is inappropriate and the practice ought to be rejected. We recommend more studies to reflect on the ethical management of silica dust exposure in the South African gold mining industry.
{"title":"An Ubuntu-based reflection on the public health impact of silica dust exposure in the South African mining industry","authors":"Angeline Mojakwana, Cornelius Ewuoso","doi":"10.29392/001c.77498","DOIUrl":"https://doi.org/10.29392/001c.77498","url":null,"abstract":"Issuing fitness certificates to South African mine workers with early and mild silicosis to continue risk work underground is a public health concern. This article draws on the view of solidarity to contend this practice. We employed a normative ethics approach and the concept of solidarity in African ‘Ubuntu’ philosophy to report and reflect on the public health implications of silica dust exposure among South African miners. We argued that since silicosis is irreversible, incurable, and could be progressive, leading to death, thus, issuing certificates of fitness to individuals who have early and mild silicosis, in many ways, is inappropriate and the practice ought to be rejected. We recommend more studies to reflect on the ethical management of silica dust exposure in the South African gold mining industry.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136152975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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