Effective community entry processes influence community participation and acceptance of public health interventions. Though there is a growing body of literature on the importance of community partnerships, there is a lack of pragmatic and practical documentation of the experiences involved in the community entry process as it relates to culturally sensitive topics such as child marriage which can help to support researchers working in this field. This article highlights key themes related to knowledge of the community, effective communication, cultural sensitivity, coproduction and giving feedback which help to build trust between the community members and the research team. Institutional representation, not managing expectations, and lack of clarity, along with personal opinions of community gatekeepers can create challenges for the fostering of trustworthy relationships with the community. These realities must be actively addressed right at the onset of the process between the research team and community stakeholders. Researchers can develop trust, form connections and engage different communities by working with local groups and leaders, using culturally appropriate methods, and addressing community concerns. Future projects working with communities on child marriage in Nigeria and other countries would benefit from the reflections presented in this paper.
{"title":"Effective community entry: reflections on community engagement in culturally sensitive research in southwestern Nigeria.","authors":"Olubukola Omobowale, Alissa Koski, Halimat Olaniyan, Bidemi Nelson, Olayinka Egbokhare, Olayinka Omigbodun","doi":"10.1136/bmjgh-2024-015068","DOIUrl":"10.1136/bmjgh-2024-015068","url":null,"abstract":"<p><p>Effective community entry processes influence community participation and acceptance of public health interventions. Though there is a growing body of literature on the importance of community partnerships, there is a lack of pragmatic and practical documentation of the experiences involved in the community entry process as it relates to culturally sensitive topics such as child marriage which can help to support researchers working in this field. This article highlights key themes related to knowledge of the community, effective communication, cultural sensitivity, coproduction and giving feedback which help to build trust between the community members and the research team. Institutional representation, not managing expectations, and lack of clarity, along with personal opinions of community gatekeepers can create challenges for the fostering of trustworthy relationships with the community. These realities must be actively addressed right at the onset of the process between the research team and community stakeholders. Researchers can develop trust, form connections and engage different communities by working with local groups and leaders, using culturally appropriate methods, and addressing community concerns. Future projects working with communities on child marriage in Nigeria and other countries would benefit from the reflections presented in this paper.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11381698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1136/bmjgh-2023-013393
Cecilia Jakobsson, Rhea Sanghavi, Joseph Nyamiobo, Caitlin Maloy, Arnold Mwanzu, Katherine Venturo-Conerly, Cyprian Mostert, Stefan Peterson, Manasi Kumar
Background: Adolescents comprise one-sixth of the world's population, yet there is no clear understanding of the features that promote adolescent-friendly services (AFS). The lack of clarity and consistency around a definition presents a gap in health services.
Methods: The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We conducted a scoping review of peer-reviewed empirical studies to explore AFS in low-income and middle-income countries (LMICs) published between January 2000 and December 2022. The databases searched were CAB Direct (n=11), CINAHL (n=50), Cochrane Databases (n=1103), Embase (n=1164), Global Health Medicus (n=3636) and PsycINFO (n=156). The title, abstract and full text were double screened by three independent reviewers. Three independent reviewers assessed the study's quality using the Joanna Briggs Initiative Quality Appraisal and Cochrane Risk of Bias 2 tools.
Results: We identified the key components, barriers and facilitators of AFS. The following emerged from our review: a non-judgmental environment, culturally appropriate and responsive interventions and a focus on supporting marginalised communities often living in high-poverty settings. Using these components, we have extended guidance around a possible framework and tool assessing quality of AFS.
Interpretation: As LMICs are heterogeneous and unique, it was assumed that the operational definition of 'adolescent-friendly' might vary depending on different contexts, but there must be core components that remain consistent. Possible limitations of our review include a lack of grey literature. Potential future implications include training healthcare providers, testing these attributes for service improvement and future development and localisation of policy guidelines.
Key highlights: Our review has mapped the research framing of AFS and provided a comprehensive review of barriers and facilitators to implementing a holistic outlook of AFS set-up in a tightly controlled research and real-world context. Our paper is one of the few efforts to synthesise behavioural and mental health elements underpinning AFS.
背景：青少年占世界人口的六分之一，但人们对促进青少年友好型服务（AFS）的特征却没有清晰的认识。定义的不清晰和不一致是医疗服务中的一个空白：本综述遵循《系统综述和元分析的首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews）指南进行。我们对 2000 年 1 月至 2022 年 12 月间发表的同行评审实证研究进行了范围界定，以探讨低收入和中等收入国家（LMIC）的战地服务。检索的数据库包括：CAB Direct (n=11), CINAHL (n=50), Cochrane Databases (n=1103), Embase (n=1164), Global Health Medicus (n=3636) 和 PsycINFO (n=156)。标题、摘要和全文由三位独立审稿人进行双重筛选。三位独立审稿人使用 Joanna Briggs Initiative 质量评估和 Cochrane Risk of Bias 2 工具对研究质量进行评估：我们确定了 AFS 的关键组成部分、障碍和促进因素。我们在审查中发现了以下几点：非评判性环境、文化适宜性和响应性干预措施，以及重点支持通常生活在贫困环境中的边缘化社区。利用这些要素，我们围绕评估非洲战地服务质量的可能框架和工具扩展了指导：由于低收入与中等收入国家的情况各不相同且各具特色，因此我们认为 "青少年友好型 "的操作定义可能会因环境不同而有所差异，但其核心内容必须保持一致。我们的综述可能存在局限性，包括缺乏灰色文献。未来的潜在影响包括培训医疗服务提供者、测试这些属性以改进服务以及未来政策指南的制定和本地化：我们的综述描绘了美国战地服务的研究框架，并全面回顾了在严格控制的研究和现实世界背景下实施美国战地服务整体观的障碍和促进因素。我们的论文是为数不多的对支持战地服务团的行为和心理健康要素进行综合的文章之一。
{"title":"Adolescent and youth-friendly health interventions in low-income and middle-income countries: a scoping review.","authors":"Cecilia Jakobsson, Rhea Sanghavi, Joseph Nyamiobo, Caitlin Maloy, Arnold Mwanzu, Katherine Venturo-Conerly, Cyprian Mostert, Stefan Peterson, Manasi Kumar","doi":"10.1136/bmjgh-2023-013393","DOIUrl":"10.1136/bmjgh-2023-013393","url":null,"abstract":"<p><strong>Background: </strong>Adolescents comprise one-sixth of the world's population, yet there is no clear understanding of the features that promote adolescent-friendly services (AFS). The lack of clarity and consistency around a definition presents a gap in health services.</p><p><strong>Methods: </strong>The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We conducted a scoping review of peer-reviewed empirical studies to explore AFS in low-income and middle-income countries (LMICs) published between January 2000 and December 2022. The databases searched were CAB Direct (n=11), CINAHL (n=50), Cochrane Databases (n=1103), Embase (n=1164), Global Health Medicus (n=3636) and PsycINFO (n=156). The title, abstract and full text were double screened by three independent reviewers. Three independent reviewers assessed the study's quality using the Joanna Briggs Initiative Quality Appraisal and Cochrane Risk of Bias 2 tools.</p><p><strong>Results: </strong>We identified the key components, barriers and facilitators of AFS. The following emerged from our review: a non-judgmental environment, culturally appropriate and responsive interventions and a focus on supporting marginalised communities often living in high-poverty settings. Using these components, we have extended guidance around a possible framework and tool assessing quality of AFS.</p><p><strong>Interpretation: </strong>As LMICs are heterogeneous and unique, it was assumed that the operational definition of 'adolescent-friendly' might vary depending on different contexts, but there must be core components that remain consistent. Possible limitations of our review include a lack of grey literature. Potential future implications include training healthcare providers, testing these attributes for service improvement and future development and localisation of policy guidelines.</p><p><strong>Key highlights: </strong>Our review has mapped the research framing of AFS and provided a comprehensive review of barriers and facilitators to implementing a holistic outlook of AFS set-up in a tightly controlled research and real-world context. Our paper is one of the few efforts to synthesise behavioural and mental health elements underpinning AFS.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11381706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1136/bmjgh-2024-015548
Dorothy Njagi, Mary Nyikuri, Nicaise Ndembi
{"title":"Integrating social behavioural insights in risk communication and community engagement approaches for better health outcomes in Africa.","authors":"Dorothy Njagi, Mary Nyikuri, Nicaise Ndembi","doi":"10.1136/bmjgh-2024-015548","DOIUrl":"10.1136/bmjgh-2024-015548","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11381717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1136/bmjgh-2023-012989
Natalie Evans, Noorwhiza Ahmadi, Alice Morgan, Sadia Zalmai, Kate M Milner, Mohamed Faiz Atif, Hamish R Graham
Introduction To ensure that humanitarian action is disability-inclusive, evidence is needed to understand how different strategies to support children living with disabilities and their families can work in these settings. Evidence from other contexts suggests support groups can improve caregiver quality of life (QOL). This study reports an evaluation of the ‘ Mighty Children’ programme a participatory educational support group programme for caregivers of children living with disability in Kabul province, Afghanistan. Methods We conducted a mixed-methods realist-informed before-and-after study to measure change in caregiver-reported QOL and explore how and for whom the programme worked, and in what contexts. Female caregivers of children with any disability were recruited through clinics in urban Kabul (n=3) and rural Paghman district (n=3). We collected quantitative data on QOL pre/post programme using the Paediatric Quality of Life Inventory Family Impact Module (PedsQL-FIM). Qualitative data were collected through facilitator and participant focus groups postprogramme. Results 118 caregivers participated in two cohorts (November 2020, February 2021). Caregivers expressed a significant increase in QOL from baseline to programme completion (t(125)=−10.7, p≤0.0001). Participation in cohort 2 was associated with the greatest PedsQL-FIM change. Qualitative data revealed positive changes postprogramme in five key areas: caregiver mindset, parenting practices, disability-inclusive behaviours, psychological well-being and child functioning. These changes were seen as both outcomes and mechanisms influencing the primary outcome of QOL. Mechanisms that mediated these changes included increased knowledge of disability and the core acceptance and commitment therapy components of mindfulness and acceptance. Conclusion The Mighty Children caregiver support programme for children living with disability in Afghanistan was associated with improved caregiver QOL. Further studies are warranted to explore pathways to scale, sustainability and potential application in other settings. Data are available on reasonable request.
导言 为确保人道主义行动兼顾残疾问题，我们需要证据来了解支持残疾儿童及其家庭的不同策略如何在这些环境中发挥作用。来自其他环境的证据表明，支持小组可以改善照顾者的生活质量（QOL）。本研究报告对 "全能儿童 "计划进行了评估，该计划是一项参与式教育支持小组计划，面向阿富汗喀布尔省的残疾儿童照顾者。方法 我们采用混合方法进行了一项真实的前后对比研究，以衡量照顾者报告的 QOL 变化情况，并探索该计划如何发挥作用、对谁发挥作用以及在什么情况下发挥作用。我们通过喀布尔市区（3 人）和帕格曼农村地区（3 人）的诊所招募了残疾儿童的女性照顾者。我们使用儿科生活质量量表家庭影响模块（PedsQL-FIM）收集了计划前后生活质量的定量数据。计划结束后，通过主持人和参与者焦点小组收集定性数据。结果 118 名护理人员参加了两次培训（2020 年 11 月和 2021 年 2 月）。从基线到计划完成，护理人员的 QOL 有了明显提高（t(125)=-10.7，p≤0.0001）。参加第二组计划的护理人员的 PedsQL-FIM 变化最大。定性数据显示，计划结束后，以下五个关键领域发生了积极变化：照顾者心态、养育实践、残疾包容行为、心理健康和儿童功能。这些变化被视为影响 QOL 这一主要结果的结果和机制。影响这些变化的机制包括对残疾的进一步了解，以及接受和承诺疗法的核心内容--正念和接受。结论 针对阿富汗残疾儿童的 "强大儿童 "照顾者支持计划与照顾者 QOL 的改善有关。有必要开展进一步研究，以探索扩大规模的途径、可持续性以及在其他环境中的潜在应用。如有合理要求，可提供相关数据。
{"title":"Supporting caregivers of children living with disability in a humanitarian context: realist-informed evaluation of the ‘Mighty Children’ programme in Afghanistan","authors":"Natalie Evans, Noorwhiza Ahmadi, Alice Morgan, Sadia Zalmai, Kate M Milner, Mohamed Faiz Atif, Hamish R Graham","doi":"10.1136/bmjgh-2023-012989","DOIUrl":"https://doi.org/10.1136/bmjgh-2023-012989","url":null,"abstract":"Introduction To ensure that humanitarian action is disability-inclusive, evidence is needed to understand how different strategies to support children living with disabilities and their families can work in these settings. Evidence from other contexts suggests support groups can improve caregiver quality of life (QOL). This study reports an evaluation of the ‘ Mighty Children’ programme a participatory educational support group programme for caregivers of children living with disability in Kabul province, Afghanistan. Methods We conducted a mixed-methods realist-informed before-and-after study to measure change in caregiver-reported QOL and explore how and for whom the programme worked, and in what contexts. Female caregivers of children with any disability were recruited through clinics in urban Kabul (n=3) and rural Paghman district (n=3). We collected quantitative data on QOL pre/post programme using the Paediatric Quality of Life Inventory Family Impact Module (PedsQL-FIM). Qualitative data were collected through facilitator and participant focus groups postprogramme. Results 118 caregivers participated in two cohorts (November 2020, February 2021). Caregivers expressed a significant increase in QOL from baseline to programme completion (t(125)=−10.7, p≤0.0001). Participation in cohort 2 was associated with the greatest PedsQL-FIM change. Qualitative data revealed positive changes postprogramme in five key areas: caregiver mindset, parenting practices, disability-inclusive behaviours, psychological well-being and child functioning. These changes were seen as both outcomes and mechanisms influencing the primary outcome of QOL. Mechanisms that mediated these changes included increased knowledge of disability and the core acceptance and commitment therapy components of mindfulness and acceptance. Conclusion The Mighty Children caregiver support programme for children living with disability in Afghanistan was associated with improved caregiver QOL. Further studies are warranted to explore pathways to scale, sustainability and potential application in other settings. Data are available on reasonable request.","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1136/bmjgh-2024-014971
Carla Saenz, Timothy M Krahn, Maxwell J Smith, Michelle M Haby, Sarah Carracedo, Ludovic Reveiz
The calls for health research to be collaborative are ubiquitous—even as part of a recent World Health Assembly resolution on clinical trials—yet the arguments in support of collaborative research have been taken for granted and are absent in the literature. This article provides three arguments to justify why health research ought to be collaborative and discusses trade-offs to be considered among the ethical values guiding each argument. No data are available.
{"title":"Advancing collaborative research for health: why does collaboration matter?","authors":"Carla Saenz, Timothy M Krahn, Maxwell J Smith, Michelle M Haby, Sarah Carracedo, Ludovic Reveiz","doi":"10.1136/bmjgh-2024-014971","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-014971","url":null,"abstract":"The calls for health research to be collaborative are ubiquitous—even as part of a recent World Health Assembly resolution on clinical trials—yet the arguments in support of collaborative research have been taken for granted and are absent in the literature. This article provides three arguments to justify why health research ought to be collaborative and discusses trade-offs to be considered among the ethical values guiding each argument. No data are available.","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1136/bmjgh-2023-014887
Aku Kwamie, Sara Causevic, Goran Tomson, Ali Sie, Rainer Sauerborn, Kumanan Rasanathan, Ole Petter Ottersen
The Sustainable Development Goals are far off track. The convergence of global threats such as climate change, conflict and the lasting effects of the COVID-19 pandemic—among others—call for better data and research evidence that can account for the complex interactions between these threats. In the time of polycrisis, global and national-level data and research evidence must address complexity. Viewed through the lens of ‘systemic risk’, there is a need for data and research evidence that is sufficiently representative of the multiple interdependencies of global threats. Instead, current global published literature seems to be dominated by correlational, descriptive studies that are unable to account for complex interactions. The literature is geographically limited and rarely from countries facing severe polycrisis threats. As a result, country guidance fails to treat these threats interdependently. Applied systems thinking can offer more diverse research methods that are able to generate complex evidence. This is achievable through more participatory processes that will assist stakeholders in defining system boundaries and behaviours. Additionally, applied systems thinking can draw on known methods for hypothesising, modelling, visualising and testing complex system properties over time. Application is much needed for generating evidence at the global level and within national-level policy processes and structures. All data relevant to the study are included in the article.
{"title":"Prepared for the polycrisis? The need for complexity science and systems thinking to address global and national evidence gaps","authors":"Aku Kwamie, Sara Causevic, Goran Tomson, Ali Sie, Rainer Sauerborn, Kumanan Rasanathan, Ole Petter Ottersen","doi":"10.1136/bmjgh-2023-014887","DOIUrl":"https://doi.org/10.1136/bmjgh-2023-014887","url":null,"abstract":"The Sustainable Development Goals are far off track. The convergence of global threats such as climate change, conflict and the lasting effects of the COVID-19 pandemic—among others—call for better data and research evidence that can account for the complex interactions between these threats. In the time of polycrisis, global and national-level data and research evidence must address complexity. Viewed through the lens of ‘systemic risk’, there is a need for data and research evidence that is sufficiently representative of the multiple interdependencies of global threats. Instead, current global published literature seems to be dominated by correlational, descriptive studies that are unable to account for complex interactions. The literature is geographically limited and rarely from countries facing severe polycrisis threats. As a result, country guidance fails to treat these threats interdependently. Applied systems thinking can offer more diverse research methods that are able to generate complex evidence. This is achievable through more participatory processes that will assist stakeholders in defining system boundaries and behaviours. Additionally, applied systems thinking can draw on known methods for hypothesising, modelling, visualising and testing complex system properties over time. Application is much needed for generating evidence at the global level and within national-level policy processes and structures. All data relevant to the study are included in the article.","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
### Summary box Nutrition remains a critical priority in Ukraine, even in the midst of the ongoing war. One of the specific nutrition-related concerns that many countries, including Ukraine, have been addressing is the reduction of trans fats and especially the elimination of industrially produced trans fats in the food supply. Trans fatty acids (TFA), or trans fats, are either naturally occurring or industrially synthesised type of unsaturated fatty acids with at least one double bond in the trans configuration. Industrially produced trans fats are synthesised via the partial hydrogenation of vegetable oils, which results in a semi-solid fat that is often used as a cheaper alternative to butter, has a longer shelf life and imparts desirable texture to food products. This makes trans fats more commonly found in food products that contain high amounts of partially hydrogenated oils, such as margarine, shortenings, cookies, cakes, breads and other industrially prepared foods. Developed and once widely used for their beneficial characteristics for the food industry, epidemiological evidence has since emerged on the association between regular consumption of trans fats and increased risk of non-communicable diseases (NCD), especially coronary heart disease. Approximately, 540 000 deaths each year may be attributed to intake of industrially produced TFAs.1 High TFA intake increases all-cause mortality by 34%, coronary heart disease deaths by 28% and coronary heart disease by 21%.2 This is likely due to their effect on increasing …
{"title":"Nutrition remains a top priority in Ukraine despite the ongoing war: the fight against trans fats","authors":"Gerard Bryan Gonzales, Carla Motta, Clare Farrand, Jarno Habicht, Olena Kuriata, Pyi Pyi Phyo, Andrii Skipalskyi, Kremlin Wickramasinghe","doi":"10.1136/bmjgh-2024-016301","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-016301","url":null,"abstract":"### Summary box Nutrition remains a critical priority in Ukraine, even in the midst of the ongoing war. One of the specific nutrition-related concerns that many countries, including Ukraine, have been addressing is the reduction of trans fats and especially the elimination of industrially produced trans fats in the food supply. Trans fatty acids (TFA), or trans fats, are either naturally occurring or industrially synthesised type of unsaturated fatty acids with at least one double bond in the trans configuration. Industrially produced trans fats are synthesised via the partial hydrogenation of vegetable oils, which results in a semi-solid fat that is often used as a cheaper alternative to butter, has a longer shelf life and imparts desirable texture to food products. This makes trans fats more commonly found in food products that contain high amounts of partially hydrogenated oils, such as margarine, shortenings, cookies, cakes, breads and other industrially prepared foods. Developed and once widely used for their beneficial characteristics for the food industry, epidemiological evidence has since emerged on the association between regular consumption of trans fats and increased risk of non-communicable diseases (NCD), especially coronary heart disease. Approximately, 540 000 deaths each year may be attributed to intake of industrially produced TFAs.1 High TFA intake increases all-cause mortality by 34%, coronary heart disease deaths by 28% and coronary heart disease by 21%.2 This is likely due to their effect on increasing …","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Increasing trust and confidence in vaccines is a global priority, as countries have grappled with delivering COVID-19 vaccines, maintaining routine childhood vaccination rates and introducing new vaccines. Community-based vaccine promotion interventions are commonly implemented, but effectiveness evidence is limited. In 2022, supported by the Australian Government and in partnership with Fiji’s Ministry of Health and UNICEF, we codesigned, delivered and comprehensively evaluated a vaccine education and communication training programme for health workers and community influencers to promote COVID-19 and routine immunisation. Methods The Vaccine Champions programme included three phases: (1) codesign with Fiji stakeholders; (2) vaccine education and communication training for Vaccine Champions and (3) support for Champions to deliver community vaccine discussion sessions over 6 months. The RE-AIM framework evaluation measured programme reach, effectiveness, adoption, implementation and maintenance. Mixed-methods data were collected through interviews, surveys and field notes, integrating qualitative and quantitative data to triangulate findings. Primary outcomes included Champions’ knowledge, communication self-efficacy, trust in COVID-19 vaccines, programme satisfaction and community members’ intention to vaccinate. Results We trained 35 Champions (27/35 female), including health workers, faith and community influencers. Half had a health background (17/35). Champions conducted 54 discussion sessions, reaching 1717 community members. Most Champions (22/35) conducted at least 1 session, with 16 running 3 or more. Champions who did not run sessions reported barriers like lack of confidence and competing duties. Training increased Champions’ communication self-efficacy and trust in COVID-19 vaccines. Community member intention to vaccinate increased from 41% (394/960) to 83% (822/991) before and after a session. The programme was well received with interest in continued engagement. Conclusion Training health workers and community Vaccine Champions can promote vaccine confidence. Programmes require government support and engagement for sustainability. Robust evaluation frameworks are needed to build the evidence base. Data are available on reasonable request. Deidentified individual participant data that underlie the results reported in this article, as well as the study protocol and data collection instruments, will be made available from the point of, and up to 3 years after the acceptance for publication of the main findings. Data will be shared with researchers who provide a methodologically sound proposal, for analyses that achieve the aims in the approved proposal. Proposals should be directed to jess.kaufman@mcri.edu.au. To gain access, data requesters will need to sign a data access agreement.
{"title":"Training health workers and community influencers to be Vaccine Champions: a mixed-methods RE-AIM evaluation","authors":"Jessica Kaufman, Isabella Overmars, James Fong, Jemesa Tudravu, Rachel Devi, Litiana Volavola, Luisa Vodonaivalu, Kylie Jenkins, Julie Leask, Holly Seale, Yasmin Mohamed, Kshitij Joshi, Halitesh Datt, Sonya Sagan, Michelle Dynes, Monsurul Hoq, Margie Danchin","doi":"10.1136/bmjgh-2024-015433","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-015433","url":null,"abstract":"Introduction Increasing trust and confidence in vaccines is a global priority, as countries have grappled with delivering COVID-19 vaccines, maintaining routine childhood vaccination rates and introducing new vaccines. Community-based vaccine promotion interventions are commonly implemented, but effectiveness evidence is limited. In 2022, supported by the Australian Government and in partnership with Fiji’s Ministry of Health and UNICEF, we codesigned, delivered and comprehensively evaluated a vaccine education and communication training programme for health workers and community influencers to promote COVID-19 and routine immunisation. Methods The Vaccine Champions programme included three phases: (1) codesign with Fiji stakeholders; (2) vaccine education and communication training for Vaccine Champions and (3) support for Champions to deliver community vaccine discussion sessions over 6 months. The RE-AIM framework evaluation measured programme reach, effectiveness, adoption, implementation and maintenance. Mixed-methods data were collected through interviews, surveys and field notes, integrating qualitative and quantitative data to triangulate findings. Primary outcomes included Champions’ knowledge, communication self-efficacy, trust in COVID-19 vaccines, programme satisfaction and community members’ intention to vaccinate. Results We trained 35 Champions (27/35 female), including health workers, faith and community influencers. Half had a health background (17/35). Champions conducted 54 discussion sessions, reaching 1717 community members. Most Champions (22/35) conducted at least 1 session, with 16 running 3 or more. Champions who did not run sessions reported barriers like lack of confidence and competing duties. Training increased Champions’ communication self-efficacy and trust in COVID-19 vaccines. Community member intention to vaccinate increased from 41% (394/960) to 83% (822/991) before and after a session. The programme was well received with interest in continued engagement. Conclusion Training health workers and community Vaccine Champions can promote vaccine confidence. Programmes require government support and engagement for sustainability. Robust evaluation frameworks are needed to build the evidence base. Data are available on reasonable request. Deidentified individual participant data that underlie the results reported in this article, as well as the study protocol and data collection instruments, will be made available from the point of, and up to 3 years after the acceptance for publication of the main findings. Data will be shared with researchers who provide a methodologically sound proposal, for analyses that achieve the aims in the approved proposal. Proposals should be directed to jess.kaufman@mcri.edu.au. To gain access, data requesters will need to sign a data access agreement.","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1136/bmjgh-2024-015862
Birgitta Gleeson, Cecilia Ferreyra, Kara Palamountain, Shevin T Jacob, Naomi Spotswood, Niranjan Kissoon, Yasir Bin Nisar, Felicity Fitzgerald, Sarah Murless-Collins, Uduak Okomo, James H Cross, Elizabeth Molyneux, Erwan Piriou, Kenechukwu K Iloh, Data Santorino, David Goldfarb, Alex Stevenson, Rebecca Kirby, Brooke E Nichols, Benjamin Blumel, Cassandra Kelly-Cirino, Timothy Walsh, Lizel Lloyd, Sara Liaghati-Mobarhan
#### SUMMARY BOX The first month of life is the most critical period for an infant’s survival, yet the most neglected for the provision of quality care. Each year, an estimated 2.3 million neonates die in their first month of life.1 Sepsis alone is responsible for 7.3% of all neonatal deaths worldwide, with a significant burden falling on low- and middle-income countries (LMICs).2 While there remains an ongoing debate regarding the definition of neonatal sepsis, it is broadly described as a suite of non-specific signs that may include fever or hypothermia, respiratory distress, cyanosis and apnoea, feeding difficulties, lethargy or irritability, hypotonia, seizures, bulging fontanelle, poor perfusion, bleeding problems, abdominal distention, hepatomegaly, unexplained jaundice or more importantly ‘just not looking right’.3 The absence of a conclusive, easily accessible and affordable diagnostic test for sepsis, as well as the multitude of potential pathogens, allows for ambiguity. This can result in underdiagnosis or overdiagnosis, both of which can have life-altering consequences for vulnerable neonates …
{"title":"A call to bridge the diagnostic gap: diagnostic solutions for neonatal sepsis in low- and middle-income countries","authors":"Birgitta Gleeson, Cecilia Ferreyra, Kara Palamountain, Shevin T Jacob, Naomi Spotswood, Niranjan Kissoon, Yasir Bin Nisar, Felicity Fitzgerald, Sarah Murless-Collins, Uduak Okomo, James H Cross, Elizabeth Molyneux, Erwan Piriou, Kenechukwu K Iloh, Data Santorino, David Goldfarb, Alex Stevenson, Rebecca Kirby, Brooke E Nichols, Benjamin Blumel, Cassandra Kelly-Cirino, Timothy Walsh, Lizel Lloyd, Sara Liaghati-Mobarhan","doi":"10.1136/bmjgh-2024-015862","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-015862","url":null,"abstract":"#### SUMMARY BOX The first month of life is the most critical period for an infant’s survival, yet the most neglected for the provision of quality care. Each year, an estimated 2.3 million neonates die in their first month of life.1 Sepsis alone is responsible for 7.3% of all neonatal deaths worldwide, with a significant burden falling on low- and middle-income countries (LMICs).2 While there remains an ongoing debate regarding the definition of neonatal sepsis, it is broadly described as a suite of non-specific signs that may include fever or hypothermia, respiratory distress, cyanosis and apnoea, feeding difficulties, lethargy or irritability, hypotonia, seizures, bulging fontanelle, poor perfusion, bleeding problems, abdominal distention, hepatomegaly, unexplained jaundice or more importantly ‘just not looking right’.3 The absence of a conclusive, easily accessible and affordable diagnostic test for sepsis, as well as the multitude of potential pathogens, allows for ambiguity. This can result in underdiagnosis or overdiagnosis, both of which can have life-altering consequences for vulnerable neonates …","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1136/bmjgh-2024-015624
Rakesh Ghosh, Kassoum Kayentao, Jessica Beckerman, Bréhima Traore, Sasha Rozenshteyn, Ari Johnson, Emily Treleaven, Jenny X Liu
### Summary box In the global maternal and newborn health (MNH) literature, care providers have been classified in several ways, engendering the question—whether providers who care for the mother and her newborn(s) have the necessary training and skills to provide quality care. This question underscores the importance of clearly defining who provided care. A specific definition not only facilitates correct interpretation of findings but helps understand potential reasons behind successes or failures of MNH interventions. Additionally, in low- and middle-income countries (LMICs), providers who routinely attend deliveries often receive varying levels of training, even within the same classifications. This inconsistency can result in incomparable estimates of skilled birth attendance, an indicator used to reference MNH care globally. This commentary emphasises the importance of a provider definition that is beyond the use of standard terminology like qualified, skilled or trained. We begin by reviewing the common definitions used globally, then demonstrate, using an example, the effect of definition on study findings. MNH care provider definitions should include who was involved (eg, education and training, licensing, experience and the signal function responsibilities for each provider category), where care was provided (eg, level of the facility, facility vs outreach, current national regulations for adequate contextual description) and when to describe any recent event that …
{"title":"Qualified, skilled or trained delivery care provider: a conundrum of who, where and when","authors":"Rakesh Ghosh, Kassoum Kayentao, Jessica Beckerman, Bréhima Traore, Sasha Rozenshteyn, Ari Johnson, Emily Treleaven, Jenny X Liu","doi":"10.1136/bmjgh-2024-015624","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-015624","url":null,"abstract":"### Summary box In the global maternal and newborn health (MNH) literature, care providers have been classified in several ways, engendering the question—whether providers who care for the mother and her newborn(s) have the necessary training and skills to provide quality care. This question underscores the importance of clearly defining who provided care. A specific definition not only facilitates correct interpretation of findings but helps understand potential reasons behind successes or failures of MNH interventions. Additionally, in low- and middle-income countries (LMICs), providers who routinely attend deliveries often receive varying levels of training, even within the same classifications. This inconsistency can result in incomparable estimates of skilled birth attendance, an indicator used to reference MNH care globally. This commentary emphasises the importance of a provider definition that is beyond the use of standard terminology like qualified, skilled or trained. We begin by reviewing the common definitions used globally, then demonstrate, using an example, the effect of definition on study findings. MNH care provider definitions should include who was involved (eg, education and training, licensing, experience and the signal function responsibilities for each provider category), where care was provided (eg, level of the facility, facility vs outreach, current national regulations for adequate contextual description) and when to describe any recent event that …","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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