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Beyond 'Go and bring your husband': a COM-B guided qualitative study on the barriers to male involvement in antenatal care in Bamenda Health District, Cameroon.
Get PDFMaternal and infant mortality remains a major public health concern in sub-Saharan Africa. While male involvement in pregnancy and child birth has proven to be an effective intervention that can significantly reduce these deaths, low-income settings like Cameroon continue to encounter obstacles in engaging men in maternal and child health services. This study seeks to examine and contextualize barriers to male partner involvement in antenatal care in order to inform the development of an intervention aimed at promoting male participation in maternal and child health in Cameroon. We employed a qualitative approach drawing upon 68 semi-structured interviews (SSIs) and three focus group discussions (FGDs). This involved purposively selected pregnant women (SSIs-38; FGD-01), male partners (SSIs-30; FGD-01) and health workers (FGD-01). Semi-structured interviews and group discussions were audio-recorded, transcribed and organized using Nvivo. Guided by the Capability, Opportunity and Motivation (COM-B) model of behaviour and Theoretical Domains Framework, we coded and analyzed data using directed content analysis, followed by inductive thematic analysis. Our findings suggest that, the behaviour of expectant fathers during pregnancy is shaped by the dynamic interaction between limited awareness on the role of men in pregnancy care and limited maternal agency to initiate or involve their partners in antenatal care. We also noted that the low motivation of male partners to participate in antenatal care is at the intersection of limiting health system approaches that have not moved beyond mandating women to go and bring their husbands, restrictive gender norms on masculinity-underpinned by the perception that antenatal care is a woman's affair and the fear of judgement/HIV testing. Based on our findings, we recommend that health system approaches specifically take into account existing knowledge gaps on male partner role, culture-specific gender norms and restructure the health system to promote male participation in maternal and child health services
Unwrapping the Global Financing Facility: understanding implications for women's children's and adolescent's health through layered policy analysis.
Get PDFThe Global Financing Facility (GFF), launched in 2015, aims to catalyse funding for reproductive, maternal, newborn, child, and adolescent health, and nutrition. Few independent assessments have evaluated its processes and impact. We conducted a multi-layered policy analysis of GFF documents - the Investment Cases (ICs) and the GFF-linked World Bank Project Appraisal Documents (PADs) - examining the content of GFF documents for 28 countries, comparing four tracer themes (maternal and newborn health, adolescent health, community health, and quality), and analysing the policy processes in four country studies (Burkina Faso, Mozambique, Tanzania, and Uganda). From 2015 to 2022, GFF-linked PADs reported US$ 14.5 billion of funding across 26 countries through 30 PADs, with GFF contributing 4% to this value. GFF investments primarily focused on service delivery, governance, and performance-based financing. Countries received more targeted investments for maternal and newborn health and adolescent health linked to their burden of these tracer themes. Attention to community health and quality varied. ICs were broader than PADs and more inclusive in their development. Local contexts shaped policy processes. GFF supported priority-setting and learning; however, translating priorities into resourced actions proved challenging. Power dynamics influenced country ownership, donor coordination and resource mobilisation. The GFF is a significant opportunity to advance health for vulnerable populations. Progress in transparency and data use is evident, but accountability gaps, power imbalances, and limited engagement with civil society and private sector hinder national ownership. Further research is needed to determine GFF's attribution to catalytic resource mobilization
Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1.
Get PDFBACKGROUND: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.0 was developed as a three-phase process to integrate evidence-based interventions into a unified care pathway, ensuring consistency across fragmented guidelines. This paper focuses on Phase 1, highlighting targeted interventions to improve and update the HEARTS Clinical Pathway. METHODS: First, the coordinating group defined the project's scope, objectives, principles, methodological framework, and tools. Second, international experts from different disciplines proposed interventions to enhance the HEARTS Clinical Pathway. Third, the coordinating group harmonized these proposals into unique interventions. Fourth, experts appraised the appropriateness of the proposed interventions on a 1-to-9 scale using the adapted RAND/UCLA Appropriateness Method. Finally, interventions with a median score above 6 were deemed appropriate and selected as candidates to enhance the HEARTS Clinical Pathway. RESULTS: Building on the existing HEARTS Clinical Pathway, 45 unique interventions were selected, including community-based screening, early detection and management of risk factors, lower blood pressure thresholds for diagnosing hypertension in high-CVD-risk patients, reinforcement of single-pill combination therapy, inclusion of sodium-glucose cotransporter-2 inhibitors for patients with diabetes, CKD, or heart failure, expanded roles for non-physician health workers in team-based care, and strengthened clinical documentation, monitoring, and evaluation. CONCLUSION: HEARTS 2.0 Phase 1 identifies key interventions to integrate and improve hypertension and cardiovascular-kidney-metabolic care within primary care, enabling their seamless incorporation into a unified and effective clinical pathway. This process will inform an update to the HEARTS Clinical Pathway, optimizing resources, reducing care fragmentation, improving care delivery, and advancing health equity, thereby supporting global efforts to combat the leading causes of death and disability
Barriers and facilitators to accessing sexual health services among middle-aged and older adults in the UK, including those with disabilities: a qualitative analysis.
Get PDFBackground Middle-aged and older adults have unmet sexual health needs but often encounter challenges in accessing sexual health services (SHS). Individual, social, and environmental issues discourage middle-aged and older adults from accessing SHS. This study aimed to examine the barriers and facilitators experienced by middle-aged and older adults when accessing SHS in the UK. We included disabled people and sexual minorities with intersectional needs. Methods We organised semi-structured interviews with residents in England aged 45 years and older, including disabled people and sexual minorities. Participants were recruited using social media, primary care clinics, and community-based organisations. Interviews were audio-recorded and transcribed. Levesque et al .'s framework of healthcare access was used as a theoretical guide for analysing and presenting the study findings. After initial coding and theme generation, sub-themes of barriers and facilitators were mapped onto the healthcare access framework. Results The mean age of the 22 participants was 59years with 15 men and 7 women. Participants included people of different ethnicities (White British, Black African, and White mixed), disabilities, and sexualities. These participants highlighted various barriers to accessing SHS. Physical obstacles, such as narrow corridors, were cited as significant hindrances, although accommodations, such as physical assistance, were noted to enhance accessibility. Additionally, participants noted the pervasive stigma surrounding sexual health in older adults, exacerbated by healthcare providers presuming asexuality within this demographic. To address these multi-faceted challenges, greater involvement of disabled older individuals in the design of SHS is advocated. This collaborative approach is believed to expedite the development of age-responsive clinical services, fostering inclusivity and accessibility while simultaneously addressing psychological and social barriers. Conclusions Our data suggest that physical inaccessibility and stigma are persistent barriers to accessing SHS for older disabled people. Increasing training for healthcare providers, further research, and supportive policies are needed to improve delivery and access to SHS for older adults, including those with disabilities in the UK
A core outcome set for maternal and neonatal health research and surveillance of emerging and ongoing epidemic threats (MNH-EPI-COS): a modified Delphi-based international consensus.
Get PDFBACKGROUND: Disease outbreaks significantly affect maternal and neonatal health. Variability in reporting health outcomes hinder evidence generation. We aimed to develop a core outcome set (COS) for maternal and neonatal health research and surveillance during emerging and ongoing epidemic threats and to agree on outcomes' definitions. METHODS: We conducted a systematic review of observational and experimental studies related to epidemics to identify outcomes, and a four-stage modified-Delphi consensus. 150 international stakeholders participated in online surveys, and 24 representatives in consensus meetings. The panels were diverse, with balanced representation of professional background, gender, and geography, including civil society representatives. Outcome were included if ≥ 80% of participants scored them as critically important and ≤10% rated them as not important. FINDINGS: The final COS includes seven main maternal outcomes-pregnancy outcome, maternal death, suspected symptomatic infection, confirmed infection, severe disease, preterm delivery, mode of birth; seven complementary maternal outcomes-antepartum haemorrhage, postpartum haemorrhage, hypertensive disorders of pregnancy, maternal sepsis, admission to intensive care unit/special units, respiratory support, depression and anxiety; 11 main neonatal outcomes-neonatal death, neonatal suspected symptomatic infection, confirmed infection, severe disease, vertical transmission, low birth weight, prematurity, congenital disorder, respiratory support, skin-to-skin contact, breastfeeding; and, four complementary neonatal outcomes-admission to neonatal intensive care unit/special units, respiratory failure, birth asphyxia, sepsis. INTERPRETATION: This COS could contribute to standardize maternal and neonatal outcomes selection and reporting in observational and experimental studies, facilitating efficient data comparison and timely evidence-based decision-making in the context of ongoing and emerging epidemic threats. FUNDING: Bill & Melinda Gates Foundation (grant INV-041181) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (HQHRP2422779)
Impact of digital antenatal care intervention on paper-based antenatal care recordkeeping: a before-and-after study in primary healthcare facilities in Nepal.
Get PDFOBJECTIVE: To assess the impact of introducing electronic decision support systems (EDSS)-electronic data entry implemented alongside existing paper-based antenatal care (ANC) records-on the completeness and agreement of ANC records. DESIGN: Two-phase cross-sectional (before and after) substudy of the mobile health integrated model of hypertension, diabetes and ANC (mIRA project) process evaluation. SETTING: Four rural districts in Bagmati Province, Nepal, in 19 primary healthcare facilities. PARTICIPANTS: ANC records from pregnant women attending facilities before (n=136) and after (n=138) EDSS implementation. MAIN OUTCOME MEASURES: For selected indicators in the ANC card and ANC register, we estimated the percentage completeness (any value recorded) and agreement (whether values matched) before and after EDSS implementation. We also reported the completeness of indicators in the EDSS and calculated the agreement between the ANC card and EDSS. χ2 or Fisher's exact test, as appropriate, was used to assess differences in completeness before and after implementation. RESULTS: Completeness of paper-based ANC records was high before implementation (>90%) for all indicators, except tetanus vaccination (15% improvement in the completeness of tetanus vaccination date in paper-based ANC records (77.0%-96.4% for ANC cards and 81.9%-98.9% for ANC register). Agreement between the ANC card and ANC register increased slightly for all indicators after implementation, and the tetanus vaccination date showed the largest increase (38.2%-57.2%). Indicator completeness in the EDSS was low, ranging from 38.2% to 88.7%. CONCLUSION: We found slight improvements in the completeness and agreement of paper-based ANC records following EDSS implementation. The lower percentage of completeness in the EDSS suggests that any large-scale implementation should consider how to integrate digital and paper-based records to decrease the data entry burden on ANC providers. However, the study's small sample size limited the ability to examine variation in effects
YouTube as a Source for Arabic-Speaking Parent Education on the Oral Hygiene of Children: A Social Media Content Analysis.
Get PDFINTRODUCTION: Much primary prevention in public health dentistry depends on parents' having accurate knowledge about pediatric oral health. In areas with minimal education levels and few oral health professionals, information on this topic is available from the widespread use of the social medial resource YouTube. This study assessed the quality and viewer engagement of YouTube Arabic videos on pediatric oral health practices. METHODS: Using standard procedures to search YouTube, we identified Arabic-language pediatric oral health videos. A social media content analysis was conducted and videos analyzed for viewer engagement metrics, country of origin, and creator occupation. The DISCERN instrument was used to evaluate video quality, reliability, and information quality; statistical correlations were examined between these parameters and video statistics. RESULTS: A majority of the 47 videos that were identified originated from Egypt and were created by pediatric dentists, attracting an average of 13,328.7 views and 218.7 likes. Quality assessment found 61.7% of videos with moderate quality; 63.8% had only medium levels of reliability (63.8%) and 63.8% medium information quality (63.8%); only a minor segment achieving high reliability and information quality. Correlation analysis revealed a positive but weak association between DISCERN scores and viewer engagement metrics (e.g., likes, comments, views), suggesting that while better quality videos tend to engage more viewers, other factors also contribute to engagement. Additionally, a stronger correlation was noted between the overall quality of videos and both information quality and reliability, indicating that videos with higher-quality content were perceived as more reliable and informative by viewers. CONCLUSION: While a significant volume of pediatric oral health content is available online, variability in quality highlights the need for stringent evidence-based standards to ensure the provision of reliable, quality educational materials
Infecting minds: socio-contextual drivers of vaccine perceptions and attitudes among young and older adults living in urban and rural areas in KwaZulu-Natal, South Africa.
Get PDFBACKGROUND: We investigated how social and contextual factors, including a pandemic, shape vaccine perceptions and attitudes among people living in KwaZulu-Natal in South Africa. We assessed how participants' views, acceptance, and uptake of vaccines for a range of infectious diseases, may be influenced by experiences and events linked to the COVID-19 pandemic. METHODS: We conducted 30 in-depth face-to-face and telephonic interviews with participants living in diverse rural and urban communities in two districts within KwaZulu-Natal. Participants were adults (≥ 18 years) consisting of ordinary citizens, traditional healers, and nurses. We combined non-representative convenience, snowballing and purposeful sampling techniques to recruit participants. Data collection was conducted in IsiZulu, and we used both inductive and deductive thematic analysis approaches to identify key themes linked to participants' perceptions and attitudes towards vaccines. FINDINGS: Our study participants were mostly those who had accepted vaccination. The main reasons given for vaccine uptake included understanding the importance of vaccines for disease prevention and survival, and securing the health of family members, the fear of death, government campaigns, vaccine mandates and penalties. Older participants (≥ 40 years) demonstrated more positive attitudes towards vaccines. Most participants downplayed the role of culture and religion in attitudes towards vaccines. However, some of the drivers of vaccine hesitancy were having an ancestral calling, medical pluralism, or local myths around the treatment of infections such as influenza and mumps, and a perceived depopulation agenda couched in mistrust and the use of incentives and penalties to force people to accept COVID-19 vaccines. CONCLUSION: Exploring what shapes attitudes towards vaccines in communities provides opportunities to understand the reasoning behind how people make decisions about whether to take a vaccine in different geographical and cultural spaces. The exploration of contexts, exposures and circumstances provide insights into perceptions and behaviour. Deeper engagement with local communities is crucial to develop evidence that can inform vaccine interventions. Assumptions about how culture and religion affect vaccine hesitancy or acceptance should be avoided in the process of developing such evidence
Impact of dual active ingredients long-lasting insecticidal nets on the genetic structure of insecticide resistant populations of Anopheles gambiae in Southern Benin.
Get PDFBACKGROUND: Insecticide resistance amongst vector populations is a major challenge, exacerbated by the continued use of the same active ingredients. The present study assessed the impact of long-lasting insecticidal nets (LLINs) bi-treated with chlorfenapyr-alphacypermethrin (PY-CFP LLIN) or pyriproxyfen-alphacypermethrin (PY-PPF LLIN) on the genetic structure of resistant populations of Anopheles gambiae in 60 clusters divided into three arms from three districts in southern Benin. METHODS: The study was conducted between September 2019 and October 2021 in 123 villages grouped in 60 clusters. Mosquitoes were collected indoors and outdoors using human landing catches (HLCs) in 4 households in each cluster every 3 months. After morphological identification, a subsample of An. gambiae sensu lato (s.l.) was analysed by PCR to detect the molecular species and the presence of L1014F vgsc-kdr and G119S-ace-1 mutations. RESULTS: Anopheles coluzzii (56.9%) and An. gambiae sensu stricto (s.s.) (42.8%), with a few hybrids (0.2%), were identified within 4242 samples of An. gambiae tested. The frequency of L1014F vgsc-kdr decreased in An. coluzzii collected both indoors and outdoors locations in the PY-CFP LLIN and PY-PPF LLIN arms post-intervention compared to baseline. In An. gambiae, the frequency of the L1014F allele decreased in year one but increased above baseline in year 2. In both species, the allelic frequency of G119S-ace-1 was 0) in both species. However, it was negative (FIS < 0) for the presence of G119S-ace-1. Weak genetic differentiation, especially in the PY-PPF LLIN and PY-CFP LLIN arms (FST ≤ 0.05), was observed in An. gambiae s.s. populations with L1014F vgsc-kdr, while it was generally higher for both species with G119S-ace-1. CONCLUSION: The frequency of the L1014F vgsc-kdr resistance allele was high, while that of the G119S-ace-1 allele was low throughout the study period. Consistent changes in allele frequencies were not observed in any of the treatment arms suggesting that the pyrethroid component of dual AI (active ingredients) nets continues to select for the resistant allele and there is little if any evidence that the non-pyrethroid insecticide selects for the wild-type kdr allele
Understanding of HIV cure research in a rural community with high prevalence: the case of uMkhanyakude district, KwaZulu-Natal, South Africa.
Get PDFBACKGROUND: Curing HIV has become a scientific priority with the development of HIV cure-related research collaborations and increasing clinical efforts. However, for potential study communities the meaning of HIV cure-related research needs to be fully understood. METHODS: We conducted qualitative research in rural KwaZulu-Natal, South Africa investigating the knowledge and understanding of HIV cure. We used deliberative approaches to facilitate in-depth discussions. Five deliberative group discussions were conducted in IsiZulu (the local language) with five participants in each group. Data were audio-recorded and translated verbatim and transcribed into English in anonymised format. Data were later analysed thematically with three main themes identified: knowledge of HIV cure, HIV cure terminology and HIV cure trials. RESULTS: Our findings showed that participants had a limited understanding of HIV cure-related research, a lack of trust regarding HIV cure science and participating in future cure trials. There were no local language terms used to describe HIV cure terminology, although several suggestions were shared in the discussions. CONCLUSIONS: Understanding the level of knowledge of rural populations regarding HIV cure-related research is essential for tailoring research and intervention strategies that meet their specific needs and circumstances. This can increase participation in the research and inform future HIV cure strategies