69832 research outputs found
Sort by
Barriers to and facilitators of linkage to care following hypertension and diabetes screening among health workers in Zimbabwe: A mixed method study.
Get PDFThe benefits of screening for any condition are only realised if individuals who screen positive link to care services. We investigated linkage to hypertension and diabetes care by healthcare workers accessing a comprehensive health check service. We also explored facilitators and barriers to linkage to care. Between July 2020 and June 2022, a health check with referral and follow-up was offered to healthcare workers (clients) in Zimbabwe. We aimed to understand the proportion that linked to care after referral for an elevated blood pressure and/or HbA1c, assessed by follow-up phone calls. Linkage to care was defined as self-report of having seen a health professional within 30-60 days of the positive screening test result. In-depth interviews were conducted with 15 clients to understand associated facilitators and barriers. Overall, 3,143 clients accessed screening services. The majority were women (75.7%), and median age was 37 (IQR: 28-46) years. 785 (25.0%) clients screened positive for hypertension and 279 (8.9%) screened positive for diabetes. Clients referred for diabetes were more likely to accept referral (n=212, 72.0%) than those referred for hypertension (n=323, 41.1%). Among those referred and successfully contacted for follow-up, 131/182 (72.0%) reported having linked to care for diabetes and 218/269 (81.0%) for hypertension. Distance, accessibility, and travel costs to the facility they were referred to, influenced the decision and ability to link to care. While linkage to care for hypertension and diabetes was high among those who accepted referral, many healthcare workers did not accept referral. Greater awareness among healthcare providers regarding the importance of NCD care to improve acceptance of referral is required and every step of the care cascade must be affordable, accessible, and patient-centred
Understanding experiences and views of the menopause in Zimbabwe and South Africa: a qualitative study.
Get PDFOBJECTIVE: Menopause experiences are diverse and vary by social and cultural contexts. This study explored midlife women's experiences and views about menopause in urban settings in Zimbabwe and South Africa to inform co-production of supportive interventions. METHOD: Forty semi-structured interviews were conducted with women aged 40-60 years. Purposive sampling identified women, considering their age, comorbidities, HIV status and socioeconomic background. Data were audio-recorded, transcribed and analyzed thematically. RESULTS: Three inter-related themes were identified: loss and decline; uncertainty; and acceptance and growth. For some women, fertility was integral to their identity, without which they felt 'incomplete'. Several women described shock and confusion at their unanticipated experiences of bodily changes. Difficulties arose distinguishing menopause symptoms from other conditions, and women highlighted absence of information about symptom management. To gauge what was 'normal', women compared their experiences with those of trusted women. Some women in South Africa welcomed menopause as their transition to a respected elder; menopause meant freedom from menstruation and childbirth. Acceptance related to women's sense of whether they experienced menopause at 'the right time'. CONCLUSION: The study highlights similarities in women's menopausal experiences across Africa, as well as affirming the existence of wide and varied local views
Gaps and opportunities for data systems and economics to support priority setting for climate-sensitive infectious diseases in sub-Saharan Africa: A rapid scoping review.
Get PDFClimate change alters risks associated with climate-sensitive infectious diseases (CSIDs) with pandemic potential. This poses additional threats to already vulnerable populations, further amplified by social factors such as gender inequalities. Currently, critical evidence gaps, along with inadequate institutional and governance mechanisms, hinder African states' ability to prevent, detect and respond to CSIDs. Effective responses require transparent and evidence-based decision-making processes, supported by fit-for-purpose data systems and robust economic analyses. The aim of this study was to explore the role of data systems and economics in priority setting for CSID pandemic preparedness in sub-Saharan Africa. We conducted a rapid scoping review following PRISMA-ScR guidelines. A literature search was performed across six bibliographic databases in November 2023. A list of 14 target CSIDs was produced, informed by the World Health Organization's Public Health Emergencies of International Concern and R&D Blueprint Pathogen lists, and a database of CSIDs. Studies were included if published between 2010 and 2023, were relevant to sub-Saharan Africa, pandemic preparedness, and a target CSID, and applied or assessed economic evaluations or data systems. Extracted data were synthesised using bibliometric analysis, topic categorisation, and a narrative synthesis including the application of a gender lens. We identified 68 relevant studies. Data system studies (n = 50) showed broad coverage across target CSIDs and the WHO AFRO region but also a high degree of heterogeneity, which may indicate a lack of clearly defined standards or research priorities. Economic studies (n = 18) primarily focused on COVID-19 or Ebola and mostly originated from South Africa. Both data system and economic studies identified limited interoperability across sectors and showed a notable absence of gendered considerations. These gaps present important opportunities to strengthen priority setting during pandemics and may contribute to improved and equitable health outcomes
Understanding non-partner sexual violence perpetration in young Tanzanian men: a cross-sectional study.
Get PDFBACKGROUND: The World Health Organisation estimates that worldwide six percent of women aged 15-49 have experienced non-partner sexual violence (NPSV) in their lifetimes. A similar prevalence is found in sub-Saharan Africa. This form of violence is comparatively under-researched, leading to a dearth of knowledge around potential risk factors for male perpetration of NPSV. METHODS: We sought to explore key risk factors for perpetration of non-partner rape, verbal and physical sexual harassment in young Tanzanian men by conducting a cross-sectional survey of 1002 young men aged 18 to 24 living in Mwanza, Tanzania between June 2021 and March 2022. We conducted unadjusted logistic regression for bivariate associations between all three forms of NPSV and risk factors at the sociodemographic, behavioural, and mental health and substance misuse level. The risk factors independently associated with the outcomes were included in three separate multivariable logistic regression models. We then used dominance analysis to determine which factors had the strongest association with all three forms of NPSV perpetration. RESULTS: Among the young men in our sample, 9% reported having perpetrated non-partner rape (n = 86), 19% having physically harassed a woman (n = 188) and 33% having verbally harassed a woman (n = 330). After adjustment for the other risk factors in the model, pornography consumption, having multiple sexual partners, gambling, and depressive symptoms remained significantly associated with more than one form of NPSV. CONCLUSIONS: The widespread nature of sexual harassment and rape perpetration among young men in our study and the associated risk factors, which are all tied to notions of masculinity encouraging domination, promiscuity, and risky health behaviours, call for harmful gender norms to be addressed to reduce the incidence of NPSV
Co-Designing Tiyanjane, A Participatory Intervention to Promote Parental Involvement in the Education of Children with Disabilities in Malawi
Get PDFThis paper describes the co-design of a participatory group intervention developed to promote and enhance parental involvement in supporting the education of children with disabilities in Malawi. The intervention was developed through participatory co-design workshops and consensus meetings involving 23 stakeholders, including parents, teachers, and community leaders. The Behaviour Change Wheel framework and the Delphi technique guided the intervention development process, ensuring theoretical robustness and contextual relevance. The proposed intervention, Tiyanjane (‘Let Us Unite’), includes facilitator and participant training and practical face-to-face sessions over 12 weeks. The intervention targets four key areas: developing family action plans, holding regular meetings, providing ongoing support at home and school, and facilitating training and information exchange. This participatory approach, involving a wide range of local stakeholders, offers valuable insights into the process and outcomes of co-developing culturally relevant and theoretically grounded interventions to address the needs of families with children with disabilities in low-resource settings. Future research should include an evaluation of the feasibility and acceptability of the intervention and examine its applicability in diverse sociocultural settings within LMICs (low- and middle-income countries)
Digital interventions for alcohol use and alcohol use disorders in low- and-middle-income countries: a systematic review.
Get PDFBACKGROUND: Despite the high burden of alcohol use and alcohol use disorders (AUDs) in low-and-middle-income countries (LMICs), access to health care is poor. Digital interventions (DIs) have recently emerged as promising avenues for addressing substance use. Such interventions could potentially address barriers to help-seeking in LMICs, such as travel costs, shortage of professionals, stigma, etc. AIM: To synthesize evidence on the effectiveness and implementation of DIs for AUDs in LMICs. METHODS: The systematic review had a comprehensive search strategy that combined search terms for DIs (e.g. SMS, eHealth), alcohol use (e.g. hazardous drinking) and LMICs (e.g. India). Studies presenting primary data that reported effectiveness (e.g. relapse) and/or implementation or intervention-related outcomes (e.g. feasibility) of DIs for AUDs in LMICs were eligible. Three databases (EMBASE, MEDLINE and PsycINFO) were searched from their inception till June 2023. Data was extracted in relevant categories and analysed. RESULTS: Twenty-one reports from 19 studies were included. Types of DIs ranged from standalone mobile applications and web portals to human-delivered interventions via digital platforms. 12 studies reported positive or partially positive alcohol use outcomes (e.g. number of drinking days, abstinence). DIs with human involvement were found to be more effective than standalone DIs. Additionally, high levels of acceptability, feasibility and satisfaction were reported across interventions. CONCLUSION: DIs are acceptable and feasible in LMICs and broadly effective in improving alcohol use outcomes. Firm conclusions could not be drawn because of methodological issues such as small sample sizes, short follow-up periods and limited generalisability. Adequate investment, improved research methodology and increased focus on implementation outcomes are required for determining the role that DIs can play in addressing AUDs in LMICs
Calorie labelling and other drivers of takeaway food choices.
Get PDFBACKGROUND: Frequent consumption of out-of-home (OOH) foods, including takeaways, is linked to higher energy intake and poorer diet quality. In April 2022, calorie labelling was mandated in England for large OOH businesses to support healthier choices. This paper aimed to explore knowledge and use of calorie labelling when ordering takeaway food online and other factors influencing food choices, overall and by sociodemographic characteristics. METHODS: A cross-sectional survey of 1040 takeaway consumers in England from an OOH purchase panel assessed knowledge and awareness of calorie labelling legislation, self-reported impact on online takeaway choices, and key drivers of takeaway consumption. Data were analysed using descriptive statistics, logistic regressions and thematic analysis. RESULTS: Over 27% of respondents ordered takeaways once or more per week. Respondents aged 35 years and older were less likely (OR 0.28-0.52, p<0.05), while those with obesity were more likely (OR 2.01, p<0.001) to report frequent takeaway purchases. Women were more knowledgeable about the recommended energy meal content than men (OR 2.06, p<0.001), yet only 15% of respondents knew the guideline amount. Awareness of calorie labelling regulations was 63% overall, but was less likely in middle socioeconomic groups (OR 0.56-0.63, p<0.05). During past online orders, 23% noticed calorie labels; of these, 26% reduced food calories ordered, and 10% reduced drink calories ordered. Taste and price were key drivers of takeaway choices, while health and sustainability were less influential. Strong support emerged for healthier menu options and traffic light labelling to help improve the healthiness of takeaway orders. CONCLUSION: Given the limited reported impact, calorie labels may only benefit a minority. As meal healthiness was ranked as a relatively less important driver for takeaway choices, further policies are required to complement calorie labelling in promoting healthier food environments
Gender differences in Leptospira exposure risk, perceptions of disease severity, and high-risk behaviours in Salvador, Brazil: A cross-sectional study.
Get PDFVulnerability to climate hazards and infectious diseases is not gender-neutral, meaning that men, women, and other gender identities experience different risks. Leptospirosis is a zoonotic climate-sensitive infectious disease caused by the bacteria Leptospira and is transmitted to humans through contact with infected animals or contaminated environments, particularly soil and floodwater. Globally, studies report a higher risk of leptospiral infection among men than women, a trend also observed in Salvador, Brazil; however, the factors driving this difference are poorly understood. This study aimed to investigate how Leptospira exposure differs between men and women living in urban informal settlements in Salvador. We conducted a cross-sectional serosurvey among 761 adults (280 men and 481 women) in four communities previously identified as high-risk by surveillance data. Using a causal inference approach and a two-part sex-disaggregated analysis, we applied logistic regression models to examine: (1) the association between perceived severity and high-risk behaviours with Leptospira seropositivity, and (2) the association between perceived severity with high-risk behaviours. Seroprevalence was 14.6% (95% CI: 10.5%-18.8%) in men and 9.4% (95% CI: 6.7%-12.0%) in women. Men who perceived leptospirosis as extremely serious had lower odds of being seropositive (OR: 0.38, 95% CI: 0.15-0.99), walking through sewage (OR: 0.41, 95% CI: 0.17-1.00), and walking barefoot outside (OR: 0.24, 95% CI: 0.08-0.76) compared with men who perceived leptospirosis as less serious. These associations were not observed in women and differed across age groups in men. Behaviours were not associated with seropositivity in either gender. Our results identify perceived severity as a potential driver of high-risk behaviours and exposure in men, indicating perceptions as targets for health promotion programs, while also highlighting evidence gaps in understanding exposure risks among women. As the first sex-disaggregated study investigating Leptospira exposure risks, we advocate for a gendered lens in future studies to understand gender-specific risks
Factors influencing uptake of COVID-19 diagnostics in Sub-Saharan Africa: a rapid scoping review.
Get PDFBACKGROUND: Diagnostics are critical for preventing COVID-19 transmission, enabling disease management and engagement with care. However, COVID-19 testing uptake remained low in low- and middle- income countries in Sub-Saharan Africa (SSA) during the recent pandemic, due to issues of supply, access and acceptability. Early studies conducted outside of the region provide insight into uptake of COVID-19 testing, however there has been no systematic research within the region. The aim of this scoping review is to investigate factors influencing uptake of COVID-19 testing in different settings across SSA. MATERIALS AND METHODS: Inclusion criteria was any study employing qualitative or mixed methodologies, addressing uptake of COVID-19 testing conducted in SSA. MEDLINE, PubMed, Google Scholar, Web of Science, and Africa-Wide Information were searched. Thematic content analysis was conducted across all included articles until saturation was attained. RESULTS: In total 2994 articles were identified and fourteen reviewed. Structural, social, epidemiological, informational, and political elements affected how the public interacted with COVID-19 testing. Coverage was limited by insufficient diagnostic capabilities caused by a shortage of laboratory resources and trained personnel. False information spread through social media led to testing misperceptions and apprehension. Testing hesitancy was ascribed to fear of restrictive measures and the possibility of social harms if positive. Facility-based testing was physically inaccessible and perceived as lacking privacy, whereas self-testing distributed by the community removed lengthy distances and prevented stigma. Perceptions that COVID-19 was not severe and low numbers of confirmed cases in comparison to other settings undermined public urgency for testing. Low testing frequency led to low-rate assumptions, which in turn generated denial and othering narratives. Politicians' acceptance or denial of COVID-19 affected the mobilization of the health system, and their model actions-such as testing openly-promoted public confidence and involvement in interventions. CONCLUSIONS: This review emphasizes the necessity of strong political commitments to enhancing health systems for future pandemic preparedness. Response plans should consider contextual elements that affect how people react to interventions and perceive health emergencies. Community-driven self-testing distribution could enhance the uptake of diagnostics through addressing socio-economic constraints impacting facility-delivered testing
Factors associated with tuberculosis treatment initiation among bacteriologically negative individuals evaluated for tuberculosis: An individual patient data meta-analysis.
Get PDFBACKGROUND: Globally, over one-third of pulmonary tuberculosis (TB) disease diagnoses are made based on clinical criteria after a negative bacteriological test result. There is limited information on the factors that determine clinicians' decisions to initiate TB treatment when initial bacteriological test results are negative. METHODS AND FINDINGS: We performed a systematic review and individual patient data meta-analysis using studies conducted between January 2010 and December 2022 (PROSPERO: CRD42022287613). We included trials or cohort studies that enrolled individuals evaluated for TB in routine settings. In these studies, participants were evaluated based on clinical examination and routinely used diagnostics and were followed for ≥1 week after the initial test result. We used hierarchical Bayesian logistic regression to identify factors associated with treatment initiation following a negative result on an initial bacteriological test (e.g., sputum smear microscopy (SSM), Xpert MTB/RIF). Multiple factors were positively associated with treatment initiation: male sex [adjusted odds ratio (aOR) 1.61 (1.31, 1.95)], history of prior TB [aOR 1.36 (1.06, 1.73)], reported cough [aOR 4.62 (3.42, 6.27)], reported night sweats [aOR 1.50 (1.21, 1.90)], and having HIV infection but not on ART [aOR 1.68 (1.23, 2.32)]. Treatment initiation was substantially less likely for individuals testing negative with Xpert [aOR 0.77 (0.62, 0.96)] compared to smear microscopy and declined in more recent years. We were not able assess why clinicians made treatment decisions, as these data were not available. CONCLUSIONS: Multiple factors influenced decisions to initiate TB treatment despite negative test results. Clinicians were substantially less likely to treat in the absence of a positive test result when using more sensitive, PCR-based diagnostics