Multilevel determinants of community health workers for an effective maternal and child health programme in sub-Saharan Africa: a systematic review

Determinants of effective interventions for HIV prevention, treatment, and care to address inequitable HIV outcomes among Black Women of African Descent (BWAD) in High-Income Countries: Systematic review protocol

BACKGROUND

In High-Income Countries (HICs) HIV/AIDS continues to disproportionally affect Black Women of African Descent (BWAD) and other racialized groups and is now a major public health concern. Despite the multiple efforts, evidence is limited on the effectiveness of HIV interventions to address the HIV outcomes inequalities among BWAD. This protocol outlines the methodological process of a systematic review that will gather quantitative and qualitative data to examine existing determinants of effective HIV prevention, treatment, and care interventions to address the HIV outcomes disparities and inequities among BWAD in HICs.

METHODS

A systematic review of eligible articles will be conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive search of the literature will be made in MEDLINE(R) ALL (Ovid), Embase (Ovid), CINAHL (EBSCO Host), and Global Health (Ovid). Peer-reviewed studies involving the experience of BWAD in HICs; different HIV prevention, treatment, and care interventions both in the community and in a clinical setting; studies that report on the experience of BWAD on HIV intervention/ service including different levels of barriers and facilitators; reports of original research and peer-reviewed articles based on qualitative, quantitative, and mixed study designs published in English from 1980 onwards in HICs will be included. A narrative synthesis, thematic synthesis, and descriptive quantitative analysis of both extracted qualitative and quantitative data will be undertaken.

CONCLUSION

Substantial changes including tailored interventions are needed to address the inequities in HIV outcomes that disproportionally impact BWAD in HICs. Understanding the determinants of the effectiveness of BWAD-focused HIV interventions is critical to stemming the HIV epidemic and reducing the burden of the disease and poor health outcomes experienced by BWAD in HICs Our study finding will inform the multi level and multisectoral stakeholder including public health, community-based organizations and nongovernmental civil society organization engaged in BWAD HIV and health policy and practice in HICs. Findings from this review will be used to guide effective response to HIV/AIDS using an equity-driven policy and practice framework.

TRIAL REGISTRATION

PROSPERO registration number: CRD42023458938.

Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study

BACKGROUND

Low-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala.

METHODS

This qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model.

RESULTS

Three themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology.

CONCLUSION

Despite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs' demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts.

Review of investigational medical devices' clinical trials and regulations in Africa as a benchmark for new innovations

Medical technologies present a huge potential in improving global health playing a key role toward achieving Sustainable Development Goal 3 by 2030. A number of clinicians, innovators, business entities and biomedical engineers among others have developed a number of innovative medical devices and technologies to address the healthcare challenges especially in Africa. Globally, medical devices clinical trials present the most acceptable method for determining the risks and benefits of medical device innovations with the aim of ascertaining their effectiveness and safety as compared with established medical practice. However, there are very few medical device clinical trials reported in Africa compared to other regions like USA, UK and Europe. Most of the medical device clinical trials reported in Africa are addressing challenges around HIV/AIDS, maternal health and NCDs. In this mini review, we report about some of the published medical device clinical trials in Africa PubMed and Google Scholar and their associated challenges.

Conceptualising the Factors Influencing Community Health Workers’ Preparedness for ICT Implementation: A Systematised Scoping Review

Background: Globally, community health workers (CHW) are increasingly viewed as an integral part of the health system as opposed to simply being an extension of it. Given this view, most low- or middle-income countries (LMICs) have refocused their efforts on reorganising CHW initiatives to maximise their impact. The ongoing endeavours to augment the practice of community health workers using technological solutions are characterised by as many challenges as opportunities. In low- and middle-income countries, including South Africa, information and communication technology (ICT) has become a promising development in the enhancement of the equitable coverage of health services by community health workers. However, there has not been a wide-scale implementation and adoption of ICT; most technology initiatives fail to scale up during the implementation stage, which is attributable to human and context-related factors. Although there has been an effort to develop solutions to address ICT infrastructure and technical barriers, conceptualising an evidence-based understanding of the contextual and user-related factors that influence the efficacy of technology adoption by CHWs within their multidimensional system remains critical. Objective: The purpose of the study is to conceptualise the social factors to consider when implementing a bespoke ICT solution suited to the specific demands of CHWs in primary healthcare in developing contexts, with a particular focus on the South African context. Methodology: The methodology involves synthesizing, extracting, and consolidating the findings of a systematised scoping review into concepts and factors. The review adapts Arksey and O’Malley’s scoping review approach to the study and incorporates 59 relevant articles. Results: Although the knowledge base on CHWs is extensive, there is a considerable gap in addressing structural challenges within the community system, which contributes significantly to the overall performance of CHW programs. Factors promoting policy adaptations, common practice within the health system, CHW competencies, a community’s development in terms of knowledge and economic advancement, safety and security, the environment, and the socio-cultural context all play a significant role in facilitating or impeding the success of health interventions from the individual to the national level. Conclusions: Within several practical limitations, the study shows that despite the efforts of various developing countries to promote technology adoption, the barriers to ICT adoption outweigh the benefits gained in developing countries. The paper argues that addressing these challenges before and during implementation is critical. The authors conclude with some essential concerns about assisting CHWs towards realising the desired health outcomes through ICT.