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Zegeye AF, Tamir TT, Mekonen EG, Ali MS, Gonete AT, Techane MA, Wassie M, Kassie AT, Ahmed MA, Tsega SS, Wassie YA, Tekeba B, Workneh BS. Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression. Hum Vaccin Immunother 2024; 20:2352905. [PMID: 38772729 PMCID: PMC11110706 DOI: 10.1080/21645515.2024.2352905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/04/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND In low- and middle-income countries where vaccination rates are low, tetanus is still an important threat to public health. Although maternal and neonatal tetanus remains a major global health concern, its magnitude and determinates are not well studied. Therefore, this study aimed to assess the number of tetanus toxoid injections and associated factors among pregnant women in low- and middle-income countries. METHODS Data from the most recent Demographic and Health Surveys, which covered 60 low- and middle-income countries from 2010 to 2022, was used for secondary data analysis. The study included a total of 118,704 pregnant women. A statistical software package, STATA 14, was used to analyze the data. A negative binomial regression of a cross-sectional study was carried out. Factors associated with the number of tetanus vaccinations were declared significant at a p-value of < 0.05. The incidence rate ratio and confidence interval were used to interpret the results. A model with the smallest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was considered the best-fit model for this study. RESULTS In low- and middle-income countries, 26.0% of pregnant women took at least two doses of the tetanus toxoid vaccine. Factors such as maternal education, primary (IRR = 1.22, 95% CI: 1.17, 1.26), secondary (IRR = 1.19, 95% CI: 1.15, 1.23), higher (IRR = 1.16, 95% CI: 1.12, 1.20), employment (IRR = 1.11, 95% CI: 1.09, 1.13), 1-3 ANC visits (IRR = 2.49, 95% CI: 2.41, 2.57), ≥4 visits (IRR = 2.94, 95% CI: 2.84, 3.03), wealth index (IRR = 1.06; 95% CI: 11.04, 1.08), ≥birth order (IRR = 1.04, 95% CI: 1.02, 1.27), distance to health facility (IRR = 1.02, 95% CI: 1.00, 1.03), and health insurance coverage (IRR = 1.08; 95% CI: 1.06, 1.10) had a significant association with the number of tetanus vaccinations among pregnant women. CONCLUSIONS AND RECOMMENDATIONS This study concludes that the number of tetanus toxoid vaccinations among pregnant women in low- and middle-income countries is low. In the negative binomial model, the frequency of tetanus vaccinations has a significant association with maternal employment, educational status, wealth index, antenatal care visits, birth order, distance from a health facility, and health insurance. Therefore, the ministries of health in low and middle-income countries should give attention to those women who had no antenatal care visits and women from poor wealth quantiles while designing policies and strategies.
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Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Medina Abdela Ahmed
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yilkal Abebaw Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Oni TO, Petlele R, Banjo OO, Bankole A, Akinyemi AI. Measurement and conceptualization of male involvement in family planning: a bibliometric analysis of Africa-based studies. Contracept Reprod Med 2024; 9:29. [PMID: 38867339 PMCID: PMC11170783 DOI: 10.1186/s40834-024-00293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Male involvement in Family Planning (FP) is an exercise of men's sexual and reproductive health rights. However, the measurement of male involvement has been highly inconsistent and too discretional in FP studies. As a result, we used bibliometric tools to analyze the existing measures of male involvement in FP and recommend modifications for standard measures. METHODS Using developed search terms, we searched for research articles ever published on male involvement in FP from Scopus, Web of Science, and PubMed databases. The search results were filtered for studies that focused on Africa. A total of 152 research articles were selected after the screening, and bibliometric analysis was performed in R. RESULTS Results showed that 54% of the studies measured male involvement through approval for FP, while 46.7% measured it through the attitude of males to FP. About 31% measured male involvement through input in deciding FP method, while others measured it through inputs in the choice of FP service center (13.6%), attendance at FP clinic/service center (17.8%), and monetary provision for FP services/materials (12.4%). About 82.2% of the studies used primary data, though the majority (61.2%) obtained information on male involvement from women alone. Only about one in five studies (19.1%) got responses from males and females, with fewer focusing on males alone. CONCLUSION Most studies have measured male involvement in FP through expressed or perceived approval for FP. However, these do not sufficiently capture male involvement and do not reflect women's autonomy. Other more encompassing measures of male involvement, which would reflect the amount of intimacy among heterosexual partners, depict the extent of the exercise of person-centered rights, and encourage the collection of union-specific data, are recommended.
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Affiliation(s)
- Tosin Olajide Oni
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Rebaone Petlele
- Department of Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Akanni Ibukun Akinyemi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Slivesteri S, Ssali A, Bahemuka UM, Nsubuga D, Muwanga M, Nsereko C, Ssemwanga E, Robert A, Seeley J, Elliott A, Ruzagira E. Structural and social factors affecting COVID-19 vaccine uptake among healthcare workers and older people in Uganda: A qualitative analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002188. [PMID: 38809910 PMCID: PMC11135783 DOI: 10.1371/journal.pgph.0002188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/26/2024] [Indexed: 05/31/2024]
Abstract
The COVID-19 vaccine rollout programme in Uganda was launched in March 2021 for priority groups: Healthcare Workers (HCWs), older persons (≥50 years), and persons with chronic conditions. Misinformation, distrust in healthcare systems, and cultural beliefs, pose significant challenges to vaccine uptake. We describe the social and structural factors affecting the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21-63 years from three hospitals in central Uganda and eight older people from Wakiso district. Participant selection was purposive, based on sex, occupation, education, cadre of HCWs and vaccination status. We explored participants' knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake as well as suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, transcribed and translated into English, coded, and analysed by theme. Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Age, chronic health conditions, and the fear of death were facilitating factors for older people. Misconceptions about COVID-19 vaccines and fear of side effects were common social barriers for both groups. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers for older people. The prerequisite of signing a consent form was a specific structural barrier for HCWs. Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through community outreach, reliable vaccine supplies and addressing vaccine misinformation, may enhance COVID-19 vaccine uptake.
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Affiliation(s)
| | - Agnes Ssali
- MRC/UVRI & LSHTM Uganda Research Unit, Wakiso, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Denis Nsubuga
- MRC/UVRI & LSHTM Uganda Research Unit, Wakiso, Uganda
| | | | | | | | - Asaba Robert
- Our Lady of Consolata, Kisubi Hospital, Wakiso, Uganda
| | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Wakiso, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison Elliott
- MRC/UVRI & LSHTM Uganda Research Unit, Wakiso, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eugene Ruzagira
- MRC/UVRI & LSHTM Uganda Research Unit, Wakiso, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Marme G, Kuzma J, Zimmerman PA, Harris N, Rutherford S. Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea. J Public Health (Oxf) 2024; 46:267-276. [PMID: 38326281 DOI: 10.1093/pubmed/fdae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/04/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders' perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. METHODS Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. RESULTS Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers' safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. CONCLUSIONS The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.
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Affiliation(s)
- Gigil Marme
- School of Medicine & Dentistry (Public Health), Griffith University, Gold Coast, QLD 4215, Australia
| | - Jerzy Kuzma
- Department of Medicine, Divine Word University, Madang Province 511, Papua New Guinea
| | - Peta-Anne Zimmerman
- Graduate Infection Prevention and Control Program, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4215, Australia
| | - Neil Harris
- Higher Degree Research, Health Group, School of Medicine and Dentistry (Public Health), Griffith University, Gold Coast, QLD 4215, Australia
| | - Shannon Rutherford
- School of Medicine & Dentistry (Public Health), Griffith University, Gold Coast, QLD 4215, Australia
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Ayanore MA, Adjuik M, Zuñiga RAA, Amuna P, Ezechi O, Brown B, Uzochukwu B, Aly NM, Quadri MFA, Popoola BO, Ishabiyi AO, Ellakany P, Yousaf MA, Virtanen JI, Lawal FB, Ara E, Khan ATA, Gaffar B, El Tantawi M, Nguyen AL, Foláyan MO. Economic and social determinants of health care utilization during the first wave of COVID-19 pandemic among adults in Ghana: a population-based cross-sectional study. BMC Public Health 2024; 24:455. [PMID: 38350910 PMCID: PMC10865527 DOI: 10.1186/s12889-024-17912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic had socioeconomic effects in Africa. This study assessed the social and economic determinants of healthcare utilization during the first wave of COVID-19 among adults in Ghana. METHODS Information about individuals residing in Ghana was derived from a survey conducted across multiple countries, aiming to evaluate the impact of the COVID-19 pandemic on the mental health and overall well-being of adults aged 18 and above. The dependent variable for the study was healthcare utilization (categorized as low or high). The independent variables were economic (such as financial loss, job loss, diminished wages, investment/retirement setbacks, and non-refunded travel cancellations) and social (including food scarcity, loss of financial support sources, housing instability, challenges affording food, clothing, shelter, electricity, utilities, and increased caregiving responsibilities for partners) determinants of health. A multinomial logistic regression was conducted to identify factors associated with healthcare utilization after adjusting for confounders (age, gender, access to medical insurance, COVID-19 status, educational background, employment, and marital status of the participants). RESULTS The analysis included 364 responses. Individuals who encountered a loss of financial support (AOR: 9.58; 95% CI: 3.44-26.73; p < 0.001), a decrease or loss of wages (AOR: 7.44, 95% CI: 3.05-18.16, p < 0.001), experienced investment or retirement setbacks (AOR: 10.69, 95% CI: 2.60-43.88, p = 0.001), and expressed concerns about potential food shortages (AOR: 6.85, 95% CI: 2.49-18.84, p < 0.001) exhibited significantly higher odds of low healthcare utilization during the initial phase of the pandemic. Contrastingly, participants facing challenges in paying for basic needs demonstrated lower odds of low healthcare utilization compared to those who found it easy to cover basic expenses (AOR: 0.19, 95% CI: 0.06-0.67, p = 0.001). CONCLUSION Economic and social factors were associated with low healthcare utilization in Ghana during the first wave of the pandemic. Investment or retirement loss and financial support loss during the pandemic had the largest effect on healthcare utilization. Further research is needed to understand the connection between concerns about food shortages, welfare losses during pandemics and healthcare utilization during pandemics in Ghana.
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Affiliation(s)
- Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Ho, Ghana.
- Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana.
| | - Martin Adjuik
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | | | - Paul Amuna
- Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Oliver Ezechi
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Social Medicine, Population and Public Health, University of California, Riverside School of Medicine, Riverside, CA, United States of America
| | - Brandon Brown
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Benjamin Uzochukwu
- Mental Health and Wellness Study Group, Ho, Ghana
- University of Nigeria Nsukka (UNN) Enugu Campus, Nsukka, Nigeria
| | - Nourhan M Aly
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Ho, Ghana
- Texas Tech University and Health Sciences Center, Texas, United States of America
| | - Bamidele Olubukola Popoola
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Child Oral Health, University of Ibadan, Ibadan, Nigeria
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Sociology, Florida Atlantic University, Boca Raton, Florida, USA
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Ho, Ghana
- Institute of Zoology, University of the Punjab, Lahore, Pakistan
| | - Jorma I Virtanen
- Mental Health and Wellness Study Group, Ho, Ghana
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Ho, Ghana
- Government College for Women, Srinagar, Kashmir (J&K), India
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Biological Sciences, Faculty of Allied Health Sciences, Superior University, Kot Araian, Raiwind Road, Lahore, Punjab, Pakistan
- School of Biological Sciences, University of the Punjab, Quaid-e-Azam Campus, Lahore, Punjab, Pakistan
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Annie L Nguyen
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Moréniké Oluwátóyìn Foláyan
- Mental Health and Wellness Study Group, Ho, Ghana
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Izudi J, Cattamanchi A, Castelnuovo B, King R. Barriers and facilitators to viral load suppression among people living with HIV following intensive adherence counseling in Kampala, Uganda: A qualitative study. Soc Sci Med 2024; 343:116595. [PMID: 38242033 DOI: 10.1016/j.socscimed.2024.116595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/08/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
We explored the barriers and facilitators to viral load (VL) suppression after three or more intensive adherence counseling (IAC) sessions among adolescents and adults living with human immunodeficiency virus (HIV) on a first-line anti-retroviral therapy (ART) with initially unsuppressed VL in Kampala, Uganda. Using a qualitative study, data were collected through in-depth interviews with people living with HIV (PLHIV) with unsuppressed and suppressed VL and caregivers of younger adolescents living with HIV after three or more IAC sessions. We held key informant interviews with health workers involved in IAC implementation, namely ART/HIV focal persons, IAC Team Leaders, and linkage facilitators. Guided by the socioecological model, we performed content analysis and reported the findings using themes along with the participants' quotes. We studied 24 participants and found the individual-level barriers as forgetting to take HIV medications, high pill burden, medication side effects, a lack of food, and HIV-related psychological distress. Undisclosed HIV status and broken families were the barriers at the interpersonal level. Institutional-level barriers included insufficient HIV and ART counseling. Stigma was considered a community-level barrier while nonadherence to HIV treatment guidelines was a policy-level barrier. Facilitators included personal reminders, knowing the importance of taking treatment, and the ability to deal with side effects of HIV medications at the personal level; treatment support, peer support clubs, and incentivized treatment at the interpersonal level; and mental health support club and explaining during counseling that HIV is a chronic disease at the institutional level. We found an unsuppressed VL after completing IAC was due to several barriers at the personal, interpersonal, health systems, community, and policy levels. Achieving ≥95% VL suppression necessitates tackling the barriers to VL suppression and scaling up the facilitators by HIV control programs.
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Affiliation(s)
- Jonathan Izudi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; University of California Global Health Institute (UCGHI), University of California San Francisco, San Francisco, CA, USA.
| | - Adithya Cattamanchi
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda
| | - Rachel King
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Rony MKK, Alamgir HM. High temperatures on mental health: Recognizing the association and the need for proactive strategies-A perspective. Health Sci Rep 2023; 6:e1729. [PMID: 38059052 PMCID: PMC10696165 DOI: 10.1002/hsr2.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/28/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background and Aims The influence of temperature on various aspects of daily life is often underestimated, and its effects on mental health are not widely recognized. Understanding and addressing the relationship between temperature and mental well-being is crucial in the context of climate change and rising global temperatures. This perspective aimed to investigate the effects of high temperatures on mental health and identify proactive strategies to mitigate these effects. Methods This perspective adopted a twofold approach, including a comprehensive literature review and socioecological framework. The literature review involved extensive searches across Google Scholar, PubMed, and Scopus to identify relevant, peer-reviewed articles, and reports from diverse disciplines. Results The perspective emphasized the significance of recognizing heat stress and its consequences on mental well-being. Chronic heat stress can lead to increased stress, anxiety, and cognitive impairment. Vulnerable populations include, the very young, older adults, and individuals with pre-existing mental health conditions. Socioeconomic factors can further exacerbate vulnerability, highlighting the need for tailored strategies to manage mental health challenges during high temperatures. Additionally, the article identified and discussed proactive coping strategies to minimize both the psychological and physical impacts of heat stress. Mindfulness, stress management techniques, and therapy are suggested as effective means for individuals to manage psychological distress. Conclusion Implementing preventive measures are essential steps in promoting mental wellness in high temperatures. Proactive strategies by addressing the physiological and psychological effects of heat and considering the specific needs of vulnerable populations can help individuals and communities navigate the challenges posed by rising temperatures and promote resilience and preserve their mental well-being.
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Affiliation(s)
- Moustaq Karim Khan Rony
- Department of Public HealthBangladesh Open UniversityGazipurBangladesh
- Department of Institute of Social Welfare and ResearchUniversity of DhakaDhakaBangladesh
| | - Hasnat M. Alamgir
- Department of Career & Professional Development Services (CPDS)Southeast UniversityDhakaBangladesh
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Naigino R, Miller AP, Ediau M, Anecho A, Senoga U, Tumwesigye NM, Wanyenze RK, Mukasa B, Hahn JA, Reed E, Sileo KM, Kiene SM. Stakeholder perspectives on the Kisoboka intervention: A behavioral and structural intervention to reduce hazardous alcohol use and improve HIV care engagement among men living with HIV in Ugandan fishing communities. Drug Alcohol Depend 2023; 253:111011. [PMID: 37952352 PMCID: PMC11016226 DOI: 10.1016/j.drugalcdep.2023.111011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND East Africa's fishing communities experience a high burden of two interrelated and frequently co-occurring health issues: HIV and hazardous alcohol use. Nearly two-thirds of Ugandan fisherfolk men meet the criteria for harmful alcohol use. We developed a multilevel intervention to reduce hazardous alcohol use and improve HIV care engagement among fisherfolk men living with HIV (LWHIV) in Wakiso district, Uganda. METHODS This is a qualitative study of stakeholder perspectives on the appropriateness, acceptability, and feasibility of a multilevel intervention for fisherfolk men LWHIV. The proposed intervention, Kisoboka ("It is possible!"), combines a structural component [changing the mode of work payments from cash to mobile money] with a behavioral component [motivational interviewing-based counseling combined with content using behavioral economic principles to promote behavior change]. We conducted one focus group (n=7) and eight in-depth interviews with fisherfolk men LWHIV and 19 key informant (KI) interviews with health workers, employers, and community leaders. These explored the appropriateness, acceptability, and feasibility of specific key intervention components. RESULTS Overall, stakeholders' perspectives supported high intervention acceptability and perceived appropriateness of the proposed intervention. It was perceived to be feasible with some caveats of recommendations for overcoming potential implementation challenges identified (e.g., having a friend assist with documenting savings and alcohol use if an individual was unable to write themselves) which are discussed. CONCLUSION This work highlights the potential of the Kisoboka intervention and the importance of early engagement of key stakeholders in the intervention development process to ensure appropriateness, acceptability, feasibility, and socio-cultural fit.
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Affiliation(s)
- Rose Naigino
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, CA, USA; Makerere University School of Public Health, Kampala, Uganda
| | - Amanda P Miller
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, CA, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, CA, USA; Makerere University School of Public Health, Kampala, Uganda
| | - Asha Anecho
- Makerere University School of Public Health, Kampala, Uganda
| | - Umar Senoga
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | - Judith A Hahn
- Department of Medicine, University of California San Francisco, CA, USA
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, San Diego State University, CA, USA
| | - Katelyn M Sileo
- Department of Public Health, University of Texas at San Antonio, TX, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, CA, USA; Makerere University School of Public Health, Kampala, Uganda.
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Daramola T, Szatkowski L. Association between women's experience of domestic violence and childhood vaccination in West Africa: Cross-sectional analysis of Demographic and Health Survey data. PLoS One 2023; 18:e0293900. [PMID: 37917734 PMCID: PMC10621962 DOI: 10.1371/journal.pone.0293900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In 2021, 25 million children worldwide did not receive full basic childhood vaccinations, the highest figure in over a decade. There are large variations between countries in vaccination coverage. Globally, the lifetime prevalence of domestic violence among ever-partnered women is 30%. Exposure to domestic violence affects both maternal and child health. However, there is limited contemporary evidence on whether children born to women who are exposed to domestic violence are any more or less likely to be vaccinated. METHODS We conducted a cross-sectional study using data from the most recent Demographic and Health Surveys (DHS) from 7 West African countries (Benin, Gambia, Liberia, Mali, Nigeria, Senegal, Sierra Leone). We used multivariable logistic regression to examine the association between women's lifetime experience of any emotional, physical and/or sexual domestic violence and whether her most-recent born child aged 12-35 months old had received a full complement of basic childhood vaccinations (covering tuberculosis, diphtheria, tetanus, pertussis, polio and measles). RESULTS Data from 9,104 mother-child pairs was analysed (range 480 from Senegal to 3,230 from Nigeria). Overall, 47% of children were fully vaccinated (range 31% in Nigeria to 81% in The Gambia). 41% of women reported any experience of domestic violence (range 20% in Senegal to 54% in Sierra Leone). After adjustment for a range of child, maternal, household and partner-level variables, children born to women who reported experience of domestic violence were no more or less likely to be fully vaccinated (adjusted odds ratio = 1.02, 95% confidence interval 0.90-1.17). There was some evidence that the association may vary by country; in Sierra Leone, children born to women who reported experience of domestic violence were significantly less likely to be fully vaccinated (adjusted odds ratio = 0.62, 95%CI 0.44-0.88). CONCLUSIONS There was no significant association between a woman's exposure to domestic violence and whether her child was fully vaccinated. Further work is needed to understand the contextual factors which may explain potential variations between countries.
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Affiliation(s)
- Toluwalogo Daramola
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Lisa Szatkowski
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Adetunji A, Silva M, Tulsiani NJ, Adediran M. "Like a broom tied together": A qualitative exploration of social cohesion and its role in community capacity strengthening to support integrated health in Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002508. [PMID: 37874785 PMCID: PMC10597522 DOI: 10.1371/journal.pgph.0002508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023]
Abstract
Social cohesion, broadly understood as the degree of connectedness, solidarity, and trust across various community groups and between individuals, is critical for community capacity. This paper examines social cohesion and its role in community capacity strengthening for sustaining integrated health gains in Nigeria. This study took place in the context of a mid-course qualitative evaluation of a Community Capacity Strengthening approach that focuses on engaging Ward Development Committees (WDC) to increase community agency, coordinate and support the ward-level health ecosystem and ensure sustained community-level activities supporting behaviour change for improved health outcomes. This qualitative study was conducted in four selected wards per state in Bauchi and Sokoto states, targeting WDC members, Village Development Committee members, Community Volunteers, local government officials, traditional leaders, and Community Capacity Strengthening project staff. Thematic content analysis findings show that recognition and legitimacy were operationalized through the election of members into committees which in turn gave them a sense of identity and credibility. At the community level, WDCs leveraged the influence of social networks in the community to achieve their goal. Trust was also identified as a prerequisite to the acceptance and accomplishment of social and behaviour change programming. At the institutional level, our findings revealed strong conflict management skills and high collective efficacy of committee members for programme implementation. This study found high cohesion among committee members, promoting a sense of belonging and agency, and facilitating social and behavior change activities for improved health outcomes. However, we found clear limits to the extent to which high social cohesion can contribute to community capacity to sustain health implementation and improvements. While cohesive community organizations present a good opportunity for health programmes, there is a need for more investment of resources to address funding, logistics, and service delivery limitations.
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Affiliation(s)
- Adetayo Adetunji
- Population Council, Utako, Abuja, Federal Capital Territory, Nigeria
| | - Martha Silva
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | | | - Mayokun Adediran
- Population Council, Utako, Abuja, Federal Capital Territory, Nigeria
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Jelle M, Seal AJ, Mohamed H, Mohamed H, Omar MS, Mohamed S, Mohamed A, Morrison J. Understanding multilevel barriers to childhood vaccination uptake among Internally Displaced Populations (IDPs) in Mogadishu, Somalia: a qualitative study. BMC Public Health 2023; 23:2018. [PMID: 37848917 PMCID: PMC10580585 DOI: 10.1186/s12889-023-16153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/19/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Disparities in vaccination coverage exist in Somalia with Internally Displaced Persons (IDPs) being among the groups with the lowest coverage. We implemented an adapted Participatory Learning and Action (PLA) intervention, which focused on routine vaccinations among displaced populations living in Mogadishu IDP camps. The intervention was successful in improving maternal knowledge and vaccination coverage but unsuccessful in improving timely vaccination. We conducted a qualitative study to understand this result and analyze the multi-level barriers to routine childhood immunization uptake. METHOD In this qualitative study we used observation data from 40 PLA group discussions with female caregivers and purposively sampled nine vaccination service providers and six policy makers for interview. We also reviewed national-level vaccine policy documents and assessed the quality of health facilities in the study area. We used the socioecological framework to structure our analysis and analyzed the data in NVivo. RESULTS The barriers to childhood vaccination among IDPs at the individual level were fear due to lack of knowledge, mistrust of vaccines, concerns about side effects and misinformation; opportunity costs; and costs of transportation. At the interpersonal level, family members played an important role as did the extent of decision-making autonomy. Community factors such as cultural practices, gender roles, and household evictions influenced vaccination. Organizational issues at health facilities such as waiting times, vaccine stock-outs, distance to the facility, language differences, and hesitancy of health workers to open multi-dose vials affected vaccination. At the policy level, confusion about the eligible age for routine vaccination and age restrictions for catch-up vaccination and certain antigens such as BCG were important barriers. CONCLUSION Complex and interrelated factors affect childhood vaccination uptake among IDPs in Somalia. Interventions that address multiple barriers simultaneously will have the greatest impact given the complex nature of vulnerabilities in this population. There is a need to strengthen the health system and connect it with existing community structures to increase demand for services. Our research highlights the importance of formative research before implementing interventions. Further research on the integration of health service strengthening with PLA to improve childhood vaccination among IDPs is recommended. TRIAL REGISTRATION NUMBER ISRCTN-83,172,390. Date of registration: 03/08/2021.
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Simonetti JA, Anderson ML. When the messenger affects the message: Trustworthiness in the context of COVID vaccination. J Hosp Med 2023; 18:193-195. [PMID: 35535927 PMCID: PMC9088351 DOI: 10.1002/jhm.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Joseph A. Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional VA Medical CenterVeterans Health AdministrationAuroraColoradoUSA
- Denver‐Seattle Center of Innovation for Veteran‐Centered and Value‐Driven CareVeterans Health AdministrationAuroraColoradoUSA
- Division of Hospital MedicineUniversity of Colorado Anschutz School of MedicineAuroraColoradoUSA
- Rocky Mountain Regional VA Medical CenterAuroraColoradoUSA
| | - Mel L. Anderson
- Division of Hospital MedicineUniversity of Colorado Anschutz School of MedicineAuroraColoradoUSA
- Rocky Mountain Regional VA Medical CenterAuroraColoradoUSA
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Socioecological Challenges of Polio Supplementary Immunization Activities (SIAs) in the Asia-Pacific Region: A Systematic Review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2023; 2023:4801424. [PMID: 36747498 PMCID: PMC9899143 DOI: 10.1155/2023/4801424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/29/2023]
Abstract
Background Polio supplementary immunization activities (SIAs) are one of the polio eradication pillars in the Global Polio Eradication Initiative (GPEI) that increased the immunization coverage and made progress towards polio eradication. However, socioecological challenges faced during SIAs contribute to suboptimal campaign quality. The aim of this review is to identify the reported challenges during polio supplementary immunization activities (SIAs) and associated improvement strategies based on the socioecological model (SEM). Methods Articles were searched from three databases which were WOS, Scopus, and PubMed. The systemic review identified the primary articles related to SIA that focused on the impact of immunization coverage, challenges, and improvement strategies. The inclusion criteria were open access English articles that were published between 2012 and 2021 and conducted in the Asia region. Results There are nine articles described and explained regarding some form of supplementary immunization activities (SIAs) in their findings across Asia region. The majority of studies selected reported on post vaccination coverage and revealed a multifaceted challenge faced during SIAs which are widely diverse range from the microlevel of interpersonal aspects up to the macrolevel of government policy. Upon further analysis, the intervention at community level was the most dominant strategies reported during the SIA program. Conclusions An effective SIAs program provides the opportunity to increase the national capacity of the polio immunization program, reducing inequities in service delivery and offering additional public health benefits in controlling polio outbreaks in both endemic and nonendemic countries. Strengthening routine immunization (RI) programmes is also important for the sustainability of SIA's programs. Despite the challenges and hurdles, many Asian countries exhibited great political willingness to boost polio immunization coverage through SIA efforts.
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Ssekamatte T, Nalugya A, Isunju JB, Naume M, Oputan P, Kiguli J, Wafula ST, Kibira SPS, Ssekamatte D, Orza L, Mugambe RK, Wanyenze RK. Help-seeking and challenges faced by transwomen following exposure to gender-based violence; a qualitative study in the Greater Kampala Metropolitan Area, Uganda. Int J Equity Health 2022; 21:171. [PMID: 36463185 PMCID: PMC9719638 DOI: 10.1186/s12939-022-01786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The high prevalence of gender-based violence (GBV) among transwomen is a human rights and public health challenge. Nonetheless, there is limited evidence of sources of GBV support services and the challenges faced by transwomen while help-seeking, especially in transphobic settings like Uganda. This study explored the sources of GBV support services and the challenges faced by transwomen in the Greater Kampala Metropolitan Area during help-seeking. METHODS A qualitative study design involving 60 transwomen and 10 key informants was conducted. Respondents were recruited using snowball sampling. An in-depth interview (IDI), and a focus group discussion guide were used to collect data from 20 IDI respondents and six focus group discussants. Each focus group discussion averaged six participants. A key informant interview guide was used for key informant interviews. Data were transcribed verbatim and analysed following a thematic framework, informed by the socio-ecological model. Data were organised into themes and subthemes using NVivo 12.0. RESULTS The sources of support following exposure to GBV included key population-friendly healthcare facilities and civil society organisations (CSOs), and friends and family. Friends and family provided emotional support while key population-friendly healthcare facilities offered medical services including HIV post-exposure prophylaxis. Key population CSOs provided shelter, nutritional support, and legal advice to GBV victims. Lack of recognition of transgender identity; long distances to healthcare facilities; discrimination by healthcare providers and CSO staff, inappropriate questioning of the trans-gender identity by police officers and healthcare providers, and the lack of trans-competent healthcare providers and legal personnel hindered help-seeking following exposure to GBV. CONCLUSION The immediate sources of GBV support services included key population-friendly healthcare facilities and CSOs, police, and friends and family. However, a significant number of transwomen did not report incidences of GBV. Transwomen were discriminated against at some key population healthcare facilities and CSOs, and police, which hindered help-seeking following exposure to GBV. This study highlights the need to tackle internalized stigma and discrimination against transwomen at the existing sources of GBV support. There is also a need to train law enforcers and legal personnel on the right to access healthcare among transwomen in Uganda.
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Affiliation(s)
- Tonny Ssekamatte
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Aisha Nalugya
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - John Bosco Isunju
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Muyanga Naume
- Programs Department, Transgender Equality Uganda, Kampala, Uganda
| | - Patience Oputan
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Juliet Kiguli
- grid.11194.3c0000 0004 0620 0548Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Solomon Tsebeni Wafula
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Simon Peter S. Kibira
- grid.11194.3c0000 0004 0620 0548Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - David Ssekamatte
- grid.442646.60000 0004 0644 3312Department of Management, Uganda Management Institute, Plot 44-52, Jinja Road, Kampala, Uganda
| | | | - Richard K. Mugambe
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
| | - Rhoda K. Wanyenze
- grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Gate Rd, Kampala, Uganda
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Olaniyan A, Isiguzo C, Agbomeji S, Akinlade-Omeni O, Ifie B, Hawk M. Barriers, facilitators, and recommendations for childhood immunisation in Nigeria: perspectives from caregivers, community leaders, and healthcare workers. Pan Afr Med J 2022; 43:97. [PMID: 36660086 PMCID: PMC9816885 DOI: 10.11604/pamj.2022.43.97.35797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction vaccination is one of the most successful and cost-effective public health interventions, significantly reducing childhood morbidity and mortality. In 2019, Nigeria had almost 2.5 million unvaccinated children. This study highlights barriers, facilitators, and recommendations for childhood immunisation uptake from various stakeholder perspectives. Methods the study team conducted ten focus groups with mothers/caregivers and community leaders and nine semi-structured interviews with healthcare workers who provide routine immunisation services in Lagos State primary healthcare facilities. We performed a descriptive thematic analysis of the focus groups and semi-structured interviews. Results study participants included 44 mothers/caregivers and 24 community leaders, and 19 primary healthcare workers in the State. Study participants reported barriers, facilitators, and recommendations for childhood immunisation uptake. Barriers include poor geographical and financial constraints to access healthcare services, inconducive health facility attributes, negative attitudes of health facility staff, vaccination misperceptions, and adverse events following immunisation. Facilitators include free immunisation service policy, optimal vaccine and device supply chain system, adequate knowledge of immunisation benefits and efficacy, vaccination outreaches, and provision of incentives to caregivers. Participants also made recommendations for implementation, including more awareness creation, use of community resources, employing more healthcare workers, frequent and optimal immunisation services and planning, and instituting a reminder system and defaulter tracking. Conclusion: our results can inform the development of interventions to improve childhood immunisation uptake. In addition, study findings can be employed to improve adult immunisation acceptance and uptake and other services provided within the primary healthcare setting.
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Affiliation(s)
- Abisola Olaniyan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America,,Corresponding author: Abisola Olaniyan, Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
| | - Chinwoke Isiguzo
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Saheed Agbomeji
- Department of Primary Care, Derbyshire Community Health Service NHS Trust, Chesterfield, United Kingdom
| | - Olubunmi Akinlade-Omeni
- Directorate of Medical Services and Disease Control, Lagos State Primary Healthcare Board, Lagos, Nigeria
| | - Belinda Ifie
- Clinton Health Access Initiative, Lagos, Nigeria
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Perceived Vaccine Availability and the Uptake of Measles Vaccine in Sudan: The Mediating Role of Vaccination Hesitancy. Vaccines (Basel) 2022; 10:vaccines10101674. [PMID: 36298539 PMCID: PMC9611017 DOI: 10.3390/vaccines10101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate whether measles vaccine uptake can be predicted directly or indirectly by parental perceptions about the availability of measles vaccine services with parental hesitancy towards the measles vaccine as a potential mediator. This was a community-based cross-sectional study conducted at Omdurman locality in Khartoum state, Sudan in February 2019. The study population included parents/guardians having at least one child aged 2-3 years old. Mediation analysis was conducted using two models, the ordinary least squares path analysis and multiple logistic regression. These models considered perceived vaccine accessibility and availability as independent factors, vaccine uptake as dependent factors, and vaccine hesitancy (PACV scores) as a mediator. A total of 495 responded and the mean age of the mothers who participated in the study was 31.1 (SD = 5.73). Half of the respondents (50.1%) completed university education and nearly three-quarters of the respondents (74.7%) were housewives. After controlling for the other factors, including the mother's age and the number of children, parental perception about the accessibility and availability of the measles vaccine influences the uptake of the measles vaccine indirectly through the mediation effect of measles vaccine hesitancy. We suggest that intervening in measles vaccine hesitancy in addition to measles vaccination access issues will have a positive impact on the uptake and coverage of the measles vaccine in Sudan.
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Tuck CZ, Akparibo R, Gray LA, Aryeetey RNO, Cooper R. What influences cancer treatment service access in Ghana? A critical interpretive synthesis. BMJ Open 2022; 12:e065153. [PMID: 36198450 PMCID: PMC9535186 DOI: 10.1136/bmjopen-2022-065153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Multiple social-cultural and contextual factors influence access to and acceptance of cancer treatment in Ghana. The aim of this research was to assess existing literature on how these factors interplay and could be susceptible to local and national policy changes. DESIGN This study uses a critical interpretive synthesis approach to review qualitative and quantitative evidence about access to adult cancer treatment services in Ghana, applying the socioecological model and candidacy framework. RESULTS Our findings highlighted barriers to accessing cancer services within each level of the socioecological model (intrapersonal, interpersonal community, organisational and policy levels), which are dynamic and interacting, for example, community level factors influenced individual perceptions and how they managed financial barriers. Evidence was lacking in relation to determinants of treatment non-acceptance across all cancers and in the most vulnerable societal groups due to methodological limitations. CONCLUSIONS Future policy should prioritise multilevel approaches, for example, improving the quality and affordability of medical care while also providing collaboration with traditional and complementary care systems to refer patients. Research should seek to overcome methodological limitations to understand the determinants of accessing treatment in the most vulnerable populations.
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Affiliation(s)
- Chloe Zabrina Tuck
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Laura A Gray
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Richard Cooper
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Boisson A, Morgan CE, Fried B, Shea CM, Yotebieng M, Ngimbi P, Mbonze N, Mwandagalirwa K, Babakazo P, Thompson P. Barriers and facilitators to timely birth-dose vaccines in Kinshasa Province, the DRC: a qualitative study. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.35449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background National vaccine policies across the world have successfully improved infant vaccine coverage, but birth-dose (BD) vaccine coverage remains low. Countries such as the Democratic Republic of the Congo (DRC) aim to include the hepatitis B birth-dose (HepB-BD) vaccine in their national immunization schedule. HepB-BD’s short window for administration – within 24 hours of delivery to prevent mother-to-child transmission – adds to the complexity of streamlined and timely BD vaccines. This study aims to identify and understand barriers and facilitators to timely delivery of BD vaccine in Kinshasa Province, DRC, through individuals’ accounts with different perspectives on the uptake of the BD vaccine in preparation for its future roll-out. Methods We conducted semi-structured interviews in seven health facilities across Kinshasa Province from June to July 2021. We purposefully sampled health facilities from the provinces’ five most prominent facility types—private, public, Catholic, Protestant, and not-for-profit. We interviewed decision-makers and/or providers from various levels of the health care continuum, including midwives, immunization staff, heads of maternity and immunizations, and vaccine officials at the health zone and the Programme Elargi de Vaccination (PEV) to understand administrative barriers to BD vaccines. We also conducted interviews with expectant mothers to elicit knowledge and perceptions about infant vaccines. Results We interviewed 30 participants (16 informants and 14 expectant mothers). Interviewees were recruited from 7 health facilities, 2 health zones, and PEV. Data analysis was guided by the Consolidated Framework for Implementation Research (CFIR). Our analysis identified 13 constructs (2-3 per domain) related to the success of timely and streamlined BD vaccines. We found significant barriers within and across each domain; most notably, the multi-dose vials of existing BD vaccines determining when facility staff could vaccinate newborns, often resulting in untimely vaccinations; logistical concerns with regular national vaccine stockouts and ability to store vaccines; complex and unsynchronized vaccine fees across facilities; inadequate communication across delivery and vaccination wards; and limited and at times incorrect understanding of vaccines among mothers and other community members. Conclusions Using the CFIR framework, this study integrated perspectives from facility informants and expectant mothers to inform national policy and implementation of the HepB-BD in DRC. These stakeholder-driven findings should guide the streamlining of timely BD vaccinations upon HepB-BD implementation.
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Affiliation(s)
- Alix Boisson
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Camille E. Morgan
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bruce Fried
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher M. Shea
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Patrick Ngimbi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nana Mbonze
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Pélagie Babakazo
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Peyton Thompson
- University of North Carolina, Chapel Hill, North Carolina, USA
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Idris IO, Tapkigen J, Kabutaulaka G, Ayeni GO, Ayomoh FI, Obwoya JG. Are children on track with their routine immunization schedule in a fragile and protracted conflict state of South Sudan? A community-based cross-sectional study. BMC Pediatr 2022; 22:147. [PMID: 35307026 PMCID: PMC8935713 DOI: 10.1186/s12887-022-03213-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives The objective of this study was to assess if children aged 0–23 months in a conflict-affected state of South Sudan were on track with their immunization schedule and to identify predisposing factors that affected this study population from being on track with their routine immunization schedule. Design Community-based cross-sectional study using a semi-structured questionnaire. The binary outcome of interest was defined as being on or off track with routine vaccination schedule. Multivariable logistic regression was used to analyze for the association between the predisposing factors surveyed and being off track with one’s routine immunization schedule. Setting Rural communities in four counties (Rumbek Center, Rumbek North, Rumbek East and Wulu) of the Western Lakes state in South Sudan during January 10, 2020 to June 10, 2020. Participants We surveyed 428 children aged 0–23 months and their mothers/caregivers who lived in either of the four counties in the Western Lakes State. Participants were selected using random ballot sampling. Results More than three-quarters of the children surveyed (75.5%) were off track with their vaccination schedule. Children with an immunization card had 71% reduced odds of being off track with their immunization (AOR = 0.29; 95% CI 0.10–0.83, p-value = 0.021) compared to children without immunization cards. Children who reside near health facilities and do not require transportation to facilities had 87% reduced odds of being off track with their immunization compared to those who lived far and required transport to facilities. Giving an adequate immunization notice before conducting immunization outreach visits to communities was also associated with reduced odds (AOR = 0.27; 95% CI 0.09–0.78. p-value = 0.016) of children being off track with their immunization. Conclusion This study revealed that most children were off track with their vaccination schedule in South Sudan, which is not only influenced by maternal characteristics but mainly by community- and state-level immunization service delivery mechanisms. Policies and interventions to improve child immunization uptake should prioritize these contextual characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03213-5.
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Affiliation(s)
| | - Janet Tapkigen
- Department of Health Sciences, University of Tampere, Tampere, Finland
| | - Germaine Kabutaulaka
- Department of Epidemiology and Biostatistics, New York University, New York, USA
| | - Gabriel Omoniyi Ayeni
- Department of Field Operation and Project Coordination, Health Pooled Fund, Rumbek, South Sudan
| | | | - Justin Geno Obwoya
- Department of Field Operation and Project Coordination, Health Pooled Fund, Rumbek, South Sudan.
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Sabahelzain MM, Moukhyer M, van den Borne B, Bosma H. Vaccine Hesitancy among Parents and Its Association with the Uptake of Measles Vaccine in Urban Settings in Khartoum State, Sudan. Vaccines (Basel) 2022; 10:vaccines10020205. [PMID: 35214664 PMCID: PMC8875338 DOI: 10.3390/vaccines10020205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/10/2022] Open
Abstract
Vaccine uptake is one of the indicators that has been used to guide immunization programs. This study aimed to evaluate whether measles vaccine uptake is predicted by measles vaccine hesitancy. A community-based cross-sectional study was conducted in urban districts in Khartoum state in February 2019. Measles vaccine uptake among children was measured as either fully vaccinated or partially/not vaccinated. The Parent Attitudes about Childhood Vaccines (PACV) scale was used to measure measles vaccine hesitancy. Multivariate logistic regression was run to identify the predictors of measles vaccination uptake, controlling for sociodemographic variables, and the adjusted odds ratios (aORs) with 95% CI were calculated. The receiver operator characteristic (ROC) curve was created, and the area under the curve (AUC) for the PACV was computed. Data were collected from 495 participants. We found that measles vaccine hesitancy (PACV scores) predicts the uptake of measles vaccine after controlling for other potential social confounders, such as the mother’s age and the number of children (aOR 1.055; 95% CI 1.028–1.028). Additionally, the ROC for the PACV yielded an area under the curve (AUC 0.686 (95% CI 0.620–0.751; p < 0.001)). Our findings show that measles vaccine hesitancy in Sudan directly influences the uptake of the measles vaccine. Addressing the determinants of vaccine hesitancy through communication strategies will improve vaccine uptake.
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Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman P.O. Box 167, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Correspondence:
| | - Mohamed Moukhyer
- Department of Research and Development, Faculty of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia;
- Department of Emergency Medical Services, Faculty of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia
- Public Health Programmes, School of Medicine, University of Limerick, V94 PX58 Limerick, Ireland
| | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
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