Health services uptake among nomadic pastoralist populations in Africa: A systematic review of the literature

Hotspot areas of tetanus-unprotected births and its associated factors in Ethiopia: Spatial analysis of EDHS data

Neonatal tetanus persists as a public health problem in many developing countries including Ethiopia. Maternal tetanus toxoid vaccination is a cornerstone to prevent neonatal tetanus. However, its prevalence is low in Ethiopia, and little has been devoted to its spatial epidemiology and associated factors. Hence, this study aimed to explore the spatial pattern and factors affecting tetanus-unprotected births in Ethiopia. A further analysis of the 2016 Ethiopia Demographic and Health Survey data was conducted, and a weighted sample of 7590 women was used for analysis. Spatial analysis was done using ArcGIS and SaTScan software. A binary logistic regression model was fitted to identify factors and variables with a p-value <.05 were considered as statistically significant. About 54.13% (95% CI: 53.01, 55.25) of births were not protected against neonatal tetanus, and spatial clustering of tetanus unprotected births was observed (Moran's I = 0.144, p-value = .028). The primary and secondary SaTScan clusters were detected in Northeastern Tigray, Eastern Amhara, and almost the entire Afar (RR = 1.34 & LLR = 66.5, p < .01), and in the Somali region, and the western border of Gambela (RR = 1.44 & LLR = 31.3, p < .01), respectively. Tetanus unprotected births were higher among women without formal education (AOR = 1.63; 95% CI: 1.29, 2.04), came from poor households (AOR = 1.27; 95% CI: 1.12, 1.45), who had no ANC contact (AOR = 6.97; 95% CI: 6.21, 7.88), and who were not exposed to the media (AOR = 1.26; 95% CI: 1.09, 1.47). Hence, tetanus-unprotected birth hotspots require priority interventions, and it is good if the targeted interventions consider the identified factors.

Geographical variation in hotspots of stunting among under-five children in Ethiopia: A geographically weighted regression and multilevel robust Poisson regression analysis

INTRODUCTION

Childhood stunting is a global public health concern, associated with both short and long-term consequences, including high child morbidity and mortality, poor development and learning capacity, increased vulnerability for infectious and non-infectious disease. The prevalence of stunting varies significantly throughout Ethiopian regions. Therefore, this study aimed to assess the geographical variation in predictors of stunting among children under the age of five in Ethiopia using 2019 Ethiopian Demographic and Health Survey.

METHOD

The current analysis was based on data from the 2019 mini Ethiopian Demographic and Health Survey (EDHS). A total of 5,490 children under the age of five were included in the weighted sample. Descriptive and inferential analysis was done using STATA 17. For the spatial analysis, ArcGIS 10.7 were used. Spatial regression was used to identify the variables associated with stunting hotspots, and adjusted R2 and Corrected Akaike Information Criteria (AICc) were used to compare the models. As the prevalence of stunting was over 10%, a multilevel robust Poisson regression was conducted. In the bivariable analysis, variables having a p-value < 0.2 were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval is presented to show the statistical significance and strength of the association.

RESULT

The prevalence of stunting was 33.58% (95%CI: 32.34%, 34.84%) with a clustered geographic pattern (Moran's I = 0.40, p<0.001). significant hotspot areas of stunting were identified in the west and south Afar, Tigray, Amhara and east SNNPR regions. In the local model, no maternal education, poverty, child age 6-23 months and male headed household were predictors associated with spatial variation of stunting among under five children in Ethiopia. In the multivariable multilevel robust Poisson regression the prevalence of stunting among children whose mother's age is >40 (APR = 0.74, 95%CI: 0.55, 0.99). Children whose mother had secondary (APR = 0.74, 95%CI: 0.60, 0.91) and higher (APR = 0.61, 95%CI: 0.44, 0.84) educational status, household wealth status (APR = 0.87, 95%CI: 0.76, 0.99), child aged 6-23 months (APR = 1.87, 95%CI: 1.53, 2.28) were all significantly associated with stunting.

CONCLUSION

In Ethiopia, under-five children suffering from stunting have been found to exhibit a spatially clustered pattern. Maternal education, wealth index, birth interval and child age were determining factors of spatial variation of stunting. As a result, a detailed map of stunting hotspots and determinants among children under the age of five aid program planners and decision-makers in designing targeted public health measures.

Perceived barriers of access to health and nutrition services under drought and food insecurity emergency in north-east Uganda: a qualitative study

BACKGROUND

In the face of drought and food insecurity emergency, evidence on access to health and nutrition services is important. Karamoja is one of the regions that have experienced extreme drought and food insecurity emergency in Uganda. As a part of the drought and food insecurity emergency response, World Health Organization (WHO) with Ministry of Health (MoH) has designed and implemented a qualitative study in 15 districts that have experienced drought and food insecurity emergency in north-east Uganda. Thus, we aimed to explore the barriers of access to health and nutrition services in drought and food insecurity emergency affected districts in north-east Uganda.

METHODS

We employed a descriptive qualitative study design. We interviewed 30 patients and 20 Village Health Teams (VHT) from 15 districts. We employed an in-depth interview with semi-structured questions to collect data until information saturation reached. We used thematic data analysis approach by ATLAS.ti version 7.5.1.8 software.

RESULTS

Of the 30 interviewed subjects, 15 were female, and the median age of the subjects was 29 years with interquartile range (IQR) of 23 to 37 years. Majority (68.8%) of subjects reported that access to health and nutrition services was harder to them. Four themes: sociocultural and economic; environmental; health system, and individual related factors were identified as the barriers of access to health and nutrition services.

CONCLUSION

The present study identified several modifiable barriers that hinder access to health and nutrition services in drought and food insecurity affected districts. Comprehensive interventions aimed at addressing sociocultural, economic, environmental, health system and subject related challenges are required to improve access to health and nutrition services in drought and food insecurity affected setups.

Assessing Vaccination Delivery Strategies for Zero-Dose and Under-Immunized Children in the Fragile Context of Somalia

Somalia is one of 20 countries in the world with the highest numbers of zero-dose children. This study aims to identify who and where zero-dose and under-vaccinated children are and what the existing vaccine delivery strategies to reach zero-dose children in Somalia are. This qualitative study was conducted in three geographically diverse regions of Somalia (rural/remote, nomadic/pastoralists, IDPs, and urban poor population), with government officials and NGO staff (n = 17), and with vaccinators and community members (n = 52). The data were analyzed using the GAVI Vaccine Alliance IRMMA framework. Nomadic populations, internally displaced persons, and populations living in remote and Al-shabaab-controlled areas are three vulnerable and neglected populations with a high proportion of zero-dose children. Despite the contextual heterogeneity of these population groups, the lack of targeted, population-specific strategies and meaningful engagement of local communities in the planning and implementation of immunization services is problematic in effectively reaching zero-dose children. This is, to our knowledge, the first study that examines vaccination strategies for zero-dose and under-vaccinated populations in the fragile context of Somalia. Evidence on populations at risk of vaccine-preventable diseases and barriers to vital vaccination services remain critical and urgent, especially in a country like Somalia with complex health system challenges.

Influences of community engagement and health system strengthening for cholera control in cholera reporting countries

The 2030 Global Task Force on Cholera Control Roadmap hinges on strengthening the implementation of multistranded cholera interventions, including community engagement and health system strengthening. However, a composite picture of specific facilitators and barriers for these interventions and any overlapping factors existing between the two, is lacking. Therefore, this study aims to address this shortcoming, focusing on cholera-reporting countries, which are disproportionately affected by cholera and may be cholera endemic. A scoping methodology was chosen to allow for iterative mapping, synthesis of the available research and to pinpoint research activity for global and local cholera policy-makers and shareholders. Using the Arksey and O'Malley framework for scoping reviews, we searched PubMed, Web of Science and CINAHL. Inclusion criteria included publication in English between 1990 and 2021 and cholera as the primary document focus in an epidemic or endemic setting. Data charting was completed through narrative descriptive and thematic analysis. Forty-four documents were included, with half relating to sub-Saharan African countries, 68% (30/44) to cholera endemic settings and 21% (9/44) to insecure settings. We identified four themes of facilitators and barriers to health systems strengthening: health system cooperation and agreement with external actors; maintaining functional capacity in the face of change; good governance, focused political will and sociopolitical influences on the cholera response and insecurity and targeted destruction. Community engagement had two themes: trust building in the health system and growing social cohesion. Insecurity and the community; cooperation and agreement; and sociopolitical influences on trust building were themes of factors acting at the interface between community engagement and health system. Given the decisive role of the community-health system interface for both sustained health system strengthening and community engagement, there is a need to advocate for conflict resolution, trust building and good governance for long-term cholera prevention and control in cholera reporting countries.

Probable cases of tuberculosis in Early Medieval pastoralists of Eastern Europe

Two anthropological collections of the 8-9th century AD from the forest-steppe area of the southern Eastern Europe has been the subject of analysis of the osteo-articular alterations concerning tuberculosis related lesions. According to archaeological data, the Mayaki and Dmitrievka groups are from the territory of Khazar Khaganate, which is well-known by historical data. It was a traditional population with settled pastoral farming. There were studied 292 adult human remains by macroscopic morphological and radiological methods. The completeness of the skeletons could have been better due to the intentional selection of their parts for the museum funds, so there were limitations for the differential diagnosis of TB by morphological criteria. In general, 31 individuals (20 men, 11 women) were marked as possible candidates with skeletal TB. The number of skeletons with possible specific infections from the two series is comparable, but according to sex distribution, there are some significant differences. If in the Dmitrievka group, there was approximately the same distribution of the number of cases of possible infected men and women; in the Mayaki group then there was a significant difference in the prevalence of the male sample. Various reasons can explain the observed differences. Firstly, we cannot rule out an error in the diagnosis of tuberculosis only by morphological methods since the preservation of the skeletons leaves much to be desired. Secondly, as it is known, only a few percent of tuberculosis patients show skeletal alterations, so the direct quantitative comparison cannot be adequate in paleopathological studies. The ambiguity of morphological criteria, particularly for destructive lesions of bone other than vertebrae, does not allow asserting that all identified cases result from TB. However, the results of differential diagnosis can underline that at least half of the skeletons have skeletal alterations most likely related to TB. The final analysis of the remains by aDNA methods will permit more certain confirmation of the diagnosis.

Assessment of Place of Delivery and Associated Factors among Pastoralists in Ethiopia: A Systematic Review and Meta-Analysis Evaluation

Background

Pastoralist communities rely on their livestock for at least 50% of their food supply and source of income. Home births raise the risk of maternal morbidity and death, whereas institutional births lessen the likelihood of difficulties during labor. Around 70% of labors in pastoralist regions of Ethiopia were assisted by traditional birth attendants.

Methods

Studies done from January 2004 to January 2023, accessed in PubMed, EMBASE, Medline, and other search engines, were included. PRISMA guidelines and JBI critical appraisal checklist were used to assure the quality of the review. Ten articles were included in this review. Data were extracted with Excel and exported to STATA 16 for analysis. Heterogeneity of literatures was evaluated using I2 statistics and publication bias using the Egger regression asymmetry test and the Duval and Tweedie trim-fill analysis. Statistical significance was declared at p value less than 0.05.

Result

The pooled estimate of institutional delivery among the pastoralist community in Ethiopia is 21.2% (95% CI: 16.2-26.1). Husbands who were involved to decide place of delivery (OR = 3.47; 95% CI: 1.61, 7.50), women with good knowledge of MCH services (OR = 2.283; 95% CI: 1.51, 3.44), women who had a positive attitude towards MCH services (OR = 1.69; 95% CI: 0.79, 3.6), availability of health institutions (OR = 2.6; 95% CI: 0.95, 7.20), and women who had an ANC follow-up (OR = 2.78; 95% CI: 2.07, 3.73) were higher institutional delivery prevalence among pastoralist women. Moreover, institutional delivery among women who were educated above the college level was more than two times (OR = 2.56; 95% CI: 1.985, 3.304) higher than among women who were not educated.

Conclusion

Pastoralist women in Ethiopia were found to be a disadvantaged group for institutional delivery at national level. Husband involvement, educational level, ANC visit, knowledge and attitude for MCH service, and health facility distance were identified to have significant association with institutional delivery.

Constraints to maternal healthcare access among pastoral communities in the Darussalam area of Mudug region, Somalia "a qualitative study"

Background

While countries embrace efforts to achieve Sustainable Development Goals (SDG) goal 3.1 (to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 and end preventable deaths of new-borns and children), an estimated 2.5 million pastoralists in Somalia are struggling to access maternal and child healthcare services. Institutional delivery and access to antenatal care remained to be a challenge in Somalia, where pastoralism is a common means of livelihood. The aim of this study is to explore the maternal health services available for settled pastoralists (transhumant) and their families who still practice nomadic pastoralism in the Mudug region of Somalia.

Methods

A qualitative study, including 14 interviews and one FGD, was conducted in Darussalam village (a transhumant village along the border between Somalia and Ethiopia), Puntland State, from December 2022 to January 2023. The study participants were community members who support the maternal and child health clinic (MCH), village administration, and health providers.

Results

We found that the efficiency of the health facilities that serve for pastoralist women and children are hampered by staff-related, supply-related, patients-related and referral-related constraints. This study highlights that the absence of essential supplies, the unmet need for training among the staff as well as the absence of important facilities in the MCH such as ambulance and blood bags.

Conclusion

Numerous strides could be made in the provision of affordable maternal healthcare to pastoralist communities in Darussalam areas of the Mudug region when organizations that support health care in Somalia and the Ministry of Health include pastoralists' healthcare in their priorities.

Ivermectin and doxycycline treatments against Onchocerciasis: Adaptations and impact among semi-nomadic population in Massangam Health District, Cameroon

We trialed strategies to reach semi-nomadic population with interventions targeting onchocerciasis including a combination of community knowledge and Geographical Information System (GIS) technology; nomad-specific sensitization; and mobile outreach. The interventions included ivermectin (ivm) mass drug administration (MDA) and treating infected individuals (found upon skin snip microscopy test) with doxycycline for 35 days. Microscopy-negative snips were further tested by Polymerase Chain Reaction (PCR). After 8 months, individuals immigrating or emigrating constituted 47% of the initial population; 59% of individuals not born in the area have immigrated during the last five years; 28% (age>9) reportedly never taken ivm; 72% (compared to 51% previously) of eligible population (age ≥ 5 years) took ivm; and 47% (age > 8, not pregnant, not breastfeeding, not severely ill,) participated in the test. A high prevalence of onchocerciasis,15.1%, was found upon microscopy & PCR test; 9/10 tested by skin snip microscopy and PCR at follow-up were all negative. Microfilaria prevalence and intensity upon skin snip microscopy reduced significantly from baseline following the intervention (8.9% to 4.1%, p = 0.032; 0.18 to 0.16, p = 0.013, respectively). The strategies considerably increased reach to nomadic camps. Treating with doxycycline in combination with ivm is feasible and has led to a significant reduction in infection level within one year among the semi-nomads. Being potentially curative in one intervention round, this combination should be considered for population group faced with challenges of achieving adequate coverage and adhesion to ivm MDA over prolonged period (>10 years).

Sexual and reproductive health services use among adolescents in pastoralist settings, northeastern Ethiopia

BACKGROUND

Adolescents have special sexual and reproductive health (ASRH) needs and are susceptible to poor health outcomes. The global burden of ill sexual health includes a significant proportion of Adolescents. The existing ASRH services in Ethiopia and particularly in the Afar region are currently not well suited to meet the needs of pastoralist adolescents. This study assesses the level of ASRH service utilization among pastoralists in Afar regional state, Ethiopia.

METHOD

A community based cross-sectional study was conducted from January to March 2021 in four randomly chosen pastoralist villages or kebeles of Afar, Ethiopia. A multistage cluster sampling procedure was used to select 766 volunteer adolescents aged 10-19. SRH services uptake was measured asking whether they had used any SRH service components during the last year. Data was collected through face-to-face interviews with a structured questionnaire; data entry was done with Epi info 3.5.1. Logistic regression analyses was used to assess associations with SRH service uptake. SPSS version 23 statistical software package was used for advanced logistic regression analyses to assess the associations between dependent and predictor variables.

RESULTS

The study revealed that two-thirds or 513 (67%) of the respondents are aware of ASRH services. However, only one-fourth (24.5%) of the enrolled adolescents used at least one ASRH service in the past twelve months. ASRH services utilization was significantly associated with gender (being female [AOR = 1.87 (CI 1.29-2.70)], being in school [AOR = 2.38(CI: 1.05-5.41), better family income [AOR = 10.92 (CI; 7.10-16.80)], prior discussions of ASRH issues [AOR = 4.53(CI: 2.52, 8.16)], prior sexual exposure [AOR = 4.75(CI: 1.35-16.70)], and being aware of ASRH services [AOR = 1.96 (CI: 1.02-3.822)]. Being pastoralist, religious and cultural restrictions, fear of it becoming known by parents, services not being available, income, and lack of knowledge were found to deter ASRH service uptake.

CONCLUSION

Addressing ASRH needs of pastoralist adolescents is more urgent than ever, sexual health problems are increasing where these groups face broad hurdles to SRH service uptake. Although Ethiopian national policy has created an enabling environment for ASRH, multiple implementation issues require special attention to such neglected groups. "Gender-culture-context-appropriate" interventions are favorable to identify and meet the diverse needs of Afar pastoralist adolescents. Afar regional education bureau and concerned stakeholders need to improve adolescent education to overcome social barriers (e.g. humiliation, disgrace, and deterring gender norms) against ASRH services through community outreach programs. In addition, economic empowerment, peer education, adolescent counseling, and parent-youth communication will help address sensitive ASRH issues.

Challenges and strategies for the uptake of mass drug administration among pastoralist communities in South Sudan

Preventive chemotherapy through mass drug administration (MDA) to control and eliminate neglected tropical diseases (NTDs) requires the active participation of communities living with NTDs, or at risk of NTD infections. Despite considerable progress by national control and elimination programs, achieving consistent and sustainable treatment campaigns that reach pastoralist communities remains challenging, which in turn delays the achievement of global disease elimination goals. The challenges of accessing pastoralist communities for treatment also hinder the achievement of the UN’s Sustainable Development Goals’ (SDGs) pledge to “leave no one behind“. Elimination targets cannot be achieved if significant proportions of endemic populations, such as pastoralists, are missed out during treatment campaigns. In South Sudan, close to 70% of the population is categorized as pastoralist, with previous data on MDA showing low access to and acceptance of MDA among the pastoralist community, as well as inconsistent treatment coverage. To address this challenge, a cross-sectional study design was conducted in five counties, with 239 pastoralist community respondents participating in in-depth interviews (IDIs), key informant interviews (KIIs), and focus group discussions (FGDs). Our findings show that, in the pastoralist community, high mobility, lay perceptions about the causes of NTDs and methods of treating them, limited awareness of MDA, and suboptimal health-seeking behaviors are the major factors that limit accessibility and participation. Our results suggest that improved uptake of MDA in these communities may be achieved by timing treatment campaigns to take account of pastoralists’ seasonal migration patterns, by involving pastoralist leaders in planning and social mobilization activities, by engaging community members as community drug distributors (CDDs), by using participatory behavior change approaches to design NTD interventions, and by addressing negative perceptions around the medicines involved, including those related to drug expiry and drugs causing impotence or other side effects. The results from this study could enable national programs to address the challenges of implementing treatment campaigns through the enhanced involvement and representation of pastoralist communities.

Nomadic pastoralists' experience accessing reproductive and maternal healthcare services in low and middle-income countries: A contextual scoping review

Globally, discriminately vulnerable and marginalized groups, such as nomadic pastoralist populations, have perhaps the least access to reproductive and maternal health services (R/MHCSs). Previous studies report that most nomadic pastoralist mothers use both traditional methods of childbirth (i.e. delivering at home and assistance by traditional birth attendants (TBAs)) and traditional methods of contraception. However, determining factors of R/MHCSs in these nomadic pastoralist communities remain scarcely explored and condensed. This study aims to analyse quantitative, qualitative, and mixed methods studies and summarize pastoralists’ experience accessing R/MHCSs in low- and middle-income countries (LMICs).

We employed a mixed method approach in conducting this scoping review by including studies applying quantitative, qualitative, and mixed methods retrieved from online databases (PubMed, Google Scholar, and JSTOR) as well as reviewing indexes of journals specific to the field by using a set of keywords related to R/MHCSs in LMICs. Thematic content analysis was performed to generate four themes and codes.

We retrieved 2131 articles and retained 25 that met our inclusion criteria. Of these, 6 were quantitative studies, 12 were qualitative studies, and 7 were mixed methods studies. We found that nomadic pastoralists face multi-faceted barriers in access to R/MHCS that can be broadly categorized into four themes: (i) physical (geographic isolation and access), (ii) political (discriminatory/marginalized status, poor transport system, lack of infrastructure, and little political status to improve their lives), (iii) economic (poor quality of service/lack of available resources in rural areas where nomadic pastoralists live, vulnerability, poverty/affordability of R/MHCSs), and (iv) socio-cultural (misconceptions, perception, gender roles in decision-making, low demand for R/MHCSs by nomadic pastoralists, autonomy for females to travel) factors. Therefore, to effectively address the needs of nomadic pastoralist populations, R/MHCSs must be available, accessible, acceptable, and affordable through political, economic, geographic, and socio-culturally sensitive approaches.

Low awareness of, and low access to, modern R/MHCSs and their benefits is a critical barrier to service utilization. Partnership with nomad communities through leveraging existing structures, networks, and decision-making patterns and involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key to R/MHCS access.

What is known about this topic?

What the study adds

Disparities in the implementation of the Health Extension Program in Ethiopia: Doing more and better towards universal health coverage

Introduction

Large-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in the implementation of the HEP is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia.

Methods

We used data from the 2019 National HEP assessment which was conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data were collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), and 7043 women from 7122 Households. This study focused on selected input, service delivery, and coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions.

Results

We found wide inter-regional disparities in HEP implementation. Developing regional states (DRS) had significantly lower availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40), and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There were also significant disparities in HEP implementation among DRS in the proportion of households visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services was relatively high.

Conclusion

There were significant inter-regional disparities in the implementation HEP in Ethiopia. The level of disparity among DRS was also remarkable. To achieve Universal Health Coverage, it is important that these disparities are addressed systematically and strategically. We recommend a tailored approach in HEP implementation in DRS.

Gendered asymmetry of access to knowledge for brucellosis control among pastoral communities in north-west Côte d'Ivoire

Brucellosis is an infectious zoonotic disease considered as a threat to public health and pastoralist livelihoods. Symptoms of the disease can lead to gender-specific ailments such as abortions in women and orchitis in men. Pastoralists and their families are at high risk of contracting the disease. Access to health information reinforces existing knowledge and contributes to disease prevention. However, in developing countries, interventions for knowledge sharing on zoonotic diseases predominantly target men. This study aimed to describe mechanisms of knowledge production and transfer on brucellosis according to gender, by assessing the way knowledge affects behaviours of pastoral communities. A community-based cross-sectional survey was conducted among a pastoral community (PC) of the Folon region in north-west Côte d’Ivoire. The study included transhumant pastoralists, sedentary livestock owners, shepherds and their wives. By using mixed methods, 26 semi-structured interviews were conducted, and 320 questionnaires were completed. Statistical analysis with chi-square (χ²) comparison tests was performed to compare variables between men and women. Findings were interpreted through the concept of specialisation of the social exclusion theory. We found that gender influences access to information on brucellosis and transfer of knowledge on brucellosis appeared gender-biased, especially from veterinarians towards men in the community. The social labour division and interventions of veterinarians through awareness reinforce the knowledge gap on brucellosis between men and women. Men and women consume raw milk, whilst only men in general handle animal discharges with bare hands. To improve the control of brucellosis, knowledge on best practice should be shared with pastoral communities using the One Health approach that encourages mutual learning. Innovative strategies based on gender daily tasks such as safe dairy processing by women and safe animal husbandry to expand their herd for men can be the entry point for the prevention of brucellosis.

Leaving no one behind: targeting mobile and migrant populations with health interventions for disease elimination-a descriptive systematic review

BACKGROUND

Mobile and migrant populations (MMPs) pose a unique challenge to disease elimination campaigns as they are often hard to survey and reach with treatment. While some elimination efforts have had success reaching MMPs, other campaigns are struggling to do so, which may be affecting progress towards disease control and elimination. Therefore, this paper reviews the literature on elimination campaigns targeting MMPs across a selection of elimination diseases-neglected tropical diseases, malaria, trypanosomiasis, polio, smallpox, and rinderpest.

METHODS

Through a systematic review process following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a three-person review team identified papers from databases, conference records, and citation searches using inclusion/exclusion criteria. Papers were divided into three key outcome domains during the synthetization process: (1) MMP movement patterns in East Africa including reasons for movement and consequences in terms of health outcomes and healthcare access; (2) MMP contribution to the transmission of disease across all geographies; (3) surveillance methods and treatment interventions used to implement programming in MMPs across all geographies. Experts in the field also provided supplemental information and gray literature to support this review.

RESULTS

The review identified 103 records which were descriptively analyzed using the outcome domains. The results indicate that in East Africa, there are various motivations for migration from economic opportunity to political unrest to natural disasters. Regardless of motivation, mobile lifestyles affect health service access such that MMPs in East Africa report barriers in accessing healthcare and have limited health knowledge. Often lower service delivery to these populations has resulted in higher disease prevalence. A minority of articles suggest MMPs do not pose challenges to reaching disease control and elimination thresholds. Finally, the literature highlighted surveillance methods (e.g., using satellite imagery or mobile phone data to track movement, participatory mapping, snowball sampling) and intervention strategies (e.g., integration with animal health campaigns, cross-border coordination, alternative mass drug administration [MDA] methods) to implement health interventions in MMPs.

CONCLUSIONS

Ultimately, the literature reviewed here can inform programmatic decisions as the community attempts to reach these never treated populations.

SYSTEMATIC REVIEW REGISTRATION

The protocol for this manuscript was registered with the International Prospective Registry of Systematic Reviews (PROSPERO) (No. CRD42021214743).

Reach and Utility of COVID-19 Information and Preventive Measures for Nomadic Populations in Massangam, West Region of Cameroon

The separation of nomadic pastoralist settlements from settled communities is a well-known challenge to the health system. Difficulties reaching these groups contribute to inequities in their health and impact the spread or control of several diseases. COVID-19 has led to the suspension of many public health interventions in Cameroon, while preventive measures including behavior change communication have been ongoing since the onset of the pandemic. The reach and utility of these campaigns in semi-nomadic population remain unclear. This exploratory qualitative study was conducted in September to October 2020 using semi-structured interviews and focus group discussions with nomadic camp heads, and their wives to explore their interactions with communication campaigns, awareness, understanding, and acceptance of behavior change messages. The study revealed a general awareness of COVID-19 and its preventive measures and a prevailing belief that they were less at risk because their camps are isolated from the main communities, and the fact that they had never met a COVID-19 case. They perceived that the women were at lower risk because of their limited interaction outside the camps. There was a common concern regarding the transmission of COVID-19 to their cattle. Routes of communication were markets and mosques frequented by men, making access to information limited to or dependent on men. Financial constraints and lack of water were the main barriers affecting the access to and use of COVID-19 prevention measures. There is need for adaptive communication strategies especially tailored to the culture of nomadic pastoralists addressing gender dynamics of this subgroup.

Exploring community tuberculosis program in the pastoralist setting of Ethiopia: a qualitative study of community health workers' perspectives in Borena Zone, Oromia Region

BACKGROUND

Pastoralist community accounts for a significant portion of the population in Ethiopia. This community is different from majority of the country's population. Access to TB prevention and control services is uneven in the country. The community TB program is designed to improve the access. Exploring the program performance from the perspectives of its implemters in a pastoral setting remains important.

METHOD

We conducted a qualitative study using an interpretive description method in the pastoralist community setting of Ethiopia. Study participants were recruited from geographically dispersed areas. We collected data through in-depth interview using semi-structured interview guides and audio recordings during February 01-30, 2020. The guides were developed in consultation with TB program experts and clinicians treating TB patients in the study area. Notes were taken at the interviews to enrich transcription of the data. Principal investigator conducted the interview. The subsequent interviews were informed by emerging ideas from forgoing interview transcriptions and continued until data saturation was achieved.

RESULTS

One hundred and fifty six codes, nine categories and three themes emanated. The first theme was inadequate community TB performance and some of its codes include inadequate presumptive TB case identification and compromised directly observed treatment short course service delivery. The second theme was factors contributing to the program performance. Community factors, lack of physical access to health facilities and indirect non-medical cost were some categories under this theme. The final theme was suggested solutions; and its categories include a need for active community involvement and modification of service delivery approaches.

CONCLUSIONS

Community TB performance was inadequate in the pastoralist community. Multifaceted factors contributed to the inadequate program performance. Socioeconomic and access related factors were major contributers. Aligning the program to the context of the pastoralist community setting is required to improve the performance.

Reproductive health decision making among nomadic pastoralists in North Eastern Kenya: a qualitative social network analysis

BACKGROUND

To our knowledge, no studies exist on the influence of nomadic pastoralist women's networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP).

METHODS

Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data.

RESULTS

Women named 10-12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks.

CONCLUSIONS

Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women's networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women's wider networks.

Impacts of the COVID-19 pandemic on food security among East and West African pastoralists

The focus of attention regarding the impacts of the COVID-19 pandemic has been on direct health outcomes and the macroeconomic impacts of control measures. Here we review the available evidence about the food security impacts of the pandemic on pastoralists in Eastern and Western Africa. While pastoralism occurs on more than 50% of the world's land area, the landscapes that pastoralists exploit tend to be remote and highly variable arid and semi-arid lands with low population densities. Over time pastoralists have developed sophisticated mechanisms to enhance their self-sufficiency. At the same time, remoteness and sociopolitical marginalization have resulted in higher rates of food insecurity and underdevelopment among pastoralists relative to more sedentary populations. These dynamics tend to be intractable to standardized food security, malnutrition, and economic development interventions. The COVID-19 pandemic is contributing to a worsening of food security trends in pastoralist areas of East and West Africa due to a multiplicity of factors, including the closure of livestock markets, movement restrictions, disruptions of supply chains and livestock production inputs, reduced frequency and quality of human and animal healthcare delivery, and lost income from complementary livelihoods. It opens, however, space for innovations that may contribute to the food-secure future of pastoralism, including adapting a One Health approach that addresses the social, economic, and environmental health determinants of food security among African pastoralists.