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Ssali SN, Morgan R, Nakiranda S, Opio CK, Otmani del Barrio M. Gendered lives, gendered Vulnerabilities: An intersectional gender analysis of exposure to and treatment of schistosomiasis in Pakwach district, Uganda. PLoS Negl Trop Dis 2023; 17:e0010639. [PMID: 37948453 PMCID: PMC10684070 DOI: 10.1371/journal.pntd.0010639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/28/2023] [Accepted: 08/17/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Schistosomiasis is a neglected tropical disease (NTD) that is endemic in Uganda, despite several interventions to eliminate it. It is transmitted when people infected with it pass on their waste matter into fresh water bodies used by others, consequently infecting them. Several studies have demonstrated gender and age differences in prevalence of schistosomiasis and NTDs such as lymphatic filariasis and soil transmitted helminths. However, few intersectional gender analysis studies of schistosomiasis have been undertaken. Using the World Health Organisation (WHO)'s intersectional gender analysis toolkit, this study was undertaken to identify which social stratifiers most intersected with gender to influence vulnerability to and access to treatment for schistosomiasis disease, to understand how best to implement interventions against it. METHODOLOGY This was a qualitative study comprising eight focus group discussions (FGDs) of community members, disaggregated by age, sex and location, and 10 key informant interviews with health care providers and community leaders. The Key informants were selected purposively while the community members were selected using stratified random sampling (to cater for age, sex and location). The data was analysed manually to identity key themes around gender, guided by a gender and intersectionality lens. RESULTS The study established that while the River Nile provided livelihoods it also exposed the community to schistosomiasis infection. Gender relations played a significant role in exposure to and access to treatment for schistosomiasis. Traditional gender roles determined the activities men and women performed in the private and public spheres, which in turn determined their exposure to schistosomiasis and treatment seeking behaviour. Gender relations also affected access to treatment and decision making over family health care. Men and some women who worked outside the home were reported to prioritise their income earning activities over seeking health care, while women who visited the health facilities more regularly for antenatal care and to take sick children were reported to have higher chance of being tested and treated in time, although this was undermined by the irregular and infrequent provision of praziquantel (PZQ) mass drug administration. These gender relations were further compounded by underdevelopment and limited economic opportunities, insufficient health care services, as well as the respondent's age and location. CONCLUSIONS The study concludes that vulnerability to schistosomiasis disease and treatment occurred within a complex web of gender relations, culture, poverty, limited economic opportunities and insufficient health services delivery, which together undermined efforts to eliminate schistosomiasis. This study recommends the following: a) increased public health campaigns around schistosomiasis prevention and treatment; b) more regular PZQ MDA at home and schools; c) improved health services delivery and integration of services to include vector control; d) prioritising NTDs; e) providing alternative economic activities; and f) addressing negative gender norms that promote social behaviours which negatively influence vulnerability, treatment seeking and decision making for health.
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Affiliation(s)
- Sarah N. Ssali
- Makerere University School of Women and Gender Studies, Kampala, Uganda
| | - Rosemary Morgan
- Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Salama Nakiranda
- Makerere University School of Women and Gender Studies, Kampala, Uganda
| | | | - Mariam Otmani del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Sahoo KC, Negi S, Mahapatra P, Samantaray K, Dash GC, Dubey S, Sahay MR, Sahoo RK, Bhattacharya D, Sahoo B, Pani SP, Otmani del Barrio M, Pati S. Gender dimensions of health-related challenges among urban poor during COVID-19 pandemic in low-and middle-income countries: a systematic review and gap analysis. Front Public Health 2023; 11:1170386. [PMID: 37361176 PMCID: PMC10288984 DOI: 10.3389/fpubh.2023.1170386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic has varying effects on men, women, and the transgender population. However, there is a paucity of systematic evidence on how gender and other social determinants of health during COVID-19 are affected in resource constraint urban settings. This review describes the gender dimensions of health-related challenges among the urban poor during COVID-19 in LMICs. We searched 11 scholarly online repositories including PubMed, Embase, Web of Science, CINAHL using the domain "slums," "COVID-19", "LMICs" and "gender identities." We used thematic framework analysis to synthesize qualitative data, and meta-analysis to determine the pooled prevalence. We registered in PROSPERO (CRD42020203783). We identified 6490 records, and 37 articles included. The studies reported stress among 74% women and 78% men, depression among 59% women and 62% men, and anxiety among 79% women and 63% men. Men had more stress than women during COVID-19; men are primarily responsible for household sustenance. Women had more anxiety than men, possibly because they are often the primary caregivers for children and the older population. While the severity varies according to gender identity, their vulnerability mostly related to their literacy and economy, highlighting the significance of including all social determinants in future primary studies. Systematic review registration https://www.crd.york.ac.uk/prospero/#recordDetails.
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Affiliation(s)
- Krushna Chandra Sahoo
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sapna Negi
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kajal Samantaray
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Girish Chandra Dash
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Shubhankar Dubey
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Mili Roopchand Sahay
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Rakesh Kumar Sahoo
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Debdutta Bhattacharya
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Banamber Sahoo
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Mariam Otmani del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Sanghamitra Pati
- Health Technology Assessment in India, Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Dubey S, Sahoo KC, Dash GC, Sahay MR, Mahapatra P, Bhattacharya D, del Barrio MO, Pati S. Housing-related challenges during COVID-19 pandemic among urban poor in low- and middle-income countries: A systematic review and gap analysis. Front Public Health 2022; 10:1029394. [PMID: 36211702 PMCID: PMC9540216 DOI: 10.3389/fpubh.2022.1029394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 01/29/2023] Open
Abstract
The abysmal health of the urban poor or slum dwellers was attributed to structural inequities such as inadequate housing, water, and sanitation. This review aimed to assess housing-related opportunities and challenges during the COVID-19 pandemic among urban poor in low-and middle-income countries. For study identification, a comprehensive search was performed in 11 databases that yielded 22 potential studies. The inadequate housing infrastructure makes the lives of the urban poor more precarious during COVID-19. Typically, the houses lacked lighting, ventilation, and overcrowding. This review reflected that it is crucial to reimagine housing policy for the urban poor with an emphasis on pandemic/epidemic guidelines.
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Affiliation(s)
- Shubhankar Dubey
- Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Krushna Chandra Sahoo
- Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Girish Chandra Dash
- Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Mili Roopchand Sahay
- Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Pranab Mahapatra
- Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, India
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Debdutta Bhattacharya
- Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Mariam Otmani del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Sanghamitra Pati
- Health Technology Assessment in India, ICMR-Regional Medical Research Centre, Bhubaneswar, India
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Sahoo KC, Dubey S, Dash GC, Sahoo RK, Sahay MR, Negi S, Mahapatra P, Bhattacharya D, Sahoo B, Pani SP, del Barrio MO, Pati S. A Systematic Review of Water, Sanitation, and Hygiene for Urban Poor in Low- and Middle-Income Countries during the COVID-19 Pandemic through a Gendered Lens. Int J Environ Res Public Health 2022; 19:ijerph191911845. [PMID: 36231147 PMCID: PMC9565771 DOI: 10.3390/ijerph191911845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 05/10/2023]
Abstract
Inadequate water, sanitation, and hygiene (WASH) among urban poor women is a major urban policy concern in low- and middle-income countries (LMICs). There was a paucity of systematic information on WASH among the urban poor during the pandemic. We reviewed the opportunities and challenges faced by the urban poor in LMICs during the COVID-19 pandemic. We used the PRISMA guidelines to conduct a comprehensive search of 11 databases, including MEDLINE, Embase, Web of Science, and CINAHL, between November 2019 and August 2021. We used thematic analysis to synthesize the qualitative data and meta-analyses to estimate the pooled prevalence. We screened 5008 records, conducted a full-text review of 153 studies, and included 38 studies. The pooled prevalence of shared water points was 0.71 (95% CI 0.37-0.97), non-adherence to hygiene practices was 0.15 (95% CI 0.08-0.24), non-adherence to face masks was 0.27 (95% CI 0.0-0.81), and access to shared community toilets was 0.59 (95% CI 0.11-1.00). Insufficient facilities caused crowding and long waiting times at shared facilities, making physical distancing challenging. Women reported difficulty in maintaining privacy for sanitation, as men were present due to the stay-at-home rule. Due to unaffordability, women reported using cloth instead of sanitary pads and scarves instead of masks.
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Affiliation(s)
- Krushna Chandra Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Shubhankar Dubey
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Girish Chandra Dash
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Rakesh Kumar Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Mili Roopchand Sahay
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Sapna Negi
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, India
| | - Debdutta Bhattacharya
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Banamber Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
| | - Subhada Prasad Pani
- Department of Research and Development, Sri Balaji Vidyapeeth Deemed to be University, Puducherry 605007, India
| | - Mariam Otmani del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, 1211 Geneva, Switzerland
| | - Sanghamitra Pati
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India
- Correspondence:
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Ozano K, Dean L, Yoshimura M, MacPherson E, Linou N, Otmani del Barrio M, Halleux CM, Ogundahunsi O, Theobald S. A call to action for universal health coverage: Why we need to address gender inequities in the neglected tropical diseases community. PLoS Negl Trop Dis 2020; 14:e0007786. [PMID: 32163416 PMCID: PMC7067373 DOI: 10.1371/journal.pntd.0007786] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mami Yoshimura
- United Nations Development Program, New York, United States of America
| | | | - Natalia Linou
- United Nations Development Program, New York, United States of America
| | - Mariam Otmani del Barrio
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Christine M. Halleux
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Olumide Ogundahunsi
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Otmani del Barrio M, Simard F, Caprara A. Supporting and strengthening research on urban health interventions for the prevention and control of vector-borne and other infectious diseases of poverty: scoping reviews and research gap analysis. Infect Dis Poverty 2018; 7:94. [PMID: 30173669 PMCID: PMC6120070 DOI: 10.1186/s40249-018-0462-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than half of the world's population currently lives in urban settlements that grow both in size and number. By 2050, approximately 70% of the global population will be living in urban conglomerations, mainly in low- and middle-income countries. Mobility, poverty, different layers of inequalities as well as climate variability and change are some of the social and environmental factors that influence the exposure of human populations in urban settings to vector-borne diseases, which pose eminent public health threats. Accurate, consistent, and evidence-based interventions for prevention and control of vector-borne and other infectious diseases of poverty in urban settings are needed to implement innovative and cost-effective public policy and to promote inclusive and equitable urban health services. MAIN BODY While there is growing awareness of vector-borne diseases epidemiology at the urban level, there is still a paucity of research and action being undertaken in this area, hindering evidence-based public health policy decisions and practice and strategies for active community engagement. This paper describes the collaboration and partnership of the Special Programme for Research and Training in Tropical Diseases (TDR) hosted by the World Health Organization (WHO) and the "VEctor boRne DiseAses Scoping reviews" (VERDAS) Research Consortium as they joined efforts in response to filling this gap in knowledge and evidence by supporting the development of a series of scoping reviews that highlight priority research gaps and policy implications to address vector-borne and other infectious diseases at the urban level. CONCLUSIONS The set of scoping reviews proposed in this special issue presents a critical analysis of the state-of-the-art of research on urban health interventions for the prevention and control of vector-borne and other infectious diseases of poverty. The authors of the 6 reviews highlighted severe gaps in knowledge and identified organizational and theoretical limitations that need to be urgently tackled to improve cities preparedness and vector control response. The more pressing need at present is to ensure that more implementation research on vector-borne diseases in urban settings is conducted, addressing policy and practice implications and calling for more political commitment and social mobilization through adequate citizen engagement strategies.
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Affiliation(s)
- Mariam Otmani del Barrio
- Vectors, Environment and Society Unit, Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), 20, avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Frédéric Simard
- Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Controle (MIVEGEC), IRD-CNRS University of Montpellier, Montpellier, France
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