Female genital mutilation: trends, economic burden of delay and basis for public health interventions

BACKGROUND

The practice of female genital mutilation (FGM) is a health and social problem. Millions of girls and women have undergone FGM or will soon, and more information is needed to effectively reduce the practice. The aim of this research is to provide an overview of the FGM trendlines, the inequality of its prevalence, and the economic burden. The findings shed light on 30-year trends and the impact of the pandemic on planned efforts to reduce FGM which helps with public health interventions.

METHODS

Temporal trend analysis, and graphical analysis were used to assess the change and inequality over the last 30 years. We included 27 countries in which FGM is prevalent. We calculated the extra economic burden of delayed interventions to reduce FGM like COVID-19.

RESULTS

For the 27 countries analyzed for temporal trendlines, 13 countries showed no change over time while 14 had decreasing trends. Among the 14, nine countries, Uganda, Togo, Ghana, Benin, Kenya, Nigeria, Central African Republic, Chad, and Ethiopia had high year-decrease (CAGR - 1.01 and - 10.26) while five, Côte d'Ivoire, Egypt, Gambia, Djibouti, and Mali had low year-decrease (CAGR>-1 and < 0). Among these five are the highest FGM prevalence similar distribution regardless the wealth quintiles or residence. There is an economic burden of delay or non-decline of FGM that could be averted.

CONCLUSION

Findings indicate that some countries show a declining trend over time while others not. It can be observed that there is heterogeneity and homogeneity in the FGM prevalence within and between countries which may indicate inequality that deserves further investigation. There is considerable economic burden due to delays in the implementation of interventions to reduce or eliminate FGM. These insights can help in the preparation of public health interventions.

Barcelona Salut als Barris: Twelve years' experience of tackling social health inequalities through community-based interventions

Community health can reduce inequalities in health and improve the health of the most disadvantaged populations. In 2007, Barcelona Salut als Barris (Barcelona Health in the Neighbourhoods) was launched, a community health programme to reduce social inequalities in health. In 2018, this programme reached the 25 most disadvantaged neighbourhoods of the city. This article shares the lessons learned after 12 years of work. The programme was initially funded by a research grant and the funds were maintained during the economic crisis and were tripled when the programme became a political priority in the last municipal government. During the 12-year period, partnerships with stakeholders were generally stable and productive. Maximum community participation was obtained in the detection of health assets and needs and in action plans. During 2018, Barcelona Salut als Barris worked with more than 460 agents that co-produced 183 interventions involving more than 13,600 people. Most of the interventions assessed showed improvements in the health of participants, which could help to reduce health inequalities. The greatest difficulties were: a) citizen participation, b) the sustainability of working groups over the years, c) conflicts of interest, d) the sustainability of interventions, e) reaching certain minority groups and f) evaluation. The increase in resources in the last period contributed to the maturity and expansion of the programme. Key factors in its scope and results were political will, strong technical capacity and methodology, strong intersectoral partnerships and continued community work.

Effective nutrition education and communication for sustainable maternal and child health

Maternal and child health (MCH) consists of an interdependent reproductive system that collectively determines the survival of the mother during childbirth, and determines the health and survival of the child. This interdependency underscores the importance of appropriate and timely interventions during pregnancy through the first 1000 d at the minimum. The Millennium Development Goals (MDG) recommended the use of the continuum of care for the development of interventions by addressing all the stages of MCH. The purpose of the present paper is to review the factors that contributed to the attainment of the MDG 4 and MDG 5 by analysing the interventions conducted by the countries that achieved at least 5·0 and 5·5 %, respectively, and determine the level of their intervention based on the MCH conceptual framework. Out of the eighteen selected countries discussed, fifteen countries achieved their target for either MDG 4 or MDG 5 or both, while three countries did not achieve their target. The countries that were more likely to achieve their targets addressed the societal, underlying and direct causes, and implemented country wide policies. In contrast, the countries that did not succeed were more likely to address the direct causes with poor policy implementation. Understanding the motivation and limitations of the target population, including nutrition education and targeting behaviour change has the potential to result in sustainable MCH. This information has the potential to enlighten the policymakers as we progress to the sustainable development goals, specifically goals 2 and 3.

Climatic and psychosocial risks of heat illness incidents on construction site

The study presented in this paper aims to identify prominent risks leading to heat illness in summer among construction workers that can be prioritised for developing effective interventions. Samples are 216 construction workers' cases at the individual level and 26 construction projects cases at the organisation level. A grounded theory is generated to define the climatic heat and psychosocial risks and the relationships between risks, timing and effectiveness of interventions. The theoretical framework is then used to guide content analysis of 36 individual onsite heat illness cases to identify prominent risks. The results suggest that heat stress risks on construction site are socially constructed and can be effectively managed through elimination at supply chain level, effective engineering control, proactive control of the risks through individual interventions and reactive control through mindful recognition and response to early symptoms. The role of management infrastructure as a base for effective interventions is discussed.

Conquering malaria: enhancing the impact of effective interventions towards elimination in the diverse and changing epidemiology

Malaria remains a major global disease burden causing just under a million deaths each year, mainly of children and pregnant women in sub-Saharan Africa. It consumes up to 40% of public health expenditure of these poor countries, causing in Africa US$ 12 billion in lost GDP every year. This should not be acceptable since malaria is preventable, and there is clear evidence that optimal use of current tools can reduce much of the suffering and deaths. Three major factors allowing this to happen include: (i) inadequate funding to implement a massive initial surge, to achieve universal coverage, (ii) weak country capacities for rapid scale up of such interventions and little or no use of evidence-guided methods, and (iii) insufficient coordination of efforts between national programmes, donors and technical agencies in strategic planning for sustaining gains and in building capacity. We discuss the importance of the surge and the kind of approaches that would accelerate the pace toward elimination and eventual eradication.