Achieving the UNAIDS 95-95-95 treatment target by 2025 in Ghana: a myth or a reality?

The United Nations Joint Programme on HIV/AIDS (UNAIDS) has set ambitious treatment targets known as Project 95-95-95, aiming to achieve 95% of people living with HIV knowing their status, 95% of diagnosed individuals on antiretroviral therapy (ART), and 95% of those on ART achieving viral suppression by 2025. Through a comprehensive analysis of Ghana's HIV/AIDS response, we evaluate the feasibility of Ghana's efforts in realising these targets. The discussion explores Ghana's achievements in HIV testing and diagnosis, ART coverage, and viral suppression rates, as well as challenges related to stigma, limited access to healthcare services, funding constraints, and data quality. Strategies such as strengthening prevention efforts, expanding access to ART, addressing stigma, and enhancing health systems are discussed as the way forward to advance Ghana's progress towards the UNAIDS 95-95-95 treatment targets. While Ghana has made significant strides in its HIV/AIDS response, achieving the 95-95-95 targets is a challenging yet realistic goal.

Widening, Narrowing, and Persistence of Socioeconomic Gaps Between Sexual Minorities and Heterosexuals Across Adulthood

In socioeconomic attainment, same-sex sexuality (SSS) matters, as well as whether SSS is experienced in adolescence (early) or not until later in adulthood (late). Using data from 8912 participants of the National Longitudinal Study of Adolescent to Adult Health, sexual minorities are identified as the early or late groups. Multilevel regression models were used to compare their income, occupational status, and education separately against heterosexuals, based on repeated measures taken in their 20s, 30s, and 40s. This study found a significant lag in high-school graduation compared to a subgroup of men in the early group that did not express same-sex sexuality in adulthood. Independently, "gay penalty" in income emerged for the late group as they entered their 30s, and persisted into their 40s. No socioeconomic gaps were observed for the women. To serve equity goals for all sexualities, closer attention needs to be given to those with an evolving history of same-sex sexuality.

How growth mindset influences mathematics achievements: A study of Chinese middle school students

Introduction

It has been suggested that students with growth mindsets are more likely to achieve better mathematics learning results than their counterparts with fixed mindsets. However, inconsistent and some even contradictory results have been reported in recent studies which examined the associations between growth mindset and mathematics achievements, suggesting the complexity regarding the effects of growth mindset on academic achievements.

Methods

This study aims to examine students' growth mindsets, failure attributions, intrinsic motivation, mathematics self-efficacy, mathematics anxiety and mathematics achievements in one model to capture the sophisticated functioning processes of growth mindset. A total number of 266 middle school students in China participated in this study. Students' mindset and related variables (i.e.,motivations to learn mathematics, attributions of failure in mathematics, mathematics anxiety, mathematics self-efficacy) were measured at year 7, the first year of junior middle school in China. These students' mathematics learning outcomes were tracked from year 7 to year 9, the end of junior middle school. Structural equation modeling (SEM) was used to investigate the relations among students' growth mindsets, failure attributions, intrinsic motivation, mathematics self-efficacy, mathematics anxiety and mathematics achievements.

Results

The results show that: (1) growth mindset doesn't directly predict mathematics achievements; (2) growth mindset indirectly influences mathematics achievements through intrinsic motivation; (3) failure attributions and mathematics self-efficacy sequentially mediate the association between growth mindset mathematics achievements; (4) failure attributions and mathematics anxiety sequentially mediate the relationship between growth mindset mathematics achievements.

Discussion

The results of this study contribute a better understanding about how growth mindsets make impacts on middle school students' mathematics achievements. These findings have important implications for mathematics education in that we could not simply cultivate students' growth mindset in schools with expectations of higher mathematics learning outcomes. Instead, along with the growth mindset intervention, it is fundamental to make interventions on students' intrinsic motivation, failure attribution, mathematics self-efficacy, and mathematics anxiety in mathematics teaching and learning.

The first 30 days of COVID-19 vaccination in Cameroon: achievements, challenges, and lessons learned

Introduction

Cameroon's national vaccination campaign was launched on April 12, 2021, amid a nationwide outbreak of COVID-19 with two types of vaccines. This study provides preliminary evidence to assess early outputs of the COVID-19 vaccination response strategy implementation.

Methods

a cross-sectional study was conducted from April 12, 2021, to May 11, 2021, and data on COVID-19 vaccination were reviewed from the Ministry of Public Health database. Descriptive statistical analyses were conducted.

Results

thirty days after the introduction of COVID-19 vaccines, just about five percent of the target population was vaccinated. Women represented one-third of the people vaccinated regardless of age and health conditions. Although AEFI reported were minor and scanty with both vaccines, most of the vaccinated did not come back for their second dose. There was a need to build confidence among eligible beneficiaries to expand the benefits of vaccination to control the current pandemic.

Conclusion

the country was still far below the target, which was worrisome given that vaccine uptake was slow. Also, 391 200 doses of the Covishield were at risk of expiration in August 2021. This study offers insights into those early efforts contributing to significant discussions about the approaches to improve service delivery and vaccine uptake.

Assessment of Medical Laboratory Undergraduates Training in Different School Year Systems

OBJECTIVE

To assess the effect of the change from the 5-year system of coursework to a 4-year system on the achievements of medical laboratory undergraduates.

METHODS

We analyzed and then compared the topics of training and the test scores among all subject individuals in the 5-year vs the 4-year undergraduate program.

RESULTS

Five-year-program undergraduates and 4-year-program undergraduates were required to complete 50 courses. The average weekly education time in the 4-year program (27.05 lesson-hours/week) was greater than that in the 5-year program (22.99 lesson-hours/week). The proportion of clinical practice in the hospital setting in the 4-year program (26.8%) was higher than that in the 5-year program (24.5%). The average, excellent, and good scores among 4-year-program undergraduates in general education courses, professional basic courses, professional courses, all courses, and common courses were lower than those scores among the 5-year-program undergraduates.

CONCLUSIONS

The 5-year undergraduate program should be adapted to help boost the achievements and practical skills among its students, in helping them adapt quickly to the new, 4-year training plan (which presented a serious challenge in our cohort).

The effects of long-term extracurricular scientific research on the medical students: Insight from Jinan University Medical School

The benefits and long-term effects of extracurricular scientific research on undergraduate students in many countries have been intensively investigated, but it remains obscure for Chinese medical students. In this study, we investigated the outcome of 60 medical students who have participated in extracurricular scientific research at Jinan University Medical School over a period of 7 years (2011-2018). The results revealed that these students have contributed to 31 biomedical science articles in reputable academic journals, as first- or co-authors. Furthermore, they also independently procured various funding based on their research achievements, and smaller awards for achievements in conferences and competitions. Assessment of the grade point average score of these students revealed that conducting extracurricular scientific research did not affect their routine medical study and exam grades (P>0.05). The students benefited from participating in extracurricular research, by acquiring the ability to think scientifically and enhancing their communication skills. In addition, the medical students were motivated to enlist for postgraduate studies so that they could further embark in scientific research. In sum, Chinese medical students are capable of participating in scientific research and make a significant contribution to science.

"But I Gathered My Courage": HIV Self-Testing as a Pathway of Empowerment Among Ugandan Female Sex Workers

HIV self-testing (HIVST) increases HIV testing in diverse populations, but little is known about the experiences of individuals who self-test. We used a five-step framework approach to analyze 62 qualitative interviews with 33 female sex workers (FSWs) participating in an HIVST trial in urban Uganda. Notions of empowerment emerged from the data, and findings were interpreted based on Kabeer's empowerment framework of resources, agency, and achievements. We found that access to HIVST bolstered empowerment because it increased participant's time and money (resources), control of testing circumstances and status disclosure (agency), and sense of competency (achievements). In addition, we found that knowledge of HIV status empowered participants to better control HIV-related behaviors (agency) and recognize a new sense of self (achievements). This suggests that the availability of HIVST can facilitate feelings of empowerment, meriting a higher awareness for benefits outside of linkage to HIV treatment and prevention services.

Towards the elimination of mother-to-child transmission of HIV in Nigeria: a health system perspective of the achievements and challenges

Despite its scaled-up response for prevention of mother-to-child transmission of HIV (PMTCT), Nigeria still contributes the greatest number of infants infected with HIV worldwide. Drawing on our knowledge, and review of policy documents and research papers, we explored the achievements and challenges in the elimination of mother-to-child transmission of HIV in Nigeria using the WHO's health systems framework. We found that Nigeria has increased the number of PMTCT sites, decentralized and integrated PMTCT care for expanded service delivery, adopted task-shifting to address the shortage of skilled healthcare providers, explored alternative sources of domestic funding to bridge the funding gap and harmonized the health management information system to improve data quality. Some of the challenges we identified included: difficulty in identifying HIV-infected pregnant women because of low uptake of antenatal care; interrupted supplies of medical commodities; knowledge gaps among healthcare workers; and lack of a national unique identifying system to enhance data quality. While there have been some achievements in the PMTCT program, gaps still exist in the different blocks of the health system. Elimination of mother-to-child transmission of HIV in Nigeria will require the implementation of feasible, culturally acceptable and sustainable interventions to address the health system-related challenges.

Landmark studies in coronary heart disease epidemiology. The Framingham Heart Study after 70 years and the Seven Countries Study after 60 years

This year we celebrate anniversaries of two prospective studies that have contributed most to our understanding of the epi-demiology of coronary heart disease (CHD): the Framingham Heart Study (FHS) and the Seven Countries Study (SCS). The FHS was initiated 70 years ago and is continued in the subsequent generations using new research opportunities, including evaluation of the risk factors for chronic non-cardiovascular diseases. The SCS is now finished because the original study population are mostly deceased, and the study did not continue in the children and grandchildren of the participants. The FHS allowed identification of factors predisposing to CHD, which were referred to as "risk factors" for the first time. Based on the FHS findings, a multivariate model of the 10-year CHD risk was developed, known as the Framingham Heart Score. In addition, criteria of heart failure and risk factors for atrial fibrillation were defined. The SCS provided the first evidence for an association between nutrition and CHD and laid the foundations for recommending the Mediterranean diet for cardio-vascular disease prevention.

Contemporary issues in north-south health research partnerships: perspectives of health research stakeholders in Zambia

Background

The late 1990s and early 2000s have seen a growth in north–south health research partnerships resulting from scientific developments such as those in genetic studies and development of statistical techniques and technological requirements for the analysis of large datasets. Despite these efforts, there is inadequate information representing the voice of African researchers as stakeholders experiencing partnership arrangements, particularly in Zambia. Furthermore, very little attention has been paid to capturing the practice of guidelines within partnerships. In this paper, we present achievements and highlight challenges faced by southern partners in north–south health research partnerships.

Methods

A qualitative inquiry was employed using in-depth interviews developed using the Bergen Model of Collaborative Functioning with 20 key informants in Lusaka district in Zambia purposively sampled from a wide range of health research partnerships.

Results

Partnerships produce benefits for southern partners, including evidence generation to influence policy, improved service delivery, infrastructure development and designing interventions to improve the healthcare of populations in greatest need. Most importantly, through partnerships, there is availability of financial resources to accomplish partnership goals. For success to be achieved, there must be effective communication and leadership, values and accountability that go into the process of partnership functioning. Trust interacts with different elements that create partnerships where there is co-ownership of study rewards. Challenging aspects of the interaction are largely due to funding mechanisms where 90% of the funding for health research is from northern partners. This funding mechanism results in power imbalances that lead to publication challenges, dictation of research agenda and ownership of samples and data leading to a general lack of motivation to collaborate.

Conclusion

Mistrust has implications on joint working such that partners find it difficult to work together and produce results greater than their individual efforts. Property rights and resource sharing must be resolved early in the partnership and each partner’s contributions recognised. These findings highlight areas that partnerships need to focus on to make the most of guidelines on research partnership with developing countries.

Enabling positive change: Progress and setbacks in HIV and sexual and reproductive health and rights

At a point in history when the future of sexual and reproductive health including HIV looks particularly uncertain, it is helpful to recognise that many of the challenges currently faced are neither new nor insurmountable. Reflecting on past achievements and lessons learned helps us to have confidence that positive change is feasible. This paper reflects on some of the changes observed in countries like India and Mozambique and identifies a range of factors which need to coalesce to enable these developments, along with specific contextual factors. It is the combination of these influences rather than any one of them alone that brought about the change in the three instances described - fostering a positive political response to HIV in its early years in India; bringing about policy reform on abortion in Mozambique; and increasing contraceptive prevalence and age at marriage in some districts in Bihar, India. Change is always fragile and susceptible to setbacks, but change-seekers can learn in the process and gain renewed hope that progress can and often does take place if they persevere.

Healthcare and healthcare systems: inspiring progress and future prospects

BACKGROUND

Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties.

METHODS

A structured review of both peer-reviewed and gray literature on the topic was carried out.

RESULTS

On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world's population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years, most of the world population growth will occur in the urban areas of poor countries. The rapid, unplanned and unsustainable style of urban development will make developing countries cities the key focal points for emerging environmental and health hazards. Changes will be seen in design, culture and practices of hospitals to better meet the needs of patients, families and providers. Top driving factors of global healthcare system for next 30 years will be leading causes of mortalities, non-health factors (impact of nutrition, sanitation and women's empowerment), investment in health workforce and growth of medical tourism in future healthcare scenario.

CONCLUSIONS

Evaluating the patterns of previous 30 years and predicting the progress and challenges of future health system are no rocket science. Medical care will be more self-directed in a more tech-savvy population as information will be more accessible and user friendly with higher quality. Health driving factors such as clean water, sanitation and food will take the center stage in humanities struggle and even increase population size.

Transformation of organ donation in China

The organ donation system in China has far lagged behind international levels. Transformation of this situation began in July 2005. A complete organ donation system that ensures fairness, impartiality, transparency, and respect for life has now been developed. This system is composed of regulations and policies, an organizational structure, operational guidelines, organ procurement organizations, registration of donors and recipients, and an organ allocation system. Since March 2010, pilot trials on donation after circulatory death (DCD) have been carried out. In 4 years, organ donation has started in 25 of 32 provinces in the country. From 2010 to 2013, the ratio of DCD liver transplantation to total case numbers in China rose from 1.38% to 26.1%, whereas for kidney, the ratio were 0.59% and 24.6%, respectively. The total number of DCD in China has accumulated to 1564 cases, and 4243 organs were transplanted. To alleviate the further difficulties of donation, establishment of professional organ procurement organizations in transplant hospitals, legislation of brain death, and promulgation of legal guidelines on DCD will be the main targets of organ donation development in China.

Achieving the millennium development goal for under-five mortality in Bangladesh: current status and lessons for issues and challenges for further improvements

The study assessed the achievements in, critically reviewed the relevant issues of, and put forward recommendations for achieving the target of the Millennium Development Goal relating to mortality of children aged less than five years (under-five mortality) in Bangladesh within 2015. To materialize the study objectives, a thorough literature review was done. Mortality of under-five children and infants decreased respectively to 65 from 151 and to 52 from 94 per 1,000 livebirths during 1990-2006. The immunization coverage increased from 54% to 81.9% during the same period. The projection shows that Bangladesh will achieve targeted reduction in under-five mortality and infant mortality within the time limit, except immunization coverage. Neonatal mortality contributed to the majority of childhood deaths. Contribution of neonatal mortality to child mortality was the highest. There were remarkable differences in child mortality by sex, division, and residence. To progress further for achieving the target of MDG relating to child mortality, some issues, such as lower use of maternal healthcare services, hazardous environmental effects on childhood illness, high malnutrition among children, shorter duration of exclusive breastfeeding practices, various child injuries leading to death, low healthcare-use of children, probable future threat of financial shortage, and strategies lacking area-wise focus on child mortality, need to be considered. Without these, the achievement of MDG relating to child mortality may not be possible within 2015.

Disease control and prevention in China in the 20(th) century and prospects for the new millennium

In the first part of the paper, the main achievements and experience of disease control and prevention in China during last 50 years are described. Infectious diseases and parasitosis have been successfully controlled and prevented and people's health enhanced owing to the establishment of an effective system of public health, the launch of a campaign called "Patriotic Public Health", immunization planning, and the improvement of economic and environmental conditions. In the second part, the challenges to public health in China are presented. The threat from old and emerging infectious diseases, especially sexually transmitted diseases, a sustained increase in the prevalence of chronic non-infectious diseases (cardiovascular diseases tumors and diseases of the respiratory system), environmental problems and the health problems of aging are discussed. Finally, strategies for disease control and prevention in the new century is suggested.