Global Health Action最新文献

Background: Ethiopia has experienced growth in the utilization of family planning services. However, there are reports of relatively low client satisfaction across the country.

Objective: The objective of this study was to assess client and facility level predictors of satisfaction with family planning services in Ethiopia.

Method: A multi-level mixed effects logistic regression analysis was conducted on a national survey obtained from the service provision assessment 2021-22. A total of 2071 clients (level one) and 529 facilities (level two) were included.

Results: Overall, 56% of clients were highly satisfied with the family planning service they received. Findings from the random effects of the multilevel analysis show there is a significant difference in client satisfaction between facilities, with an intra-class correlation of 0.56 in the null model. At the client-level, age above 30, auditory privacy, and discussion on side effects are significantly associated with higher client satisfaction. At the facility level, having a waiting area, facilities with a quality unit and/or committee, a DHIS2 reporting system, operating for more than 20 days a month, privately owned facilities and availability of family planning guidelines are associated with higher odds of being satisfied. On the other hand, at the client level, having a primary or higher education, increasing wait time and clients asking their providers questions are associated with lower odds of being satisfied. At the facility level, having a fixed user fee significantly reduces the odds of client satisfaction.

Conclusions: Human resource and professional development training and health system strengthening is recommended.

The University of Global Health Equity's (UGHE) One Health Field School (OHFS) in Rwanda exemplifies an experiential approach to education that integrates human, animal, and environmental health. This field-based program engages students in real-world settings such as abattoirs, health centers, and mining sites to confront pressing public health issues, from zoonotic diseases and antimicrobial resistance to food safety and environmental health. Following Kolb's experiential learning model, OHFS equips graduate students to observe, analyze, and apply solutions to complex health challenges, fostering adaptability, resilience, and collaborative problem-solving skills. By bridging classroom theory with practical application, OHFS cultivates leadership and a holistic understanding of health, preparing graduates to navigate the interconnected global health landscape. Through this innovative approach, UGHE aims to train a generation of health professionals capable of addressing crises such as climate change, biodiversity loss, and emerging infectious diseases at the human-animal-environment interface.

Background: Cervical cancer is the leading cause of cancer-related deaths in Tanzania and the most common form of cancer among Tanzanian women. Screening attendance remains among the lowest globally, necessitating improved attendance and screening methods.

Objective: This study aims to assess the feasibility of implementing the World Health Organization's 2021 hPV-based screening guideline in Tanzania by identifying potential barriers and facilitators to HPV-based screening among screening clients, healthcare providers, and stakeholders.

Methods: From October 2022 to February 2023, 25 semi-structured interviews were conducted with screening clients (n = 16) and healthcare providers and stakeholders (n = 9) in Moshi and Dar es Salaam. Data were analyzed using a deductive framework based on Bronfenbrenner's Social Ecological Model, supplemented with inductive subcategories from the transcripts.

Results: Barriers and facilitators emerged across all levels of the Social Ecological Model. At the individual level, clinic-based screening and a one-visit approach were barriers, while HPV-self-sampling was a facilitator. Interpersonal barriers included limited social support, while referrals served as facilitators. Community-level barriers included fear and misconceptions, countered by facilitators such as increased awareness and health education. Health system challenges included restrictive age limits and urbanization of human resources, with uptake through other health services acted as a facilitator. Political barriers highlighted the need for a steady local supply chain, while cost reduction could serve as a facilitator for guideline implementation.

Conclusion: WHO's 2021 hPV-based screening guideline shows promise in Tanzania, but barriers such as clinic availability, fear, misconceptions, and supply chain issues must be addressed to ensure successful implementation.

People living in low - and middle-income countries are less likely to receive palliative care. Early delivery of palliative care reduces unnecessary hospital admissions and improves patients' and their families' quality of life. This systematic review has compiled and scrutinized adult cancer patients' benefits, barriers, and specific palliative care needs in sub-Saharan Africa (SSA) to provide stakeholders with vital information that can improve the support and care provided to this expanding patient population. A systematic literature search was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Medline, and ProQuest under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included in the review focused on the utilization of palliative care among adult cancer patients in sub-Saharan Africa. The Joanna Briggs Institute (JBI) Critical Appraisal tools assessed study quality. This review synthesized findings from 16 studies and highlights that access to palliative care improves cancer patients' quality of life, satisfaction, and outlook on diagnosis. However, limited knowledge, financial constraints, and systemic obstacles impede access. Patients' needs were categorized into four themes: physical comfort, psychosocial support, spiritual well-being, and socioeconomic assistance. Palliative care improves adult cancer patients' quality of life in sub-Saharan Africa, but barriers hinder access. To address the challenges and meet patients' needs, enhancing literacy about palliative care, providing financial support, and implementing structured and sustainable palliative care models are essential for strengthening services and improving regional healthcare.

Background: This study describes the evaluation of a twinning initiative between the Ghana Register Midwives Association and the Swedish Association of Midwives. Recognising the importance of midwives being supported by a national midwife association, the initiative was to strengthen the professional association in Ghana as a labour union and to inspire Swedish midwives to involve themselves in international work.

Objective: The study aimed to evaluate a twinning initiative between the Ghana Registered Midwives Association and the Swedish Association of Midwives.

Method: Two focus group discussions and four individual interviews were held with nine midwives from the Ghana Registered Midwives Association (n = 6) and the Swedish Association of Midwives (n = 3). The interviews and analysis were guided by a process evaluation framework using content analysis.

Results: The twinning initiative was successfully implemented regarding fidelity, dose, and reach, despite adaptations to the original project plan. Both associations gained visibility, with the Ghana Registered Midwives Association growing its paid membership by 97%, from 631 to 1,245 members during the twinning initiative. The results suggest that the Swedish Association of Midwives enhanced its understanding of international midwifery, promoted knowledge exchange, and raised awareness of midwives' global roles in improving care.

Conclusion: The Ghana Registered Midwives Association and the Swedish Association of Midwives had a positive experience with the twinning initiative, despite deviations from the original plan. Midwives from both associations benefitted from sharing best practices and mutual support in their roles as newly formed labour trade unions. These findings could benefit other midwife associations in future twinning initiatives.

The balls are rolling for climate change, with increasing vulnerability to women and children related to climate extreme events. Recent evidence has shown that acute exposure to heat wave during pregnancy can be associated with adverse health outcomes in childhood, with the risk being significantly higher among socially disadvantaged population, despite their lack of contribution to global carbon dioxide emissions and the rising global ambient temperature. This unequal impact requires utmost attention to develop tools, establish interdisciplinary teams, and to implement evidence-based interventions for the betterment of women and children in climate-vulnerable populations.

Background: Intimate partner violence (IPV) is a global issue, with women, especially those with disabilities, facing a higher lifetime risk than those without disabilities. Given the elevated risk factors and challenges related to having a disability, it is crucial to provide effective IPV support. The competence and expertise of service providers regarding IPV significantly influence their ability to provide adequate IPV support. Understanding service providers' self-perceived competence is essential for improving the quality of IPV support for women with disabilities.

Objective: This study assesses the self-perceived competence of service providers in supporting women with disabilities subjected to IPV in Sweden.

Methods: A cross-sectional survey was distributed to professionals in healthcare, social services, and the police, and 1,151 people participated. Descriptive statistics and linear regression analyses were performed to assess the factors influencing service providers' self-perceived competence.

Results: The findings indicate that healthcare, police, and social services professionals often encounter women with disabilities, but they rarely ask them directly about IPV. Many don't routinely inquire about IPV exposure. While institutional routines for addressing IPV exist, service providers don't consistently implement or use them. Key factors influencing self-perceived competence include receiving IPV and disability-specific training and sufficient employer support for addressing IPV among women with disabilities.

Conclusions: The findings underscore the need for a more consistent application of routines and enhanced training to strengthen the capacity of service providers to support women with disabilities subjected to IPV.

Community health workers (CHWs) are key players in providing primary healthcare in low- and middle-income countries. However, their absence from the formal health system in many of these countries often presents a challenge to their remuneration. The objective of this scoping review is to document programs implemented at both small and large scales in low- and middle-income countries, the remuneration strategies they have established, and the effects of these strategies on the work of CHWs. In total, we included 50 articles in this review. We have identified four types of compensation: fixed compensation, performance-based compensation, compensation based on income-generating activities (IGAs), and combined compensation. We identified the strengths and weaknesses of each type of compensation. A common strength for most models was improvement in motivation and performance. A common weakness for most models was irregular payments. The results of this review highlight the need to consider the economic, social, and cultural settings of the countries or environments at hand, and to include CHWs in discussions regarding the selection of a compensation model.

Background: To attain universal health care, health managers need to monitor progress in service uptake, changes and geographic coverage. Although routine health management information systems are now well established in many resource-constrained countries, such data have not yet been used to examine geographic access trends over time.

Objective: This study aims to quantify changing patterns of geographic access to healthcare in the Volta Region, Ghana.

Methods: The repeated cross-sectional ecological spatio-temporal analysis used routine health management information systems data from 2016 to 2022, and geospatial data to examine changes in healthcare accessibility and services provided for population subgroups. Changes in healthcare provision, travel time to services and population coverage were estimated.

Results: Most health facilities (60.6%) provided the same range of services or added new services between 2016 and 2022. Childhood immunisation services had the highest geographic coverage within 30 min of the nearest health facility from 2016 to 2022 (minimum 97.2%), while Caesarean births had the lowest (maximum 75.2%). More health facilities provide antenatal services (2022: 59.9%) than birthing care (2022: 52.6%). Of all new health facilities, 93.2% were Community Health Planning and Services (CHPS) facilities. The majority of the population lived within 30 min of services in 2016 and 2022 for all the services studied.

Conclusion: The study provides a new approach to monitoring service changes through routine health data and spatial analysis. The analysis provided evidence to improve geographic accessibility, address gaps in service changes and consolidate the gains of high geographic coverage with quality care.

Background: Sub-Saharan African countries like Burkina Faso face a dietary transition and are experiencing a shift in disease burden.

Objective: We explored perceptions of healthy and environmentally sustainable dietary habits in urban Burkina Faso in order to tailor nutritional interventions to the local population and ultimately improve public and planetary health.

Methods: We conducted an exploratory qualitative study with semi-structured face-to-face interviews in three informal and two formal neighborhoods of Ouagadougou. The sample comprised 36 adult participants. The interviews were conducted in Mooré and French, audio-recorded, and transcribed verbatim. Data were analysed inductively, using thematic analysis.

Results: Participants described their ideal healthy and environmentally sustainable diet as traditional, local, natural, pure, organic, and transparent in terms of food production, processing, and preparation. Perceived barriers to achieve such diets were: limited financial resources, reduced availability of products and limited time for food preparation. Furthermore, participants highlighted discordant food preferences in the family, and a lack of understanding around the interconnection between nutrition, health and the environment as barriers. Most of these barriers were aggravated by the experience of a life in transition due to modernizing lifestyles, globalizing food systems, and a changing environment.

Conclusions: Participants' ideal of a healthy and environmentally sustainable diet clashed with a life in transition. To improve public and planetary health, interventions should aim to empower individuals, alleviate financial constraints, and shape global and local food environments.