• A comparative analysis of teenagers and older pregnant women in the utilization of prevention of mother to child transmission [PMTCT] services in, Western Nigeria

      Amoran Olorunfemi E; Salami Omotayo F; Oluwole Francis A (BMC, 2012-08-01)
      <p>Abstract</p> <p>Introduction</p> <p>Most HIV/AIDS infections in women occur at a younger age, during the first few years after sexual debut. This study was therefore designed to assess factors associated with the knowledge and utilization of the prevention of mother-to-child transmission (PMTCT) services by the teenage pregnant women when compared to mature pregnant women in Ogun state, Nigeria.</p> <p>Methods</p> <p>This study is an analytical cross-sectional study. A total sample of all pregnant women [52 teenagers and 148 adults] attending the primary health care centres in Sagamu local government area, Ogun State, Nigeria within a 2 months period were recruited into the study.</p> <p>Results</p> <p>A total of 225 respondents were recruited into the study. The overall point prevalence of HIV/AIDS infection among those that had been tested and disclosed their result was 4 [2.8%]. The prevalence of HIV among the teenagers was 2 [7.4%] compared with 2 [1.8%] among older women. Only 85 [37.8%] of all respondents were tested through the Voluntary counseling and testing (VCCT) programme and 53 (23.7%) were aware of antiretroviral therapy while 35 (15.6%) have ever used the PMTCT services before.</p> <p>There was no statistically significant difference in the knowledge of the teenage pregnant women when compared with the older women about mother to child transmission (MTCT) [OR = 1.47, C.I = 0.57-3.95] and its prevention [OR = 0.83, C.I = 0.38-1.84]. The teenagers were 3 times less likely to use the services when compared with the older women. [OR = 0.34, C.I = 0.10-1.00]. Those from the low socio-economic background were about 6 times more likely to utilize PMTCT facilities when compared to those from high socioeconomic background [OR = 6.01, C.I = 1.91-19.19].</p> <p>Conclusion</p> <p>The study concludes that the teenage pregnant women who were more vulnerable to HIV/AIDS infection did not utilize PMTCT services as much as the older pregnant women. Special consideration should be given to teenagers and those from high socioeconomic group in the design of scale up programmes to improve the uptake of PMTCT services in Nigeria and other low income countries.</p>
    • A comparative study of Taiwan's short-term medical missions to the South Pacific and Central America

      Chiu Ya-Wen; Weng Yi-Hao; Chen Chih-Fu; Yang Chun-Yuh; Chiou Hung-Yi; Lee Ming-Liang (BioMed Central, 2012-12-01)
      <p>Abstract</p> <p>Background</p> <p>Taiwan has been dispatching an increasing number of short-term medical missions (STMMs) to its allied nations to provide humanitarian health care; however, overall evaluations to help policy makers strengthen the impact of such missions are lacking. Our primary objective is to identify useful strategies by comparing STMMs to the South Pacific and Central America.</p> <p>Methods</p> <p>The data for the evaluation come from two main sources: the official reports of 46 missions to 11 countries in Central America and 25 missions to 8 countries in the South Pacific, and questionnaires completed by health professionals who had participated in the above missions. In Central America, STMMs were staffed by volunteer health professionals from multiple institutions. In the South Pacific, STMMs were staffed by volunteer health professionals from single institutions.</p> <p>Results</p> <p>In comparison to STMMs to Central America, STMMs to the South Pacific accomplished more educational training for local health providers, including providing heath-care knowledge and skills (p<0.05), and training in equipment administration (p<0.001) and drug administration (p<0.005). In addition, language constraints were more common among missions to Central America (p<0.001). There was no significant difference in the performance of clinical service between the two regions.</p> <p>Conclusions</p> <p>Health-care services provided by personnel from multiple institutions are as efficient as those from single institutions. Proficiency in the native language and provision of education for local health-care workers are essential for conducting a successful STMM. Our data provide implications for integrating evidence into the deployment of STMMs.</p>
    • A cross-sectional survey of parental attitudes towards Human papillomavirus vaccination exclusion categories in Brazil

      Mariana V. Gattegno; Maria A. F. Vertamatti; Robert A. Bednarczyk; Dabney P. Evans (BMC, 2019-02-01)
      Abstract Background In 1988, Brazil established a constitutional right to health and universal access to health care for all Brazilians through the creation of the Unified Health System (SUS). As part of its efforts to fulfill this right, the quadrivalent Human papillomavirus (HPV) vaccine was introduced into the national immunization program in 2014. The non-discriminatory provision of healthcare goods, facilities, and services is a fundamental part of the right to health. Yet HPV vaccination was limited to females aged 9–13, despite the universal nature of SUS and scientific support for the vaccination of males and older females. The purpose of this cross-sectional study was to describe parental attitudes regarding age- and gender-based HPV vaccination exclusions, as well as parental knowledge of HPV and the HPV vaccine. Methods Data were gathered from parents with children aged 9–17 in a health post located in the municipality of Mauá (São Paulo, Brazil) through interviewer-administered questionnaires. We analyzed attitudes regarding HPV vaccination and its eligibility guidelines by comparing parents of HPV vaccine eligible and ineligible children. Results In this low-income population, the majority of the 219 parents surveyed supported the inclusion of males and females over 13 into the HPV vaccination program; support for the non-discriminatory provision of the HPV vaccine was high among parents – especially if financially accessible. Additionally, there were high levels of knowledge and positive parental attitudes regarding HPV vaccination safety and efficacy among both parent groups suggesting information accessibility – a key component of the right to health and informed decision-making. Conclusions Support for the expansion of HPV vaccination for excluded populations exists, and is not based on current eligibility, or differential knowledge and attitudes about the vaccine. Moving forward, careful consideration of gender- based eligibility for vaccination, informed decision-making, and the importance of community participation in health policy development and implementation may be gleaned from the case of Brazil and beyond.
    • A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador

      Kelder Steven; Springer Andrew; Selwyn BJ (BioMed Central, 2006)
      <p>Abstract</p> <p>Background</p> <p>Adolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains&#8211;aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors&#8211;among public secondary school students in central El Salvador.</p> <p>Methods</p> <p>We employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12&#8211;20 years participated in the study.</p> <p>Results</p> <p>Health risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%).</p> <p>Conclusion</p> <p>A high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.</p>
    • A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador

      Kelder Steven H; Selwyn BJ; Springer Andrew E (BMC, 2006-04-01)
      &lt;p&gt;Abstract&lt;/p&gt; &lt;p&gt;Background&lt;/p&gt; &lt;p&gt;Adolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains–aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors–among public secondary school students in central El Salvador.&lt;/p&gt; &lt;p&gt;Methods&lt;/p&gt; &lt;p&gt;We employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12–20 years participated in the study.&lt;/p&gt; &lt;p&gt;Results&lt;/p&gt; &lt;p&gt;Health risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%).&lt;/p&gt; &lt;p&gt;Conclusion&lt;/p&gt; &lt;p&gt;A high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.&lt;/p&gt;
    • A grander challenge: the case of how Makerere University College of Health Sciences (MakCHS) contributes to health outcomes in Africa

      Groves Sara; Sewankambo Nelson K; Serwadda David; Pariyo George; Bollinger Robert C; Peters David H (BMC, 2011-03-01)
      &lt;p&gt;Abstract&lt;/p&gt; &lt;p&gt;Background&lt;/p&gt; &lt;p&gt;“Grand challenges” in global health have focused on discovery and development of technologies to save lives. The “grander challenge” involves building institutions, systems, capacity and demand to effectively deliver strategies to improve health. In 2008, Makerere University began a radical institutional change to bring together four schools under one College of Health Sciences. This paper’s objective is to demonstrate how its leadership in training, research, and services can improve health in Uganda and internationally, which lies at the core of the College’s vision.&lt;/p&gt; &lt;p&gt;Methods&lt;/p&gt; &lt;p&gt;A comprehensive needs assessment involved five task forces that identified MakCHS’s contribution to the Ugandan government health priorities. Data were collected through analysis of key documents; systematic review of MakCHS publications and grants; surveys of patients, students and faculty; and key informant interviews of the College’s major stakeholders. Four pilot projects were conducted to demonstrate how the College can translate research into policy and practice, extend integrated outreach community-based education and service, and work with communities and key stakeholders to address their priority health problems.&lt;/p&gt; &lt;p&gt;Results&lt;/p&gt; &lt;p&gt;MakCHS inputs to the health sector include more than 600 health professionals graduating per year through 23 degree programs, many of whom assume leadership positions. MakCHS contributions to processes include strengthened approaches to engaging communities, standardized clinical care procedures, and evidence-informed policy development. Outputs include the largest number of outpatients and inpatient admissions in Uganda. From 2005-2009, MakCHS also produced 837 peer-reviewed research publications (67% in priority areas). Outcomes include an expanded knowledge pool, and contributions to coverage of health services and healthy behaviors. Impacts include discovery and applications of global significance, such as the use of nevirapine to prevent HIV transmission in childbirth and male circumcision for HIV prevention. Pilot projects have applied innovative demand and supply incentives to create a rapid increase in safe deliveries (3-fold increase after 3 months), and increased quality and use of HIV services with positive collateral improvements on non-HIV health services at community clinics.&lt;/p&gt; &lt;p&gt;Conclusion&lt;/p&gt; &lt;p&gt;MakCHS has made substantial contributions to improving health in Uganda, and shows great potential to enhance this in its new transformational role – a model for other Universities.&lt;/p&gt;
    • A harmful traditional practice exposing young girls to experience virgin pregnancy (Shilshalo): a qualitative study in Argoba community, Amhara National Regional State, Ethiopia

      Yohannes Mersha Belete; Negesse Kebede Atlaw (BMC, 2018-11-01)
      Abstract Background There are various harmful traditional practices and beliefs across the different parts of Ethiopia. Shilshalo, which is yet little known about, is one of these practices existing in Argoba, a community in Amhara National Regional State of Ethiopia. This study was conducted to explore the various features associated with the practice of Shilshalo. Methods To address the objective of the study, qualitative approach with case study design was employed. Purposive sampling technique was used to select the participants of the study. Data were collected through interview and focus group discussion and analyzed using thematic qualitative analysis technique. Results This study found that Shilshalo is practiced by unmarried young boys and girls as a substitute for sexual intercourse. The actors conduct all activities performed during sexual intercourse except inserting the boy’s genital organ (penis) into the girl’s (vagina). The activities include warming up the girls’ body by hand, kissing and brushing the girl’s thigh and the areas around the outer part of the vagina with the erected penis. Shilshalo is practiced in two ways, i.e. between a boy and a girl, and between boys and a girl. This study also indicated that most members of the Argoba community including the actors consider Shilshalo as a beneficial cultural practice, yet the most shocking story is that some teenage girls experienced unwanted pregnancy without losing their virginity. In addition to virgin pregnancy, Shilshalo exposed girls to STIs, psycho-social problems and physical injuries. Conclusion This study concluded that Shilshalo is a harmful traditional practice that severely affects the lives of girls. The overall health and social well beings of girls are affected by different saddles that came from it. It brings almost all kinds of consequences that the other harmful traditional practices such as female genital mutilation and early marriage bring. It is also worse than the other harmful traditional practices as it poses virgin pregnancy as an additional consequence. Therefore, it is suggested that international and national organizations working on issues related to harmful traditional practice should pay due attention to Shilshalo just like what they are doing with female genital mutilation and early marriage.
    • A model explaining refugee experiences of the Australian healthcare system: a systematic review of refugee perceptions

      Michael Au; Athire Debbie Anandakumar; Robyn Preston; Robin A. Ray; Meg Davis (BMC, 2019-07-01)
      Abstract Background Refugees have significant unmet health needs. Delivering services to refugees continues to be problematic in the Australian healthcare system. A systematic review and thematic synthesis of the literature exploring refugee perceptions of the Australian healthcare system was performed. Methods Titles and abstracts of 1610 articles published between 2006 and 2019 were screened, and 147 articles were read in full text. Depending on the type of study, articles were appraised using the Modified Critical Appraisal Tool (developed by authors), the Mixed Methods Appraisal Tool, or the JBI Appraisal Checklist for Systematic Reviews. Using QSR NVivo 11, articles were coded into descriptive themes and synthesised into analytical themes. An explanatory model was used to synthesise these findings. Confidence in the review findings were assessed with GRADE-CERQual approach. Results The final synthesis included 35 articles consisting of one systematic review, 7 mixed methods studies, and 27 qualitative studies. Only one study was from a regional or rural area. A model incorporating aspects of engagement, access, trust, and privacy can be used to explain the experiences of refugees in using the Australian healthcare system. Refugees struggled to engage with health services due to their unfamiliarity with the health system. Information sharing is needed but this is not always delivered effectively, resulting in disempowerment and loss of autonomy. In response, refugees resorted to familiar means, such as family members and their pre-existing cultural knowledge. At times, this perpetuated their unfamiliarity with the broader health system. Access barriers were also encountered. Trust and privacy are pervasive issues that influenced access and engagement. Conclusions Refugees face significant barriers in accessing and engaging with healthcare services and often resorted to familiar means to overcome what is unfamiliar. This has implications across all areas of service provision. Health administrators and educators need to consider improving the cultural competency of staff and students. Policymakers need to consider engaging communities and upscale the availability and accessibility of professional language and cultural supports. Research is needed on how these measures can be effectively delivered. There is limited research in remote areas and further evidence is needed in these settings.
    • A multilevel analysis of effect of neighbourhood and individual wealth status on sexual behaviour among women: evidence from Nigeria 2003 Demographic and Health Survey

      Uthman Olalekan; Kongnyuy Eugene (BioMed Central, 2008)
      <p>Abstract</p> <p>Background</p> <p>Nigeria is home to more people living with HIV than any other country in the world, except South Africa and India &#8211; where an estimated 2.9 million [1.7 million &#8211; 4.2 million] people were living with the virus in 2005. Women bear the greatest burden of frequent high-risk pregnancies, raising large families, and increasingly, the AIDS epidemic. Thus, there is a need for better understanding of the determinants of high risk sexual behaviour among women. In this study, we examined factors associated with extra-marital sex among women in Nigeria and investigated how much variation in reported extra-marital sex can be attributed to individual-, and community-level factors.</p> <p>Methods</p> <p>We analyzed data from 6362 sexually active women aged 15 &#8211; 49 years who participated in the Nigeria 2003 Demographic and Health Survey using multilevel logistic regression models. Results are presented as odds ratio with 95% confidence interval.</p> <p>Results</p> <p>Independent of other factors, compared to women aged 15&#8211;24 years, those 25 &#8211; 34 years (odds ratio [OR] 0.59; 95% CI: 0.44 &#8211; 0.79) and 35 years or older (OR 0.36; 95% CI: 0.24 &#8211; 0.54) were less likely to have reported multiple concurrent sex partners in the last 12 years. As expected, women currently or formerly married were less likely to have reported multiple concurrent sex partners than women never married. Women who drank alcohol in the last three months were more likely to have reported multiple concurrent sex partners. Compared to women from richest household, women from poorest and middle household were 83% and 51% more likely to multiple concurrent sex partners in the last 12 month respectively. After individual compositional and contextual factors, community wealth status was statistically significant with sexual behaviour.</p> <p>Conclusion</p> <p>The study has demonstrated that individual and community wealth status are independent predictors of women's sexual behaviour, and that there is significant neighbourhood variation in odds of multiple concurrent sex partners, even after controlling for effects of both individual- and community-level characteristics. Scholars trying to understand variation individual high risk sexual behaviour should pay attention to the characteristics of both individuals and places of residence.</p>
    • A multilevel analysis of effect of neighbourhood and individual wealth status on sexual behaviour among women: evidence from Nigeria 2003 Demographic and Health Survey

      Kongnyuy Eugene J; Uthman Olalekan A (BMC, 2008-06-01)
      &lt;p&gt;Abstract&lt;/p&gt; &lt;p&gt;Background&lt;/p&gt; &lt;p&gt;Nigeria is home to more people living with HIV than any other country in the world, except South Africa and India – where an estimated 2.9 million [1.7 million – 4.2 million] people were living with the virus in 2005. Women bear the greatest burden of frequent high-risk pregnancies, raising large families, and increasingly, the AIDS epidemic. Thus, there is a need for better understanding of the determinants of high risk sexual behaviour among women. In this study, we examined factors associated with extra-marital sex among women in Nigeria and investigated how much variation in reported extra-marital sex can be attributed to individual-, and community-level factors.&lt;/p&gt; &lt;p&gt;Methods&lt;/p&gt; &lt;p&gt;We analyzed data from 6362 sexually active women aged 15 – 49 years who participated in the Nigeria 2003 Demographic and Health Survey using multilevel logistic regression models. Results are presented as odds ratio with 95% confidence interval.&lt;/p&gt; &lt;p&gt;Results&lt;/p&gt; &lt;p&gt;Independent of other factors, compared to women aged 15–24 years, those 25 – 34 years (odds ratio [OR] 0.59; 95% CI: 0.44 – 0.79) and 35 years or older (OR 0.36; 95% CI: 0.24 – 0.54) were less likely to have reported multiple concurrent sex partners in the last 12 years. As expected, women currently or formerly married were less likely to have reported multiple concurrent sex partners than women never married. Women who drank alcohol in the last three months were more likely to have reported multiple concurrent sex partners. Compared to women from richest household, women from poorest and middle household were 83% and 51% more likely to multiple concurrent sex partners in the last 12 month respectively. After individual compositional and contextual factors, community wealth status was statistically significant with sexual behaviour.&lt;/p&gt; &lt;p&gt;Conclusion&lt;/p&gt; &lt;p&gt;The study has demonstrated that individual and community wealth status are independent predictors of women's sexual behaviour, and that there is significant neighbourhood variation in odds of multiple concurrent sex partners, even after controlling for effects of both individual- and community-level characteristics. Scholars trying to understand variation individual high risk sexual behaviour should pay attention to the characteristics of both individuals and places of residence.&lt;/p&gt;
    • A participatory intervention to improve the mental health of widows of injecting drug users in north-east India as a strategy for HIV prevention

      Herrman Helen; Chandra Prabha; Devine Alexandra; Kermode Michelle (BioMed Central, 2007)
      <p>Abstract</p> <p>Background</p> <p>Manipur and Nagaland, in the north-east of India, are classified as high prevalence states for HIV, and intravenous drug use is an important route of transmission. Most injecting drug users (IDUs) are men, an estimated 40% are married, and death rates have been high in the last five years, consequently the number of widows of IDUs has increased. Many of these widows and their children are HIV-infected and experience poor health, discrimination, and impoverishment; all factors likely to be compromising their mental health. People with poor mental health are more likely to engage in HIV risk behaviours. Mental health can be promoted by public health actions with vulnerable population groups.</p> <p>Methods</p> <p>We designed an intervention study to assess the feasibility and impact of a participatory action process to promote the mental health and well-being of widows of IDUs in Manipur and Nagaland, as a strategy for reducing the risk of engagement in HIV risk behaviours. This paper describes the background and rationale for the study, the intervention, and the study methods in detail.</p> <p>Results</p> <p>Pending analysis.</p> <p>Conclusion</p> <p>This intervention study will make a significant contribution to the emerging evidence that supports associations between mental health and HIV. The concept of promoting mental health among women who are vulnerable to HIV infection or already infected as a strategy for HIV prevention in a development setting is breaking new ground.</p>
    • A participatory intervention to improve the mental health of widows of injecting drug users in north-east India as a strategy for HIV prevention

      Chandra Prabha; Kermode Michelle; Devine Alexandra; Herrman Helen (BMC, 2007-04-01)
      &lt;p&gt;Abstract&lt;/p&gt; &lt;p&gt;Background&lt;/p&gt; &lt;p&gt;Manipur and Nagaland, in the north-east of India, are classified as high prevalence states for HIV, and intravenous drug use is an important route of transmission. Most injecting drug users (IDUs) are men, an estimated 40% are married, and death rates have been high in the last five years, consequently the number of widows of IDUs has increased. Many of these widows and their children are HIV-infected and experience poor health, discrimination, and impoverishment; all factors likely to be compromising their mental health. People with poor mental health are more likely to engage in HIV risk behaviours. Mental health can be promoted by public health actions with vulnerable population groups.&lt;/p&gt; &lt;p&gt;Methods&lt;/p&gt; &lt;p&gt;We designed an intervention study to assess the feasibility and impact of a participatory action process to promote the mental health and well-being of widows of IDUs in Manipur and Nagaland, as a strategy for reducing the risk of engagement in HIV risk behaviours. This paper describes the background and rationale for the study, the intervention, and the study methods in detail.&lt;/p&gt; &lt;p&gt;Results&lt;/p&gt; &lt;p&gt;Pending analysis.&lt;/p&gt; &lt;p&gt;Conclusion&lt;/p&gt; &lt;p&gt;This intervention study will make a significant contribution to the emerging evidence that supports associations between mental health and HIV. The concept of promoting mental health among women who are vulnerable to HIV infection or already infected as a strategy for HIV prevention in a development setting is breaking new ground.&lt;/p&gt;
    • A renewed call for transdisciplinary action on NCDs

      Brigit Toebes; Marlies Hesselman; Jochen O. Mierau; Jitse P. van Dijk (BMC, 2020-08-01)
      Abstract Notwithstanding COVID-19, non-communicable diseases (NCDs) will be the leading cause of death in every region in the world by 2030. This contribution, which forms an introduction to our collection of articles in this journal, identifies elements for a transdisciplinary research agenda between law, public health, health economics and international relations aimed at designing concrete interventions to curb the NCD pandemic, both globally and domestically.
    • A social-ecological examination into the research, policy and health service delivery environment related to early marriage and sexual and gender-based violence among youth in Jordan

      Jewel Gausman; Areej Othman; Abeer Dababneh; Maysoon Dabobe; Iqbal Hamad; Insaf Daas; Ana Langer (BMC, 2020-07-01)
      Abstract Background The determinants of sexual- and gender-based violence (SGBV) and early marriage are embedded across different levels of the social ecological system, including at the individual, family, community, and policy levels. In Jordan and the Middle East, SGBV, honor killing, and early marriage are priority public health and human rights issues that often overlap, and affect a significant percentage of youth. Jordan is home to a large number of refugees from across the Middle East, who may be even more vulnerable to these forms of violence than the local youth. The purpose of this analysis is to 1) synthesize the existing literature and 2) present the perspectives of key stakeholders to identify research gaps, programmatic lessons learned, and opportunities for policy change from an ecological perspective at the individual, community, health-system, and policy/legal levels. Methods This study includes 1) a systematic literature review of both published and unpublished literature since 2008 and 2) focus group discussions (FGDs) with key stakeholders representing 18 international and local governmental and non-governmental organizations. Results The literature review included 27 documents. Stakeholder discussions highlighted important research and policy gaps. Prevalence estimates of SGBV, honor killing, and early marriage vary across sources; however, all of them indicate that they remain important issues for youth in Jordan. Several sources indicate that early marriage has been increasing in Jordan since the beginning of the war in Syria, especially among Syrian refugees. Refugee youth are particularly vulnerable to SGBV and early marriage given the worsening economic situation in Jordan. The norms, attitudes, and practices that support SGBV in Jordan appear to be reinforced within families and communities. Despite ongoing programs, SGBV services are limited, especially for youth, and there is little awareness of service availability amongst target populations. Laws and policies continue to offer legal justification for SGBV, honor killing, and early marriage. Discussion As countries across the Middle East face instability and continue to struggle with the urgent health needs of large refugee and youth populations, this review provides valuable insight relevant to research, programs, and policy in Jordan and across the region.
    • A survey of health problems of Nepalese female migrants workers in the Middle-East and Malaysia

      Padam Simkhada; Edwin van Teijlingen; Manju Gurung; Sharada P. Wasti (BMC, 2018-01-01)
      Abstract Background Nepal is a key supplier of labour for countries in the Middle East, India and Malaysia. As many more men than women leave Nepal to work abroad, female migrant workers are a minority and very much under-researched. The aim of the study was to explore the health problems of female Nepalese migrants working in the Middle-East and Malaysia. Methods The study was conducted among 1010 women who were registered as migrant returnees at an organisation called Pourakhi Nepal. Secondary data were extracted from the records of the organisation covering the five-year period of July 2009 to July 2014. Results The 1010 participants were aged 14 to 51 with a median age of 31 (IQR: 38-25) years. A quarter of respondents (24%) reported having experienced health problems while in the country of employment. Fever, severe illness and accidents were the most common health problems reported. Working for unlimited periods of time and not being able to change one’s place of work were independently associated with a greater likelihood of health problems. Logistic regression shows that migrant women who are illiterate [OR = 1.56, 95% CI: 1.02 to 2.38, p = 0.042], who had changed their workplace [OR = 1.63, 95% CI: 1.14 to 2.32, p = 0.007], who worked unlimited periods of time [OR = 1.64, 95% CI: 1.44 to 1.93, p = 0.020], had been severely maltreated or tortured in the workplace [OR = 1.84, 95% CI: 1.15 to 2.92, p = 0.010], were not being paid on time [OR = 2.38, 95% CI: 1.60 to 3.55, p = 0.038] and migrant women who had family problems at home [OR = 3.48, CI 95%: 1.22 to 9.98, p = 0.020] were significantly associated with health problems in their host country in the Middle East. Conclusion Female migrant workers face various work-related health risks, which are often related to exploitation. The Government of Nepal should initiate awareness campaigns about health risks and rights in relation to health care services in the host countries. Recruiting agencies/employers should provide information on health risks and training for preventive measures. Raising awareness among female migrant workers can make a change in their working lives.
    • A taxonomy of dignity: a grounded theory study

      Jacobson Nora (BioMed Central, 2009)
      <p>Abstract</p> <p>Background</p> <p>This paper has its origins in Jonathan Mann's insight that the experience of dignity may explain the reciprocal relationships between health and human rights. It follows his call for a taxonomy of dignity: "a coherent vocabulary and framework to characterize dignity."</p> <p>Methods</p> <p>Grounded theory procedures were use to analyze literature pertaining to dignity and to conduct and analyze 64 semi-structured interviews with persons marginalized by their health or social status, individuals who provide health or social services to these populations, and people working in the field of health and human rights.</p> <p>Results</p> <p>The taxonomy presented identifies two main forms of dignity&#8211;human dignity and social dignity&#8211;and describes several elements of these forms, including the social processes that violate or promote them, the conditions under which such violations and promotions occur, the objects of violation and promotion, and the consequences of dignity violation. Together, these forms and elements point to a theory of dignity as a quality of individuals and collectives that is constituted through interaction and interpretation and structured by conditions pertaining to actors, relationships, settings, and the broader social order.</p> <p>Conclusion</p> <p>The taxonomy has several implications for work in health and human rights. It suggests a map to possible points of intervention and provides a language in which to talk about dignity.</p>
    • A taxonomy of dignity: a grounded theory study

      Jacobson Nora (BioMed Central, 2009-02-01)
      &lt;p&gt;Abstract&lt;/p&gt; &lt;p&gt;Background&lt;/p&gt; &lt;p&gt;This paper has its origins in Jonathan Mann's insight that the experience of dignity may explain the reciprocal relationships between health and human rights. It follows his call for a taxonomy of dignity: "a coherent vocabulary and framework to characterize dignity."&lt;/p&gt; &lt;p&gt;Methods&lt;/p&gt; &lt;p&gt;Grounded theory procedures were use to analyze literature pertaining to dignity and to conduct and analyze 64 semi-structured interviews with persons marginalized by their health or social status, individuals who provide health or social services to these populations, and people working in the field of health and human rights.&lt;/p&gt; &lt;p&gt;Results&lt;/p&gt; &lt;p&gt;The taxonomy presented identifies two main forms of dignity–human dignity and social dignity–and describes several elements of these forms, including the social processes that violate or promote them, the conditions under which such violations and promotions occur, the objects of violation and promotion, and the consequences of dignity violation. Together, these forms and elements point to a theory of dignity as a quality of individuals and collectives that is constituted through interaction and interpretation and structured by conditions pertaining to actors, relationships, settings, and the broader social order.&lt;/p&gt; &lt;p&gt;Conclusion&lt;/p&gt; &lt;p&gt;The taxonomy has several implications for work in health and human rights. It suggests a map to possible points of intervention and provides a language in which to talk about dignity.&lt;/p&gt;
    • Acceptability of HIV counselling and testing among tuberculosis patients in south Ethiopia

      Lindtj&#248;rn Bernt; Jerene Degu; Endale Aschalew (BioMed Central, 2007)
      <p>Abstract</p> <p>Background</p> <p>To benefit from available care and treatment options, patients should first be counselled and tested for HIV. Our aim was to assess the acceptability of HIV testing among tuberculosis patients under routine care conditions in south Ethiopia.</p> <p>Methods</p> <p>We interviewed all adult tuberculosis patients who were treated at Arba Minch Hospital in Ethiopia between January and August 2005. After recording socio-demographic information and tuberculosis treatment history, we referred those patients who showed initial willingness to a counsellor for HIV counselling and testing. Rapid test methods were used following a pretest counselling session. The results were disclosed during a post-test counselling session. We used the logistic regression method to assess factors associated with willingness and acceptability.</p> <p>Results</p> <p>190 adult tuberculosis patients were treated at the hospital and all of them consented to take part in the study. Their median age was 30 years (range, 15&#8211;68) and 52% of them were males. 49 patients (26%) were previously tested including 29 (59%) HIV positive. Of 161 patients (excluding the 29 already positive), 118 (73%) were willing to be tested and 58% (68/118) of those willing accepted the test. The overall acceptability rate was 35% (56/161). Fourteen (20.6%) were HIV positive and women were more likely to be HIV infected (p = 0.029). Unemployment and self-perceived high risk of HIV infection were associated with initial willingness (OR [95%CI]:2.6 [1.3&#8211;5.5] vs. 5.0 [1.1&#8211;22.4], respectively). However, only being unemployed was associated with accepting the test (OR = 4.2; 95%CI = 1.9&#8211;9.3).</p> <p>Conclusion</p> <p>The low acceptability of HIV counselling and testing among tuberculosis patients poses a challenge to the scale-up of TB/HIV collaborative efforts. There is a need for alternative counselling and testing strategies.</p>
    • Acceptability of HIV counselling and testing among tuberculosis patients in south Ethiopia

      Endale Aschalew; Jerene Degu; Lindtjørn Bernt (BMC, 2007-05-01)
      &lt;p&gt;Abstract&lt;/p&gt; &lt;p&gt;Background&lt;/p&gt; &lt;p&gt;To benefit from available care and treatment options, patients should first be counselled and tested for HIV. Our aim was to assess the acceptability of HIV testing among tuberculosis patients under routine care conditions in south Ethiopia.&lt;/p&gt; &lt;p&gt;Methods&lt;/p&gt; &lt;p&gt;We interviewed all adult tuberculosis patients who were treated at Arba Minch Hospital in Ethiopia between January and August 2005. After recording socio-demographic information and tuberculosis treatment history, we referred those patients who showed initial willingness to a counsellor for HIV counselling and testing. Rapid test methods were used following a pretest counselling session. The results were disclosed during a post-test counselling session. We used the logistic regression method to assess factors associated with willingness and acceptability.&lt;/p&gt; &lt;p&gt;Results&lt;/p&gt; &lt;p&gt;190 adult tuberculosis patients were treated at the hospital and all of them consented to take part in the study. Their median age was 30 years (range, 15–68) and 52% of them were males. 49 patients (26%) were previously tested including 29 (59%) HIV positive. Of 161 patients (excluding the 29 already positive), 118 (73%) were willing to be tested and 58% (68/118) of those willing accepted the test. The overall acceptability rate was 35% (56/161). Fourteen (20.6%) were HIV positive and women were more likely to be HIV infected (p = 0.029). Unemployment and self-perceived high risk of HIV infection were associated with initial willingness (OR [95%CI]:2.6 [1.3–5.5] vs. 5.0 [1.1–22.4], respectively). However, only being unemployed was associated with accepting the test (OR = 4.2; 95%CI = 1.9–9.3).&lt;/p&gt; &lt;p&gt;Conclusion&lt;/p&gt; &lt;p&gt;The low acceptability of HIV counselling and testing among tuberculosis patients poses a challenge to the scale-up of TB/HIV collaborative efforts. There is a need for alternative counselling and testing strategies.&lt;/p&gt;
    • Access to primary healthcare services for the Roma population in Serbia: a secondary data analysis

      Schrecker Ted; Patrick Jonathan; Adams Orvill; Idzerda Leanne; Tugwell Peter (BioMed Central, 2011-08-01)
      &lt;p&gt;Abstract&lt;/p&gt; &lt;p&gt;Background&lt;/p&gt; &lt;p&gt;Serbia has proclaimed access to healthcare as a human right. In a context wherein the Roma population are disadvantaged, the aim of this study was to assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. The history of the Roma in Serbia is described in detail so as to provide a context for their current vulnerable position.&lt;/p&gt; &lt;p&gt;Methods&lt;/p&gt; &lt;p&gt;Disaggregated data were analyzed from three population groups in Serbia; the general population, the Roma population, and the poorest quintile of the general population not including the Roma. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness of health services, was used to structure the secondary data analysis. Acute respiratory infection (ARI) in children less than five years of age was used as an example as this is the leading cause of death in children under 5 years old in Serbia.&lt;/p&gt; &lt;p&gt;Results&lt;/p&gt; &lt;p&gt;Roma children were significantly more likely to experience an ARI than either the general population or the poorest quintile of the general population, not including the Roma. All three population groups were equally likely to not receive the correct treatment regime of antibiotics. An analysis of the factors that affect quality of access to health services reveal that personal documentation is a statistically significant problem; availability of health services is not an issue that disproportionately affects the Roma; however the geographical accessibility and affordability are substantive issues that disproportionately affect the Roma population. Affordability of services affected the Roma and the poorest quintile and affordability of medications significantly affected all three population groups. With regards to acceptability, mothers from all three population groups are equally likely to recognize the importance of seeking treatment.&lt;/p&gt; &lt;p&gt;Conclusions&lt;/p&gt; &lt;p&gt;The Roma should be assisted in applying for personal documentation, the geographical accessibility of clinics needs to be addressed, and the costs of healthcare visits and medications should be reviewed. Areas for improvement specific to ARI are the costs of antibiotics and the diagnostic accuracy of providers. A range of policy recommendations are outlined.&lt;/p&gt;