Table of Contents - Issue
Recent articles
-
Beyond the Pill: Psychosocial and Behavioural Predictors of ART Non-Adherence Following the Single-Tablet Regimen Transition in Yaoundé, CameroonAuthor: Mbohli Semirnyuy Sharon LumDOI: 10.21522/TIJPH.2013.14.01.Art001
Beyond the Pill: Psychosocial and Behavioural Predictors of ART Non-Adherence Following the Single-Tablet Regimen Transition in Yaoundé, Cameroon
Abstract:
Achieving the UNAIDS 95-95-95 targets depends on optimal adherence to antiretroviral therapy (ART). While Cameroon transitioned to simplified Dolutegravir-based Single-Tablet Regimens (STR), the impact on adherence relative to Multiple-Tablet Regimens (MTR) remains to be elucidated. This hospital-based cross-sectional study among 680 participants at Yaoundé Jamot Hospital quantified adherence using a modified CPCRA 7-day recall and CASE Adherence Index. Results indicated an optimal adherence prevalence of 79.7% (95% CI: 76.4–82.7%) for the 7-day recall and 80.9% for the CASE Index. No significant difference in adherence was observed between STR and MTR users (p = 0.494). Multivariable modified Poisson regression revealed that lack of family support was the strongest predictor of non-adherence (aPR: 1.407, 95% CI: 1.203–1.646; p < 0.001). Other significant factors included depressive symptoms (aPR: 1.257, 95% CI: 1.036–1.525) and risky alcohol consumption (aPR: 1.158, 95% CI: 1.096–1.224). These findings suggest that in the era of simplified regimens, adherence is driven primarily by psychosocial and behavioural determinants rather than physical drug complexity. To bridge the final 20% gap, interventions must prioritize family support systems and mental health screening alongside pharmacological simplification.
Beyond the Pill: Psychosocial and Behavioural Predictors of ART Non-Adherence Following the Single-Tablet Regimen Transition in Yaoundé, Cameroon
References:
[1]. UNAIDS, 2022, Global HIV & AIDS statistics. UNAIDS Reports, Geneva. https://www.unaids.org/en/resources/documents/2022/2022_Global_AIDS_Update.
[2]. Bangsberg, D. R., et al., 2001, Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS, 15(9), 1181–1183, https://doi.org/10.1097/00002030-200106150-00015
[3]. Fonsah, J. Y., et al., 2017, Adherence to Antiretroviral Therapy (ART) in Yaoundé, Cameroon: Association with Opportunistic Infections, Depression, ART Regimen, and Side Effects. PLoS One, 12(1), e0170893, https://doi.org/10.1371/journal.pone.0170893.
[4]. Pefura-Yone, E. W., et al., 2013, Non-adherence to antiretroviral therapy in Yaounde: Prevalence, determinants and the concordance of two screening criteria. Journal of Infection and Public Health, 6(4), 307–315, https://doi.org/10.1016/j.jiph.2013.02.003.
[5]. World Health Organization, 2019, Update of recommendations on first- and second-line antiretroviral regimens. WHO Guidelines, Geneva.
[6]. Kounafack, et al., 2019, Dolutegravir-Based or Low-Dose Efavirenz–Based Regimen for the Treatment of HIV-1. New England Journal of Medicine, 381(9), 816–826, https://doi.org/10.1056/NEJMoa1904340.
[7]. Venter, W. D. F., et al., 2019, Dolutegravir-based ART for HIV treatment: Evidence and implications. Lancet HIV, 6(7), e430–e442.
[8]. Mbengue, M. A. S., et al., 2019, Prevalence and determinants of adherence to antiretroviral treatment among HIV patients on first-line regimen: a cross-sectional study in Dakar, Senegal. Pan African Medical Journal, 33(95), https://doi.org/10.11604/pamj.2019.33.95.17248.
[9]. Tchokonte-Nana, V., et al., 2021, The effectiveness of SMS reminders to improve ART adherence in Cameroon. Pan African Medical Journal, 38(6), 307.
[10]. Diyir, E. B., et al., 2025, HIV/AIDS and Adolescent Adherence to Antiretroviral Therapy: A Cross-Sectional Study of Adolescents in the Bamenda Health Districts, Cameroon. Journal of Biosciences and Medicines, 13(11), 237–266, https://doi.org/10.4236/jbm.2025.1311017.
[11]. Chesney, M. A., et al., 2000, Adherence to HIV combination therapy. Social Science & Medicine, 50(11), 1599–1605, https://doi.org/10.1016/S0277-9536(99)00468-2.
[12]. Rostant Pokam Djoko, G., et al., 2024, Factors influencing adherence to antiretroviral treatment among people living with HIV aged 15–60 years at Cité des Palmiers District Hospital, Cameroon. Global Health Economics and Sustainability, 3(1), 118, https://doi.org/10.36922/ghes.4077.
[13]. Mekolle, J. E., et al., 2023, Political instability and HIV/AIDS response in the south west and north west regions of Cameroon: a qualitative study. BMC Public Health, 23(1), 2155, https://doi.org/10.1186/s12889-023-16994-w.
[14]. Mbuagbaw, L., et al., 2012, Trends and determining factors associated with adherence to antiretroviral therapy (ART) in Cameroon: a systematic review and analysis of the CAMPS trial. AIDS Research and Therapy, 9(1), 37, https://doi.org/10.1186/1742-6405-9-37.
[15]. Cameroon Demographic and Health Survey (DHS), 2018, HIV prevalence statistics. DHS Program, Rockville, MD.
[16]. Mannheimer, S. B., et al., 2006, The CASE adherence index: A novel method for measuring adherence to antiretroviral therapy. AIDS Care, 18(7), 853–861, https://doi.org/10.1080/09540120500465160.
[17]. Chesney, M. A., et al., 2000, Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG Adherence Instruments. AIDS Care, 12(3), 255–266, https://doi.org/10.1080/09540120050042891.
[18]. Mannheimer, S. B., et al., 2006, The CASE adherence index: A novel method for measuring adherence to antiretroviral therapy. AIDS Care, 18(7), 853–861, https://doi.org/10.1080/09540120500465160.
[19]. Kroenke, K., et al., 2003, The Patient Health Questionnaire-2. Medical Care, 41(11), 1284–1292, https://doi.org/10.1097/01.MLR.0000093487.78664.3C.
[20]. Bush, K., et al., 1998, The AUDIT Alcohol Consumption Questions (AUDIT-C): An Effective Brief Screening Test for Problem Drinking. Archives of Internal Medicine, 158(16), 1789, https://doi.org/10.1001/archinte.158.16.1789.
[21]. Byrd, K. K., et al., 2019, Antiretroviral adherence level necessary for HIV viral suppression using real-world data. JAIDS Journal of Acquired Immune Deficiency Syndromes, 82(3), 245–251, https://doi.org/10.1097/QAI.0000000000002142.
[22]. Clay, P. G., et al., 2018, A meta-analysis comparing 48-week treatment outcomes of single and multi-tablet antiretroviral regimens for the treatment of people living with HIV. AIDS Research and Therapy, 15(1), 17, https://doi.org/10.1186/s12981-018-0204-0.
[23]. Altice, F., et al., 2019, Adherence to HIV treatment regimens: systematic literature review and meta-analysis. Patient Preference and Adherence, 13, 475–490, https://doi.org/10.2147/PPA.S192735.
[24]. Braitstein, P., et al., 2008, Gender and the Use of Antiretroviral Treatment in Resource-Constrained Settings: Findings from a Multicenter Collaboration. Journal of Women's Health, 17(1), 47–55, https://doi.org/10.1089/jwh.2007.0353.
[25]. Mabou, G. T., et al., 2025, Factors associated with HIV status non-disclosure among people entering care at IeDEA sites in Cameroon: a cross-sectional study. AIDS Research and Therapy, 22(1), 100, https://doi.org/10.1186/s12981-025-00765-1.
[26]. Kagee, A., et al., 2011, Structural barriers to ART adherence in Southern Africa: Challenges and potential ways forward. Global Public Health, 6(1), 83–97, https://doi.org/10.1080/17441691003796387.
[27]. Constantin, T., et al., 2020, Risky Behaviors among HIV Serodiscordant and Seroconcordant Couples in Yaounde-Cameroon. International Journal of Virology and AIDS, 7(1), https://doi.org/10.23937/2469-567X/1510062.
[28]. Kalichman, S. C., et al., 2012, Alcohol and Adherence to Antiretroviral Medications: Interactive Toxicity Beliefs Among People Living With HIV. Journal of the Association of Nurses in AIDS Care, 23(6), 511–520, https://doi.org/10.1016/j.jana.2011.11.005.
Viewed PDF 168 22 -
Evaluating the Psychosocial Needs and Reintegration of Returnee Migrants in NigeriaAuthor: Olatunji Joshua AwoleyeDOI: 10.21522/TIJPH.2013.14.01.Art002
Evaluating the Psychosocial Needs and Reintegration of Returnee Migrants in Nigeria
Abstract:
Returnee migrants in Nigeria face complex psychosocial challenges that hinder their reintegration into society. This study evaluated the psychosocial needs and reintegration experiences of returnee migrants across Nigeria. A mixed-method design was used to assess returnees’ psychosocial needs. Quantitative data were collected from 1,316 returnee migrants using a structured, pretested questionnaire with a 5-point Likert scale, selected through multistage sampling across Nigeria’s six geopolitical zones. Qualitative data were obtained through 8 focus group discussions (FGD) with 12 participants each. Quantitative data were analyzed using SPSS version 28.0, while qualitative data were analyzed thematically using QDA Miner. The mean age of respondent was 29.11 ± 6.21. Psychosocial needs assessments revealed limited access to mental health services (36.6%). Most respondents reported weak community belonging (75.7%) and high levels of social isolation (84.7%), while stigma related to returnee status was widely prevalent (85.1%). Psychosocial factors such as Sex, and religion shows a strong independent association with psychosocial needs among returnees. Male respondents have significantly higher odds (AOR= 5.533: p<0.001) of reporting psychosocial needs compared to females. Muslim participants reported lower odds of psychosocial needs (AOR=0.559: p=0.026) compared to Christian respondents. Qualitative findings revealed widespread stigma, broken relationships, and systemic exclusion, particularly affecting women. Returnees emphasized the need for trauma-informed mental health care, sustainable livelihoods, and structural support such as transitional housing. Returnee migrants in Nigeria experience profound psychosocial distress characterized by stigma, economic hardship, and weak community integration. Interventions should focus on reducing stigma, strengthening community acceptance, and integrating psychosocial support.
Evaluating the Psychosocial Needs and Reintegration of Returnee Migrants in Nigeria
References:
[1]. Henkelmann, J. R., de Best, S., Deckers, C., Jensen, K., Shahab, M., Elzinga, B., et al., 2020, Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: A systematic review and meta-analysis. BJPsych Open, 6, 1–8. https://doi.org/10.1192/bjo.2020.54
[2]. Siriwardhana, C., Stewart, R., 2013, Forced migration and mental health: Prolonged internal displacement, return migration and resilience. International Health, 5, 19–23. https://doi.org/10.1093/inthealth/ihs014
[3]. World Health Organization (WHO), 2022, Refugee and Migrant Health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health
[4]. Blais, R. K., Renshaw, K. D., Jakupcak, M., 2014, Posttraumatic stress and stigma in active-duty service members relate to lower likelihood of seeking support. Journal of Traumatic Stress, 27, 116–119. https://doi.org/10.1002/jts.21888
[5]. Chy, M. T., Uddin, M. K., Ahmmed, H. U., 2023, Forced returnee Bangladeshi female migrant domestic workers and their social reintegration experiences. Current Sociology, 71, 133–151. https://doi.org/10.1177/00113921211048533
[6]. Mreji, P., Barnard, H., 2021, The micro-foundations of the returnee liability: The interpersonal challenges of returnee entrepreneurs in Kenya. Journal of International Management, 27. https://doi.org/10.1016/j.intman.2021.100846
[7]. Konzett-Smoliner, S., 2016, Return migration as a ‘family project’: Exploring the relationship between family life and the readjustment experiences of highly skilled Austrians. Journal of Ethnic and Migration Studies, 42, 1094–1114. https://doi.org/10.1080/1369183X.2016.1138853
[8]. Aker, D. Y., Görmüş, A., 2018, Employment of return migrants in Turkey: Evidence from the labour force survey. Migration Letters, 15, 437–451. https://doi.org/10.33182/ml.v15i3.364
[9]. Openshaw, E. H., 2022, Effects of psychological and psychosocial interventions for refugees: A systematic review.
[10]. Wapmuk, S., 2019, International migration, Nigerian returnee migrants, and challenges of reintegration. Journal of Social Sciences, 9, 158–180.
[11]. Mercier, M., David, A., Mahia, R., De Arce, R., 2016, Reintegration upon return: Insights from Ecuadorian returnees from Spain. International Migration, 54, 56–73. https://doi.org/10.1111/imig.12288
[12]. Zandonini, G., 2020, Nigerians returned from Europe face stigma and growing hardship. The New Humanitarian. https://www.thenewhumanitarian.org/news-feature/2020/07/28/Nigeria-migrants-return-Europe
[13]. Lindert, J., Samkange-Zeeb, F., Jakubauskiene, M., Bain, P. A., Mollica, R., 2023, Factors contributing to resilience among first-generation migrants, refugees and asylum seekers: A systematic review. International Journal of Public Health, 68. https://doi.org/10.3389/ijph.2023.1606406
[14]. Yamane, Y., 1967, Mathematical formulae for sample size determination. Open Journal of Statistics, 12, 291–302.
[15]. International Organization for Migration (IOM), 2023, IOM Nigeria Annual Report. International Organization for Migration.
[16]. Joshi, A., Kale, S., Chandel, S., Pal, D., 2015, Likert scale: Explored and explained. British Journal of Applied Science & Technology, 7, 396–403. https://doi.org/10.9734/bjast/2015/14975
[17]. Koo, M., Yang, S., 2025, Likert-type scale.
[18]. Tessitore, F., Parola, A., Margherita, G., 2023, Mental health risk and protective factors of Nigerian male asylum seekers hosted in Southern Italy: A culturally sensitive quantitative investigation. Journal of Racial and Ethnic Health Disparities, 10, 730–742. https://doi.org/10.1007/s40615-022-01260-3
[19]. Sen, P., 2016, The mental health needs of asylum seekers and refugees – challenges and solutions. BJPsych International, 13, 30–32. https://doi.org/10.1192/s2056474000001069
[20]. Nwozor, A., Oshewolo, S., Olanrewaju, J. S., Ake, M. B., Okidu, O., 2022, Return migration and the challenges of diasporic reintegration in Nigeria. Third World Quarterly, 43, 432–451. https://doi.org/10.1080/01436597.2022.2026216
[21]. Karimi, B. A., Azizi, B. A., Zahir, A. H., 2025, The effects of forced deportation of migrants on their mental health in Herat City. Kunduz University International Journal of Islamic Studies and Social Sciences, 2, 215–228. https://doi.org/10.71082/fsdhd609
[22]. Richardson, D., Laurie, N., 2019, Returning to sexual stigma: Post-trafficking lives. British Journal of Sociology, 70, 1926–1945. https://doi.org/10.1111/1468-4446.12707
[23]. Simoni, V., Voirol, J., 2025, Moral articulations of economic life in returns to Ecuador and Cuba. Open Research Europe, 5, 68. https://doi.org/10.12688/openreseurope.19587.1
[24]. Medase, K., Barasa, L., 2019, Absorptive capacity, marketing capabilities, and innovation commercialisation in Nigeria. European Journal of Innovation Management, 22, 790–820. https://doi.org/10.1108/EJIM-09-2018-0194
[25]. Nisrane, B. L., 2020, Home, but not ‘at home’: The reintegration of unskilled Ethiopian female return migrants from Arabian Gulf countries. Ekonomika Regiona, 32.
Viewed PDF 156 30 -
Perceptions of Healthcare Seekers on Universal Health Coverage in Lubero Territory and Butembo City in Democratic Republic of CongoAuthor: Paluku Kahuko-Wa-MithimboDOI: 10.21522/TIJPH.2013.14.01.Art003
Perceptions of Healthcare Seekers on Universal Health Coverage in Lubero Territory and Butembo City in Democratic Republic of Congo
Abstract:
This study aims to contribute to the implementation of universal health coverage in the Democratic Republic of Congo and to assess the implementation of UHC through the level of perception of healthcare seekers. The study is descriptive, cross-sectional, comparative, and correlational. It was conducted from March to August 2025. A survey was carried out using an interview guide submitted to 1, 068 heads of households in nine health zones in Lubero Territory and Butembo City. After data analysis, the findings read as follows: First, expectations regarding the UHC were positive in Lubero (M= 3.50 ± 0.85) and in Butembo (M=3.30 ± 0.82). Second, perceptions in terms of fears were considered negative in Lubero Territory (M= 2.68 ± 0.94) and in Butembo City (M= 2.74 ± 0.86). Third, the expectations of healthcare seekers differ according to place of residence (t =3.75; p=0.000), whereas fears do not (t=-1.01; p=0.310). Fourth, the expectations of healthcare seekers do not differ according to main profession (F=0.500; p=0.776), while fears do (F=5.052; p=0.000). Fifth, perceptions of UHC differ according to marital status (F=3.806; p=0.010) but not according to gender (F=-0.696; p=0.486). Sixth, there was no significant relationship between expectations of UHC and characteristics such as age, level of education, household size, and household income. Indeed, fears about UHC are influenced by educational level (r=0.117; p=0.000), household size (r=-0.125; p=0.000), and household income (r=-0.101; p=0.001).
Perceptions of Healthcare Seekers on Universal Health Coverage in Lubero Territory and Butembo City in Democratic Republic of Congo
References:
[1]. Alkodaymi, S. M., Abou Shaar, B., Ashraf Fawzy, N., Alhabbbash, R., Senjab, A., & Rawan AlSaoudm, R., 2020, Knowledge, perception, and attitudes of Universal Health Coverage policies among Alfaisal University students in Saudi Arabia. Journal of education and health promotion. https://pmc.ncbi.nlm.nih.gov/articles/PMC7871921/
[2]. USAID, 2017, Financing Universal Health Coverage and Family Planning.
[3]. AISS, 2023, Reforms in Africa to Expand Health Insurance Coverage. https://www.issa.int/fr/analysis/reforms-africa-achieve-universal-health-coverage
[4]. Awawda, S., et al., 2021, Universal Health Coverage in the Sahel: The Cases of Mali and Chad. https://hal-amu.archives-ouvertes.fr/hal-03552258/document
[5]. Boyer, A. & Nefzi, A., 2009, The Perception of Quality in the Field of Services: Toward a Clarification of Concepts. The Journal of Management Sciences, 2009/3 (237-238), pp. 43 – 54. Consulté sur file:///C:/Users/PC/Downloads/la-perception-de-la-qualite-dans-le-domaine-des-services-vers-une-clarification-des-concepts.pdf
[6]. Boidin, B., 2018, Is Universal Health Coverage Possible in Africa Without an Integrated Health Policy? French journal of Social Affairs, 2018/1, pp 85-105, ed. DREES. DOI10.3917/rfas.181.0085
[7]. Defrenne, F., & Chapoix, G., 2016, Universal Health Coverage: Definition and Origins – Maison Médicale, Santé Conjuguée no76 available to https://www.maisonmedicale.org/la-couverture-sanitaire-universelle-defi-nition-et-origine/
[8]. Govender, N., & Mahomet, O., 2020, Knowledge, attitude and perceptions of the national health insurance amongst health workers in Ugu district, Kwa-Zulu Natal, South Africa in 2017. The Open Public Health Journal, Tome 13, pp. 763-770. DOI: 10.2174/1874944502013010763
[9]. Ifeagwu, S. C., Nakaboga Kikonyogo, R., Nakkazi, S., Beinomugisha, J., Ojiambo Wandera, S., Kiwanuka, S. N., King, R., Tine Van Bortel, T. V., Brayne, C., Parkes-Ratanshi, R., 2024, Sickness has no time: Awareness and perceptions of health care workers on universal health coverage in Uganda. [La maladie n’a pas de date » : sensibilisation et perceptions des professionnels de santé sur la couverture sanitaire universelle en Ouganda]. Plos one 19(7). https://doi.org/10.1371/journal.pone.0306922
[10]. Heikel, J., 2021, Evaluation des effets de la couverture sanitaire universelle (CSU) sur l’utilisation effective des services de santé au Maroc. [Thèse de doctorat, Université Sorbonne Paris Nord]. https://theses.hal.science/tel-03357656/
[11]. Herry, S., 2020, Social Categorization of Universal Health Coverage Beneficiaries by Physiotherapists: Analysis of a Stereotype Attributed to Patients. Physiotherapy, (20) 219, pp. 3-9. https://www.sciencedirect.com/science/article/abs/pii/S1779012320300012
[12]. Ismail, S., 2016, Economic Evaluation of Health Insurance Reform in Tunisia. [Doctoral Theses. PARIS-DAUPHINE UNIVERSITY]. https://theses.hal.science/tel-01300569/
[13]. Larson, E., Mbaruku, G., Jessica, Cohen, J., & Kruk, M., 2020, Has a Quality Improvement Intervention Improved the Quality of Maternal Health Care? International Journal for Quality in Health Care, Volume 32, Issue 1, pp. 54-63. https://doi.org/10.1093/intqhc/mzaa014
[14]. Mugo, M., 2022, Health Insurance and Health Status in Kenya: Toward Universal Health Coverage. http://publication.aercafricalibrary.org/bitstream/handle/123456789/3390/HC-002.pdf?sequence=1&isAllowed=y
[15]. Nana, C., Y., 2014-2015, Assessment of Health Care Utilization Among Mandatory Health Insurance Beneficiaries at Point G University Hospital. [Doctoral Theses, University of Sciences, Techniques and Technologies of Bamako]. http://revues-ufhb-ci.org/fichiers/FICHIR_ARTICLE_2929.pdf
[16]. United States, 2022, Report of the International Universal Health Coverage Day, 12 December. entra%C3%AEnent%20pas%20de%20difficult%C3%A9s%20financi%C3%A8res.
[17]. Nkuoh, N. G., Banlack, E., Chiabi, E., & Tung, C. W., 2024, Knowlodge and perceptions of Universal Health Coverage among health professionals of the Southwest region of Cameroon. Health sciences & diseases.
[18]. OECD, 2021, Population Covered by Health Insurance », in Health at a Glance 2021: OECD Indicators, Éditions OCDE, Paris. https://doi.org/10.1787/d9136695-fr
[19]. WHO., 2015, Making Fair Choices for Universal Health Coverage. https://iris.who.int/bitstream/handle/10665/185069/9789242507157_fre.pdf
[20]. WHO, 2016, Global Strategy on Human Resources for Health: Workforce 2030. Geneva: WHO. , https://www.who.int/hrh/resources/global-strategy 2030fr.pdf
[21]. ONUSIDA, 2019, Universal Health Coverage. https://www.unaids.org/fr/topic/UHC#:~:text=Le%20but%20de%20la%20Couverture,%C3%A0%20payer%20pour%20ces%20services.
[22]. National Strategic Plan., 2020, National Strategic Plan for Universal Health Coverage 2020–2030.
[23]. Etikan, I., Musa, S. A., & Alkassim, R. S., 2016, Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4.
[24]. Lavrakas, P. J., 2008, Encyclopedia of Survey Research Methods. Sage.
[25]. DeVellis, R. F., 2017, Scale Development: Theory and Applications (4th ed.). Sage.
[26]. Boone, H. N., & Boone, D. A., 2012, Analyzing Likert data. Journal of Extension, 50(2), 1–5.
[27]. Joshi, A., Kale, S., Chandel, S., & Pal, D. K., 2015, Likert scale: Explored and explained. Current Journal of Applied Science and Technology, 7(4), 396–403.
[28]. Norman, G., 2010, Likert scales, levels of measurement and the “laws” of statistics. Advances in Health Sciences Education, 15(5), 625–632.
[29]. Mukaka, M. M., 2012, A guide to the appropriate use of the correlation coefficient in medical research. Malawi Medical Journal, 24(3), 69–71.
Viewed PDF 141 6 -
Strengthening Public Health through Prioritization of Village Resilience Components Using the Quadrant of Difficulty-Usefulness ApproachAuthor: SunartoDOI: 10.21522/TIJPH.2013.14.01.Art004
Strengthening Public Health through Prioritization of Village Resilience Components Using the Quadrant of Difficulty-Usefulness Approach
Abstract:
This study aims to evaluate the resilience of Disaster Resilient Villages (Destana) in Magetan Regency, East Java, Indonesia in facing public health crises due to disasters, and to map the priority of village resilience components using the Quadrant of Difficulty and Usefulness (QoDU) approach. This descriptive study took place over eight months in 32 villages, involving 640 respondents consisting of 20 active administrators per village. The evaluation was conducted using the PKD (Village Resilience Assessment) questionnaire which included 32 indicators and 128 questions, filled out through Focus Group Discussions (FGD), while determining the priority of components that had high benefits but were difficult to realize using the QoDU-VR (Quadrant of Difficulty-Usefulness Village Resilience Questionnaire) questionnaire. The results showed that 3 villages (9.4%) were in the primary category, 12 villages (37.5%) were in the middle category, and 17 villages (53.1%) were in the main category, with the district's resilience level at the middle level (score 80.06). The recovery preparedness component scored the lowest (69.94), followed by prevention and mitigation (70.75). Using the QoDU approach, the prevention and mitigation components were prioritized due to their high utility but difficulty in implementation, followed by the post-disaster recovery component. The study also found that disaster-resilient villages in the primary category were not yet fully capable of implementing prevention and mitigation measures, and that the majority of villages did not yet have a post-crisis recovery plan document. The QoDU approach helps establish strategic priorities in building public health resilience. These findings form the basis for strengthening public health through participatory studies based on component and sub-component prioritization strategies in further research.
Strengthening Public Health through Prioritization of Village Resilience Components Using the Quadrant of Difficulty-Usefulness Approach
References:
[2]. Sunarto, 2025, Kuesioner Kesulitan-Kegunaan Mewujudkan Ketangguhan Desa (QoDU-VR Questionnaire), 1-12.
[3]. Nugroho, H. S. W., Sunarto, Suparji, Prasetyo, A., Koesmantoro, H., 2024, Risalah Kebijakan (Policy Brief):Harmonisasi dan Akselerasi Destana (HaDe) Sebagai Pendekatan Pengembangan Desa Tangguh Bencana di Kabupaten Magetan, Magetan, 1–4.
[4]. Sanggelorang, Y., Sebayang, F. A. A., Malonda, N. S. H., Rumayar, A. A., 2024, Insights Into Childhood Malnutririon: An Analysis on Food Vulnerability and Stunting Using 2021 Indonesia Nutritional Status Survey Data, Natl. Nutr. J., 19(3), 282–290.
[5]. Adom, P. K., 2024, Heliyon The socioeconomic impact of climate change in developing countries over the next decades : A literature survey, Heliyon, 10(5), e35134, doi: 10.1016/j.heliyon.2024.e35134.
[6]. Handayani, E., Garad, A., Suyadi, A., Tubastuvi, N., 2023, Increasing the performance of village services with good governance and participation, World Dev. Sustain., 3(6), 100089, doi: 10.1016/j.wds.2023.100089.
[7]. Haksama, S., et al., 2025, Health Disaster Capacity and Preparedness in the Case of Tsunami and Earthquake Disaster, Texila Int. J. Public Heal., 13(1), 1-8, doi: 10.21522/TIJPH.2013.13.01.Art091.
[8]. Purwanto, S., et al., 2021. Panduan: penilaian ketangguhan desa/kelurahan. Jakarta: Direktorat Kesiapsiagaan, Kedeputian Bidang Pencegahan, Badan nasional Penanggulangan Bencana, 1-50.
[9]. Ayuningtyas, D., Windiarti, S., Sapoan Hadi, M., Fasrini, U. U., Barinda, S., 2021, Disaster Preparedness and Mitigation in Indonesia: A Narrative Review, Iran. J. Public Health, 50(8), 1536–1546, doi: 10.18502/ijph.v50i8.6799.
[10]. Karnaji, K., Susanti,E., Ariadi, S., Saud, M., 2024, Social impacts and post-disaster management in disaster-prone areas of East Java, Indonesia, Jamba-Journal Disaster Risk Stud., 16(1), a1747, 1-9.
[11]. Arifin, S., Wicaksono, S. S., Sumarto, S., Martitah, M., Sulistianingsih, D., 2021, Disaster resilient village-based approach to disaster risk reduction policy in Indonesia: A regulatory analysis, Jamba J. Disaster Risk Stud., 13(1), 1–9, doi: 10.4102/JAMBA.V13I1.1021.
[12]. Bishai, D., Saleh, B. M., Huda, M., Aly, E. M., Hafiz, M., Ardalan, A., 2024, Practical strategies to achieve resilient health systems : results from a scoping review, BMC Health Serv. Res., 24(297), 1–11, doi: https://doi.org/10.1186/s12913-024-10650-8.
[13]. Sunarto, Nugroho, H. S. W., Suparji, Santosa, B. J., 2024, Quadrant of difficulty and usefulness for prioritizing community-based disaster preparedness parameter elements, Rawal Med. J., 49(1), 172–175, doi: 10.5455/rmj.20230918043333.
[14]. Nugroho, H. S. W., et al., 2020, Quadrant of difficulty-usefulness (QODU) as new method in preparing for improvement of e-learning in health college, Risk Manag. Healthc. Policy, 13, 1625–1632, 2020, doi: 10.2147/RMHP.S268814.
[15]. Nkombi, Z., Wentink, G. J., 2022, The role of public participation in disaster risk reduction initiatives: The case of Katlehong township, Jamba J. Disaster Risk Stud., 14(1), 1–12, doi: 10.4102/jamba.v14i1.1203.
[16]. Lin, B., Lee, C., 2025, Enhancing community-based earthquake disaster management : resident preferences and adaptive, Geomatics, Nat. Hazards Risk, 16(1), 1–25, doi: 10.1080/19475705.2025.2450290.
[17]. Sunarto et al., 2025, Strengthening Disaster-Resilient Villages Through Participatory Approaches: Policy Recommendations for Village Governments, Heal. Dyn., 2(4), 166–171, 2025, doi: 10.33846/hd20405.
[18]. Sunarto, Nugroho, H. S. W., Suparji, Rahayu, T. P., Handayani, T. E., Haksama, S., 2024, Participatory Action Research to Realize Disaster Health Crisis Preparedness in the Community, Texila Int. J. Public Heal., 12(4), doi: 10.21522/TIJPH.2013.12.04.Art087.
[19]. Hati, B., 2025, Polymorphic grassroots networks and implications for disaster resilience in popular settlements in Sierra Leone, India and Kenya, Environ. Urban., 37(1), 159–182, doi: 10.1177/09562478251318230.
[20]. Sunarto, Nugroho, H. S. W., Suparji, Hanifah, A. N., Prasetyo, A., 2025, ntegration of Participatory Action Research Approaches in Realizing Disaster Preparedness, Disaster Adv., 18(4), 55–63, 2025, doi: 10.25303/184da055063.
[21]. Fortnam, M., Hailey, P., Witter, S., Balfour, N., 2023, Resilience in interconnected community and formal health (and connected) systems, SSM - Heal. Syst., 3(11), 100027, doi: 10.1016/j.ssmhs.2024.100027.
[22]. Van Assen, M. F., 2021, Training, employe involvement and continuous improvement-the moderating effect of a common improvement method, Prod. Plan. Control, 32(2), 132–144, doi: 10.1080/09537287.2020.1716405.
[23]. Srivastava, P., 2023, Evaluating the Role of Training Programs in Enhancing Employee Skills and Retention, J. Bus. Manag., 25(8), 66–71, doi: 10.9790/487X-2508016671.
[24]. Nugroho, H. S. W., Suparji, Sunarto, 2019, Quadrant of Difficulty-Usefulness (QoDU): Metode baru untuk Menyusun Prioritas Perbaikan Elemen Sistem Informasi Kesehatan, Bangli Bali: Aliansi Aktivis Kesehatan/Alliance of Health Activists (AloHA), 1-67.
Viewed PDF 122 11 -
Malaria Epidemiology and Control among Under-Five Children in Northeastern NigeriaAuthor: Mohammed Bala AminuDOI: 10.21522/TIJPH.2013.14.01.Art005
Malaria Epidemiology and Control among Under-Five Children in Northeastern Nigeria
Abstract:
In Nigeria, malaria continues to be a leading cause of morbidity and mortality among children under five, with disproportionate effects in areas affected by violence. The findings and discussion of a doctoral thesis conducted in the Jere Local Government Area (LGA), Borno State, are presented in this study as a publication-ready synthesis. Multistage cluster sampling was used to gather data from 235 families with children under 5 through a community-based cross-sectional study. Sociodemographic traits, malaria episodes, preventive measures, treatment-seeking behavior, and surveillance performance were all evaluated using structured questionnaires that were modified from WHO and DHS assessments. To assess community outreach and reporting completeness, facility-based surveillance records were examined. SPSS version 26 was used to perform logistic regression analysis, chi-square tests, and descriptive statistics. Over 95% of households reported at least one malaria episode in the six months prior, indicating a persistently high malaria burden. Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) were reported to have high preventive coverage; however, symptom-based evaluation was a major component of diagnostic confirmation. Despite widespread community awareness of government and non-governmental organization efforts, surveillance outreach and home visits by medical professionals were scarce. There was no statistically significant correlation found between the incidence of malaria and the age of caregivers. The results show a dichotomy between persistent hyperendemic transmission and high knowledge and reported preventative coverage. Achieving significant reductions in the malaria burden among children under five in conflict-affected areas requires bolstering community-based case detection, expanding surveillance reach, and strengthening diagnostic confirmation.
Malaria Epidemiology and Control among Under-Five Children in Northeastern Nigeria
References:
[1]. World Health Organization, 2024, World malaria report 2024. WHO.
[2]. World Health Organization, 2023, World malaria report 2023. WHO.
[3]. National Malaria Elimination Programme (NMEP) [Nigeria], National Population Commission (NPC) [Nigeria], & ICF, 2022, Nigeria malaria indicator survey 2021. NMEP, NPC, and ICF.
[4]. Snow, R. W., Sartorius, B., Kyalo, D., Maina, J., Amratia, P., Mundia, C. W., Bejon, P., Noor, A. M., & Rogers, D. J., 2017, The prevalence of Plasmodium falciparum in sub-Saharan Africa since 1900. Nature, 550(7676), 515–519.
[5]. Oresanya, O. B., Hoshen, M., & Sofola, O. T., 2018, Utilization of insecticide-treated nets by under-five children in Nigeria: Assessing progress towards malaria control. Malaria Journal, 17(1), 1–9.
[6]. United Nations Children’s Fund, 2021, Malaria and child health in humanitarian settings. UNICEF.
[7]. Bousema, T., Okell, L., Felger, I., & Drakeley, C., 2019, Asymptomatic malaria infections: Detectability, transmissibility and public health relevance. PLoS Medicine, 16(8), e1002922.
[8]. Ambe, J. P., Balogun, S. T., Waziri, N. E., Dalhat, M. M., Nglass, I. N., & Umar, A. S., 2020, Malaria burden among internally displaced children in Borno State, Nigeria. Malaria Journal, 19(1), 1–10.
[9]. Inuwa, M. S., Yakubu, A., & Musa, A., 2021, Determinants of malaria infection among under-five children in Maiduguri, northeastern Nigeria. BMC Public Health, 21, 112.
[10]. Aregawi, M., Lynch, M., Bekele, W., Kebede, H., Jima, D., Taffesse, H. S., & Woldeyes, D., 2017, Time series analysis of trends in malaria cases and deaths in Ethiopia. The Lancet Global Health, 5(1), e67–e75.
[11]. Bhatt, S., Weiss, D. J., Cameron, E., Bisanzio, D., Mappin, B., Dalrymple, U., Battle, K. E., Moyes, C. L., Henry, A., Eckhoff, P. A., Wenger, E. A., Briet, O., Penny, M. A., Smith, T. A., Bennett, A., Yukich, J., Eisele, T. P., Griffin, J. T., Fergus, C. A., & Gething, P. W., 2015, The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature, 526(7572), 207–211.
[12]. Okell, L. C., Ghani, A. C., Lyons, E., & Drakeley, C. J., 2016, Submicroscopic infection in Plasmodium falciparum–endemic populations: A systematic review and meta-analysis. The Journal of Infectious Diseases, 200(10), 1509–1517.
[13]. Tusting, L. S., Willey, B., Lucas, H., Thompson, J., Kafy, H. T., Smith, R., & Lindsay, S. W., 2019, Socioeconomic development as an intervention against malaria: A systematic review and meta-analysis. PLoS Medicine, 16(3), e1002820.
[14]. Worrall, E., Basu, S., & Hanson, K., 2018, Is malaria a disease of poverty? A review of the literature. Tropical Medicine & International Health, 10(10), 1047–1059.
[15]. Adebayo, A. M., Akinyemi, O. O., & Cadmus, E. O., 2020, Household costs of malaria treatment in Nigeria. African Health Sciences, 20(1), 230–239.
[16]. Yusuf, O. B., Adeoye, B. W., Oladepo, O., Peters, D. H., & Bishai, D., 2019, Poverty and fever vulnerability in Nigeria. Malaria Journal, 18, 45. https://doi.org/10.1186/s12936-019-2673-1.
[17]. Gething, P. W., Elyazar, I. R. F., Moyes, C. L., Smith, D. L., Battle, K. E., Guerra, C. A., Patil, A. P., Tatem, A. J., Howes, R. E., Myers, M. F., George, D. B., Horby, P., Wertheim, H. F. L., Price, R. N., Mueller, I., Baird, J. K., & Hay, S. I., 2012, A long-neglected world malaria map. Nature, 465(7296), 342–345.
[18]. World Health Organization, 2015, Guidelines for the treatment of malaria, 3rd ed. World Health Organization.
[19]. Korenromp, E. L., Hosseini, M., Newman, R. D., & Cibulskis, R. E., 2020, Progress towards malaria elimination in Africa. Malaria Journal, 19, 1–12.
[20]. Afolayan, D. O., Oloyede, O. O., & Afolabi, B. M., 2022, Insecticide resistance in malaria vectors in Nigeria: Implications for vector control. Parasites & Vectors, 15, 98.
[21]. Yeka, A., Gasasira, A., Mpimbaza, A., Achan, J., Nankabirwa, J., Nsobya, S., Staedke, S. G., & Kamya, M. R., 2012, Malaria in Uganda: Challenges to control on the long road to elimination. Malaria Journal, 11, 181.
[22]. Okorie, P. N., McKenzie, F. E., Ademowo, O. G., & Bockarie, M., 2021, Nigeria’s malaria surveillance system: Performance, challenges, and prospects. Global Health Action, 14(1), 188–195.
[23]. Nankabirwa, J., Brooker, S. J., Clarke, S. E., Fernando, D., Gitonga, C. W., Schellenberg, D., Greenwood, B., & Brooker, S., 2020, Malaria surveillance and response systems in sub-Saharan Africa. BMC Medicine, 18, 1–12.
[24]. Wangdi, K., Gatton, M. L., Kelly, G. C., & Clements, A. C. A., 2018, Malaria elimination in fragile states: Evidence and challenges. Malaria Journal, 17, 256.
[25]. Tanner, M., Greenwood, B., Whitty, C. J. M., Ansah, E. K., Price, R. N., Dondorp, A. M., von Seidlein, L., Baird, J. K., Beeson, J. G., Fowkes, F. J. I., Hemingway, J., Marsh, K., Osier, F., & Schellenberg, D., 2015, Malaria eradication and elimination: Views on how to translate a vision into reality. Science, 350(6264), 389–390.
[26]. Roca-Feltrer, A., Lalloo, D. G., Phiri, K., Terlouw, D. J., & Clarke, S. E., 2018, Household ownership and use of insecticide-treated nets in sub-Saharan Africa. PLoS ONE, 13(1), e0191113.
[27]. Pulford, J., Hetzel, M. W., Bryant, M., Siba, P. M., & Mueller, I., 2011, Reported reasons for not using mosquito nets in malaria-endemic areas. Social Science & Medicine, 72(7), 1035–1042.
[28]. Hemingway, J., Ranson, H., Magill, A., Kolaczinski, J., Fornadel, C., Gimnig, J., Coetzee, M., Simard, F., Roch, D. K., Hinzoumbe, C. K., Pickett, J., & Schellenberg, D., 2016, Averting a malaria disaster: Will insecticide resistance derail malaria control? The Lancet, 387(10029), 1785–1788.
Viewed PDF 146 9 -
Associations between Wildfire Smoke Exposure and Chronic Cardiovascular and Respiratory Conditions in Selected Provinces in Canada: A Retrospective Ecological StudyAuthor: Chukwubuikem Cornelius OkaforDOI: 10.21522/TIJPH.2013.14.01.Art006
Associations between Wildfire Smoke Exposure and Chronic Cardiovascular and Respiratory Conditions in Selected Provinces in Canada: A Retrospective Ecological Study
Abstract:
Wildfire smoke (PM2.5) has been recognized as an environmental risk factor with severe adverse health outcomes. Exposure to PM 2.5 can lead to severe cardiovascular and respiratory health conditions. The study aims to assess and examine the ecological associations between wildfire smoke exposure and the burden of chronic cardiovascular and respiratory conditions in Canada from 2010 to 2023, by integrating health outcome data with wildfire activity and air quality indicators across provinces. The study used a retrospective study design to collect secondary data from the Canadian Chronic Disease Surveillance System (CCDSS) for health outcomes (acute myocardial infarction, asthma, chronic obstructive pulmonary disease (COPD), heart failure, stroke) across the selected provinces, from the Canadian Wildland Fire Information System (CWFIS), for wildfire perimeters and their causes, and from the National Air Pollution Surveillance Program (NAPS), for air quality using PM 2.5 concentration as a proxy for air pollution exposure. The correlation between average PM₂.₅ concentrations and incidence rates was weakly negative (r = –0.106, p = 0.238), and the wide confidence interval (95% CI: –0.6357 to 0.1593). Similarly, the correlation between high-risk air quality days (HRD) and incidence rates was also weak and negative (r = –0.042, p = 0.643), again failing to reach statistical significance. The findings indicate that wildfire smoke exposure, though an important environmental health concern, was not a statistically significant predictor of chronic cardiovascular and respiratory disease incidence across the studied provinces. This does not negate the potential health risks of wildfire smoke.
Associations between Wildfire Smoke Exposure and Chronic Cardiovascular and Respiratory Conditions in Selected Provinces in Canada: A Retrospective Ecological Study
References:
[1]. Franchini, M., & Mannucci, P. M., 2012, Air pollution and cardiovascular disease. Thrombosis Research. 129(3), 230–234. https://doi.org/10.1016/j.thromres.2011.10.030.
[2]. Canadian Interagency Forest Fire Centre. 2024, Annual report 2024. https://ciffc.ca.
[3]. Delaney, E. J., 2023, The chemistry of fires at the wildland–urban interface. CHOICE: Current Reviews for Academic Libraries, 60(10), 1014–1015.
[4]. United States Environmental Protection Agency, 2024, Particulate matter (PM) basics. https://www.epa.gov/pm-pollution.
[5]. Seinfeld, J. H., & Pandis, S. N., 1998, Atmospheric chemistry and physics: From air pollution to climate change (2nd ed.). John Wiley & Sons.
[6]. Liu, J. C., Pereira, G., Uhl, S. A., Bravo, M. A., & Bell, M. L., 2015, A systematic review of the physical health impacts from non-occupational exposure to wildfire smoke. Environmental Research, 136, 120–132. https://doi.org/10.1016/j.envres.2014.10.015.
[7]. Brook, R. D., Rajagopalan, S., Pope, C. A., Brook, J. R., Bhatnagar, A., Diez-Roux, A. V., et al., 2010, Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association. Circulation, 121(21), 2331–2378. https://doi.org/10.1161/CIR.0b013e3181dbece.
[8]. Jones, C. G., Rappold, A. G., Vargo, J., Cascio, W. E., Kharrazi, M., McNally, B., et al., 2020, Out-of-hospital cardiac arrests and wildfire-related particulate matter during 2015–2017 California wildfires. Journal of the American Heart Association, 9(8), e014125. https://doi.org/10.1161/JAHA.119.014125
[9]. Jain, P., Barber, Q. E., Taylor, S. W., Whitman, E., Castellanos Acuna, D., Boulanger, Y., et al., 2024, Drivers and impacts of the record-breaking 2023 wildfire season in Canada. Nature Communications, 15, 6764. https://doi.org/10.1038/s41467-024-51154-7
[10]. Reid, P. T., & Innes, J. A., 2014, Respiratory diseases. In B. R. Walker, N. R. Colledge, S. H. Ralston, & I. Penman (Eds.), Davidson’s principles and practice of medicine (22nd ed., pp. 661–730). Elsevier.
[11]. Canadian Wildland Fire Information System. (n.d.). Data Mart. https://cwfis.cfs.nrcan.gc.ca/datamart
[12]. [Canadian Wildland Fire Information System. (n.d.). NBAC Downloads. https://cwfis.cfs.nrcan.gc.ca/downloads/nbac/
[13]. Environment and Climate Change Canada. (n.d.). Air quality indicators. https://www.canada.ca/en/environment-climate-change/services/environmental-indicators/air-quality.html
[14]. Public Health Agency of Canada. (n.d.). Chronic Disease and Surveillance System (CCDSS) data tool. https://health-infobase.canada.ca/ccdss/data-tool/
[15]. Black, C., Gerriets, J. E., Fontaine, J. H., Harper, R. W., Kenyon, N. J., Tablin, F., et al., 2017, Early life wildfire smoke exposure is associated with immune dysregulation and lung function decrements in adolescence. American Journal of Respiratory Cell and Molecular Biology, 56(5), 657–666. https://doi.org/10.1165/rcmb.2016-0380OC.
[16]. Haydon, E., Roerecke, M., Giesbrecht, N., Rehm, J., & Kobus-Matthews, M., 2006, Chronic disease in Ontario and Canada: Determinants, risk factors and prevention priorities. Ontario Chronic Disease Prevention Alliance.
[17]. Dai, H., Younis, A., Kong, J. D., Bragazzi, N. L., and Wu, J., 2021, Wildfire smoke exposure and health outcomes: A review. Environmental Research, 198, 111239. https://doi.org/10.1016/j.envres.2021.111239
[18]. Yu, M., Zhang, S., Ning, H., Li, Z., & Zhang, K., 2024, Assessing the 2023 Canadian wildfire smoke impact in the Northeastern US: Air quality, exposure, and environmental justice. Science of the Total Environment, 926, 171853. https://doi.org/10.1016/j.scitotenv.2024.171853
[19]. Campos-Ruiz, R., Parisien, M. A., & Flannigan, M. D., 2018, Temporal patterns of wildfire activity in areas of contrasting human influence in the Canadian boreal forest. Forests, 9(4), 159. https://doi.org/10.3390/f9040159
[20]. Renouf, R., 2021, Vancouver’s air quality worst of any ‘major city’ in the world due to wildfire smoke, heat. CityNews. https://vancouver.citynews.ca/2021/08/13/vancouver-air-quality-wqorst-wildifres/
[21]. Henderson, S. B., Brauer, M., & Vedanthan, R., 2022, Wildfire smoke as a global health issue. The Lancet Planetary Health, 6(4), e302–e313. https://doi.org/10.1016/S2542-5196(22)00044-0.
Viewed PDF 122 4 -
From Ward to Policy: Nurses’ Views on Breastmilk Donation and Banking in Selected Hospitals in Bono Region, GhanaAuthor: Bennin Juabie DouriDOI: 10.21522/TIJPH.2013.14.01.Art007
From Ward to Policy: Nurses’ Views on Breastmilk Donation and Banking in Selected Hospitals in Bono Region, Ghana
Abstract:
Breast milk donation and banking provide lifesaving nutrition for preterm and vulnerable infants. However, the success of such programs depends largely on the knowledge, perceptions, and acceptability among frontline health professionals. This study assessed nurses’ views on breast milk donation and banking in Bono regional hospitals, Ghana. A cross-sectional descriptive study was conducted among nurses across three selected referral hospitals in the Bono region of Ghana. Data were collected using structured questionnaires covering knowledge, perceptions, and acceptability of breast milk donation and banking. Four hundred and twenty-two (422) nurses were randomly selected for data collection. Descriptive and inferential statistics were used to analyze responses, with associations tested between socio-demographic factors and acceptability. Nurses demonstrated moderate knowledge of breast milk donation, with notable gaps in conceptual understanding and safety protocols. Perception toward breastmilk donation and banking were neutral, with recognition of donor milk’s role in improving neonatal survival, though concerns about affordability and disease transmission persisted. Acceptability was high, with many nurses expressing willingness to donate or encourage donation. Age, workplace, and religion significantly influenced acceptance levels. The study concludes that while nurses in Bono regional hospitals show readiness to support breast milk donation and banking, targeted education, cultural and religious engagement, clear safety and financing frameworks are needed to address existing concerns.
From Ward to Policy: Nurses’ Views on Breastmilk Donation and Banking in Selected Hospitals in Bono Region, Ghana
References:
[1]. Adjei, B., Adu-Kofi, I. M., Alpan, C., Ababio, N., Dsaue, N. A., 2025, Acceptance and perception of human milk banking: A review. International Journal of Multidisciplinary Research, 7(2), 1-10.
[2]. Iloh, K. K., Osuorah, C. D. I., Ndu, I. K., Asinobi, I. N., Obumneme-Anyim, I. N., Ezeudu, C. E., et al., 2018, Perception of donor breast milk and determinants of its acceptability among mothers in a developing community: A cross-sectional multi-center study in south-east Nigeria. International Breastfeeding Journal, 13(1), 1-13.
[3]. Mampane, T., Wolvaardt, J. E., 2024, The acceptability of a donor human milk bank and donated human milk among mothers in Limpopo Province, South Africa. Maternal and Child Nutrition, 20(3).
[4]. Appiah, P. K., Amu, H., Osei, E., Konlan, K. D., Mumuni, I. H., Verner, O. N., et al., 2021, Breastfeeding and weaning practices among mothers in Ghana: A population-based cross-sectional study. PLoS ONE, 16(11), 1-19. Available at: https://doi.org/10.1371/journal.pone.0259442
[5]. Namuddu, M. G., Kiguli, J., Nakibuuka, V., Nantale, R., Mukunya, D., 2023, Acceptability of donated breast milk among pregnant women in selected hospitals in central Uganda: A cross-sectional study. International Breastfeeding Journal, 18(1), 1-11.
[6]. Zamahlubi, H. T., Naidoo, K. L., Khan, F., Masekela, R., 2024, Knowledge, attitudes and awareness regarding donor breast milk: A cross-sectional study of mothers in a high HIV-prevalent area. South African Journal of Clinical Nutrition, 37(1), 1-8. Available at: https://doi.org/10.1080/16070658.2023.2189347
[7]. National Institute for Health and Care Excellence (NICE), 2021, Quick reference guide: Donor breast milk banks-The operation of donor breast milk bank services. NICE Clinical Guideline, February 1-15.
[8]. Pinto, M., Moehlecke Iser, B., Molon Fernandes, T., Oliveira Schuelter, P., Ferreira D’Agostini, M., 2020, Contributing and limiting factors for human milk donation. Journal of Health Sciences, 22(2), 177-182.
[9]. Chagwena, D. T., Mugariri, F., Sithole, B., Mataga, S. F., Danda, R., Matsungo, T. M., et al., 2020, Acceptability of donor breastmilk banking among health workers: A cross-sectional survey in Zimbabwean urban settings. International Breastfeeding Journal, 15(1), 1-11.
[10]. Ramli, N., Ibrahim, N. R., Hans, V. R., 2021, Human milk banks-The benefits and issues in an Islamic setting. East Journal of Medicine, 15(4), 163-167.
[11]. Tende, F. K., Nwameme, A. U., Tabong, P. T. N., 2023, Acceptability of breast milk donor banking: A qualitative study among health workers in Greater Accra Regional Hospital, Ghana. PLOS Global Public Health, 3(8), 1-17. Available at: https://doi.org/10.1371/journal.pgph.0001870
[12]. Obeng, C., Jackson, F., Amissah-Essel, S., Siah-Asamoah, C., Perry, C. A., Gonzalez Casanova, L., et al., 2023, Women’s perspectives on human milk banking in Ghana: Results from a cross-sectional study. Frontiers in Public Health, 11. Available at: https://doi.org/10.3389/fpubh.2023.xxxxxx
[13]. Mpayo, L. L., Msuya, M. A., Moshiro, R., Cosmas, I. L., Kimaryo, Y., 2024, Awareness and acceptability of donor human milk banking among women in Dar es Salaam, Tanzania: A cross-sectional study. Journal of African Neonatal, 4, 77-83.
[14]. UNICEF, 2010, Implementation guidance: Making EHS an integral part of process design. UNICEF Publication, 135-149.
[15]. Dalinjong, P. A., Wang, A. Y., Homer, C. S. E., 2018, The implementation of the free maternal health policy in rural Northern Ghana: Synthesised results and lessons learnt. BMC Research Notes, 11, Article 276.
[16]. Nanjundeswaraswamy, T. S., Divakar, S., 2021, Determination of sample size and sampling methods in applied research. Proceedings in Engineering Sciences, 3(1), 25-32.
[17]. Abdul Hamid, S. B., Haris, S. N., Hui, J. C., 2022, Breastfeeding knowledge, attitude and practices and its association with food insecurity during COVID-19. Environment and Public Health Journal, 7(21), 153-164. Available at: https://doi.org/10.21834/ebpj.v7i21.3686
[18]. Masi, A. C., Stewart, C. J., 2024, Role of breastfeeding in disease prevention. Microbial Biotechnology, 17(7), 1-10.
[19]. World Health Organization (WHO), 2003, Global strategy for infant and young child feeding. Fifty-Fourth World Health Assembly Document, 1-8.
[20]. Ogundare, E. O., Dedeke, I. O. F., Babatola, A. O., Adeniyi, A. T., Ajite, A. B., Lawal, O. A., et al., 2023, Human milk banking acceptability among pregnant and nursing mothers in Southwest Nigeria. Journal of Public Health Research, 12(3).
Viewed PDF 612 34 -
Knowledge and Utilization of Health Insurance following the Rollout of the State Contributory Health and Basic Healthcare Provision Fund in Kaduna State, NigeriaAuthor: Muazu HabibuDOI: 10.21522/TIJPH.2013.14.01.Art008
Knowledge and Utilization of Health Insurance following the Rollout of the State Contributory Health and Basic Healthcare Provision Fund in Kaduna State, Nigeria
Abstract:
The availability of information to the public plays a fundamental role in creating awareness, building trust and improving utilization of health insurance schemes. Knowledge of health insurance is often limited, and results in low utilization rates of services among vulnerable groups or those in informal sectors. This study examines the knowledge and utilization of health insurance schemes in Kaduna State, using z-test of difference of two proportions at 5% level of significance for 1944 respondents. Statistical analysis (chi-square tests and Z-test of proportions) using Stata 16.0 revealed that 86.1% of respondents have heard of the general term ‘Health Insurance”. Knowledge declined significantly for specific schemes (KADCHMA: 67.0% and BHCPF: 59.2%). The State Contributory Health Scheme (KADCHMA) shows the highest mean utilization of services at 1,167.08 enrollees, National Health Insurance at 458.23 enrollees, private health insurance at 219.90 enrollees, BHCPF 179.61 at enrollees and Tertiary institutions Social Insurance scheme at 0.33. Despite the successes recorded, less than half of the population (49.6%) understands the operationality of the schemes, 29.3% only heard of the schemes with no understanding of their functionality, and 9.8% only heard of the schemes indicating low knowledge. The average percentage of the catchment population covered under all the schemes is extremely low, averaging 15.97% per facility. Addressing these issues requires multi-stakeholders’ engagement to create awareness and mobilize citizens to understand and enrolled into the health insurance schemes.
Knowledge and Utilization of Health Insurance following the Rollout of the State Contributory Health and Basic Healthcare Provision Fund in Kaduna State, Nigeria
References:
[1]. Lawan, U. M., Iliyasu, Z., Daso, A. M., 2012, Challenges to the scale-up of the Nigerian National Health Insurance Scheme: Public knowledge and opinions in urban Kano, Nigeria. Ann Trop Med Public Health. Available from: http://www.atmph.org/text.asp?2012/5/1/34/92878. Accessed on 12/10/2025.
[2]. Abiba, L., Janine, H., and Jeroen, S., 2012, Effects of Knowledge, Acceptance and use of Contraceptives on Household Wealth in 26 African Countries. Available at: http://www.ru.nl/nice/workingpapers. Accessed 22/10/2025.
[3]. Mimmie, C. N., Pranee, L., and Mary, C., 2013, Contraception Knowledge and Attitudes: Truths and Myths among African Australian Teenage Mothers in Greater Melbourne, Australia. Available at: University of Roehampton Online Library. Accessed 12/10/2025.
[4]. Elegbede, O. E., Kabir, A., Durowade, T., Adedayo, S., Tope, M., Ipinnimo, A., Kamal, A., 2022, Knowledge of Community Based Health Insurance and Associated Factors among Artisans in a Selected Community of Ekiti State. Nigerian Journal of Medicine 31(5):p509-514, Sep–Oct 2022. | DOI: 10.4103/NJM.NJM_47_22.
[5]. United Health Care, Understanding health Insurance. Available from: https://www.uhc.com/individual-andfamily/understanding-health-insurance. Last accessed on 3/10/2025.
[6]. Muofhe, T., Makwakwa, N., Pagollang, D., 2023, Knowledge and perception of oral health professionals regarding the National Health Insurance. SADJ October 2023, Vol. 78 No.9 p432-436. Available at: https://www.researchgate.net/publication/376805382_Knowledge_and_perception_of_oral_health_professionals_regarding_the_National_Health_Insurance.
[7]. Ogundeji, Y. K., Akomolafe, B., Ohiri, K., Butawa, N. N., 2019, Factors influencing willingness and ability to pay for social health insurance in Nigeria. PLoS One. 2019;14(8): e0220558. doi: 10.1371/journal.pone.0220558.
[8]. Elegbede, O. E., Durowade, K. A., Sanni, T. A., Ipinnimo, T. M., Alabi, A. K., 2022, Assessment of Willingness to pay for Community-Based Health Insurance among Artisans in a selected Community of Ekiti State, Southwest Nigeria. DOI: https://doi.org/10.61386/imj.v15i2.253.
[9]. Danielle, L., Baron, O., Mensah, K., Cheryl, L., Lettenmaier, S., Krenn, C., Michelle, E., Bashin, M., Jato, C., Church, A., Young, Mi Kim., and Philippe, F. L., 1993, Qualitative Research for Family Planning Programs in Africa. ‘Centre for Communication Programs, Johns Hopkins School of Public Health, Occasional Paper Series, No. 2, Baltimore, Maryland.
[10]. Howell, B., and Kerry, E., 2012, An Introduction to the Philosophy of Methodology. SAGE. ISBN 978-1-4462-9062-0.
[11]. Onwujekwe, O., Onoka, C., Uguru, N., Tasie, N., Uzochukwu, B., Kirigia, J., et al., Socioeconomic and geographic differences in acceptability of community-based health insurance. Public health. 2011;125(11):1;06-808. https//doi.org/10.1016/j.puhe.2011.09.006
[12]. Harvey, R. B., 2011, Research Methods in Anthropology: Qualitative and Quantitative Approaches.
[13]. Trueman, C. N., 2015, Structured Questionnaires. Available at: historylearningsite.co.uk. The History Learning Site. Accessed 18/10/2025.
[14]. Chris, O. l., Diane, M., George, M. S., 2004, Cross-Sectional Study Design and Data Analysis. Available at: http://www.collegeboard.com/prod_downloads/yes/4297_MODULE_05.pdf. Accessed 26/10/2025.
[15]. Abiiro, G. A., McIntyre, D., 2012, Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector. BMC Int Health Hum Rights 2012; 12:25.
[16]. Wagstaff, A., van Doorsaler, E., 2000, Equity in healthcare financing and delivery. In: Culyer, AJ, Newhouse JP, editors. Handbook of Health Economics. 1st ed., Vol. B. Ch. 34. North Holland: Elsevier; 2000. p. 1803-62.
[17]. Bawa, S. K., Ruchita, M., 2011, Awareness and Willingness to Pay for Health Insurance: An Empirical Study with Reference to Punjab India. International Journal of Humanities and Social Science. 2011;1(7): l00-108.
[18]. Carrin, G., 2003, Community based health insurance scheme in developing countries: Facts, problems and perspectives. Discussion paper No 1. Geneva: World Health Organisation, Department of Health System Financing, Expenditure and Resource Allocation (FER); 2003.
[19]. World Health Organization, 2010, The World Health Report - Health Systems Financing: The Path to Universal Coverage 2010, Geneva: The World Health Organization; 2010. Available from: http://www.who.int/whr/2010/en/index.html. (Accessed 15th October 2025).
[20]. Aregbeshola, B, S., Khan, S, M., 2010, Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria, Int J Health Policy Manag. 2018;7(9):798-806. doi:10.15171/ijhpm.2018.19
[21]. Andrew, G., Charles, C., Tolib, M., 2012, Management and Planning for Global Health in Merson, M. H., R. E. Black, & A. J. Mills, (eds) Global Health: Diseases, Programs, Systems, and Policies, Burlington, MA: Jones & Bartlett Learning.
[22]. Uzochukwu, B., Ughasoro, M. D., Etiaba, E., Okwuosa, C., Envuladu, E., Onwujekwe, O. E., 2015, Health care financing in Nigeria: implications for achieving universal health. Nigerian Journal of Clinical Practice. 18:437-444.
[23]. Garba, M. B., Ejembi, C. L., 2015, The role of National Health Insurance Scheme on structural development of health facilities in Zaria, Kaduna State, Northwestern Nigeria. Annals of Nigerian Medicine. 9(1):9–14. doi: 10.4103/0331-3131.163327.
Viewed PDF 127 8 -
Vision Assessment of Drivers of Passenger Service Vehicles Operating across Bushenyi-Ishaka MunicipalityAuthor: Okaali Simon DanielDOI: 10.21522/TIJPH.2013.14.01.Art009
Vision Assessment of Drivers of Passenger Service Vehicles Operating across Bushenyi-Ishaka Municipality
Abstract:
The main purpose of the study is to establish the vision of the drivers of Passenger Service Vehicles operating across Bushenyi – Ishaka municipality in Uganda. A cross-sectional descriptive study with both quantitative and qualitative techniques was used. Semi structured questionnaires were administered to 392 participants and the data was analysed at three (3) different levels; Univariate, to find out the proportion of respondents with reduced vision for driving, Bivariate, to assess the effect of individual factors on accident involvement & Multivariate, to assess for the effect of the potential confounding variables. Participants underwent eye examinations comprising visual acuity, colour vision test using Ishihara Pseudo-Isochromatic plates, confrontational visual fields, external and internal Ocular eye health examinations. 87% of the drivers of Passenger Service Vehicles met the visual requirement for driving (visual acuity greater than 6/9 in both eyes) while 13% had inadequate vision for driving (visual acuity less than 6/9 in both eyes). The commonest cause of reduced vision was refractive error (71%) and the factors associated with it according to the respondents were the family history of blindness, old age and accidents (trauma). Poor visual acuity was significantly associated with road traffic accidents (P-0.004). This study implies that the number of operators of passenger service vehicles in Bushenyi District with visual acuity less than 6/9 for driving is high and the level of awareness and utilization of eye care services by the drivers of Passenger Service Vehicles in Bushenyi is low.
Vision Assessment of Drivers of Passenger Service Vehicles Operating across Bushenyi-Ishaka Municipality
References:
[1]. Bushenyi District Records Department, 2012, Annual Report (unpublished).
[2]. Owsley, C., 1999, Vision impairment and Driving. https://www.sciencedirect.com/science/article/pii/S0039625799000351
[3]. International Centre for Eye health journal, 1998, Vision and Driving, vol.6, Pgs, 10-11.
[4]. John Sanford Smith, 1993, Eye diseases in Hot Climates.
[5]. Kanski, J. J., 1999, Clinical Ophthalmology 4th Edition., The Glaucoma Perimetry, Pgs, 6-12., Macmillan publishers Ltd.
[6]. Kaweesa, S., 2003, Road trafic accidents and Procudure for Registration of Vehicles Imported into Uganda(unpublished).
[7]. Mwangi, C. W., 2000, Vision assessment of drivers in Nairobi.,dissertation, University of Nairobi.
[8]. Mantyjarvi, et al, 1999, January - March., Visual functions of drivers involved in road traffic accidents. Journal of Safety Research, vol.31 no.1-2. Pgs, 121-124. https://www.researchgate.net/publication/257939664_Trafiksakerhet_skadehandelse_och_prevention_for_synskadade_och_blinda_i_norra_delen_av_Sverige_-_ett_vinterlandskap
[9]. Margie Peden., 2004, World Report on Road Traffic Injury prevention., Pgs, 11-103. https://apps.who.int/iris/bitstream/handle/10665/42871/9241562609.pdf
[10]. Shanahan., E. M., 2007, A Chapter in Medical Aspects of fitness to Drive. https://pubmed.ncbi.nlm.nih.gov/17535380/
[11]. Ocansley, J., 2010, Social economic differences in road traffic injuries in mexico, a multi-method Approach, vol.57 Pg,11.
[12]. Sali, G., 2003, Vision assessment of public service vehicle drivers operating in and from Kampala., Dissertation, Makerere University, Kampala.
[13]. The Uganda Traffic and Road Safety Act,1998, Application form for Driving Licenses., Section 11. https://ulii.org/akn/ug/act/1998/15/eng@2020-05-22
[14]. Uganda National Traffic Police Department Report, 2003/2006, unpublished.
[15]. Ophthalmological society of East Africa (OSEA) meeting recommendation., 2005, unpublished.
[16]. Vingrys et al, 2000. Are colour vision standards justified in the transport industry? Ophthalmic Physiology, vol. 6 Pgs,23-38). https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-1313.1988.tb01056.x
[17]. Ovenseri Ogomo., Adofo M., 2011. Poor vision, Refractive errors and barriers to treatment among commercial vehicle drivers in cape coast municipality. https://www.ajol.info/index.php/ahs/article/view/65003
[18]. Cynthia Owsley, et al., 1998, Visual processing impairment and risk of motor vehicle crash among older drivers. Vol. 279. https://jamanetwork.com/journals/jama/article-abstract/187414
[19]. Eby, G. W., 2012, Importance of eye checkup among American adults.
[20]. Kulmala., Erapparssinen, O., Sakari., Rantanel, 2010, Lowered vision as a risk factor for injurious accidents in older people. https://link.springer.com/article/10.1007/BF03324744.
Viewed PDF 131 9 -
Healthcare Providers' Perceptions of Universal Health Coverage in Lubero and Butembo, DR-CongoAuthor: Paluku Kahuko-Wa-MithimboDOI: 10.21522/TIJPH.2013.14.01.Art010
Healthcare Providers' Perceptions of Universal Health Coverage in Lubero and Butembo, DR-Congo
Abstract:
The target of this investigation is to contribute to the implementation of universal health coverage in the Democratic Republic of Congo. As a descriptive, cross-sectional, comparative, and correlational study, it was conducted from March to August 2025. Data collection consisted of a survey questionnaire administered to 920 healthcare providers in both the Lubero Territory and Butembo City. Regarding increased frequency and use of services, expectations on UHC are positive (M=3.75[3.68; 3.81] ± 0.05), increasing rate of income recovery (M=3.39[3.31; 3.46] ± 1.15) and protecting of household finances (M=3.38[3.32; 3.45] ± 1.07). Healthcare providers fear delays in patient bill payments (M=2.42 [2.35; 2.50] ± 1.13) and disruption of input stocks (M=2.55 [2.47; 2.63] ± 1.23). Expectations of healthcare providers vary by residence (t = 7.06; p = 0.000), whereas fears do not (t = 0.00; p = 0.999). Expectations of healthcare providers vary depending on each one’s main job (F = 3.536; p = 0.001). The same is observed for fears (F=3.390; p=0.001). Perceptions vary by marital status (F=2.832; p=0.037) but not by gender (F=-0.074; p=0.918). Expectations of healthcare providers of UHC are influenced by the level of education (r=0.094; p=0.004) and depend on household income (r=-0.079; p=0.016).
Healthcare Providers' Perceptions of Universal Health Coverage in Lubero and Butembo, DR-Congo
References:
[1]. Alkodaymi, S. M., Abou Shaar, B., Ashraf Fawzy, N., Alhabbbash, R., Senjab, A., & Rawan AlSaoudm, R., 2020, Knowledge, perception, and attitudes of Universal Health Coverage policies among Alfaisal University students in Saudi Arabia. Journal of education and health promotion. https://pmc.ncbi.nlm.nih.gov/articles/PMC7871921/
[2]. Bukele Kekemb, T., & Mbuyi, Y., 2022, Determinants of the Universal Health Coverage Process in the Democratic Republic of Congo: An Econometric Approach Using the PLS Algorithm International Journal of Multidisciplinary and Current Research, Vol.10 (July/Aug 2022 issue), pp. 332-343.
[3]. Care, et al., 2017, Health for All: Why Universal Health Coverage Is Important ?. https://www.cordaid.org/en/wp-content/uploads/sites/11/2017/12/Cordaid_Health_HealthForAll-Why-is-Universal-Health-Coverage-important-FR-LR.pdf
[4]. Etcheberry, J., 2015, Knowledge and Perceptions of DCEM4 Students from Île-de-France on Complementary Universal Health Coverage and Its Beneficiaries. [Doctoral Theses, Paris Diderot University – Paris 7]. http://www.bichat-larib.com/publications.documents/4995_ETCHEBERRY_these.pdf
[5]. Faye, M. F., 2021, Universal Health Coverage in Senegal: Impact Evaluation and Analysis of Health Financing Policies. [Doctoral Thesis, Cheikh Anta Diop University of Dakar]. https://theses.hal.science/tel-03690782/
[6]. Ifeagwu, S. C., Nakaboga Kikonyogo, R., Nakkazi, S., Beinomugisha, J., Ojiambo Wandera, S., Kiwanuka, S. N., King, R., Tine Van Bortel, T. V., Brayne, C., Parkes-Ratanshi, R., 2024, Sickness has no time: Awareness and perceptions of health care workers on universal health coverage in Uganda. Plos one 19(7). https://doi.org/10.1371/journal. pone.0306922
[7]. Ismail, S., 2016, Economic Evaluation of Health Insurance Reform in Tunisia. [Doctoral Theses. PARIS-DAUPHINE UNIVERSITY]. https://theses.hal.science/tel-01300569/
[8]. Kabinda, J., Mitashi, P., & Chengem, F., 2017, Universal Health Coverage (UHC): How to Finance the Inclusion of the Informal Sector in the Democratic Republic of Congo (DRC)? https://aenweb.blob.core.windows.net/aenweb/files/files/Policy_brief_1.pdf
[9]. Maeda, A., Araujo, E., Cashin, C., Harris, J., Ikegami, N., Michael, R., & Reich, 2015, Universal Health Coverage for Inclusive Sustainable Development. http://dx.doi.org/10.1596/978-1-4648-0592-9
[10]. Mataria, A., 2018, Basic Health Coverage: Review of International Experiences.
[11]. Mbeva, K. J-B., Ndeba, M. P., Nguemeleu, T. E., Mahamba, N., Nyavanda, K. L., & Syayipuma, K. J-R., 2023, Challenges and Issues of Universal Health Coverage in the Democratic Republic of Congo: An Interpretative Critical Literature Review. International Journal of Innovation and Scientific Research, (66)1, pp. 42-56. http://www.ijisr.issr-journals.org/
[12]. Mugo, M., 2022, Health Insurance and Health Status in Kenya: Toward Universal Health Coverage. http://publication.aercafricalibrary.org/bitstream/handle/123456789/3390/HC-002.pdf?sequence=1&isAllowed=y
[13]. Nations Unies, 2022, Report of the International Universal Health Coverage Day, 12 December. https://www.un.org/fr/observances/universal-health-coverage-day#:~:text=Les%20trois%20dimensions%20de%20la,entra%C3%AEnent%20pas%20de%20difficult%C3%A9s%20financi%C3%A8res).
[14]. OECD, 2021, Population with Health Coverage, in Health at a Glance 2021: OECD Indicators, Éditions OCDE, Paris. https://doi.org/10.1787/d9136695-fr
[15]. WHO., 2013, World Health Report 2013: Research for Universal Health Coverage. https://apps.who.int/iris/bitstream/handle/10665/85764/9789240691193_fre.pdf
[16]. WHO., 2015, Making Fair Choices for Universal Health Coverage. https://iris.who.int/bitstream/handle/10665/185069/9789242507157_fre.pdf
[17]. WHO., 2022a, Universal Health Coverage. https://www.who.int/fr/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
[18]. WHO., 2022b, Progress Report of the Democratic Republic of Congo (DRC). https://www.social-protection.org/gimi/gess/Media.action;jsessionid=Sr_t4Y570uMPw6YHT30Pt3KEeO9i5wLBm2JW_kSOH-WZPE1oWwng!-1975053523?id=19073#:~:text=Pour%20progresser%20vers%20la%20couverture,financement%20de%20la%20CSU%2C%20la
[19]. ONUSIDA., 2019, Universal Health Coverage. https://www.unaids.org/fr/topic/UHC#:~:text=Le%20but%20de%20la%20Couverture,%C3%A0%20payer%20pour%20ces%20services.
[20]. Sanoussi, Y., et., Ametoglo, M., 2019, Extent and Determinants of Catastrophic Health Expenditures: The Case of Togolese Households. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3440106
[21]. Shan, L., Wu, O., Liu, C., Li, Y., Cui, C., Zi Liang, Z., Hao, Y., Liang, L., Ning, N., Ding, D., Qingxia Pan, Q., & Han, L., 2017, Perceived challenges to achieving universal health coverage: A cross-sectional survey of social health insurance managers/administrators in China. https://bmjopen.bmj.com/content/7/5/e014425
[22]. Taverne, B., Laborde-Balen, G., Rassoul Top, B., Sow, K., & Coumé, M., 2023, Perceptions and Use of Universal Health Coverage (Plan Sésame) by Elderly People in Dakar (Senegal), and Its Impact on Health Expenditures Related to Diabetes and Hypertension. Médecine Tropicale Et Santé Internationale. 10.48327/mtsi.v3i3.2023.320
[23]. Inter-Parliamentary Union, & WHO., 2022, The Path to Universal Health Coverage. https://apps.who.int/iris/bitstream/handle/10665/365283/9789240061408-fre.pdf?sequence=1
[24]. USAID., 2017, Financing Universal Health Coverage and Family Planning. Consulté sur file:///C:/Users/Lanares/Downloads/HFG-Region-de-lAfrique-de-lOuest-Rapport-Financement_Francais-Final_juillet-2017%20(1).pdf
[25]. OMS & Groupe de la Banque mondiale. 2014, Universal Health Coverage: Tracking Progress at the National and Global Levels. https://iris.who.int/bitstream/handle/10665/112823/WHO_HIS_HIA_14.1_fre.pdf
[26]. The Global Fund, 2016, Audit Report on Global Fund Grants to the Republic of Uganda. https://www.theglobalfund.org/media/2820/oig_gf-oig-16-005_report_fr.pdf
Viewed PDF 130 7 -
Assessing the Mental Health Challenges and Experiences of Returnee Migrants in NigeriaAuthor: Olatunji Joshua AwoleyeDOI: 10.21522/TIJPH.2013.14.01.Art011
Assessing the Mental Health Challenges and Experiences of Returnee Migrants in Nigeria
Abstract:
Returnee migrants in Nigeria often experience severe psychological distress due to traumatic migration experiences and reintegration challenges. This study assesses the mental health challenges and experiences of returnee migrant in Nigeria. This study adopted a quantitative cross-sectional design to examine mental health challenges and psychosocial experiences among returnee migrants across Nigeria’s six geopolitical zones. A sample size of 1,316 was determined using Cochran’s formula, with participants selected through multi-stage sampling and snowballing techniques. Data was collected via pretested interviewer-administered questionnaires and analyzed using SPSS 28. The mean age of the respondents was 29±6.212 years. The results revealed that the main reasons for migration were the pursuit of better living conditions (43.2%), followed by torture (38.6%), while torture (24.1%) and labour exploitation (22.3%) were the leading reasons for return. Findings revealed a high prevalence of mental health status, with over 80% reporting trouble sleeping, anxiety, and loss of interest in activities. Regression analysis on factors associated with mental health status among returnee migrants confirmed that sex and religion remained significant predictors of mental health status. Female returnees were about five times more likely to report poor mental health than males (AOR = 5.499, p < 0.001). Also. Religion showed a protective effect, with Christianity associated with lower odds of poor mental health (AOR= 0.119:P<0.001) compared to Islam. The findings underscore the urgent need for trauma-informed, community-based, and government-supported mental health interventions for returnee migrants in Nigeria.
Assessing the Mental Health Challenges and Experiences of Returnee Migrants in Nigeria
References:
[1]. International Organization for Migration, 2019, Migration in Nigeria: A Country Profile 2019. International Organization for Migration, https://publications.iom.int/system/files/pdf/iom_reintegration_handbook.pdf
[2]. International Organization for Migration, 2022, World Migration Report 2022: Migration and Migrants – A Global Overview. International Organization for Migration, https://worldmigrationreport.iom.int.
[3]. World Health Organization, 2022, Mental Health: Strengthening Our Response. World Health Organization, https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response.
[4]. World Health Organization, 2017, Depression and Other Common Mental Disorders: Global Health Estimates. World Health Organization, Geneva, Switzerland, https://apps.who.int/iris/handle/10665/254610.
[5]. Wada, Y. H., Rajwani, L., Anyam, E., Karikari, E., Njikizana, M., Srour, L., et al., 2021, Mental health in Nigeria: A neglected issue in public health. Public Health in Practice, 2, https://doi.org/10.1016/j.puhip.2021.100166.
[6]. Moullan, Y., Jusot, F., 2014, Why is the “healthy immigrant effect” different between European countries? European Journal of Public Health, 24(Suppl. 1), 80–86, https://doi.org/10.1093/eurpub/cku112.
[7]. Blair, A. H., Schneeberg, A., 2014, Changes in the “healthy migrant effect” in Canada: Are recent immigrants healthier than they were a decade ago? Journal of Immigrant and Minority Health, 16(1), 136–142, https://doi.org/10.1007/s10903-013-9813-9.
[8]. Wapmuk, S., 2019, International migration, Nigerian returnee migrants, and challenges of reintegration. Journal of African Studies and Development, 9, 158–180.
[9]. Biswas, J., Gangadhar, B. N., Keshavan, M., 2016, Cross-cultural variations in psychiatrists’ perception of mental illness: A tool for teaching culture in psychiatry. Asian Journal of Psychiatry, 23, 1–7, https://doi.org/10.1016/j.ajp.2016.05.011.
[10]. Sanderson, S., 2019, Returnees struggle to adjust to life in Nigeria. InfoMigrants, https://www.infomigrants.net.
[11]. International Organization for Migration, 2020, Returnees and health workers join hands to improve psychosocial well-being in Nigeria. International Organization for Migration, https://www.iom.int.
[12]. Kunnuji, M., Onitolo, E., Grant, C., 2024, Addressing the humanitarian needs of forced rural-to-city migrants in north-west Nigeria with a focus on mental health vulnerability. Social Science in Action, https://www.socialscienceinaction.org.
[13]. Akinlua, J. T., Meakin, R., Umar, A. M., Freemantle, N., 2015, Current prevalence pattern of hypertension in Nigeria: A systematic review. PLOS ONE, 10(10), https://doi.org/10.1371/journal.pone.0140021.
[14]. Yamane, Y., 1967, Mathematical formulae for sample size determination. Open Journal of Statistics, 12, 291–302.
[15]. International Organization for Migration, 2023, IOM Nigeria Annual Report 2023. International Organization for Migration.
[16]. Atem, D. M., 2020, Unthinkable journeys: Sub-Saharan Africa involuntary youth migration. Journal of Economic Development Studies, 8(3), https://doi.org/10.15640/jeds.v8n3a5.
[17]. Sumata, C., 2021, A framework for understanding migration from Sub-Saharan Africa: Transnational and global perspectives. In Handbook of Culture and Migration, 162–167, https://doi.org/10.4337/9781789903461.00022.
[18]. Cattaneo, C., Magli, F., Franceschetti, L., 2022, Commentary on: “Tortures alleged by migrants in Italy: compatibility and other medicolegal challenges”. International Journal of Legal Medicine, 136(2), 391–392, https://doi.org/10.1007/s00414-021-02744-3.
[19]. Esposito, M., Salerno, M., Chisari, M. G., Sessa, F., Rapisarda, V., Pomara, C., 2024, Analysis of the health conditions of migrants and asylum seekers in reception centers: From scene investigation to the evaluation of signs of torture. Forensic Science International, 365, https://doi.org/10.1016/j.forsciint.2024.112288.
[20]. Leichtle, N., 2025, Not a semester hero. Migration and Society, 8, 1–16, https://doi.org/10.3167/arms.2025.0122of5.
[21]. Tessitore, F., Parola, A., Margherita, G., 2023, Mental health risk and protective factors of Nigerian male asylum seekers hosted in Southern Italy: A culturally sensitive quantitative investigation. Journal of Racial and Ethnic Health Disparities, 10(2), 730–742, https://doi.org/10.1007/s40615-022-01260-3.
[22]. Adusei, A. B., Ayiku, R. N. B., Amarteyfio, K. A. N. A., Bondzie, E. P. K., Adjei-Banuah, N. Y., Abdul-Samed, A. B., et al., 2025, Disparities in the access and provision of mental health services as part of primary health care: A case study of Ga-South District in the Greater Accra Region. Frontiers in Public Health, 13, https://doi.org/10.3389/fpubh.2025.1537955.
Viewed PDF 137 12 -
Determinants for Pre-exposure Prophylaxis Discontinuation among Perceived Low Risk Populations in Homa Bay and Kisii Counties, KenyaAuthor: Muchele Polycarp MuseeDOI: 10.21522/TIJPH.2013.14.01.Art012
Determinants for Pre-exposure Prophylaxis Discontinuation among Perceived Low Risk Populations in Homa Bay and Kisii Counties, Kenya
Abstract:
Pre-exposure prophylaxis (PrEP) effectively prevents HIV, but early discontinuation—especially among those perceiving low risk—reduces its impact. This study explored socio-demographic and contextual factors influencing PrEP discontinuation and assessed healthcare worker engagement in Homa Bay and Kisii counties, Kenya. Using a correlational design, 293 individuals who stopped PrEP within three months were selected via stratified random sampling from LVCT Vukisha95-supported facilities. Data, collected through structured questionnaires and linked to program records, were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression to identify factors associated with discontinuation. Most participants were female (71.7%), aged 20–34 years, and from Homa Bay (68.3%). County of residence predicted discontinuation, with Kisii residents less likely to stop PrEP than Homa Bay residents (aOR = 0.09; 95% CI: 0.04–0.19; p < 0.001). Formal employment was associated with increased odds of discontinuation (aOR = 2.80; 95% CI: 1.24–6.45; p = 0.014). Individuals aged 25–29 (aOR = 0.26; p = 0.041) and 45–49 (aOR = 0.16; p = 0.038) were less likely to discontinue PrEP than adolescents 15–19 years. Education had a marginal effect, while sex, marital status, income, and HIV risk category were not significant. About 40% cited reasons differing from records, and only 15% consulted healthcare workers before stopping PrEP. PrEP discontinuation driven by perceived low HIV risk is influenced more by contextual and socioeconomic factors than actual risk, highlighting the need for personalized risk assessment, better documentation, and proactive healthcare worker engagement in high-burden areas.
Determinants for Pre-exposure Prophylaxis Discontinuation among Perceived Low Risk Populations in Homa Bay and Kisii Counties, Kenya
References:
[1]. World Health Organization, 2023, HIV statistics, globally and by WHO regions, 2023, Global HIV, Hepatitis and Sexually Transmitted Infections Programs. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategicinformation/hiv-data-and-statistics.
[2]. Blumenthal, J., Jain, S., Mulvihill, E., Sun, S., Marvin, H., Ellorin, E., Graber, S., Haubrich, R., Morris Sheldon, 2019, Perceived Versus Calculated HIV Risk: Implications for Pre-exposure Prophylaxis Uptake in a Randomized Trial of Men Who Have Sex With Men. J Acquir Immune Defic Synd, 80(2): e23–e29, doi: 10.1097/QAI.0000000000001888.
[3]. Whitfield, T. H., John, S. A., Rendhina, A. J., Grov, C., Parsons T Jeffrey, 2018, Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS Behaviour, 2018 Nov;22(11):3566-3575, doi: 10.1007/s10461-018-2045-1.
[4]. Tailor, J., Rodrigues, J., Meade, J., Segal, K., Mwakyosi Lilian Benjamin, 2022, Correlations between oral Pre-Exposure Prophylaxis (PrEP) initiations and policies that enable the use of PrEP to address HIV globally. PLOS Glob Public Health, 2022 Dec 7;2(12):e0001202, doi: 10.1371/journal.pgph.0001202.
[5]. Zhang, J., Li, C., Xu, J., Hu, Z., Rutstein, S. E., & Tucker, J. D., Ong, J. J., Jiang, Y., Geng, W., Wright, S. T., Cohen, M, S., Shang, H., Tang Weiming, 2022, Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis. Lancet HIV 2022 Apr;9(4):e254-e268, doi: 10.1016/S2352-3018(22)00030-3.
[6]. Stankevitz, K., Grant, H., Lloyd, J., Gomez, G. B., Kripke, K., Torjesen, K., Terris-Prestholt Fern, 2020, Oral preexposure prophylaxis continuation,measurementa and reporting. AIDS, 2020 Oct 1;34(12):1801-1811, doi: 10.1097/QAD.0000000000002598.
[7]. Marcus, J. L., Hurley, L. B., Hare, C. B., Nguyen, D. P., Phengrasamy, T., Silverberg, M. J., Stoltey, JE,. Volk Johnathan E, 2017, Preexposure Prophylaxis for HIV Prevention in a Large Integrated Health Care System: Adherence, Renal Safety, and Discontinuation. Pub Med Central, 540-546, doi: 10.1097/QAI.0000000000001129.
[8]. Marcus, J. L., Hurley, L. B., Ngoyen, D. P., Silverberge, M. J., Volk Johnathan E, 2017, Redefining Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis Failures. Clinical Infectious Diseases, 1768 – 1769, doi: 10.1093/cid/cix593.
[9]. Mathews, L. T., Atukunda, E. C., Owembabazi, M., Kalyebera, K. P., Psaros, C., Chitneni, P., Hendrix, C.W., Marzinke, M.A., Anderson, P.L., Ischunwa, O.O., Hurwitz, K.E., Bennett, K., Muyindike, W., Bangsberg, D.R., Haberer, E.J., Marrazzo, J.M., Bwana Mwebesa Bosco, 2023, High PrEP uptake and objective longitudinal adherence among HIV-exposed women with personal or partner plans for pregnancy in rural Uganda: A cohort study. Plos Medicine, February 16, 2023, https://doi.org/10.1371/journal.pmed.1004088
[10]. Mirembe, B. G., Donnel, D., Krows, M., Zwane, Z., Bukusi, E., Panchia, R., Louw, C., Mwelase, N., Selepe, P., Senne, M., Naidoo, L., Chihana, R., Kasaro, M., Nuwagabo-Biribonwoha, H., Kotze, P., Gill, K., MacDonald, P., Vantteerden, A., Bosman, S., Jaggernath, M., Preez, P., Ward, A., Peters, R. P. H, Elany-Moretiwe, S., Peacock, S., Johnson, R., wang, G., Gandhi, M., Velloza, J., Heffron, R., Celum Connie, 2024, High recent PrEP adherence with point-of-care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort. J Int AIDS Society, 2024 Dec;27(12):e26389, Doi: 10.1002/jia2.26389.
[11]. Ogolla, M., Nyabiage, O. L., Musingila, P., Gachau, S., Odero, T. M., June, E. O., Ochanda, B., Appolonia, A., Katiku, E., Joseph, R., Ogolla, C., Otieno, L., Odhiambo, R., Truong Hong-Ha M, 2023, Uptake and continuation of HIV pre-exposure prophylaxis among women of reproductive age in two health facilities in Kisumu County, Kenya. Journal for International AIDS Society, 023 Mar;26(3):e26069, doi: 10.1002/jia2.26069.
[12]. Tapsoba, J. d., Cover, J., Obong`o, C., Brandy, M., Cressey, T. R., Mori, K., Okomo, G., Kariithi, E., Obanda, R., Oluoch-Madiang, D., Chen, Y.Q., Drain, P., Duerr Anne, 2022, Continued attendance in a PrEP program despite low adherence and non-protective drug levels among adolescent girls and young women in Kenya: Results from a prospective cohort study. Plos Medicine, September 12, 2022, https://doi.org/10.1371/journal.pmed.1004097
[13]. Anyasi, H., Idemudia, A., Badru, T., Onyegbule, S., Isang, E., Sanwo, O., Pandey, S. R., Chiegil, R., Bateganya, M., Schartz, K., Njuguna, N., Persaud, N., Plotkin, M., Iyortim, I., Khamofu Hadiza, 2024, Discontinuation of HIV oral pre-exposure prophylaxis: findings from programmatic surveillance within two general population HIV programs in Nigeria. BMC Public Health. 2024 May 16;24(1):1325, doi: 10.1186/s12889-024-18808-z.
[14]. Ongolly, F. K., Dolla, A., Irungu, E. M., Odoyo, J., Wamoni, E., Peebles, K., Mugwanya, K., Mugo, N. R., Bukusi, E. A., Morton, J., Baeten, J. M., O`Malley Gabrielle, 2022, “I just decided to stop:” Understanding PrEP discontinuation among individuals initiating PrEP in HIV care centers in Kenya. J Acquir Immune Defic Syndr, 2021 May 1;87(1):e150-e158, doi: 10.1097/QAI.0000000000002625.
[15]. Pillay, D., Stankevitz, K., Lanham, M., Ridgeway, K., Murire, M., Briedenhann, E., jenkins, S., Subedar, H., Hoke, T., Mullick Saiqa, 2020, Factors influencing uptake, continuation, and discontinuation of oral PrEP among clients at sex worker and MSM facilities in South Africa. PLOS One, April 30, 2020, https://doi.org/10.1371/journal.pone.0228620
[16]. Dzenga, T., Moyo, E., Moyo, P., Kamangu, J., Dzinamarira Tafadzwa, 2023, Factors influencing the retention of clients in oral pre-exposure prophylaxis (PrEP) care at 3 months after initiation in the Omusati region of Namibia. International Journal of Africa Nursing Sciences, Volume 19, 2023, 100623, https://doi.org/10.1016/j.ijans.2023.100623.
[17]. Garofoli, M., Siguier, M., Robineau, O., Valette, M., Phung, B., Bachelard, A., Rioux, C., Gac, S.L., Digumber, M., Pialoux, G., Ghosn, J., Champenois Karen, 2024, Incidence and factors associated with PrEP discontinuation in France. Journal of Antimicrobial Chemotherapy, 2024 Jul 1;79(7):1555-1563, doi: 10.1093/jac/dkae133.
[18]. Churu, M., Kulemba, K., Kapesa, A., Kajura, A., Wilfred, D., Basinda, N., Kaluvya, S., Mageda Kihulya Pastory, 2023, Factors associated with adherence to oral HIV pre-exposure prophylaxis among female sexworkers in the Mara Region, Tanzania A 2022 cross-sectional study. Medicine (Baltimore) 2023 Sep 8;102(36):e34824, doi: 10.1097/MD.0000000000034824.
[19]. Herns, S., Panwala, R., Pfeil, A., Sardinho, M., Rossi, V., Blumenthal, J., & Hill Lucus, 2023, Predictors of PrEP retention in at risk patients seen at a HIV primary care clinic in San Diego. International Journal of STD and AIDS, 785–790, 2023 Oct;34(11):785-790, doi: 10.1177/09564624231179276.
[20]. Qu, D., Zhong, X., Xiao, G., Dai, J., Liang, H., Huang Ailong, 2018, Adherence to pre-exposure prophylaxis among men who have sex. International Journal of Infectious Diseases, 2018 Oct:75:52-59, doi: 10.1016/j.ijid.2018.08.006. Epub 2018 Aug 17.
[21]. Cox, J., Apelian, H., Moodie, E. E., Peet, M. M., Hart, T. A., Grace, D., Moore, D. M., Lachuwsky, N. S., Amstrong, H. L., Jollimove, J., Skakoom-Sparling, S., Rodrigues, R., Tan, D>H>S., Maheu-Giroux, M., Noor, S.W., Lebouche, B., Trembley, C., Olarewaju, G., Lambert, Gilles, 2021, Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study. CMAJ Open 2021 May 21;9(2):E529-E538, doi: 10.9778/cmajo.20200198.
[22]. Shover, C. L., Shoptaw, S., Javanbakhat, M., Lee, S. J., Bolan, R. K., Cunningham, N. J., Beymer, M., DeVost, M. A., Gorbach Pamina, M., 2020, Mind the Gaps: Prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California. PubMed Central, 2730 - 2740. doi: 10.1007/s10461-019-02493.
[23]. Krakower, D., Maloney, K. M., Powell, V. E., Levine, K., Grasso, C., Melbourne, K., Marcus,J,. Mayer Kenneth, H., 2019, Patterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care. International AIDS Society, 2019 Feb;22(2):e25250, doi: 10.1002/jia2.25250.
[24]. Jonas, K. J., Yaemim Natthakhet, 2018, HIV Prevention After Discontinuing Pre-Exposure Prophylaxis: Conclusions From a Case Study. Frontiers in Public Health 6:137, doi: 10.3389/fpubh.2018.00137.
[25]. Gilbert, H. N., Wyatt, M. A., Pisarki, E. E., Mumonge, T. R., Heffron, R., Katabira, E. T., Celum, C. L., Baeten, J. M., Haberer, J. E., Ware Norman, C., 2019, PrEP Discontinuation and Prevention-Effective Adherence: Experiences of PrEP Users in Ugandan HIV Serodiscordant couples. Journal Acquired Immune Deficiency Syndrom, 2019 Nov 1;82(3):265-274, doi: 10.1097/QAI.0000000000002139.
[26]. Damme, L. V., Corneli, A., Ahmed, K., Agot, K., Lombaard, J., Kapiga, S., Malahleha, M., Owino, F., Manongi, R., Ontango, J., temu, L., Monedi, M. C., MakOketch, P., makanda, M., Reblin, I., Makatu, S. E., Saylor, L., Kiernan, H., kirkendale, S., Wong, C., Grant, R., Kashuba, A., Nanda, K., Mandala, J., Fransen, K., deese, J., Crucitti, T., Mastro, J. D., Taylor Douglas, 2013, Preexposure Prophylaxis for HIV Infection among African Women. N Engl J Med 2012 Aug 2;367(5):411-22, doi: 10.1056/NEJMoa1202614. Epub 2012 Jul 11.
Viewed PDF 219 16 -
Epidemiology, Surveillance, and Control of Malaria Among Under-Five School Children in Jere Local Government, Borno State, NigeriaAuthor: Mohammed Bala AminuDOI: 10.21522/TIJPH.2013.14.01.Art013
Epidemiology, Surveillance, and Control of Malaria Among Under-Five School Children in Jere Local Government, Borno State, Nigeria
Abstract:
In Nigeria, malaria is a major source of illness and mortality, disproportionately affecting children under five. This study examines the prevalence, monitoring, and management of malaria among school-age children under five in Borno State, Nigeria's Jere Local Government Area, from 2012 to 2019. Structured questionnaires, key informant interviews, and medical facility records were used to gather data for this descriptive cross-sectional study. The results showed a consistently high prevalence of malaria in children under five, which was exacerbated by environmental risk factors, insufficient access to healthcare, and displacement. Low coverage, insecurity, and poor compliance hampered the use of malaria control measures, including indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), and long-lasting insecticidal nets (LLINs). Due to rising treatment expenses, decreased production, and poorer educational outcomes for afflicted children, the condition had a substantial negative influence on households' socioeconomic well-being. To reduce the disease burden among susceptible groups in conflict-affected areas, it is advised to integrate community-based awareness initiatives, enhance intervention coverage, and fortify malaria surveillance systems.
Epidemiology, Surveillance, and Control of Malaria Among Under-Five School Children in Jere Local Government, Borno State, Nigeria
References:
[1]. World Health Organization, 2023, World Malaria Report 2023, Geneva: WHO.
[2]. Lalloo, D. G., Olukoya, P., & Olliaro, P., 2006, Malaria in adolescence: Burden and prospects for control, The Lancet Infectious Diseases, 6(12), 780–793.
[3]. Snow, R. W., Sartorius, B., Kyalo, D., Maina, J., Amratia, P., Mundia, C. W., & Noor, A. M., 2017, The prevalence of Plasmodium falciparum in sub-Saharan Africa since 1900, Nature, 550(7677), 515–518.
[4]. Bundy, D. A. P., Shaeffer, S., Jukes, M., Beegle, K., Gillespie, A., Drake, L., & Savioli, L., 2000, School health and nutrition programs, World Bank Human Development Network.
[5]. Federal Ministry of Health (FMOH), 2015, National Malaria Strategic Plan 2014–2020, Abuja: Federal Ministry of Health.
[6]. World Health Organization, 2022, World Malaria Report 2022, Geneva: WHO.
[7]. Okiro, E. A., Hay, S. I., Gikandi, P. W., Sharif, S. K., Noor, A. M., Peshu, N., & Snow, R. W., 2009, The decline in paediatric malaria admissions on the coast of Kenya, Malaria Journal, 8(1), 176.
[8]. Okorie, P. N., Ademowo, O. G., Irving, H., Kelly-Hope, L. A., & Wondji, C. S., 2015, Insecticide resistance in Nigerian malaria vectors: A nationwide profile, Parasites & Vectors, 8(1), 605.
[9]. Gallup, J. L., & Sachs, J. D., 2001, The economic burden of malaria, The American Journal of Tropical Medicine and Hygiene, 64(1–2 Suppl), 85–96.
[10]. Nankabirwa, J., Brooker, S. J., Clarke, S. E., Fernando, D., Gitonga, C. W., Schellenberg, D., & Greenwood, B., 2010, Malaria in school-age children in Africa: An increasingly important challenge, Tropical Medicine & International Health, 15(11), 1319–1327.
[11]. Adepoju, P., 2021, Nigeria’s battle with malaria burden amidst conflict and displacement, The Lancet Infectious Diseases, 21(4), 450–451.
[12]. Onyiah, J. A., Akpan, E., & Umeokonkwo, C. D., 2018, Strengthening malaria surveillance in Nigeria: Gaps and opportunities, African Health Sciences, 18(3), 582–590.
[13]. Phillips, R. S., 2001, Current status of malaria and potential for control, Clinical Microbiology Reviews, 14(1), 208–226.
[14]. Federal Ministry of Health (FMOH), 1991, National Malaria Control Policy, Abuja: Federal Ministry of Health.
[15]. Federal Ministry of Health (FMOH), 2004, Malaria Indicator Survey, Abuja: Federal Ministry of Health.
[16]. Rugemalila, J. B., Wanga, C. L., & Kilama, W. L., 2006, Sixth Africa malaria day in 2006: How far have we come after the Abuja Declaration? Malaria Journal, 5, 102.
[17]. Jordan, E., & Verma, R., 2005, Malaria: Past and present, Clinical Medicine & Research, 3(2), 118–123.
[18]. Bruce-Chwatt, L. J., 1986, Essential Malariology (2nd ed.), London: William Heinemann Medical Books.
[19]. Levine, N. D., 1988, Progress in taxonomy of the Apicomplexan protozoa, The Journal of Protozoology, 35(4), 518-520.
[20]. Garnham, P. C. C., 1966, Malaria Parasites and Other Haemosporidia, Oxford: Blackwell Scientific Publications.
[21]. Welch, W. H., 1897, On the life-history of the malarial parasite, Johns Hopkins Hospital Bulletin, 8(87), 1–13.
[22]. Stephens, J. W. W., 1922, A new malaria parasite of man, Annals of Tropical Medicine & Parasitology, 16(3), 383-388.
[23]. Worrall, E., Basu, S., & Hanson, K., 2002, The relationship between socio-economic status and malaria: a review of the literature. Background paper for Ensuring that malaria control interventions reach the poor, London, 56.
[24]. Degarege, A., Fennie, K., Degarege, D., Chennupati, S., & Madhivanan, P., 2019, Improving socioeconomic status may reduce the burden of malaria in sub-Saharan Africa: A systematic review and meta-analysis. PloS one, 14(1), e0211205.
Viewed PDF 135 7 -
Stratified Evaluation of Quality Management Practices in HIV Rapid Testing Laboratories: Evidence from the South Region of CameroonAuthor: Abanda Emmanuel ChafahDOI: 10.21522/TIJPH.2013.14.01.Art014
Stratified Evaluation of Quality Management Practices in HIV Rapid Testing Laboratories: Evidence from the South Region of Cameroon
Abstract:
Ensuring high-quality HIV rapid testing is critical to accurate diagnosis and effective treatment, especially in resource-limited settings like Cameroon. This study conducted a stratified evaluation of quality management systems (QMS) in HIV rapid testing laboratories across the South Region of Cameroon using the WHO Stepwise Process for Improving the Quality of HIV Rapid Testing (SPI-RRT) tool. The objective was to assess adherence to quality standards across facility types and support levels, and to identify critical gaps in implementation. A total of 99 laboratories were audited between 2022 and 2024, stratified by ownership (government, private, faith-based, and community-based organizations) and PEPFAR support. Results showed that PEPFAR-supported laboratories had significantly higher mean SPI-RRT scores (59) compared to non-supported sites (14), p < 0.001. Community-based organizations demonstrated the highest compliance (28 ± 21), followed by faith-based (25 ± 23), private (25 ± 17), and government-owned facilities (14 ± 21). Notably, only 12% of laboratories reached SPI-RRT Level 3 or 4, indicating limited readiness for certification. The lowest-scoring elements included quality control, document management, and corrective actions, highlighting systemic weaknesses in QMS implementation. District-level disparities were also evident, with Sangmelima and Kribi outperforming other districts in readiness scores. These findings provide essential insights into quality assurance challenges in decentralized HIV testing programs and underscore the need for targeted interventions, including technical mentorship, continuous quality improvement, and enhanced supervision to improve diagnostic reliability.
Stratified Evaluation of Quality Management Practices in HIV Rapid Testing Laboratories: Evidence from the South Region of Cameroon
References:
[1]. Ngangue, P., Gagnon, M. P., and Bedard, E., 2017, “Challenges in the Delivery of Public HIV Testing and Counselling (HTC) in Douala, Cameroon: Providers Perspectives and Implications on Quality of HTC Services,” BMC Int. Health Hum. Rights, 17, p. 9. https://doi.org/10.1186/s12914-017-0118-2
[2]. Nkengasong, J. N., Mbopi-Keou, F. X., Peeling, R. W., Yao, K., Zeh, C. E., Schneidman, M., et al., 2018, “Laboratory Medicine in Africa since 2008: Then, Now, and the Future,” Lancet Infect. Dis, 18(11), pp. e362–e367. https://doi.org/10.1016/S1473-3099(18)30120-8
[3]. Mosoke, P., Ndasi, J., Dimite, L., Efuetakoa, C., Etogo, B., Jackson, K., ... & Njukeng, P., 2020, Innovative Approach to Improving Adherence to Quality Standards at HIV Rapid Testing Sites in Cameroon using the Stepwise Process for Improving the Quality of HIV Rapid Testing (SPI-RT) Checklist. International Journal of Trend in Scientific Research and Development, 4.
[4]. Ndihokubwayo, J. B., Yahaya, A. A., Coulibaly, S. O., Kasolo, F., Maruta, T., Ndlovu, N., Moyo, S et al., 2016, “Implementation of the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation,” Afr. J. Lab. Med., 5(1), pp. 1–8. https://doi.org/10.4102/ajlm.v5i1.280
[5]. Yenealem, D., Kedir, S., MekonnenWubie, A., Melese, D., Molalign, T., Yemanebirhan, N., Mohammed, A., Nurahmed, N., et al., 2023, “HIV Rapid Test Performance among Health Facilities Enrolled in HIV Rapid Test Quality Improvement Initiative (RTQII) in Ethiopia,” BMC Infect. Dis., 23(1), pp. 1–9. https://doi.org/10.1186/s12879-023-08285-x
[6]. Woldesenbet, S. A., Kalou, M., Mhlongo, D., Kufa, T., Makhanya, M., Adelekan, A., Diallo, K., et al., 2019, “An Overview of the Quality Assurance Programme for HIV Rapid Testing in South Africa: Outcome of a 2-Year Phased Implementation of Quality Assurance Program,” PLOS ONE, 14(9), p. e0221906. https://doi.org/10.1371/journal.pone.0221906
[7]. Zakumumpa, H., Paina, L., Wilhelm, J., Ssengooba, F., Ssegujja, E., Mukuru, M., and Bennett, S., 2021, “The Impact of Loss of PEPFAR Support on HIV Services at Health Facilities in Low-Burden Districts in Uganda,” BMC Health Serv. Res, 21(1), p. 302. https://doi.org/10.1186/s12913-021-06316-4
[8]. Joint United Nations Programme on HIV/AIDS, 2023, The path that ends AIDS: 2023 UNAIDS global AIDS update.
[9]. Wagner, A. D., Mugo, C., Bluemer-Miroite, S., Mutiti, P. M., Wamalwa, D. C., Bukusi, D., Neary, J., et al., 2017, “Continuous Quality Improvement Intervention for Adolescent and Young Adult HIV Testing Services in Kenya Improves HIV Knowledge,” AIDS, 31, p. S243. https://doi.org/10.1097/QAD.0000000000001531
[10]. Yapa, H. M., Dhlomo-Mphatswe, W., Moshabela, M., De Neve, J.-W., Herbst, C., et al., 2020, “A Continuous Quality Improvement Intervention to Improve Antenatal HIV Care Testing in Rural South Africa: Evaluation of Implementation in a Real-World Setting,” Int. J. Health Policy Manag., 11(5), pp. 610–628. https://doi.org/10.34172/ijhpm.2020.178
[11]. Groene, O., Klazinga, N., Kazandjian, V., Lombrail, P., and Bartels, P., 2008, “The World Health Organization Performance Assessment Tool for Quality Improvement in Hospitals (PATH): An Analysis of the Pilot Implementation in 37 Hospitals,” Int. J. Qual. Health Care, 20(3), pp. 155–161. https://doi.org/10.1093/intqhc/mzn010
[12]. Ogaji, D., 2018, “Development and Validation of the Patient Evaluation Scale (PES) for Assessing the Quality of Primary Health Care in Nigeria.” [Online]. Available: https://www.academia.edu/116319277/Development_and_validation_of_the_patient_evaluation_scale_PES_for_assessing_the_quality_of_primary_health_care_in_Nigeria [Accessed: 18-Oct-2025].
[13]. Paina, L., Rodriguez, D. C., Zakumumpa, H., Mackenzie, C., Ssengooba, F., and Bennett, S., 2023, “Geographic Prioritisation in Kenya and Uganda: A Power Analysis of Donor Transition,” BMJ Glob. Health, 8(5), p. e010499. https://doi.org/10.1136/bmjgh-2022-010499
[14]. World Health Organization, 2021, “Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach,” Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach, pp. 592–592. [Online]. Available: https://apps.who.int/iris/handle/10665/342899. [Accessed: 09-Aug-2025].
[15]. Jaya, Z., Drain, P. K., and Mashamba-Thompson, T. P., 2017, “Evaluating Quality Management Systems for HIV Rapid Testing Services in Primary Healthcare Clinics in Rural KwaZulu-Natal, South Africa,” PLoS ONE, 12(8), p. e0183044. https://doi.org/10.1371/journal.pone.0183044
[16]. Drain, P. K., Dorward, J., Bender, A., Lillis, L., Marinucci, F., Sacks, J., Bershteyn, A., et al., 2019, “Point-of-Care HIV Viral Load Testing: An Essential Tool for a Sustainable Global HIV/AIDS Response,” Clin. Microbiol. Rev., 32(3), pp. e00097-18. https://doi.org/10.1128/CMR.00097-18
[17]. Holtzman, C. W., Godfrey, C., Ismail, L., Raizes, E., Ake, J. A., Tefera, F., Okutoyi, S., and Siberry, G. K., 2022, “PEPFAR’s Role in Protecting and Leveraging HIV Services in the COVID-19 Response in Africa,” Curr. HIV/AIDS Rep., 19(1), pp. 26–36. https://doi.org/10.1007/s11904-021-00587-6
[18]. Lewis, C. C., Mettert, K. D., Dorsey, C. N., Martinez, R. G., Weiner, B. J., Nolen, E., Stanick, C., Halko, H., and Powell, B. J., 2018, “An Updated Protocol for a Systematic Review of Implementation-Related Measures,” Syst. Rev., 7(1), p. 66. https://doi.org/10.1186/s13643-018-0728-3
[19]. Elendu, C., Amaechi, D. C., Elendu, T. C., Amaechi, E. C., Elendu, I. D., Akpa, K. N., Oloyede, P. O., Adegbola, M. O., and Idowu, O. F., 2025, “Shaping Sustainable Paths for HIV/AIDS Funding: A Review and Reminder,” Ann. Med. Surg., 87(3), pp. 1415–1445. https://doi.org/10.1097/MS9.0000000000002976
[20]. Maruta, T., Motebang, D., Mathabo, L., Rotz, P. J., Wanyoike, J., and Peter, T., 2012, “Impact of Mentorship on WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA),” Afr. J. Lab. Med., 1(1), p. 6. https://doi.org/10.4102/ajlm.v1i1.6
[21]. Endalamaw, A., Khatri, R. B., Mengistu, T. S., Erku, D., Wolka, E., Zewdie, A., and Assefa, Y., 2024, “A Scoping Review of Continuous Quality Improvement in Healthcare System: Conceptualization, Models and Tools, Barriers and Facilitators, and Impact,” BMC Health Serv. Res., 24, p. 487. https://doi.org/10.1186/s12913-024-10828-0
[22]. Hontelez, J. A. C., Goymann, H., Berhane, Y., Bhattacharjee, P., Bor, J., Chabata, S. T., Cowan, F., Kimani, J., et al., 2025, “The Impact of the PEPFAR Funding Freeze on HIV Deaths and Infections: A Mathematical Modelling Study of Seven Countries in Sub-Saharan Africa,” eClinicalMedicine, 83, p. 103233. https://doi.org/10.1016/j.eclinm.2025.103233
[23]. Best, M., and Sakande, J., 2016, “Practical Recommendations for Strengthening National and Regional Laboratory Networks in Africa in the Global Health Security Era,” Afr. J. Lab. Med., 5(3), pp. 1–10. https://doi.org/10.4102/ajlm.v5i3.471
[24]. Herzig van Wees, S., Betsi, E., and Sop Sop, M. D., 2021, “A Description and Explanation of the Complex Landscape of Faith-Based Organisations in Cameroon’s Health Sector,” Dev. Pract., 31(3), pp. 356–367. https://doi.org/10.1080/09614524.2020.1841737
[25]. van Wees, S. H., and Jennings, M., 2021, “The Challenges of Donor Engagement with Faith-Based Organizations in Cameroon’s Health Sector: A Qualitative Study,” Health Policy Plan., 36(4), pp. 464–472. https://doi.org/10.1093/heapol/czab006
Viewed PDF 170 13 -
Policy Recommendations from The Gambia on Improving the Maternal Health System in Sub-Saharan AfricaAuthor: Joy MichaelDOI: 10.21522/TIJPH.2013.14.01.Art015
Policy Recommendations from The Gambia on Improving the Maternal Health System in Sub-Saharan Africa
Abstract:
The Gambia is ranked as one of the countries with the highest maternal death rate and the country has made great strides in improving maternal health through community-based interventions during the last ten years. The aim of this study is to assess policy recommendations from The Gambia on improving the maternal health system in sub-Saharan Africa. The specific objectives of this study were to; (i) determine the socio-demographic information of the respondents in the study area; (ii) determine policy and government interventions on maternal health; (iii) assess donor programs and interventions targeting on maternal health; (iv) determine external donor programs and interventions on maternal health; (v) determine representative of the community on maternal health. A retrospective quasi-experimental design with a well-structured questionnaire was used to obtain information from 217 participants across the major administrative regions of The Gambia, and the data were analysed using descriptive statistics. The results showed that the majority (64.8%) of respondents confirmed the existence of government policies to improve maternal health service quality, 52.9% were aware of interventions for maternal health in the study area, and UNICEF was the highest external donor (58.8%). Representatives of the community showed that 41.7% of the group of community representatives were community mobilizers/facilitators, the majority utilised services at hospitals (79.5%), and hospital-based service utilisation was primarily guided by the availability of good services and supplies (61.0%). Given that high maternal mortality rates persist in Sub-Saharan Africa, The Gambia's approach highlights the significance of inclusive, creative, and context-specific solutions.
Policy Recommendations from The Gambia on Improving the Maternal Health System in Sub-Saharan Africa
References:
[1]. Merdad, L., & Ali, M. M., 2018, Timing of maternal death: levels, trends, and ecological correlates using sibling data from 34 sub-Saharan African countries. PloS one, 13(1), e0189416.
[2]. Konje, E., 2020, The Context of Maternal and Child Health Services in Northwest Tanzania: Missed Opportunities for Preventing Maternal and Perinatal Mortality in Rural Communities.
[3]. Lincetto, O., & Banerjee, A., 2020, World Prematurity Day: improving survival and quality of life for millions of babies born preterm around the world. American Journal of Physiology-Lung Cellular and Molecular Physiology, 319(5), L871-L874.
[4]. Lawn, J. E., Blencowe, H., Oza, S., You, D., Lee, A. C., Waiswa, P., & Cousens, S. N., 2014, Every Newborn: progress, priorities, and potential beyond survival. The lancet, 384(9938), 189-205.
[5]. Onwuagbu, O. U., 2020, The Epidemiology of Stillbirths According to the Perinatal Problems Identification Program (PPIPP), at Rahima Moosa Mother and Child Hospital, from August 2016 to July 2017 (Master's thesis, University of the Witwatersrand, Johannesburg (South Africa)).
[6]. Stanislas, P., & Chongan, E., 2022, Communal Complexity Conflict and Security in Gambia. In Understanding and Preventing Community Violence: Global Criminological and Sociological Perspectives (pp. 205-217). Cham: Springer International Publishing.
[7]. Cole-Ceesay, R., Cherian, M., Sonko, A., Shivute, N., Cham, M., Davis, M., ... & Southall, D., 2010, Strengthening the emergency healthcare system for mothers and children in The Gambia. Reproductive Health, 7(1), 21.
[8]. Johm, P. T., 2023, Understanding factors influencing maternal vaccination acceptance in The Gambia (Doctoral dissertation, London School of Hygiene & Tropical Medicine).
[9]. Vieira, C., Portela, A., Miller, T., Coast, E., Leone, T., & Marston, C., 2012, Increasing the use of skilled health personnel where traditional birth attendants were providers of childbirth care: a systematic review. PLoS One, 7(10), e47946.
[10]. Sundby, J., Ingstad, B., & Walraven, G., 2003, Maternal Mortality in the Gambia: Contributing factors and what can be done to reduce them (Doctoral dissertation, Department of General Practice and Community Medicine Faculty of Medicine, University of Oslo).
[11]. Kanteh, O., & Palamuleni, M. E., 2019, Women status and fertility in The Gambia. Gender and Behaviour, 17(3), 13627-13644.
[12]. Afferri, A., Dierickx, S., Bittaye, M., Marena, M., Pacey, A. A., & Balen, J., 2024, Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study. Plos one, 19(5), e0301700.
[13]. Kinteh, B., Barrow, A., Nget, M., Touray, E., Touray, J., Kinteh, S. L., ... & Jatta, S. P., 2022, Research Article Maternal and Child Health Services in Rural Settings of The Gambia: Contextual Determinants of Postnatal Care from Mothers' Perspectives—A Community-Based Analytical Cross-Sectional Study.
[14]. Babajide, O. O., 2021, Model-based sub-population estimates of maternal mortality rates and ratio from siblings' survivorship histories in Nigeria (2008-2018) (doctoral dissertation).
[15]. Sundby, J., 2014, A rollercoaster of policy shifts: global trends and reproductive health policy in The Gambia. Global public health, 9(8), 894-909.
[16]. Say, L., & Raine, R., 2007, A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bulletin of the World Health Organization, 85(10), 812-819.
[17]. Gautam, S., Suso, A., & Wood, E., 2024, Effect of antenatal care on birth outcomes in The Gambia: a propensity score matching analysis.
[18]. Kothari, M. T., Coile, A., Huestis, A., Pullum, T., Garrett, D., & Engmann, C., 2019, Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys. Annals of the New York Academy of Sciences, 1450(1), 249-267.
[19]. Lowe, M., Chen, D. R., & Huang, S. L., 2016, Social and cultural factors affecting maternal health in rural Gambia: an exploratory qualitative study. PloS one, 11(9), e0163653.
[20]. Aglobitse, D. M., 2012, Intra-Family Communication and Reproductive Health Decision Making in the Volta Region of Ghana (Doctoral dissertation, University of Ghana).
[21]. Gagnon, M. P., Desmartis, M., Labrecque, M., et al., 2012, Systematic Review of Factors Influencing the Adoption of Information and Communication Technologies by Healthcare Professionals. J Med Syst, 36, 241–277.
[22]. World Health Organization, 2022, WHO recommendations on maternal and newborn care for a positive postnatal experience. World Health Organization.
[23]. Lassi, Z. S., Musavi, N. B., Maliqi, B., Mansoor, N., de Francisco, A., Toure, K., & Bhutta, Z. A., 2016, Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low-and middle-income countries. Human resources for health, 14(1), 10.
[24]. Morrison, B., 2015, The problem with workarounds is that they work: The persistence of resource shortages. Journal of Operations Management, 39, 79-91.
[25]. Veress, T. A., 2024, Community-Based Organizations and the Challenges of the Anthropocene (Doctoral dissertation, Budapesti Corvinus Egyetem).
Viewed PDF 105 4 -
Assessment of the Influence of Adolescent-Youth Friendly Health Services on HIV-related quality of life (AYLHIV) in Taraba State, NigeriaAuthor: Dadi Aisha NantimDOI: 10.21522/TIJPH.2013.14.01.Art016
Assessment of the Influence of Adolescent-Youth Friendly Health Services on HIV-related quality of life (AYLHIV) in Taraba State, Nigeria
Abstract:
Adolescents and youth living with HIV (AYLHIV) face unique challenges impacting their mental, emotional, and social well-being. In Nigeria, where youth-friendly healthcare services are evolving, the true influence of Adolescent and Youth-Friendly Health Services (AYFHS) on HIV-related quality of life (HRQoL) remains unclear. This study assessed the impact of AYFHS on the HRQoL of AYLHIV in Taraba State, Nigeria. Informed consent was obtained from all participants. A cross-sectional comparative study was conducted among 386 AYLHIV aged 10–24 years, comprising 193 AYFHS attendees and 193 non-attendees using a multistage sampling method. Data were collected via a structured, interviewer-administered questionnaire covering Anti-retro-viral therapy (ART) adherence, stigma, resilience, and overall quality of life. Analyses were performed using SPSS version 27, with t-tests and multiple regressions applied to determine group differences. Findings revealed that AYFHS attendees had significantly better ART adherence (78% vs. 62%), higher resilience (81% vs. 54%), and greater confidence in managing HIV in AYLHIV attendees. The AYLHIV attendees were also more hopeful about the future and less likely to feel ashamed of their status. Enhanced social support, peer- engagement, and provider friendliness were key contributing factors. Non-attendees reported greater emotional distress and lower treatment confidence. These results demonstrate that AYFHS attendees significantly improve HIV-related quality of life among adolescents. In conclusion, expanding youth-friendly models maybe essential for improving treatment outcomes and addressing psycho-social needs, contributing to Nigeria’s progress toward achieving UNAIDS 95-95-95 goals.
Assessment of the Influence of Adolescent-Youth Friendly Health Services on HIV-related quality of life (AYLHIV) in Taraba State, Nigeria
References:
[1]. U.S. Department of Health and Human Services, 2020, What is HIV?https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-is-hiv
[2]. UNAIDS, 2020, Seizing the moment: Tackling entrenched inequalities to end epidemics – Global AIDS Update 2020. Joint United Nations Programme on HIV/AIDS (UNAIDS). https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf
[3]. Bekker, L.-G., Johnson, L., Wallace, M., & Hosek, S., 2015, Building our youth for the future. Journal of the International AIDS Society, 18(2Suppl 1), 20027. https://doi.org/10.7448/IAS.18.2.20027
[4]. Slogrove, A. L., Sohn, A. H., Belecourt, C., Violari, A., & McNairy, M. L., 2020, Adolescents and young people with HIV: Unmet needs in the global response. Current Opinion in HIV and AIDS, 15(1), 36-42. https://doi.org/10.1097/COH.0000000000000590
[5]. UNFPA, 2021, Youth-friendly health services: An assessment of youth access to adolescent sexual and reproductive health services in Nigeria. United Nations Population Fund Nigeria. https://nigeria.unfpa.org/en/publications/youth-friendly-health-services-assessment
[6]. Mark, D., Armstrong, A., Andrade, C., Penazzato, M., Hatane, L., Taing, L., & Bekker, L.-G., 2021, Adolescent HIV treatment in the era of Universal Health Coverage: Lessons from South Africa and beyond. Journal of the International AIDS Society, 24(Suppl 2), e25652. https://doi.org/10.1002/jia2.25652
[7]. UNICEF, 2020, Improving Adolescent HIV Care and Treatment: A Peer Support Model for Africa. United Nations Children’s Fund.
[8]. Govender, K., Naicker, S. N., Meyer-Weitz, A., Fanner, J., Naidoo, A., & Penfold, L., 2020, Adolescent access to HIV prevention services in sub-Saharan Africa: A scoping review and narrative synthesis. African Journal of AIDS Research, 19(4), 267-275. https://doi.org/10.2989/16085906.2020.1861320
[9]. UNAIDS, 2022, In Danger: UNAIDS Global AIDS Update 2022. Joint United Nations Programme on HIV/AIDS.
[10]. National Bureau of Statistics (NBS), 2020, 2020 Statistical Report on Women and Men in Nigeria. Federal Republic of Nigeria. https://www.nigerianstat.gov.ng
[11]. National Agency for the Control of AIDS (NACA), 2020, Revised National HIV and AIDS Strategic Framework 2019–2021. Federal Republic of Nigeria. https://naca.gov.ng/revised-national-hiv-and-aids-strategic-framework-2019-2021/
[12]. PEPFAR Nigeria, 2023, Nigeria Country Operational Plan (COP/ROP) 2023 Strategic Direction Summary. U.S. President’s Emergency Plan for AIDS Relief. Retrieved from https://www.state.gov/wp-content/uploads/2023/07/Nigeria_COP23_SDS_Final.pdf
[13]. Busza, J., Besana, G. V. R., Mapunda, P., &Oliveras Rodriguez, M. L., 2020, Meeting the needs of adolescents living with HIV through differentiated care: Lessons from the Zvandiriprogramme in Zimbabwe. Journal of the International AIDS Society, 23(S5), e25552. https://doi.org/10.1002/jia2.25552
[14]. UNAIDS & World Health Organization, 2021, Adolescent HIV prevention and treatment: A situational analysis of adolescent HIV programming in selected countries in sub-Saharan Africa. Retrieved from https://www.unaids.org/en/resources/documents/2021/adolescent-hiv-prevention-and-treatment
[15]. O’Brien, K. K., Tynan, A. M., Nixon, S. A., & Glazier, R. H., 2020, Effectiveness of aerobic exercise for adults living with HIV: Systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infectious Diseases, 20(1), 73.https://doi.org/10.1186/s12879-020-4779-1
[16]. Denison, J. A., Banda, H., Dennis, A. C., Packer, C., Nyambe, N., Stalter, R. M., Mwansa, J. K., & McCarraher, D. R., 2020, “The sky is the limit”: Adhering to antiretroviral therapy and HIV self-management from the perspectives of adolescents living with HIV and their caregivers. Journal of the International AIDS Society, 23(3), e25470. https://doi.org/10.1002/jia2.25470
[17]. Pantelic, M., Boyes, M., Cluver, L., & Thabeng, M., 2020, ‘They Say HIV is a Punishment from God or from Ancestors’: Cross-Cultural Adaptation and Psychometric Assessment of an HIV Stigma Scale for South African Adolescents Living with HIV (ALHIV-SS). Child Indicators Research, 13(1), 149–170. https://doi.org/10.1007/s12187-019-09660-0
[18]. Willis, N., Milanzi, A., Mawodzeke, M., Dziwa, C., Armstrong, A., Yekeye, I., Keatinge, J., & Cowan, F. M., 2020, Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention in care, adherence to ART and psychosocial well-being: A randomised trial among adolescents living with HIV in rural Zimbabwe. BMC Public Health, 20, 117. https://doi.org/10.1186/s12889-019-7995-4
[19]. Mburu, G., Ram, M., Skovdal, M., Bitira, D., Hodgson, I., Mwai, G. W., & Seeley, J., 2020, Supportive social relationships and improved health-related quality of life among adolescents living with HIV in sub-Saharan Africa: A structural equation modelling analysis. AIDS Care, 32(1), 6-15. https://doi.org/10.1080/09540121.2020.1739203
[20]. de Terte, I., Becker, L. A., & Marks, D. F., 2020, Resilience and quality of life among people living with HIV: A systematic review of quantitative studies. Journal of Health Psychology, 25(6), 709-723.https://doi.org/10.1177/1359105317718053
[21]. Shah, S. K., Celum, C., Baeten, J. M., Bukusi, E., & Pintye, J., 2021, Resilience among adolescents living with HIV: A review of global literature. AIDS Care, 33(6), 713-720. https://doi.org/10.1080/09540121.2020.1742864
[22]. Mark, D., Armstrong, A., Andrade, C., Penazzato, M., Hatane, L., Taing, L., & Bekker, L.-G., 2021, Adolescent HIV treatment in the era of Universal Health Coverage: Lessons from South Africa and beyond. Journal of the International AIDS Society, 24(2), e25652.https://doi.org/10.1002/jia2.25652
Viewed PDF 165 22 -
Evaluating the Prevalence of Non-Communicable Diseases Among HIV Positive Individuals in Chingola District, ZambiaAuthor: Judith MusondaDOI: 10.21522/TIJPH.2013.14.01.Art017
Evaluating the Prevalence of Non-Communicable Diseases Among HIV Positive Individuals in Chingola District, Zambia
Abstract:
The study was aimed at evaluating the prevalence of non-communicable diseases among HIV positive individuals in Chingola District, Zambia. The widespread success of antiretroviral therapy (ART) has caused HIV to change from an acute to a chronic illness. Although the life expectancy of people living with HIV (PLHIV) has increased dramatically as a result of this advancement, new health issues have also emerged, most notably the increased prevalence of non-communicable diseases (NCDs) in this population. HIV-positive people are increasingly being diagnosed with noncommunicable diseases (NCDs), including diabetes, hypertension, cardiovascular disease, and chronic respiratory conditions. The study was carried out in Zambia's Copperbelt Province's Chingola District. Purposively, five of the district's largest antiretroviral therapy (ART) clinics were chosen based on patient volume and accessibility. Between January and May of 2025, a descriptive cross-sectional study was carried out involving 500 participants. The results show that most prevalent non-communicable disease among the 500 HIV-positive people was hypertension, which affected 268 participants i.e. 53.58% of the sample. The analysis identified predictors of non-communicable diseases (NCDs) include age which had the odds of having an NCD increased by 5% for every year, indicating that age was a significant factor (OR = 1.05, 95% CI: 1.03–1.08, p < 0.001). The study concludes that there is a significant burden of non-communicable diseases (NCDs) among people living with HIV (PLHIV) in the district.
Evaluating the Prevalence of Non-Communicable Diseases Among HIV Positive Individuals in Chingola District, Zambia
References:
[2] World Health Organization, Country Disease Outlook - Zambia. Date of access: 20/05/2025 https://www.afro.who.int/sites/default/files/2023-08/Zambia.pdf
[4] UNAIDS, Global AIDS Update 2023. Date of access: 20/05/2025 https://www.unaids.org/en/resources/documents/2023/global-aids-update
[5] Nduka, C. U., Stranges, S., Sarki, A. M., Kimani, P. K., & Uthman, O. A., 2020, Evidence of increased risk of non-communicable diseases in HIV-positive populations in sub-Saharan Africa: A systematic review and meta-analysis. PLOS ONE, 15(8), e0237420. https://doi.org/10.1371/journal.pone.0237420
[6] Rabkin, M., Nishtar, S., & Besada, D., 2018, Integrated care for chronic conditions: the global challenge to achieve health equity. Health Affairs, 37(3), 408–412. https://doi.org/10.1377/hlthaff.2017.1393
[11] World Health Organization, 2021, Noncommunicable diseases: Key facts. Date of access: 2/06/2025 https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
[13] Chanda-Kapata, P., Klinkenberg, E., Maddox, N., & Kapata, N, 2016, Health seeking behaviour among individuals with presumptive tuberculosis in Zambia. PLOS ONE, 11(3), e0149336. https://doi.org/10.1371/journal.pone.0149336
[15] Moyo-Chilufya, M., Maluleke, K., Kgarosi, K., Muyoyeta, M., Hongoro, C., & Musekiwa, A., 2023, The burden of non‑communicable diseases among people living with HIV in Sub‑Saharan Africa: A systematic review and meta‑analysis. eClinicalMedicine, 65, 102255. https://doi.org/10.1016/j.eclinm.2023.102255
[16] Nduka, C. U., Stranges, S., Sarki, A. M., Kimani, P. K., & Uthman, O. A., 2017, Evidence of increased cardiometabolic risk in HIV-positive individuals receiving antiretroviral therapy: A systematic review and meta-analysis. PLOS ONE, 12(4), e0173936. https://doi.org/10.1371/journal.pone.0173936
Viewed PDF 341 8 -
Phenomenological and Clinical Insights into Near-Death Experiences: A Retrospective Analysis in Aseer Province Population, Saudi ArabiaAuthor: Om Prakash PalanivelDOI: 10.21522/TIJPH.2013.14.01.Art018
Phenomenological and Clinical Insights into Near-Death Experiences: A Retrospective Analysis in Aseer Province Population, Saudi Arabia
Abstract:
Near death experience (NDE) reported as supernatural and emotional feelings with episodes involving a special state of consciousness, including several special elements and these experiences typically occur with often grouped contents commonly observed in life-threatening conditions. Participants were provided with an Arabic version of the Near-Death Experience (NDE) scale via mail and social media platforms, along with a contact number for inquiries. NDE scale scores, used to assess the depth of the near-death experience, were considered indicative of an NDE if they were 7 or greater. A total of 14 participants of both sex aged between 18 and 56 years, with a mean age of 37.1 years (SD = 12.4). with a gender dispersion of 57.1% (8 males) and 42.9% (6 females). The most commonly reported incidence of near-death experiences was “sudden understanding of everything” (93.0%), “time speeding up” (85.7%), and “feeling happy” (85.7%). Conversely, the incidence reported least frequently was “visions of the future” at 28.6% and “racing thoughts” at 21.4%. No statistically significant variation in the frequency of responses across the 12 of NDE elements. The elements most frequently reported exhibited narrow confidence intervals with elevated lower bounds: “sudden understanding of everything” (93.0%, 95% CI [77.9%, 100.0%]), “time speeding up” (85.7%, 95% CI [66.4%, 100.0%]), and “feeling happy” (85.7%, 95% CI [66.4%, 100.0]). This study shows that Near-Death Experiences (NDEs) involve sensory, emotional, cognitive, and spiritual elements, with altered consciousness and neural links, showing no gender differences.
Phenomenological and Clinical Insights into Near-Death Experiences: A Retrospective Analysis in Aseer Province Population, Saudi Arabia
References:
[1]. Long, J., 2014, Near-death experience: Evidence for their reality. Mo Med, 111(5):372–380.
[2]. van Lommel, P., 2014, Getting comfortable with near-death experiences: Dutch prospective research on near-death experiences during cardiac arrest. Mo Med, 111(2):126–131.
[3]. Parnia, S., Waller, D. G., Yeates, R., Fenwick, P., 2001, A qualitative and quantitative study of the incidence, features and aetiology of near-death experiences in cardiac arrest survivors. Resuscitation, 48(2):149–156.
[4]. Greyson, B., 2003, Incidence and correlates of near-death experiences in a cardiac care unit. Gen Hosp Psychiatry, 25(4):269–276.
[5]. Parnia, S., Spearpoint, K., de Vos, G., Fenwick, P., Goldberg, D., Yang, J., et al., 2014, AWARE- Awareness during resuscitation- A prospective study. Resuscitation, 85(12):1799–1805.
[6]. Moody, R. A., 2013, Getting comfortable with death & near-death experiences: An essay in medicine & philosophy. Mo Med, 110(5):368–371.
[7]. Horstmann, G., 2015, The surprise-attention link: A review. Ann N Y Acad Sci, 1339:106–115.
[8]. Ring, K., 1982, Precognitive and prophetic visions in near-death experiences. Anabiosis, 2:47–74.
[9]. Ring, K., 1988, Prophetic visions in 1988: A critical reappraisal. J Near-Death Stud, 7(1):4–18.
[10]. Shaw, N. A., 2024, The role of cerebral hypercarbia in the induction of the near-death experience. J Nerv Syst Physiol Phenom, 1(1):1–32.
[11]. Martial, C., Rousseau, A. F., Dams, L., Massart, Q., Choquer, L., Cassol, H., et al., 2024, Phenomenological memory characteristics and impact of near-death experience in critically ill survivors: Observations at discharge and after a 1-year follow-up. Int J Clin Health Psychol, 24(3):100478.
[12]. Schmied, I., Knoblauch, H., Schnettler, B., 1999, Todesnäheerfahrungen in Ost- und Westdeutschland—eine empirische Untersuchung. In: Knoblauch, H., Soeffner, H. G., eds. Todesnähe: Interdisziplinäre Zugänge zu einem außergewöhnlichen Phänomen. Konstanz: Universitätsverlag Konstanz: 217–250.
[13]. Morse, M., 1996, Parting visions: A new scientific paradigm. In: Bailey, L. W., Yates, J., eds. The near-death experience: A reader. New York and London: Routledge: 299–318.
[14]. Greyson, B., 1983, The near-death experience scale: Construction, reliability, and validity. J Nerv Ment Dis, 171(6):369–375.
[15]. Rousseau, A. F., Dams, L., Massart, Q., Choquer, L., Cassol, H., Laureys, S., et al., 2023, Incidence of near-death experiences in patients surviving a prolonged critical illness and their long-term impact: A prospective observational study. Crit Care, 27(1):76.
[16]. King, R. A., 2021, The irrelevance of time in near-death experiences (NDEs). Academia Letters, Article 2427.
[17]. Romand, R., Ehret, G., 2023, Neuro-functional modeling of near-death experiences in contexts of altered states of consciousness. Front Psychol, 13:846159.
[18]. Kopel, J., 2019, Near-death experiences in medicine. Proc (Bayl Univ Med Cent), 32(1):163–164.
[19]. Blanke, O., 2004, Out of body experiences and their neural basis. BMJ, 329(7480):1414–1415.
[20]. Greyson, B., 2003, Incidence and correlates of near-death experiences in a cardiac care unit. Gen Hosp Psychiatry, 25(4):269–276.
[21]. Schwaninger, J., Eisenberg, P. R., Schechtman, K. B., Weiss, A. N., 2002, A prospective analysis of near-death experiences in cardiac arrest patients. J Near-Death Stud, 20:215–232.
[22]. Hashemi, A., Oroojan, A. A., Rassouli, M., Ashrafizadeh, H., 2023, Explanation of near-death experiences: A systematic analysis of case reports and qualitative research. Front Psychol, 14:1048929.
[23]. Athappilly, G., Greyson, B., Stevenson, I., 2006, Do prevailing societal models influence reports of near-death experiences? J Nerv Ment Dis, 194(3):218–222.
Viewed PDF 203 7 -
Safety Climate and Practices in University Laboratories: Evidence from a Ghanaian Case StudyAuthor: James Kojo PrahDOI: 10.21522/TIJPH.2013.14.01.Art019
Safety Climate and Practices in University Laboratories: Evidence from a Ghanaian Case Study
Abstract:
Academic laboratories in developing countries face numerous occupational health and safety (OHS) challenges due to limited resources, diverse hazards, and often underdeveloped safety systems. This study was conducted to evaluate the safety climate, occupational health and safety (OHS) knowledge, attitudes, and practices of laboratory workers in academic laboratories at the University of Cape Coast, Ghana. This cross-sectional study used the Nordic Safety Climate Questionnaire (NOSACQ-50), a standard questionnaire, direct workplace observations, and a decision matrix risk assessment to identify and evaluate hazards. The study was conducted in academic laboratories across three colleges at the University of Cape Coast, Ghana. The study included 104 laboratory staff members with at least one year of work experience in laboratory settings. Participants demonstrated high knowledge of OHS (mean score: 12.94 ± 2.76) and awareness (12.42 ± 2.39), but poor safety practices (12.06 ± 4.48) and inconsistent use of personal protective equipment (PPE). The overall safety climate score was low (2.45 ± 0.71), with management's safety commitment and justice rated poorly. Observations revealed inadequate PPE availability, lack of ergonomic infrastructure, and absence of incident reporting systems. High-risk hazards, including chemical inhalation, musculoskeletal injuries, and chemical splashes, were identified with risk scores of 20 each. The findings reveal significant gaps between OHS knowledge and safety practices in academic laboratories. These gaps highlight the need for improved resource allocation, stronger management engagement, enhanced safety training, and the establishment of dedicated OHS units to foster safer working environments and promote a robust safety culture in academic institutions.
Safety Climate and Practices in University Laboratories: Evidence from a Ghanaian Case Study
References:
[2]. Mearns, K. J., & Flin, R., 1999, Assessing the state of organizational safety—culture or climate? Curr. Psychol, 18(1), 5–17, https://doi.org/10.1007/s12144-999-1013-3
[3]. Probst, T. M., Goldenhar, L. M., Byrd, J. L., & Betit, E., 2019, The Safety Climate Assessment Tool (S-CAT): A rubric-based approach to measuring construction safety climate. J. Saf. Res, 69, 43-51, ISSN 0022-4375, https://doi.org/10.1016/j.jsr.2019.02.004
[4]. Health and Safety Executive (HSE), 2011, Measuring the safety climate in organizations. Available from chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://books.hse.gov.uk/gempdf/Measuring_the_Safety_Climate_in_Organisations.pdf
[5]. Loh, M. Y., Dollard, M. F., McLinton, S. S., & Brough, P., 2024, Translating psychosocial safety climate (PSC) into real-world practice: two PSC intervention case studies. JOH, 66 (1): uiae051, https://doi.org/10.1093/joccuh/uiae051
[6]. Kines, P., Lappalainen, J., Mikkelsen, K. L., Olsen, E., Pousette, A., Tharaldsen, J., Tómasson, K., & Törner, M., 2011, Nordic Safety Climate Questionnaire (NOSACQ-50): A new tool for diagnosing occupational safety climate. Int. J. Ind. Ergon, 41(6): 634–646, https://doi.org/10.1016/j.ergon.2011.08.004
[7]. Minister, A., 2015, Unsafe science. NFPA J, Available at http://www.nfpa.org/ newsandpublications/nfpa-journal/ 2015/september-october2015/ features/unsafe-science
[8]. Singh, K., 2009, Laboratory‐Acquired Infections. Clin. Infect. Dis, 49(1) : 142–147, https://doi.org/10.1086/599104
[9]. Al-Abhar, N., Al-Gunaid, E., Moghram, G., Al-Hababi, A. A., Al Serouri, A., & Khader, Y. S., 2017, Knowledge and Practice of Biosafety Among Laboratory Staff Working in Clinical Laboratories in Yemen. Appl Biosaf, 22(4): 168–171, https://doi.org/10.1177/1535676017733451
[10]. Fadeyi, A., Fowotade, A., Abiodun, M. O., Jimoh, A. K., Nwabuisi, C., & Desalu, O. O., 2011, Awareness and practice of safety precautions among healthcare workers in the laboratories of two public health facilities in Nigeria. Niger. Postgrad. Med. J, 18(2): 141–146.
[11]. Vaz, K., McGrowder, D., Alexander-Lindo, R., Gordon, L., Brown, P., & Irving, R., 2010, Knowledge, awareness and compliance with universal precautions among health care workers at the University Hospital of the West Indies, Jamaica. Int J Occup Environ Med, 1(4):171–181.
[12]. Lestari, F., Bowolaksono, A., Yuniautami, S., Wulandari, T. R., & Andani, S., 2019, Evaluation of the implementation of occupational health, safety, and environment management systems in higher education laboratories. J. Chem.Health Saf, 26(4–5): 14–19, https://doi.org/10.1016/j.jchas.2018.12.006
[13]. Mugivhisa, L. L., Baloyi, K., & Oluwole Olowoyo, J., 2021, Adherence to safety practices and risks associated with toxic chemicals in the research and postgraduate laboratories at Sefako Makgatho Health Sciences University, Pretoria, South Africa. Afr J Sci Technol Innov Dev, 13(6): 747–756, https://doi.org/10.1080/20421338.2020.1797269
[14]. Roghani, M., Haroon, Z. H., Munir, M. U., Kirmani, S. I., Anwar, M., & Younas, M., 2023, Laboratory Safety Climate Assessment and its Correlation with Safety Procedures Amongst Staff of a Reference Clinical Laboratory. J Coll Physicians Surg Pak, 33(11): 1259–1263, https://doi.org/10.29271/jcpsp.2023.11.1259
[15]. Aluko, O. O., Adebayo, A. E., Adebisi, T. F., Ewegbemi, M. K., Abidoye, A. T., & Popoola, B. F., 2016, Knowledge, attitudes and perceptions of occupational hazards and safety practices in Nigerian healthcare workers. BMC Res Notes, 9(1), https://doi.org/10.1186/s13104-016-1880-2
[16]. Det Nationale Forskningscenter for Arbejdsmiljø, 2024, Interpreting the Nordic Occupational Safety Climate Questionnaire NOSACQ-50 results. Available at Https://Nfa.Dk/Vaerktoejer/Spoergeskemaer.
[17]. Alshalani, A. J., & Salama, K. F., 2019, Assessment of Occupational Safety Practices Among Medical Laboratory Staff in Governmental Hospitals in Riyadh, Saudi Arabia. J. Saf. Stud, 5(1): 1-23, https://doi.org/10.5296/jss.v5i1.14992
[18]. Uca, M., & Alizadehebadi, L., 2021, Risk Analysis and Assessment Using Decision Matrix Risk Assessment Technique in Sports: The Case of Boxing. PJMHS, 15(10): 2971–2976, https://doi.org/10.53350/pjmhs2115102971
[19]. Prah, J. K., Aggrey, E., Kudom, A., & Addo‑Yeboa, B., 2025, Assessment of occupational risks among academic staff in a Ghanaian public university. Texila Int J Public Health, 13(2), Doi:10.21522/TIJPH.2013.13.02.Art001.
[20]. Moda, H. M., Dama, F. M., Nwadike, C., Alatni, B. S., Adewoye, S. O., Sawyerr, H., Doka, P. J. S., & Danjin, M., 2021, Assessment of Workplace Safety Climate among Healthcare Workers during the COVID-19 Pandemic in Low and Middle Income Countries: A Case Study of Nigeria. Healthcare, 9(6): 661, https://doi.org/10.3390/healthcare9060661
[21]. Paul, E., Abidin, E. Z., Mahmmud, N. A., & Ismail, N. H., 2022, Assessment of Knowledge, Attitude and Practice on Occupational Safety and Health among Laboratory Workers in OSHMS Certified and Non-Certified Public Universities in Malaysia. MJMHS, 18(5): 3–12, https://doi.org/10.47836/mjmhs18.5.2
[22]. Alquraini, R. A., Allehyani, M. M., Wasl, M., Almogati, S., Alsulami, A. A., Alsulami, B. O., Alotaibi, Y. M. S., Alotaibi, F. F. M., & Almalki, M. Y., 2022, Assessment of Knowledge, Attitude, and Practice on Laboratory Occupational Safety and Health among Healthcare Workers. JPPW, 6(2): 2735–2743, http://journalppw.com
[23]. Nasab, H. S., Ghofranipour, F., Kazemnejad, A., Khavanin, A., & Tavakoli, R., 2009, Evaluation of Knowledge, Attitude and Behavior of Workers towards Occupational Health and Safety. Iran J Public Health, 38(2):125-129.
[24]. Ayi, H. R., & Hon, C. Y., 2018, Safety culture and safety compliance in academic laboratories: A Canadian perspective. J. Chem.Health Saf, 25(6): 6–12, https://doi.org/10.1016/j.jchas.2018.05.002
[25]. Schröder, I., Huang, D. Y. Q., Ellis, O., Gibson, J. H., & Wayne, N. L., 2016, Laboratory safety attitudes and practices: A comparison of academic, government, and industry researchers. J. Chem.Health Saf, 23(1):12–23, https://doi.org/10.1016/j.jchas.2015.03.001
[26]. Wilde, G. J. S., 1998, Risk homeostasis theory: an overview: Figure 1. Inj. Prev, 4(2): 89–91, https://doi.org/10.1136/ip.4.2.89
[27]. Enwere, O. O., & Diwe, K. C., 2014, Knowledge, perception and practice of injection safety and healthcare waste management among teaching hospital staff in southeast Nigeria: an intervention study. Pan Afr. med. J, 17:218, https://doi.org/10.11604/pamj.2014.17.218.3084
Viewed PDF 114 5 -
Clinical Study of Dickkopf-Related Protein 1 and its Relation with Biomarkers of Bone Resorption in Patients with Metabolic SyndromeAuthor: Entedhar R. SarhatDOI: 10.21522/TIJPH.2013.14.01.Art020
Clinical Study of Dickkopf-Related Protein 1 and its Relation with Biomarkers of Bone Resorption in Patients with Metabolic Syndrome
Abstract:
Metabolic syndrome (MetS) is a global health concern, with potential complications affecting bone health. Dickkopf-1 (DKK1) may serve as a marker for MetS progression, particularly when analyzed alongside other bone metabolism markers such as Bone Gamma Osteocalcin (BGP-OST), calcitonin, and intact parathyroid hormone (I-PTH). To evaluate the correlations between DKK1 levels and bone metabolism markers (BGP-OST, calcitonin, and I-PTH) in patients with MetS, this case-control study included 88 participants (60 MetS patients and 28 healthy controls). Based on data distribution, biomarker levels were analyzed using one-way ANOVA or Kruskal-Wallis H tests. Correlations were assessed using Spearman’s test, with p < 0.05 considered statistically significant. The diagnostic utility of DKK1 was evaluated using ROC curve analysis. No significant differences were observed between MetS patients and controls for DKK1, I-PTH, or calcitonin levels, whereas BGP-OST levels were significantly higher in MetS patients (p < 0.05). In MetS patients, DKK1 showed a significant negative correlation with calcitonin, while BGP-OST had a significant positive correlation with calcitonin. DKK1 demonstrated diagnostic potential with an AUC of 0.758 and a 4.11 ng/mL cut-off value. DKK1 is significantly correlated with calcitonin and shows diagnostic utility for MetS. Elevated BG-OST levels in MetS patients further suggest its potential role in bone metabolism alterations associated with MetS progression.
Clinical Study of Dickkopf-Related Protein 1 and its Relation with Biomarkers of Bone Resorption in Patients with Metabolic Syndrome
References:
[1]. Azrak, H. I., & Sarhat, E. R. (2026). Serum Klotho as a feasible diagnostic biomarker for metabolic syndrome in Iraqi adults aged over 50 years. Journal of Associated Medical Sciences, 59(2), 178–186. retrieved from https://he01.tci-thaijo.org/index.php/bulletinAMS/article/view/283498
[2]. Al Ghadeer HA, AlRamadan MS, Al Amer MM, Alshawaf MJ, Alali FJ, Bubshait AA, Alramadhan MA, Almurayhil Z, Aldandan NS, AlKhamis MA, AlHaddad HA, AlOmair A. Vitamin D Serum Levels in Type 2 Diabetic Patients: A Cross-Sectional Study. Cureus. 2022 Feb 24;14(2):e22558.
[3]. Toaama, H.R., Sarhat, E.R., Mohammed, H.S. Metformin modulated adipokines biochemical markers in type 2 diabetes patients. Georgian Medical News, 2024, 350(5), pp. 95–97
[4]. Salim J.Khalaf, Gadeer Hatem Aljader, Thuraia Rifaat Sarhat. (2021). Anti-diabetic effect of Aqueous Extract of Medicago Sativa with Enhanced Histopathology of Pancreas in Alloxan Induced Diabetic Rats. P J M H S .2021;.15(2): 492- 496.
[6]. Sarhat, E., Wadi, S. A., Sedeeq, B., Sarhat, T. R., Jasim, N. Study of histopathological and biochemical effect of Punica granatum L. extract on streptozotocin -induced diabetes in rabbits. Iraqi Journal of Veterinary Sciences, 2019; 33(2): 189-194. doi: 10.33899/ijvs.2019.125523.1045 .
[7]. Zbaar, S.,khalaf, S. Association of C-Reactive Protein with Risk of Complications of diabetic nephropathy. Egyptian Journal of Chemistry, 2022; 65(8): 181-186. doi: 10.21608/ejchem.2021.99957.4868.
[8]. Sarhat ER, Rmaid ZJ, Jabir TH (2020) Changes of salivary interleukine17, Apelin, Omentin and Vaspin levels in normal subjects and diabetic patients with chronic periodontitis, Ann Trop Med & Pub Health; 23:S404.
[9]. Zoch, M. L., Clemens, T. L., Riddle, R. C., 2016, New insights into the biology of osteocalcin. Bone,82:42–49.
[10]. Tay Donovan, Y. K., Bilezikian, J. P., 2024, Interactions between PTH and adiposity: appetizing possibilities. Journal of Bone and Mineral Research, zjae056. https://doi.org/10.1093/jbmr/zjae056
[11]. Kiriakopoulos, A., Giannakis, P., Menenakos, E., 2022, Calcitonin: current concepts and differential diagnosis. Therapeutic Advances in Endocrinology and Metabolism, 13:20420188221099344.
[12]. Viswanath, A., Vidyasagar, S., Amrutha Sukumar, C., 2023, Osteocalcin and Metabolic Syndrome. Clinical Medicine Insights: Endocrinology and Diabetes, 16:11795514231206728. https://doi.org/10.1177/11795514231206729
[13]. Ugurlu, I., Akalin, A., Yorulmaz, G., 2022, The Association of Serum Osteocalcin Levels with Metabolic Parameters and Inflammation in Postmenopausal Women with Metabolic Syndrome. Metabolic Syndrome and Related Disorders, 20(4):219–223. https://doi.org/10.1089/met.2021.0074
[14]. Expert Panel on Detection, 2001, Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA, 285(19):2486–2497. https://doi.org/10.1001/jama.285.19.2486
[15]. Farmanfarma, K., et al., 2021, Incidence of and factors associated with metabolic syndrome, south-east Islamic Republic of Iran. Eastern Mediterranean Health Journal, 27(11):1084–1091.
[16]. Zamil, A. H., Amin, S. S., 2022, The prevalence of metabolic syndrome among university students in Wasit, Iraq. Saudi Medical Journal, 43(11):1240–1247. https://doi.org/10.15537/smj.2022.43.11.20220558
[17]. Nikoloski, Z., 2023, Obesity in Middle East, in Metabolic Syndrome: A Comprehensive Textbook, Ahima, R. S. (Ed.), Springer International Publishing, Cham, pp. 65–80. https://doi.org/10.1007/978-3-031-40116-9_6
[18]. Ilyas, K. H., Tratsiakova, V. M., 2021, The Relationship Between Body Mass Index and Biochemical Parameters in Type 2 Diabetes Mellitus in Nineveh City in Iraq. NVEO – Natural Volatiles & Essential Oils Journal, 2021:8112–8127.
[19]. Li, S., et al., 2023, Dickkopf1 (DKK1) as a Potential Biomarker in Polycystic Ovary Syndrome and Insulin Resistance: A Cross-Sectional Study. International Journal of Molecular Sciences, 25(12):6330. https://doi.org/10.21203/rs.3.rs-2988034/v1
[20]. Kamel, A. A., et al., 2022, The Role of Vitamin D, DKK1, Hepcidin and Oxidative Stress Biomarkers in Type 2 Diabetes Mellitus Patients with and Without Diabetic Nephropathy. The Egyptian Journal of Hospital Medicine, 89(2):7137–7146. https://doi.org/10.21608/ejhm.2022.273057
[21]. Liu, X., et al., 2021, Associations of Osteocalcin Forms with Metabolic Syndrome and Its Individual Components in Older Men: The Health in Men Study. The Journal of Clinical Endocrinology & Metabolism, 106(9):e3506–e3518. https://doi.org/10.1210/clinem/dgab358
[22]. Kumar, V., et al., 2023, Association of serum osteocalcin with beta cell function, insulin resistance, and glycemic parameters in south Indian type 2 diabetic subjects. International Journal of Diabetes in Developing Countries, 43(3):469–475. https://doi.org/10.1007/s13410-022-01087-y
[23]. Taher, Z. M., Ahmed, S. N., 2023, Estimation of serum calcitonin, phosphate, and calcium in type 2 diabetes mellitus. Zanco Journal of Medical Sciences, 27(2):205–212.
[24]. Alemzadeh, R., Kichler, J., 2012, Parathyroid Hormone Is Associated with Biomarkers of Insulin Resistance and Inflammation, Independent of Vitamin D Status, in Obese Adolescents. Metabolic Syndrome and Related Disorders, 10(6):422–429. https://doi.org/10.1089/met.2012.0056.
[25]. Elsurer, R., Afsar, B., Guner, E., Yildiz, I., 2011, Targeting Parathyroid Hormone Level in Diabetic Patients with Stage 3 to 5 Chronic Kidney Disease: Does Metabolic Syndrome Matter? Journal of Renal Nutrition, 21(3):219–225. https://doi.org/10.1053/j.jrn.2010.04.006
[26]. Ministrini, S., et al., 2020, Determinants of High Parathyroid Hormone Levels in Patients with Severe Obesity and Their Relationship with the Cardiometabolic Risk Factors, Before and After a Laparoscopic Sleeve Gastrectomy Intervention. Obesity Surgery, 30(6):2225–2232. https://doi.org/10.1007/s11695-020-04453-z
[27]. Baron, R., Kneissel, M., 2013, WNT signaling in bone homeostasis and disease: from human mutations to treatments. Nature Medicine, 19(2):179–192. https://doi.org/10.1038/nm.3074
[28]. Karsenty, G., Ferron, M., 2012, The contribution of bone to whole-organism physiology. Nature, 481(7381):314–320. https://doi.org/10.1038/nature10763
[29]. Khosla, S., Hofbauer, L. C., 2017, Osteoporosis treatment: recent developments and ongoing challenges. The Lancet Diabetes & Endocrinology, 5(11):898–907. https://doi.org/10.1016/S2213-8587(17)30188-2
[30]. Seibel, B. A., 2016, Cephalopod Susceptibility to Asphyxiation via Ocean Incalescence, Deoxygenation, and Acidification. Physiology, 31(6):418–429. https://doi.org/10.1152/physiol.00061.2015
Viewed PDF 131 5 -
Dietary Diversity Practices of Pregnant Women and Associated Factors among Women Attending Public Hospitals in Gambella Town, Southwest EthiopiaAuthor: Gatjiek Tut WieDOI: 10.21522/TIJPH.2013.14.01.Art021
Dietary Diversity Practices of Pregnant Women and Associated Factors among Women Attending Public Hospitals in Gambella Town, Southwest Ethiopia
Abstract:
Inadequate dietary diversity among pregnant women in Ethiopia remains a major public health concern, with approximately half of the women affected. Understanding context-specific dietary practices and associated factors is essential for effective intervention. This study assessed dietary diversity practices of pregnant women and their determinants among women attending public hospitals in Gambella Town, Southwest Ethiopia. An institution-based prospective cohort design was employed from July 25, 2024, to September 10, 2024, using a single-stage cluster sampling approach. Data were collected using an interviewer-administered questionnaire with KoboCollect software and analyzed in SPSS version 25. Dietary diversity was assessed twice using a 24-hour dietary recall. A modified Poisson regression model was applied, and statistical significance was declared at p < 0.05. All 254 participants completed the first follow-up, yielding a 100% response rate. The prevalence of inadequate dietary diversity practice was 76.4%. Factors significantly associated with being exposed included having at least one child under five years (ARR = 1.27; 95% CI: 1.03–1.57), lack of television in household (ARR = 1.19; 95% CI: 1.02–1.40), lack of antenatal care (ARR = 1.25; 95% CI: 1.02–1.53), gastritis (ARR = 1.29; 95% CI: 1.13–1.47), and meals or snacks frequency of only 1–4 times per day (ARR = 1.41; 95% CI: 1.17–1.69). The prevalence of inadequate dietary diversity practice was high. Strengthening nutrition education through mass media, improving antenatal nutrition counseling on meal frequency and diversity, and enhancing the screening and management of gastritis with smaller, more frequent meals were recommended.
Dietary Diversity Practices of Pregnant Women and Associated Factors among Women Attending Public Hospitals in Gambella Town, Southwest Ethiopia
References:
[1]. Stevens, G. A., Beal, T., Mbuya, M. N. N., Luo, H., Neufeld, L. M., 2022, Micronutrients deficiencies among preschool-aged children and women of reproductive age worldwide: A pooled analysis of individual-level data from population-representative surveys. The Lancet Global Health, 10, e1590–e1599.
[2]. Getaneh, T., Asres, A., Hiyaru, T., Lake, S., 2021, Adverse perinatal outcomes and its associated factors among adult and advanced maternal age pregnancy in Northwest Ethiopia. Scientific Reports, 11. https://doi.org/10.1038/s41598-021-93613-x
[3]. Gebremichael, M. A., Lema, T. B., 2023, Dietary Diversity, Nutritional Status, and Associated Factors among Pregnant Women in Their First Trimester of Pregnancy in Ambo District, Western Ethiopia. Nutrition and Metabolic Insights, 16, 1–12. https://doi.org/10.1177/11786388231190515
[4]. Bitew, Z. W., Alemu, A., Ayele, E. G., Worku, T., 2021, Dietary diversity and practice of pregnant and lactating women in Ethiopia: A systematic review and meta-analysis. Food Science and Nutrition, 9, 2686–2702. https://doi.org/10.1002/fsn3.2228
[5]. Food and Agriculture Organization of the United Nations, 2021, Minimum Dietary Diversity for Women. FAO, Rome.
[6]. Yang, J., Wang, M., Tobias, D. K., Rich-Edwards, J. W., Darling, A. M., Abioye, A. I., Noor, R. A., Madzorera, I., Fawzi, W. W., 2022, Dietary diversity and diet quality with gestational weight gain and adverse birth outcomes, results from a prospective pregnancy cohort study in urban Tanzania. Maternal and Child Nutrition, 18, 1–13. https://doi.org/10.1111/mcn.13300
[7]. Galani, Y. J. H., Orfila, C., Gong, Y. Y., 2022, A review of micronutrients deficiencies and analysis of maize contribution to nutrient requirements of women and children in Eastern and Southern Africa. Critical Reviews in Food Science and Nutrition, 62, 1568–1591. https://doi.org/10.1080/10408398.2020.1844636
[8]. Schulz, R., Slavin, J., 2021, Perspective: Defining Carbohydrate Quality for Human Health and Environmental Sustainability. Advances in Nutrition, 12, 1108–1121. https://doi.org/10.1093/advances/nmab050
[9]. Abere, M., Azene, A. G., 2023, Food Taboo and associated factors among pregnant women attending antenatal clinics at Bahir Dar City, Northwest Ethiopia, 2021: Cross-sectional study. Scientific Reports, 13. https://doi.org/10.1038/s41598-023-34964-5
[10]. Weerasekara, P. C., Withanachchi, C. R., Ginigaddara, G. A. S., Ploeger, A., 2020, Understanding Dietary Diversity, Dietary Practices and Changes in Food Patterns in Marginalised Societies in Sri Lanka. Foods, 9, 1–24. https://doi.org/10.3390/foods9111659
[11]. Gudeta, T. G., Terefe, A. B., Mengistu, G. T., Sori, S. A., 2022, Determinants of Dietary Diversity Practice among Pregnant Women in the Gurage Zone, Southern Ethiopia, 2021: Community-Based Cross-Sectional Study. Obstetrics and Gynecology International, 8086793. https://doi.org/10.1155/2022/8086793
[12]. Tilahun, A. G., Kebede, A. M., 2021, Maternal minimum dietary diversity and associated factors among pregnant women, Southwest Ethiopia, 2021. BMC Nutrition, 7, 1–10. https://doi.org/10.1186/s40795-021-00474-8
[13]. Kebede, A. N., Sahile, A. T., Kelile, B. C., 2022, Dietary Diversity and Associated Factors among Pregnant Women in Addis Ababa, Ethiopia, 2021. International Journal of Public Health, 67, 1–7. https://doi.org/10.3389/ijph.2022.1605377
[14]. Walle, B. M., Adekunle, A. O., Arowojolu, A. O., Dugul, T. T., Mebiratie, A. L., 2022, Low birth weight and its associated factors in East Gojjam Zone, Amhara, Ethiopia. BMC Nutrition, 8, 1–9. https://doi.org/10.1186/s40795-022-00621-9
[15]. Adem, H. A., Usso, A. A., Hebo, H. J., Workicho, A., Ahmed, F., 2023, Determinants of acute undernutrition among pregnant women attending primary healthcare unit in Chinaksen District, Eastern Ethiopia: A case-control study. PeerJ, 11, e15416. https://doi.org/10.7717/peerj.15416
[16]. Hidru, H. D., Berwo Mengesha, M., Hailesilassie, Y., Tekulu Welay, F., 2020, Burden and Determinant of Inadequate Dietary Diversity among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis. Journal of Nutrition and Metabolism, 2020, 1–10. https://doi.org/10.1155/2020/1272393
[17]. Makarem, N., Chau, K., Miller, E. C., Gyamfi-Bannerman, C., Tous, I., Booker, W., Catov, J. M., Haas, D. M., et al., 2022, Association of a Mediterranean Diet Pattern with Adverse Pregnancy Outcomes among US Women. JAMA Network Open, 5, e2248165. https://doi.org/10.1001/jamanetworkopen.2022.48165
[18]. Parikh, N. I., Gonzalez, J. M., Anderson, C. A. M., Judd, S. E., Rexrode, K. M., Hlatky, M. A., Gunderson, E. P., Stuart, J. J., Vaidya, D., 2021, Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women. Circulation, 143, e902–e916. https://doi.org/10.1161/CIR.0000000000000961
[19]. Perry, A., Stephanou, A., Rayman, M. P., 2022, Dietary factors that affect the risk of pre-eclampsia. BMJ Nutrition, Prevention and Health, 5, e000399. https://doi.org/10.1136/bmjnph-2021-000399
[20]. da Silva Lopes, K., Yamaji, N., Rahman, M. O., Suto, M., Takemoto, Y., Garcia-Casal, M. N., Ota, E., 2021, Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: An overview of systematic reviews. Cochrane Database of Systematic Reviews, CD013092. https://doi.org/10.1002/14651858.CD013092.pub2.
[21]. Akowuah, J. A., Owusu-Addo, E., Opuni, A. A., 2022, Predictors of Anaemia Prevalence among Ghanaian Pregnant Women: A Cross-Sectional Study. INQUIRY: The Journal of Health Care, 59, 1–8. https://doi.org/10.1177/00469580221086919
[22]. Abu-Saad, K., Kaufman-Shriqui, V., Freedman, L. S., Belmaker, I., Fraser, D., 2021, Preconceptional diet quality is associated with birth outcomes among low socioeconomic status minority women in a high-income country. European Journal of Nutrition, 60, 65–77. https://doi.org/10.1007/s00394-020-02221-4
[23]. Raut, A. K., Hiwale, K. M., 2022, Iron Deficiency Anemia in Pregnancy. Cureus, 14, e28918. https://doi.org/10.7759/cureus.28918
[24]. Walle, B. M., Adekunle, A. O., Arowojolu, A. O., Dugul, T. T., Mebiratie, A. L., 2020, Micronutrients Deficiency and Their Associations with Pregnancy Outcomes: A Review. Nutrition and Dietary Supplements, 12, 237–254. https://doi.org/10.2147/nds.s274646
[25]. Karakochuk, C. D., Zimmermann, M. B., Moretti, D., Kraemer, K., 2023, Nutrition and health: Nutritional anemia, in: Nutrition and Health Series. Springer Nature Switzerland AG, Cham, Switzerland. https://doi.org/10.1021/ie50204a022
[26]. Ethiopian Public Health Institute, 2022, Ethiopia: Food-Based Dietary Guidelines–2022. Federal Democratic Republic of Ethiopia Ministry of Health, Addis Ababa, Ethiopia.
[27]. Central Statistical Agency of Ethiopia, 2008, Summary and Statistical Report of the 2007 Population and Housing Census: Population Size by Age and Sex. Federal Democratic Republic of Ethiopia Population Census Commission, Addis Ababa, Ethiopia.
[28]. Teferi, T., Endalk, G., Ayenew, G. M., Fentahun, N., 2023, Inadequate dietary diversity practices and associated factors among postpartum mothers in Gambella town, Southwest Ethiopia. Scientific Reports, 13. https://doi.org/10.1038/s41598-023-29962-6
[29]. Smits, J., Steendijk, R., 2013, The International Wealth Index (IWI), Nijmegen Center for Economics. Netherlands.
[30]. World Health Organization, 2022, WHO antenatal care recommendations for a positive pregnancy experience. Maternal and fetal assessment update: Imaging ultrasound before 24 weeks of pregnancy. World Health Organization, Geneva.
[31]. Coates, J., Swindale, A., Bilinsky, P., 2007, Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide (v. 3). Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, DC. https://doi.org/10.1017/CBO9781107415324.004
[32]. Takagi, K., Nakamoto, O., Watanabe, K., Tanaka, K., Matsubara, K., 2022, A Review of the Best Practice Guide 2021 for the Diagnosis and Management of Hypertensive Disorders of Pregnancy (HDP). Hypertension Research in Pregnancy, 10, Takagi K. https://doi.org/10.14390/jsshp.10.57
[33]. Federal Ministry of Health of Ethiopia, 2020, Management Protocol on Selected Obstetrics Topics for Hospitals. Federal Democratic Republic of Ethiopia Ministry of Health, Addis Ababa, Ethiopia.
[34]. Islam, H., Nayan, M., Jubayer, A., Amin, R., 2024, A review of the dietary diversity and micronutrient adequacy among the women of reproductive age in low- and middle-income countries. Food Science and Nutrition, 12, 1367–1379. https://doi.org/10.1002/fsn3.3855
[35]. Demilew, Y. M., Alene, G. D., Belachew, T., 2020, Effect of guided counseling on dietary practices of pregnant women in West Gojjam Zone, Ethiopia. PLoS ONE, 15, e0233429. https://doi.org/10.1371/journal.pone.0233429
[36]. Anyanwu, O., Ghosh, S., Kershaw, M., Abuye, C., Kennedy, E., 2022, The Role of Household Assets in Improving Women’s Dietary Diversity in Ethiopia. Current Developments in Nutrition, 6, nzab131. https://doi.org/10.1093/cdn/nzab131
[37]. Le, H. N., Nguyen, K. V., Phung, H., Hoang, N. T. D., Tran, D. T., Mwanri, L., 2023, Household Dietary Diversity among the Ethnic Minority Groups in the Mekong Delta: Evidence for the Development of Public Health and Nutrition Policy in Vietnam. International Journal of Environmental Research and Public Health, 20. https://doi.org/10.3390/ijerph20020932
[38]. O’Hara, C., Gibney, E. R., 2021, Meal Pattern Analysis in Nutritional Science: Recent Methods and Findings. Advances in Nutrition, 12, 1365–1378. https://doi.org/10.1093/advances/nmaa175
[39]. Asim, M., Ahmed, Z. H., Nichols, A. R., Rickman, R., Neiterman, E., Mahmood, A., Widen, E. M., 2021, What stops us from eating : A qualitative investigation of dietary barriers during pregnancy in Punjab, Pakistan. Public Health Nutrition, 25, 760–769. https://doi.org/10.1017/S1368980021001737
[40]. Wallin, A. R., Tielsch, J. M., Khatry, S. K., Mullany, L. C., Englund, J. A., Chu, H., Leclerq, S. C., Katz, J., 2020, Nausea, vomiting, and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: An observational cohort study. BMC Pregnancy and Childbirth, 20, 1–12. https://doi.org/10.1186/s12884-020-03141-1
Viewed PDF 138 5 -
Effect of an Educational Intervention on Menstrual Hygiene Knowledge and associated determinants among Female University Students in UgandaAuthor: Josephine NamyaloDOI: 10.21522/TIJPH.2013.14.01.Art022
Effect of an Educational Intervention on Menstrual Hygiene Knowledge and associated determinants among Female University Students in Uganda
Abstract:
Menstrual hygiene management is an important public health concern among young women, but there is a paucity of evidence on theory-based interventions at the university level. This study aimed at determining the effect of an educational Intervention on menstrual hygiene knowledge and associated determinants among female university students in Uganda. A quasi-experimental design based on Social Cognitive Theory and Health Promotion Model was used between October-December, 2025. We surveyed 436 participants from Campus A (Intervention group) and Campus B (Control Group). Propensity Score Matching, Difference-in-Differences approach and logistic regression analysis were done. The statistical significance level was p < 0.05. A theory-based educational intervention significantly enhanced knowledge and reduced sociocultural barriers. Campus A students displayed a significant improvement in their knowledge (baseline: 5.61 +- 0.99; endline: 6.00 +- 0.91; DiD = 0.807, p < 0.001) and less sociocultural barriers (DiD = 0.422, p = 0.001). While the hygiene practices of menstruation were better in both groups, the extra impact of the intervention on practices was not significant (DiD = 0.000, p = 1.000). The translation of knowledge into practice was not significant implying that there might be other interventions needed in addition to the educational intervention. Findings imply that education is necessary but not sufficient for changing menstrual hygiene practices among the study participants.
Effect of an Educational Intervention on Menstrual Hygiene Knowledge and associated determinants among Female University Students in Uganda
References:
[1]. Adane, Y., Ambelu, A., Yenesew, M. A., Mekonnen, Y., Kassahun, T., 2025, Effect of menstruation on school attendance of girls along with water, sanitation, and hygiene services in Northwest Ethiopia. Pan Afr Med J, 50:28, https://doi.org/10.11604/pamj.2025.50.28.45413
[2]. Anbesu, E. W., Asgedom, D. K., 2023, Menstrual hygiene practice and associated factors among adolescent girls in sub-Saharan Africa: A systematic review and meta-analysis. BMC Public Health, 23(1):33, https://doi.org/10.1186/s12889-022-14942-8
[3]. Worku, Y., Kassa, G. M., Mekonen, B., Desta, M., Bishaw, K. A., Gedfaw, M., Tesfaw, E., Degu, G., Shiferaw, A., 2024, Menstrual hygiene management practice and associated factors among high school and preparatory school adolescent students in Debre Markos town, Northwest Ethiopia: A mixed-method study. BMC Women's Health, 24(1):420, https://doi.org/10.1186/s12905-024-03265-y
[4]. Harerimana, A., Mchunu, G., Pillay, J. D., 2025, Menstrual hygiene management among girls and women refugees in Africa: A scoping review. Conflict and Health, 19(1):20, https://doi.org/10.1186/s13031-025-00657-1
[5]. Asumah, M. N., Abubakari, A., Aninanya, G. A., Salisu, W. J., 2022, Perceived factors influencing menstrual hygiene management among adolescent girls: A qualitative study in the West Gonja Municipality of the Savannah Region, Ghana. Pan Afr Med J, 41:146, https://doi.org/10.11604/pamj.2022.41.146.33492
[6]. Ayele, A., G/Mariam, M., Beyene, H., Tolcha, A., Tediso, D., Shalamo, T., Belayneh, T., 2025, Menstrual hygiene practice and associated factors among adolescent primary school females in Dale Woreda, Sidama, Ethiopia: A cross-sectional study. Front Reprod Health, 7:1458132, https://doi.org/10.3389/frph.2025.1458132
[7]. Tshivule, M. Z., Rasweswe, M. M., Mothiba, T. M., Bopape, M. A., 2025, Factors influencing menstrual hygiene knowledge, attitudes, and practices among adolescent girls in African rural schools: A scoping review. Front Reprod Health, 7:1553101, https://doi.org/10.3389/frph.2025.1553101
[8]. Namuwonge, F., Kizito, S., Ssentumbwe, V., Namatovu, P., Namuli, F., Tutlam, N. T., Nabunya, P., Ssewamala, F. M., 2025, Culture, self-esteem and menstrual hygiene management among adolescent girls in Uganda: The impact of economic and family strengthening. BMC Women's Health, 25(1):230, https://doi.org/10.1186/s12905-025-03778-0
[9]. Dvalishvili, D., Namuwonge, F., Ahmed, R. F., Andom, F., Sensoy Bahar, O., Nabunya, P., Ssewamala, F. M., 2025, School absenteeism during menstruation among adolescent girls in Southern Uganda: A multi-level risk factors analysis. Children and Youth Services Review, 179:108562, https://doi.org/10.1016/j.childyouth.2025.108562
[10]. Kansiime, C., Hytti, L., Nalugya, R., et al., 2020, Menstrual health intervention and school attendance in Uganda (MENISCUS-2): A pilot intervention study. BMJ Open, 10:e031182, https://doi.org/10.1136/bmjopen-2019-031182
[11]. Ameade, E. P., Garti, H. A., 2016, Relationship between female university students’ knowledge on menstruation and their menstrual hygiene practices: A study in Tamale, Ghana. Adv Prev Med, 2016:1056235, https://doi.org/10.1155/2016/1056235
[12]. Sumpter, C., Torondel, B., 2013, A systematic review of the health and social effects of menstrual hygiene management. PLoS One, 8(4):e62004, https://doi.org/10.1371/journal.pone.0062004
[13]. Hennegan, J., Montgomery, P., 2016, Do menstrual hygiene management interventions improve education and psychosocial outcomes for women and girls in low- and middle-income countries? A systematic review. PLoS One, 11(2):e0146985, https://doi.org/10.1371/journal.pone.0146985
[14]. Betsu, B. D., Medhanyie, A. A., Gebrehiwet, T. G., Wall, L. L., 2024, Menstrual hygiene management interventions and their effects on schoolgirls’ menstrual hygiene experiences in low- and middle-income countries: A systematic review. PLoS One, 19(8):e0302523, https://doi.org/10.1371/journal.pone.0302523.
[15]. Hennegan, J., Brooks, D. J., Schwab, K. J., Melendez-Torres, G. J., 2020, Effects and costs of a multi-component menstrual health intervention (MENISCUS) on mental health, educational performance and menstrual health in Ugandan secondary schools: Theory of change and study protocol. BMJ Open, 10:e031182.
[16]. Bandura, A., 1986, Social foundations of thought and action. Englewood Cliffs, NJ.
[17]. Ssemata, AS., Ndekezi, D., Kansiime, C., Bakanoma, R., Tanton, C., Nelson, KA., et al., 2023, Understanding the social and physical menstrual health environment of secondary schools in Uganda: A qualitative methods study. PLOS Glob Public Health, 3(11):e0002665, https://doi.org/10.1371/journal.pgph.0002665
[18]. Pender, N., 2011, Health promotion model. Burlington, MA: Jones & Bartlett Learning.
[19]. Hennegan, J., Kibira, S. P., Exum, N. G., Schwab, K. J., Makumbi, F. E., Bukenya, J., 2020, ‘I do what a woman should do’: A grounded theory study of women’s menstrual experiences at work in Mukono District, Uganda. BMJ Global Health, 5(11):e003433, https://doi.org/10.1136/bmjgh-2020-003433
[20]. Sommer, M., Caruso, B. A., Torondel, B., Warren, E. C., Yamakoshi, B., Haver, J., Long, J., Mahon, T., Nalinponguit, E., Okwaro, N., Phillips-Howard, P. A., 2021, Menstrual hygiene management in schools: Midway progress update on the “MHM in Ten” 2014–2024 global agenda. Health Res Policy Syst, 19(1):1, https://doi.org/10.1186/s12961-020-00669-8
[21]. UNICEF, 2019, Guidance on menstrual health and hygiene.
[22]. Gomez-Montero, A., Garcia-Lopez, A., Cabas, S., et al., 2026, Methodological guidance on implementing propensity score matching in observational studies of kidney transplantation. Sci Rep, 16:1878, https://doi.org/10.1038/s41598-025-31596-9
[23]. Nakame, R. M., Kiwanuka, F., Robert, A., 2018, Dysmenorrhoea among students aged 18–45 years attending university in Uganda: A cross-sectional multicenter study of three universities in Uganda. Nurs Open, 6(2):268–275, https://doi.org/10.1002/nop2.207
[24]. Ghimire, S., Gahatraj, N. R., Shrestha, N., Manandhar, S., Dhital, S. R., 2024, Effects of health education intervention on menstrual hygiene knowledge and practices among adolescent girls of Pokhara Metropolitan, Nepal. PLoS One, 19(9):e0291884, https://doi.org/10.1371/journal.pone.0291884
[25]. Dahal, A., Acharya, K. P., 2019, Effectiveness of information education and communication on menstrual hygiene among adolescent school girls of Jumla District. J Nobel Med Coll, 8(2):4–9, https://doi.org/10.3126/jonmc.v8i2.26714
[26]. Dorle, A. S., Gavel, S., Mannapur, B. S., 2019, Impact of health education on knowledge and practices about menstruation among college-going adolescent girls. Medica Innovatica, 8:21–25.
[27]. Johnson, E., Seed, L., Biju, A., Tulinius, C., 2025, Experiences, perceptions and barriers to use of reusable menstrual products among university students globally: A systematic review. BMJ Open, 15(8):e103159, https://doi.org/10.1136/bmjopen-2025-103159
[28]. Appiah-Agyekum, N. N., Nyamekye, M. A., Agbenu, I. A., Otoo, D. D., 2025, Menstrual hygiene knowledge and practices among female senior high school students in the New Juaben North Municipality of Ghana: A cross-sectional study. BMC Public Health, 25(1):1563, https://doi.org/10.1186/s12889-025-22836-8.
[29]. Obiageri, C. J., Uwaezu, O. E., Ifeanyi, N. H., 2025, Assessment of menstrual hygiene management practices and societal attitude towards menstruation among female undergraduate students of Federal Polytechnic Nekede Owerri, Imo State. J Obstet Gynecol Reprod Sci, 9(7), https://doi.org/10.31579/2578-8965/281
[30]. Gbogbo, S., Wuresah, I., Gbogbo, E., Axame, W. K., Klutse, P., Dowou, R. K., Mantey, S. O., Ayitey, S. A. Y., Boateng, I., Nelson, P. E., Kugbey, N., 2025, The socio-cultural construction of menstruation in the Ghanaian context: A qualitative study of the perspectives of parents, teachers, and adolescent girls. Int J Environ Res Public Health, 22:349, https://doi.org/10.3390/ijerph22030349
Viewed PDF 126 5 -
Exploring Hand Hygiene Practices for Preventing Influenza Infections among Batswana University Students during the Peak Pandemic PeriodAuthor: Joyce SetlhabiDOI: 10.21522/TIJPH.2013.14.01.Art023
Exploring Hand Hygiene Practices for Preventing Influenza Infections among Batswana University Students during the Peak Pandemic Period
Abstract:
During influenza pandemics, university settings with huge number of students who are highly active and mobile can become serious outbreak centres. As outbreak management is crucial for disease control, the current research aimed to explore hand hygiene practices to prevent influenza infections among Batswana university students during the peak of the pandemic. A quantitative, cross-sectional study was performed by collecting data from 200 Batswana university students during peak influenza season. Data was analysed using descriptive statistics. The findings showed significant insights on hand hygiene knowledge, attitudes, behaviours and practices of Batswana university students towards preventing influenza infection. The study demonstrates that Batswana university students hold strong positive attitudes, mixed levels of knowledge and compliant behaviours regarding hand hygiene for influenza prevention. The narrowing knowledge–practice gap and resourceful use of soap, water, sanitisers and wipes indicated effective internalisation of technical guidance while low adherence to the 20-second handwashing rule underscored the need for health educational campaigns. Findings also indicated that relying on self-reports, lower confidence in biomedical interventions and persistent structural barriers (costs, facilities, forgetfulness) signals ongoing vulnerabilities. Future research should incorporate objective behavioural or clinical measures, qualitative exploration of vaccine and mask hesitancy, and intervention trials that integrate behavioural practices with improved infrastructural support to ensure effective prevention of influenza.
Exploring Hand Hygiene Practices for Preventing Influenza Infections among Batswana University Students during the Peak Pandemic Period
References:
[1]. Hong, Q., & Xu, Y., 2024, Evaluating hand hygiene knowledge, attitudes, and practices among healthcare workers in post-pandemic H1N1 influenza control: a cross-sectional study from China. Frontiers in Public Health, 12, 1432445. https://doi.org/10.3389/fpubh.2024.1432445
[2]. Yang, X., Tang, W., Tan, Q., Mao, D., & Ding, X., 2022, The vaccine hesitancy profiles and determinants of seasonal influenza among Chinese community healthcare workers: a cross-sectional study. Vaccine, 10, 1547. Doi: 10.3390/vaccines10091547
[3]. Akan, H., Gurol, Y., Izbirak, G., Ozdatlı, S., Yilmaz, G., Vitrinel, A., & Hayran, O., 2010, Knowledge and attitudes of university students toward pandemic influenza: a cross-sectional study from Turkey. BMC Public health, 10(1), 413.
[4]. Seloilwe, E. S., Kealeboga, K. M., & Khutjwe, J. V., 2023, A coordinated health policy in response to COVID-19: A case of Botswana. Journal of nursing scholarship: an official publication of Sigma Theta Tau International Honour Society of Nursing, 55(1), 163–166. https://doi.org/10.1111/jnu.12821
[5]. Gozdzielewska, L., Kilpatrick, C., Reilly, J., Stewart S., Butcher, J., & Price, L., 2022, The effectiveness of hand hygiene interventions for preventing community transmission or acquisition of novel coronavirus or influenza infections: a systematic review. BMC Public Health, 22, 1283. https://doi.org/10.1186/s12889-022-13667-y
[6]. Vogel, O. A., & Manicassamy, B., 2020, Broadly protective strategies against influenza viruses: universal vaccines and therapeutics. Frontiers Microbiology, 11, 517828. doi: 10.3389/fmicb.2020.00135
[7]. Fulchini, R., Kohler, P., Kahlert, C. R., Albrich, W. C., Kuhn, R., Hoffmann, M., & Schlegel, M., 2018, Hand hygiene adherence in relation to influenza season during 6 consecutive years. American journal of infection control, 46(11), 1311-1317.doi: 10.1016/j.ajic.2018.04.203
[8]. Neo, J. R. J., Sagha-Zadeh, R., Vielemeyer, O., & Franklin, E., 2016, Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review. American Journal of Infection Control, 44(6), 691-704.
[9]. Jo, S., Han, S. Y., & Howe, N., 2023, Factors associated with handwashing behaviours during the COVID-19 pandemic: an analysis of the community health survey in Korea. SAGE open nursing. 9, 23779608231172364. Doi: 10.1177/23779608231172364
[10]. Park, J. H., Cheong, H. K., Son, D. Y., Kim, S. U., & Ha, C. M., 2010, Perceptions and behaviours related to hand hygiene for the prevention of H1N1 influenza transmission among Korean university students during the peak pandemic period. BMC infectious diseases, 10, 222. https://doi.org/10.1186/1471-2334-10-222
[11]. Aiello, A. E., Murray, G. F., Perez, V., Coulborn, R. M., Davis, B. M., Uddin, M., & Monto, A. S., 2010, Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial. The Journal of infectious diseases, 201(4), 491-498. doi: 10.1086/650396.
[12]. Moncion, K., Young, K., Tunis, M., Rempel, S., Stirling, R., & Zhao, L., 2019, Effectiveness of hand hygiene practices in preventing influenza virus infection in the community setting: A systematic review. Canada communicable disease report, 45(1), 12–23. https://doi.org/10.14745/ccdr.v45i01a02
[13]. Patient Info, 2024, Botswana: Travel health advice, vaccines and risks. Retrieved from https://patient.info/travel-and-vaccinations/botswana
[14]. Xinhua, 2024, Botswana reports increase in cases of influenza-like illness, COVID-19. Retrieved from https://english.news.cn/africa/20240222/97fedec7a1594472a5a33b327de782f7/c.html
[15]. Suess, T., Remschmidt, C., Schink, S. B., Schweiger, B., Nitsche, A., Schroeder, K., & Buchholz, U., 2012, The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011. BMC infectious diseases, 12(1), 26. https://doi.org/10.1186/1471-2334-12-26
[16]. Bruce, N., Pope, D., & Stanistreet, D., 2018, Quantitative methods for health research: a practical interactive guide to epidemiology and statistics. John Wiley & Sons.
[17]. Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A., 2021, Qualitative methods in health care research. International journal of preventive medicine, 12(1), 20.
[18]. Hunziker, S., & Blankenagel, M., 2024, Cross-sectional research design. In Research design in business and management: A practical guide for students and researchers (pp. 187-199). Wiesbaden: Springer Fachmedien Wiesbaden.
[19]. Spector, P. E., 2019, Do not cross me: Optimizing the use of cross-sectional designs. Journal of business and psychology, 34(2), 125-137.
[20]. University of Botswana. 2025, Annual Report 2023/24. Retrieved from https://www.ub.bw/sites/default/files/2025-04/UB-Annual-Report-202324-17042025.pdf
[21]. Golzar, J., Noor, S. & Tajik, O., 2022, Convenience sampling. International Journal of Education & Language Studies, 1(2), 72-77.
[22]. Etikan, I., Musa, S. A., & Alkassim, R. S., 2016, Comparison of convenience sampling and purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
[23]. Saunders, M. N. K., Lewis, P., & Thornhill, A., 2019, Research methods for Business students. 8th edition. Harlow: Pearson
[24]. Saris, W. E., & Gallhofer, I. N., 2014, Design, evaluation, and analysis of questionnaires for survey research. John Wiley & Sons.
[25]. Bulanov, N. M., Suvorov, A. Y., Blyuss, O. B., Munblit, D. B., Butnaru, D. V., Nadinskaia, M. Y., & Zaikin, A. A., 2021, Basic principles of descriptive statistics in medical research. Сеченовский вестник, 12(3), 4-16.
[26]. Hazra, A., 2023, Descriptive and inferential statistics in biomedical sciences: An overview. The quintessence of basic and clinical research and scientific publishing, 461-478.
[27]. Keeler, C., & Curtis, A.C., 2024, Descriptive and Inferential Statistics in Nursing Research. AJN The American Journal of Nursing, 124(1), 48-52.
[28]. Drolet, M. J., Rose-Derouin, E., Leblanc, J. C., Ruest, M., & Williams-Jones, B. 2023, Ethical issues in research: Perceptions of researchers, research ethics board members and research ethics experts. Journal of Academic Ethics, 21(2), 269-292.
[29]. Adeyinka, T., & Mutula, S. M., 2008, Gender differences in computer literacy among undergraduate students at the University of Botswana: Implications for library use. Malaysian Journal of Library and Information Science, 13(1), 59-76.
[30]. Mohamed, Y. S., Spaska, A., Andrade, G., Baraka, M. A., Ahmad, H., Steele, S., . & Panigrahi, D., 2024, Hand hygiene knowledge, attitude, and practice before, during and post COVID-19: a cross-sectional study among university students in the United Arab Emirates. Infection Prevention in Practice, 6(2), 100361. DOI: 10.1016/j.infpip.2024.100361
[31]. Bernard, L., Biron, A., Lavigne, G., Frechette, J., Bernard, A., Mitchell, J., & Lavoie‐Tremblay, M., 2018, An exploratory study of safety culture, biological risk management and hand hygiene of healthcare professionals. Journal of advanced nursing, 74(4), 827-837.
[32]. Dlalisa, S., Jama, S., Duma, N., Mnguni, G., & Pillay, T., 2025, Exploring the knowledge, attitudes and practices of students at Mangosuthu University of Technology on hand hygiene. Student’s Journal of Health Research Africa, 6(10), 1. https://doi.org/10.51168/sjhrafrica.v6i10.2127
[33]. Fudolig, M. A., Davis, R. E., Batra, K., & Sharma, M., 2025, Profile Analysis of Handwashing Behavior Among a Sample of College Students in the Multi-Theory Model Framework. Hygiene, 5(1), 7. https://doi.org/10.3390/hygiene5010007
[34]. Green, E. C., Murphy, E. M., & Gryboski, K., 2020, The health belief model. The Wiley encyclopedia of health psychology, 211-214.
[35]. Silago, V., Manzi, M. J., Mtemisika, C. I., Damiano, P., Mirambo, M. M., & Mushi, M. F., 2022, Knowledge, attitude and practices of hand hygiene among students and nurses staff in Mwanza Tanzania: a cross-sectional hospital-based study during global COVID-19 pandemic. East Africa Science, 4(1), 11-20.
[36]. Sultana, M., Mahumud, R. A., Sarker, A. R., & Hossain, S. M., 2016, Hand hygiene knowledge and practice among university students: evidence from private universities of Bangladesh. Risk management and healthcare policy, 13-20.
[37]. CDC, 2024, Hand Sanitizer Facts. Retrieved from https://www.cdc.gov/clean-hands/data-research/facts-stats/hand-sanitizer-facts.html?utm_source=chatgpt.com
[38]. Ahmed, J., & Ali, D., 2019, Assessment of knowledge, attitude and practices regarding H1N1 pandemic influenza among the health care providers working at a tertiary care hospital in Kashmir: a cross sectional study. International Journal of Advanced Community Medicine, 2(2), 23-27. DOI: https://doi.org/10.33545/comed.2019.v2.i2a.05
[39]. Wong, V. W. Y., Cowling, B. J., & Aiello, A. E., 2014, Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis. Epidemiology and Infection, 142(5), 922-932. doi:10.1017/S095026881400003X
Viewed PDF 145 3 -
Mismatch Between Perceived and Objective HIV Risk Among Individuals Discontinuing PrEP in Homa Bay and Kisii Counties, KenyaAuthor: Muchele Polycarp MuseeDOI: 10.21522/TIJPH.2013.14.01.Art024
Mismatch Between Perceived and Objective HIV Risk Among Individuals Discontinuing PrEP in Homa Bay and Kisii Counties, Kenya
Abstract:
Pre-exposure prophylaxis (PrEP) is highly effective HIV prevention strategy, yet discontinuation may leave individuals vulnerable. Guided by the Health Belief Model, this study examined whether perceived reductions in HIV susceptibility among PrEP discontinuers aligned with objectively assessed epidemiological risk in Homa Bay and Kisii Counties. A cross-sectional analytical study was conducted among 293 clients, of whom 175 reported a decreased perceived risk. Participants were selected using proportionate stratified random sampling across population groups. HIV risk was objectively evaluated using NASCOP-Risk Assessment Screening Tool (RAST). Descriptive statistics, chi-square and Fisher’s exact tests, and logistic regression were applied to examine alignment between perceived and actual risk and identify predictors of high-risk status. Marked discrepancies were observed between perceived and objective HIV risk. 91.4% of participants who perceived reduced HIV risk were classified as high or substantial risk by RAST. County-underestimation was 94.7% in Homa Bay and 72.0% in Kisii (p < 0.01). Despite reporting reduced perceived risk, many continued to engage in high-risk behaviors, including multiple sexual partnerships (48.4%), condomless sex (28.6%), prior sexually transmitted infections (18.7%), and low consistent condom use (22.5%). County of residence was the only significant predictor of objective high risk (aOR = 0.15; 95% CI: 0.04–0.58); Age, sex, marital status, education, and income were not independently associated. Substantial mismatch between perceived and actual HIV risk exists among PrEP discontinuers, particularly in high-prevalence settings. Strengthened risk assessment, tailored counseling, psychosocial support, and county-specific interventions are critical to prevent premature discontinuation and maintain HIV prevention gains.
Mismatch Between Perceived and Objective HIV Risk Among Individuals Discontinuing PrEP in Homa Bay and Kisii Counties, Kenya
References:
[1]. World Health Organization, 2023, HIV statistics, globally and by WHO regions, 2023, Global HIV, Hepatitis and Sexually Transmitted Infections Programs. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategicinformation/hiv-data-and-statistics
[2]. Tailor, J., Rodrigues, J., Meade, J., Segal, K., Benjamin Mwakyosi, L., 2022, Correlations between oral Pre-Exposure Prophylaxis (PrEP) initiations and policies that enable the use of PrEP to address HIV globally. PLOS Glob Public Health, 2022 Dec 7;2(12):e0001202, Doi: 10.1371/journal.pgph.0001202.
[3]. Whitfield, T. H., John, S. A., Rendhina, A. J., Grov, C., Parsons J. T., 2018, Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS Behaviour, 2018 Nov;22(11):3566-3575, Doi: 10.1007/s10461-018-2045-1.
[4]. Zhang, J., Li, C., Xu, J., Hu, Z., Rutstein, S. E., & Tucker, J. D., Ong, J. J., Jiang, Y., Geng, W., et al., 2022, Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis. Lancet HIV, 2022 Apr;9(4):e254-e268, Doi: 10.1016/S2352-3018(22)00030-3.
[5]. Stankevitz, K., Grant, H., Lloyd, J., Gomez, G. B., Kripke, K., Torjesen, K., Terris-Prestholt, F., 2020, Oral preexposure prophylaxis continuation,measurementa and reporting. AIDS, 2020 Oct 1;34(12):1801-1811, Doi: 10.1097/QAD.0000000000002598.
[6]. Vanbaelen, T., Rotsaert, A., Jacobs, B. K., Florence, E., Kenyon, C., Vuylsteke, B., Laga, M., Thijs, R., 2022, Why Do HIV Pre-Exposure Prophylaxis Users Discontinue Pre-Exposure Prophylaxis Care? A Mixed Methods Survey in a Pre-Exposure Prophylaxis Clinic in Belgium. AIDS PATIENT CARE and STDs, 2022 Apr;36(4):159-167, Doi: 10.1089/apc.2021.0197.
[7]. Krakower, D., Maloney, K. M., Powell, V. E., Levine, K., Grasso, C., Melbourne, K., Marcus,J,. Mayer Kenneth H, 2019, Patterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care. International AIDS Society, 2019 Feb;22(2):e25250, doi: 10.1002/jia2.25250.
[8]. Marcus, J. L., Hurley, L. B., Hare, C. B., Nguyen, D. P., Phengrasamy, T., Silverberg, M. J., Stoltey, J. E,. Volk Johnathan, E., 2017, Preexposure Prophylaxis for HIV Prevention in a Large Integrated Health Care System: Adherence, Renal Safety, and Discontinuation. Pub Med Central, 540-546, Doi: 10.1097/QAI.0000000000001129.
[9]. Marcus, J. L., Hurley, L. B., Ngoyen, D. P., Silverberge, M. J., Volk Johnathan, E., 2017, Redefining Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis Failures. Clinical Infectious Diseases, 1768 – 1769, Doi: 10.1093/cid/cix593.
[10]. Mboup, A., Behanzin, L., Guedou, F. A., Geraldo, N., Matsetse, E. G., Giguere, L., Aza-Gnandji, M.,et al., 2018, Early antiretroviral therapy and daily pre‐exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: a prospective observational demonstration study. Journal of International AIDS SOciety, 21(11), 21:e25208, https://doi.org/10.1002/jia2.25208
[11]. Koss, C. A., Havlir, D. V., Ayieka, J., Kwarisiima, D., Kabami, J., Chamie, G., Atukunda, M., Mwinike, J., et al., 2021, HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda. PLOS Medicine, 2021 Feb 9;18(2):e1003492, Doi: 10.1371/journal.pmed.1003492, eCollection 2021 Feb.
[12]. Ogolla, M., Nyabiage, O. L., Musingila, P., Gachau, S., Odero, T. M., June, E. O., Ochanda, B., Appolonia, A., Katiku, E., et al., 2023, Uptake and continuation of HIV pre-exposure prophylaxis among women of reproductive age in two health facilities in Kisumu County, Kenya. Journal for International AIDS Society, 023 Mar;26(3):e26069, Doi: 10.1002/jia2.26069.
[13]. Blumenthal, J., Jain, S., Mulvihill, E., Sun, S., Marvin, H., Ellorin, E., Graber, S., Haubrich, R., Morris, S., 2019, Perceived Versus Calculated HIV Risk: Implications for Pre-exposure Prophylaxis Uptake in a Randomized Trial of Men Who Have Sex With Men. J Acquir Immune Defic Synd, 80(2): e23–e29, Doi: 10.1097/QAI.0000000000001888.
[14]. Ongolly, F. K., Dolla, A., Irungu, E. M., Odoyo, J., Wamoni, E., Peebles, K., Mugwanya, K., Mugo, N. R., Bukusi, E. A., Morton, J., Baeten, J. M., O`Malley, G., 2022, “I just decided to stop:” Understanding PrEP discontinuation among individuals initiating PrEP in HIV care centers in Kenya. J Acquir Immune Defic Syndr, 2021 May 1;87(1):e150-e158, Doi: 10.1097/QAI.0000000000002625.
[15]. Gilbert, H. N., Wyatt, M. A., Pisarki, E. E., Mumonge, T. R., Heffron, R., Katabira, E. T., Celum, C. L., Baeten, J. M., Haberer, J. E., Ware Norman, C., 2019, PrEP Discontinuation and Prevention-Effective Adherence: Experiences of PrEP Users in Ugandan HIV Serodiscordant couples. Journal Acquired Immune Deficiency Syndrom, 2019 Nov 1;82(3):265-274, Doi: 10.1097/QAI.0000000000002139.
[16]. Anyasi, H., Idemudia, A., Badru, T., Onyegbule, S., Isang, E., Sanwo, O., Pandey, S.R., Chiegil, R.,et al., 2024, Discontinuation of HIV oral pre-exposure prophylaxis: findings from programmatic surveillance within two general population HIV programs in Nigeria. BMC Public Health. 2024 May 16;24(1):1325, Doi: 10.1186/s12889-024-18808-z.
[17]. Dzenga, T., Moyo, E., Moyo, P., Kamangu, J., Dzinamarira, T., 2023, Factors influencing the retention of clients in oral pre-exposure prophylaxis (PrEP) care at 3 months after initiation in the Omusati region of Namibia. International Journal of Africa Nursing Sciences, Volume 19, 2023, 100623, https://doi.org/10.1016/j.ijans.2023.100623
[18]. Herns, S., Panwala, R., Pfeil, A., Sardinho, M., Rossi, V., Blumenthal, J., & Hill, L., 2023, Predictors of PrEP retention in at risk patients seen at a HIV primary care clinic in San Diego. International Journal of STD and AIDS, 785–790, 2023 Oct;34(11):785-790, Doi: 10.1177/09564624231179276.
[19]. Garofoli, M., Siguier, M., Robineau, O., Valette, M., Phung, B., Bachelard, A., Rioux, C., Gac, S.L., Digumber, M., Pialoux, G., Ghosn, J., Champenois, K., 2024, Incidence and factors associated with PrEP discontinuation in France. Journal of Antimicrobial Chemotherapy, 2024 Jul 1;79(7):1555-1563, Doi: 10.1093/jac/dkae133.
[20]. Shover, C. L., Shoptaw, S., Javanbakhat, M., Lee, S. J., Bolan, R. K., Cunningham, N. J., Beymer, M., DeVost, M. A., Gorbach Pamina, M., 2020, Mind the Gaps: Prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California. PubMed Central, 2730 - 2740. Doi: 10.1007/s10461-019-02493.
Viewed PDF 236 26 -
Epidemiologic Trends and Determinants of Advanced HIV Disease among People Living with HIV in Zimbabwe (2017-2024): Evidence to Inform an Optimisation FrameworkAuthor: Sandra ChipukaDOI: 10.21522/TIJPH.2013.14.01.Art025
Epidemiologic Trends and Determinants of Advanced HIV Disease among People Living with HIV in Zimbabwe (2017-2024): Evidence to Inform an Optimisation Framework
Abstract:
Advanced HIV Disease (AHD) remains a leading cause of morbidity and mortality among people living with HIV (PLHIV) despite widespread antiretroviral therapy (ART) coverage. This study analysed epidemiologic trends and facility-level determinants of AHD in Zimbabwe to inform targeted programme optimisation strategies. A retrospective analysis of routine District Health Information System 2 (DHIS2) data was conducted across 16 health facilities in Harare and Mashonaland East from 2017 to 2024. AHD was defined in accordance with contemporaneous World Health Organization guidelines, and analyses included descriptive statistics, temporal trend assessment, geographic comparisons, correlation, and multivariable regression. Among 495,166 PLHIV on ART, 4,169 AHD cases were identified. AHD prevalence followed a U-shaped trend, declining from 20.31% in 2017 to 2.20% in 2020, before rising to 16.12% in 2024, reflecting programmatic shifts and COVID-19 disruptions. Rural Mashonaland East recorded significantly higher prevalence than urban Harare (16.53% vs. 9.71%, p=0.002). Facility-level variation was substantial (0.56%–40.23%), with district hospitals bearing a disproportionate burden (β = 15.24, p = 0.001). AHD was positively associated with cryptococcal meningitis (r = 0.419, p = 0.003) and mortality (r = 0.385, p = 0.007), while loss to follow-up was not strongly correlated. Despite strong retention outcomes, persistent challenges in early diagnosis and AHD identification remain. Geographic and facility-level inequities underscore the need for differentiated, equity-focused interventions. Strengthening decentralised screening, particularly for opportunistic infections such as cryptococcal disease and tuberculosis, is essential to reduce preventable mortality and improve clinical outcomes.
Epidemiologic Trends and Determinants of Advanced HIV Disease among People Living with HIV in Zimbabwe (2017-2024): Evidence to Inform an Optimisation Framework
References:
[1]. Ahmed, A., Desta, A., Gebremedhin, T., 2023, Late presentation for HIV care in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Global Health, 8(1), e010481.
[2]. Geng, E. H., Odeny, T. A., Lyamuya, R., Holmes, C. B., 2021, Retention in care and patient-reported reasons for undocumented transfer or stopping care among HIV-infected patients on antiretroviral therapy in Eastern Africa: Application of a sampling-based approach. Clinical Infectious Diseases, 72(Suppl 1), S1–S8.
[3]. Gonese, E., Dzangare, J., Takarinda, K. C., et al., 2020, High HIV prevalence and incidence inequalities amongst key populations in Zimbabwe: a case for differentiated service delivery. Journal of the International AIDS Society, 23(Suppl 1), e25506.
[4]. Hatzold, K., Ahmed, N., Gudukeya, S., 2022, Impact of COVID-19 on HIV service delivery: lessons from Zimbabwe. The Lancet HIV, 9(1), e2–e3.
[5]. Huerga, H., Rucker, S., Cossa, L., et al., 2022, Advanced HIV disease at presentation to care in Mozambique and Zimbabwe: A cross-sectional study. PLOS Global Public Health, 2(1), e0000105.
[6]. ICAP, 2023, Differentiated Service Delivery for HIV Treatment: A Toolkit for Implementation. Columbia University Mailman School of Public Health.
[7]. Jewell, B. L., Mudimu, E., Stover, J., et al., 2020, Potential effects of disruption to HIV programs in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. The Lancet HIV, 7(9), e629–e640.
[8]. Kerkhoff, A. D., Barr, D. A., Schutz, C., et al., 2023, Disseminated tuberculosis among hospitalised HIV patients in South Africa: a common condition that can be rapidly diagnosed using urine-based assays. Scientific Reports, 13, 112.
[9]. Larson, B. A., Schnippel, K., Ndibongo, B., et al., 2022, Rapid point-of-care CD4 testing at mobile units and linkage to HIV care: an evaluation of community-based mobile HIV testing in South Africa. AIDS Research and Therapy, 19(1), 1.
[10]. Mee, P., Rice, B., Duda, S., et al., 2022, Advanced HIV disease in the antiretroviral therapy era: a review. Current Opinion in HIV and AIDS, 17(3), 145–152.
[11]. Moyo, C., Chikwanha, T. M., Moyo, F., 2021, Use of routine health data in low- and middle-income countries: a review of current literature and future directions. Health Policy and Planning, 36(Supplement_1), i1–i4.
[12]. Mukwenha, S., Dzinamarira, T., Musuka, G., 2022, Impact of multi-month dispensing on HIV treatment outcomes in Zimbabwe. AIDS Research and Therapy, 19(1), 55.
[13]. Mungati, M., Dube, S., Mugurungi, O., et al., 2021, Geospatial heterogeneity of HIV and associated factors in Zimbabwe: a nationwide population-based study. BMJ Open, 11(12), e055312.
[14]. Mutevedzi, P. C., Lessells, R. J., Rodger, A. J., et al., 2020, Association of age with mortality and virological and immunological response to antiretroviral therapy in rural South African adults. PLOS ONE, 15(7), e0234789.
[15]. Phillips, A. N., Bansi-Matharu, L., Cambiano, V., 2023, The potential impact of emerging technologies in the management of advanced HIV disease. Current Opinion in HIV and AIDS, 18(2), 87–94.
[16]. Shamu, S., Farirai, T., Slabbert, J., et al., 2021, Socio-economic and demographic factors associated with late HIV diagnosis in rural South Africa. Southern African Journal of HIV Medicine, 22(1), 1198.
[17]. Takarinda, K. C., Harries, A. D., Shiraishi, R. W., et al., 2020, Gender-related differences in outcomes and attrition on antiretroviral therapy among an HIV-infected patient cohort in Zimbabwe: 2007–2010. International Journal of Infectious Diseases, 90, 34–41.
[18]. Tenforde, M. W., Mokomane, M., Leeme, T., et al., 2022, Advanced HIV disease in Botswana following successful antiretroviral therapy rollout: incidence of and temporal trends in cryptococcal meningitis. Clinical Infectious Diseases, 74(Suppl 2), S172–S179.
[19]. World Health Organization, 2021, Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. World Health Organization. https://www.who.int/publications/i/item/9789241550062
Viewed PDF 150 7 -
The Impact of Removing User Fees on Maternal and Child Health Services: A Systematic Review of Quasi-Experimental StudiesAuthor: Peter Kofi TaadiDOI: 10.21522/TIJPH.2013.14.01.Art026
The Impact of Removing User Fees on Maternal and Child Health Services: A Systematic Review of Quasi-Experimental Studies
Abstract:
User fee removal is emerging as a leading strategy to expand access to financial services for maternal and child health (MCH) services. However, whether such policies improve downstream outcomes or equity remains unclear. We conducted a systematic review of quasi-experimental studies evaluating the effects of user fee removal on the MCH continuum of care, mortality outcomes, and equity, guided by PRISMA and an original conceptual framework linking financial barriers to service use, quality, system readiness, and health outcomes. We searched PubMed and Web of Science in August 2025 for studies that used experimental or quasi-experimental designs evaluating user fee removal. Of the 933 records screened, 14 studies met the inclusion criteria; all were quasi-experimental. Narrative synthesis followed SWiM (Systematic Review Without Meta-analysis) guidelines due to heterogeneity, and risk of bias was assessed using ROBINS-I. Free health care policies consistently improved access to antenatal care, facility-based delivery, and skilled birth attendance. Effects on postnatal care and caesarean section were mixed. These improvements did not correspond to significant reductions in maternal mortality, stillbirths, or neonatal mortality. Removing user fees had no immediate effect on the initiation of early antenatal care but showed long-term gains. Some policies closed equity gaps while some unintentionally widened health disparities. Removing user fees significantly increased MCH utilisation, with limited or inconsistent effects on mortality and equity. Our framework clarifies how fee removal brings both benefits and system pressures. Future research should address quality and system readiness to achieve equitable outcomes.
The Impact of Removing User Fees on Maternal and Child Health Services: A Systematic Review of Quasi-Experimental Studies
References:
[1]. World Health Organization (WHO), & United Nations Children’s Fund (UNICEF), 1987, The Bamako Initiative. WHO/UNICEF. Accessed 10/12/2025. https://iris.who.int/server/api/core/bitstreams/93249aa1-5eac-409d-8f0d-c4fcc70fc5f3/content
[2]. World Bank, 1987, Financing Health Services in Developing Countries: An agenda for reform. Washington, DC: The World Bank. Accessed 10/12/2025. https://documents1.worldbank.org/curated/en/468091468137379607/pdf/multi-page.pdf
[3]. Lagarde, M., & Palmer, N., 2011, The impact of user fees on access to health services in low‐ and middle‐income countries. Cochrane Database of Systematic Reviews, 2011(4).
[4]. OkedoAlex, I. N., Akamike, I. C., Ezeanosike, O., & Uneke, C. J., 2019, Determinants of antenatal care utilisation in sub-Saharan Africa: A systematic review. BMJ Open.
[5]. Banke-Thomas, A., Ayomoh, F. I., Abejirinde, I. O., Banke-Thomas, O., Eboreime, E., & Ameh, C., 2020, Cost of utilizing maternal health services in low- and middle-income countries: A systematic review. International Journal of Health Policy and Management, 9(9), 409–420.
[6]. Sardan, J. O. D., & Ridde, V., 2015, Diagnosis of a public policy: An introduction to user fee exemptions for healthcare in the Sahel. BMC Health Services Research.
[7]. Dzakpasu, S., Powell-Jackson, T., & Campbell, O. M., 2014, Impact of user fees on maternal health service utilization and related health outcomes: A systematic review. Health Policy and Planning, 29(2), 137–150.
[8]. Andersen, R. M., 1995, Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.
[9]. Donabedian, A., 1988, The quality of care—How can it be assessed? JAMA, 260(12), 1743–1748.
[10]. World Health Organization, 2010. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva, Switzerland: WHO.
[11]. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T., Mulrow, C. D., ... & Moher, D., 2020, Mapping of reporting guidance for systematic reviews and meta-analyses generated a comprehensive item bank for future reporting guidelines. Journal of Clinical Epidemiology, 118, 60–68.
[12]. Qin, V. M., Hone, T., Millett, C., Moreno-Serra, R., McPake, B., Atun, R., & Lee, J. T., 2019, The impact of user charges on health outcomes in low-income and middle-income countries: A systematic review. BMJ Global Health, 3(Suppl 3), e001087.
[13]. Lagarde, M., & Palmer, N., 2008, The impact of user fees on health service utilization in low- and middle-income countries: How strong is the evidence? Bulletin of the World Health Organization, 86(11), 839–848.
[14]. Korachais, C., Macouillard, E., & Meessen, B., 2016, How user fees influence contraception in low- and middle-income countries: A systematic review. Studies in Family Planning, 47(4), 341–356.
[15]. Alfirevic, Z., Keeney, E., Dowswell, T., Welton, N. J., Medley, N., Dias, S., ... & Caldwell, D. M., 2016, Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis. Health Technology Assessment, 20(65).
[16]. Ferede Gebremedhin, A., Dawson, A., & Hayen, A., 2022, Evaluations of effective coverage of maternal and child health services: A systematic review. Health Policy and Planning, 37(7), 895–914.
[17]. Tanahashi, T., 1978, Health service coverage and its evaluation. Bulletin of the World Health Organization, 56(2), 295–303.
[18]. Thaddeus, S., & Maine, D., 1994, Too far to walk: Maternal mortality in context. Social Science & Medicine, 38(8), 1091–1110.
[19]. Sheff, M. C., et al., 2020, Evaluating health service coverage in Ghana’s Volta Region using a modified Tanahashi model. Global Health Action, 13(1), 1732664.
[20]. Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., ... & Higgins, J. P., 2016, ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 355.
[21]. Bigool, M., 2024, Effects of free maternal healthcare on stunting in children under five years of age: Evidence from Ghana. Development Policy Review, 42(4).
[22]. Manthalu, G., Yi, D., Farrar, S., & Nkhoma, D., 2016, The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi. Health Policy and Planning, 31(9), 1184–1192.
[23]. Lang’at, E., Mwanri, L., & Temmerman, M., 2019, Effects of implementing free maternity service policy in Kenya: An interrupted time series analysis. BMC Health Services Research, 19(1), 645.
[24]. Orangi, S., Kairu, A., Malla, L., Ondera, J., Mbuthia, B., Ravishankar, N., & Barasa, E., 2021, Impact of free maternity policies in Kenya: An interrupted time-series analysis. BMJ Global Health, 6(6).
[25]. Owuor, H., & Amolo, A., 2019, Interrupted time series analysis of free maternity services policy in Nyamira County, Western Kenya. PLOS ONE, 14(5).
[26]. Demissie, A., Worku, A., & Berhane, Y., 2020, Effect of implementing a free delivery service policy on women’s utilization of facility-based delivery in Central Ethiopia: An interrupted time series analysis. Journal of Pregnancy, 2020.
[27]. Lagarde, M., Lépine, A., & Chansa, C., 2022, The long-term effects of free care on birth outcomes: Evidence from a national policy reform in Zambia. SSM - Population Health, 17, 101051.
[28]. Aye, T. T., Nguyen, H. T., Petitfour, L., Ridde, V., Amberg, F., Bonnet, E., Seynou, M., Kiendrébéogo, J. A., & De Allegri, M., 2024, How do free healthcare policies impact utilization of maternal and child health services in fragile settings? Evidence from a controlled interrupted time series analysis in Burkina Faso. Health Policy and Planning, 39(9), 891–901.
[29]. Oyugi, B., Nizalova, O., Kendall, S., & Peckham, S., 2024, Does a free maternity policy in Kenya work? Impact and cost-benefit consideration based on demographic health survey data. European Journal of Health Economics, 25(1), 77–89.
[30]. Renard, Y., 2022, From fees to free: User fee removal, maternal health care utilization and child health in Zambia. World Development, 156.
[31]. Gitobu, C., Gichangi, P., & Mwanda, W., 2018, The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities. BMC Pregnancy and Childbirth, 18.
[32]. McKinnon, B., Harper, S., & Kaufman, J. S., 2015, Who benefits from removing user fees for facility-based delivery services? Evidence on socioeconomic differences from Ghana, Senegal and Sierra Leone. Social Science & Medicine, 135, 117–123.
[33]. Hatt, L. E., Makinen, M., Madhavan, S., & Conlon, C. M., 2013, Effects of user fee exemptions on the provision and use of maternal health services: A review of literature. Journal of Health, Population, and Nutrition, 31(4 Suppl 2), S67.
[34]. Tesfaye, G., Loxton, D., Chojenta, C., Semahegn, A., & Smith, R. G., 2017, Delayed initiation of antenatal care and associated factors in Ethiopia: A systematic review and meta-analysis. Reproductive Health.
[35]. Jinga, N., Mongwenyana, C., Moolla, A., Malete, G., & Onoya, D., 2019, Reasons for late presentation for antenatal care, healthcare providers perspective. BMC Health Services Research.
[36]. Bhutada, K., Venkateswaran, M., Atim, M., Munabi-Babigumira, S., Nankabirwa, V., Namagembe, F., Fren, J., & Papadopoulou, E., 2024, Factors influencing the uptake of antenatal care in Uganda: A mixed methods systematic review. BMC Pregnancy and Childbirth, 24, 6938–6.
[37]. Ali, K., Abm, A. C., & Aimakhu, C., 2023, The utilization of antenatal care services among pregnant women in Somalia: A scoping review. The Open Public Health Journal, 16, 230322–2022–116.
[38]. Osei, K., Awog-badek, A. A., Prasiska, D., Chapagain, D. D., & Ha, M., 2025, Impact of Ghana’s fee exemption policy on maternal health service utilisation: An inverse probability of treatment weighting analysis of pooled national data. Journal of Global Health.
[39]. Garchitorena, A., Miller, A. C., Cordier, L. F., Rabeza, V. R., Randriamanambintsoa, M., Razanadrakato, H. T. R., ... & Bonds, M. H., 2018. Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar. BMJ global health, 3(3).
[40]. Adepoju, V. A., Abdulrahim, A., & Adnani, Q. E. S., 2025, A systematic review of government-led free caesarean section policies in low- and middle-income countries from 2009 to 2025. Healthcare, 13(19), 2522.
[41]. Bou-Karroum, L., Iaia, D., El-Jardali, F., Samra, C. A., Salameh, S., Sleem, Z., Masri, R., Harb, A., Hemadi, N., Hilal, N., Hneiny, L., Nassour, S., Shah, M., & Langlois, E., 2024, Financing for equity for women’s, children’s and adolescents’ health in low- and middle-income countries: A scoping review. PLOS Global Public Health.
Viewed PDF 433 9 -
HIV Testing Uptake and Risk Behaviors among Youth at Institut Superieur des Techniques Medicales De Kinshasa, Democratic republic of CongoAuthor: Weko Gomer LulendoDOI: 10.21522/TIJPH.2013.14.01.Art027
HIV Testing Uptake and Risk Behaviors among Youth at Institut Superieur des Techniques Medicales De Kinshasa, Democratic republic of Congo
Abstract:
Young people aged 15–24 years represent 37% of new HIV infections globally, with sub-Saharan Africa bearing the highest burden. Students enrolled in health science programs , as future healthcare providers, are critical for HIV prevention efforts, yet limited data exist on their testing behaviors in the Democratic Republic of Congo (DRC). This study assessed HIV testing uptake and associated risk behaviors among students at Institut Supérieur des Techniques Médicales (ISTM) in Kinshasa, DRC. A cross-sectional survey was conducted using systematic sampling. The minimal sample size calculated was estimated at 384 participants, but only 300 students were recruited which may have affected the statistical power and limited generalizability. Self-administered questionnaires assessed HIV testing history, sexual behaviors, substance use, and training background. Data were analysed using IBM SPSS with descriptive statistics and chi-square tests. Among 300 participants, 60% (n=180) were females and 40% (n=120) were males; only 24.7% (n=74) had tested for HIV within the past year, while 58.0% (n=174) had never been tested. Significant gender disparities were observed, with 78.4%(n=235) of recent testers being female versus 21.6%(n=35) male (χ²=15.2, p<0.001). Reported high-risk behaviors included never using condoms 25.3% (n=76), multiple sexual partners in the past 12 months 26.7%(n=54), and recent STD treatment 16.0%(n=33). Despite 69.7% (n=209) having received HIV/STD training, testing uptake remained modest. These findings suggest that HIV testing uptake among ISTM students is suboptimal, considering their potential role in HIV prevention. The coexistence of HIV testing gaps and reported high risk behaviors among study participants underscores the need of targeted interventions particularly those addressing barriers among male students, improving HIV testing uptake and strengthen HIV prevention efforts within this student community.
HIV Testing Uptake and Risk Behaviors among Youth at Institut Superieur des Techniques Medicales De Kinshasa, Democratic republic of Congo
References:
[1]. UNICEF, 2023, Children and AIDS: Statistical update, https://data.unicef.org/wp-content/uploads/2023/11/HIVAIDS-Statistical-Update-2023.pdf.
[2]. UNICEF, 2023, To ramp up our efforts in the fight against AIDS, there is a need for more concentrated focus on adolescents and young people, https://data.unicef.org/topic/hivaids/adolescents-young-people/.
[3]. UNAIDS, 2012, Report on the global AIDS epidemic, http://www.refworld.org/docid/50eebaf52.html.
[4]. Kharsany, A. B., Karim, Q. A., 2016, HIV infection and AIDS in sub-Saharan Africa: Current status, challenges and opportunities. Open AIDS Journal, 10, 34.
[5]. DHS Program, 2025, Enquête démographique et de santé, République Démocratique du Congo (EDS-RDC III) 2023–2024. Rockville, Maryland, USA: The DHS Program, ICF, https://dhsprogram.com/pubs/pdf/FR393/FR393.pdf.
[6]. Terra, M., et al., 2024, HIV-related knowledge and practices among undergraduate students in Africa: A cross-sectional multinational study, https://www.sciencedirect.com/science/article/pii/S2949916X24000793.
[7]. UNICEF, 2024, Adolescent HIV prevention, https://data.unicef.org/topic/hivaids/adolescents-young-people/.
[8]. Rasweswe, M. M., Bopape, M. A., & Ntho, T. A., 2024, HIV voluntary counselling and testing utilisation among school of healthcare sciences undergraduate students at the university of Limpopo. International journal of Environmental Research and public health, 21(2),183
[9]. Ndim, M. C. F., Cho, F. N., Tongwa, D. Z., Kum, S. A., Tatah, C. A., Ngome, F. N., Chi, Y. M., Kofon, J. P., Mbonigaba, E., Nyanjoh, E. M., & Tassang, A. N., 2025, Knowledge, attitudes, stigma perceptions, and practices towards HIV testing among youths aged 18–35 years in Kumba, Cameroon: A community-based cross-sectional study. BMC Public Health, 25, Article 24229. https://doi.org/10.1186/s12889-025-24229-3
[10]. Osima, D. J., Hussein, A. K., Anasel, M. G., & Ngasala, B., 2025, HIV self-testing uptake and associated factors among adolescent girls and young women in certificate and diploma colleges, Dodoma, Tanzania: A cross-sectional study. BMJ Open, 15(11), e097043. https://doi.org/10.1136/bmjopen-2024-097043
[11]. Tshivhase, S. E., Makuya, T., & Takalani, F. J., 2022, Understanding reasons for low HIV testing services uptake among tertiary students in university in South Africa. HIV & AIDS Review, 21(1), 69–76. https://doi.org/10.5114/hivar.2022.112698
[12]. UNAIDS, 2024, Global HIV & AIDS statistics — Fact sheet, https://www.unaids.org/en/resources/fact-sheet.
[13]. UNAIDS,2023, Global AIDS update 2023, Geneva: Joint United Nations Programme on HIV/AIDS.
[14]. UNAIDS,2022, In danger: UNAIDS Global AIDS update 2022, https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids-update.
[15]. Topazian, H. M., et al., 2021, Variations in HIV risk by young women’s age and partner age-disparity in rural South Africa (HPTN 068) , https://pmc.ncbi.nlm.nih.gov/articles/PMC7722780/.
[16]. Underwood, C., et al., 2011, Structural determinants of adolescent girls’ vulnerability to HIV: Views from community members in Botswana, Malawi, and Mozambique, https://www.sciencedirect.com/science/article/abs/pii/S0277953611003339.
[17]. National Institutes of Health, 2015, Consolidated guidelines on HIV testing services: 5Cs—Consent, confidentiality, counselling, correct results, and connection. https://www.ncbi.nlm.nih.gov/books/NBK316039/.
[18]. Alhasawi, A., Grover, S. B., Sadek, A., Ashoor, I., Alkhabbaz, I., & Almasri, S., 2019, Assessing HIV/AIDS knowledge, awareness, and attitudes among senior high school students in Kuwait. Medical Principles and Practice, 28(5), 470–476, https://doi.org/10.1159/000500307
[19]. Ssebunya, R. N., Wanyenze, R. K., Namale, L., Lukolyo, H., Kisitu, G. P., Nahirya-Ntege, P., et al., 2018, Prevalence and correlates of HIV testing among adolescents 10–19 years in a post-conflict pastoralist community of Karamoja region, Uganda. BMC Public Health, 18(1), 1–8, https://doi.org/10.1186/s12889-018-5544-0.
[20]. Adugna, D. G., & Worku, M. G., 2022, HIV testing and associated factors among men (15–64 years) in Eastern Africa: A multilevel analysis using the recent demographic and health survey. BMC Public Health, 22(1), 1–9.
[21]. Asresie, M. B., Worku, G. T., & Bekele, Y. A., 2023, HIV testing uptake among Ethiopian rural men: Evidence from 2016 Ethiopian Demography and Health Survey data. HIV/AIDS – Research and Palliative Care, 15, 225–234.
[22]. Nkambule, B. S., et al., 2023, Factors associated with HIV-positive status awareness among adults with long-term HIV infection in four countries in the East and Southern Africa region: A multilevel approach. PLOS Global Public Health, 3(12), e0002692.
[23]. Zegeye, B., et al., 2023, HIV testing among women of reproductive age in 28 sub-Saharan African countries: A multilevel modelling. International Health, https://doi.org/10.1093/inthealth/ihad031.
[24]. Alem, A. Z., et al., 2022, Determinants of HIV voluntary counselling and testing: A multilevel modelling of the Ethiopian Demographic and Health Survey. BMC Women’s Health, 22(1), 1–10.
[25]. Fleming, P. J., Rosen, J. G., Wong, V. J., & Carrasco, M. A., 2019, Shedding light on an HIV blind spot: Factors associated with men’s HIV testing in five African countries. Global Public Health, 14(9), 1241–1251.
[26]. Chung, A. H., & Rimal, R. N., 2015, Applying choice architecture principles to understand HIV testing: Findings from Malawi and Zimbabwe. AIDS Education and Prevention, 27(4), 362–372.
[27]. Gazimbi, M. M., & Magadi, M. A., 2019, Individual- and community-level determinants of antenatal HIV testing in Zimbabwe. Journal of Biosocial Science, 51(2), 203–224.
[28]. . Oludayo, T., & Adeshewa, J. A., 2012, Transactional sex and the “aristo” phenomenon in Nigerian universities. Human Affairs, 22(2), 239–255, https://doi.org/10.2478/s13374-012-0020-5.
[29]. Tafuma, T. A., Mahachi, N., Dziwa, C., Moga, T., Baloyi, P., & Muyambo, G., et al., 2018, Barriers to HIV service utilisation by people living with HIV in two provinces of Zimbabwe: Results from 2016 baseline assessment. South African Journal of HIV Medicine, 19(1), 1–6.
[30]. Gombe, N. ,2018, Barriers to HIV testing among adolescents and young adults in Harare City, Zimbabwe. Texila International Journal of Public Health, 6(2), 62–68.
[31]. Peltzer, K., Matseke, G., Mzolo, T., & Majaja, M., 2009, Determinants of knowledge of HIV status in South Africa: Results from a population-based survey. BMC Public Health, 9, 174, https://doi.org/10.1186/1471-2458-9-174.
[32]. Weiser, S., Heisler, M., Leiter, K., Percy-de Korte, F., Tlou, S., DeMonner, S., Phaladze, N., Bangsberg, D., & Iacopino, V., 2006, Routine HIV testing in Botswana: A population-based study on attitudes, practices, and human rights concerns. PLoS Medicine, 3(7), e261, https://doi.org/10.1371/journal.pmed.0030261.
[33]. Cockcroft, A., Andersson, N., Milne, D., Mokoena, T., & Masisi, M., 2007, Community views about routine HIV testing and antiretroviral treatment in Botswana: Signs of progress from a cross-sectional study. BMC International Health and Human Rights, 7, 5, https://doi.org/10.1186/1472-698X-7-5.
[34]. Chernyshov, P. V.,2020, Risk factors for HIV transmission and HIV testing among medical students, https://pubmed.ncbi.nlm.nih.gov/32650844/
[35]. Kalichman, S. C., & Simbayi, L. C., 2003, HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a Black township in Cape Town, South Africa. Sexually Transmitted Infections, 79(6), 442–447.
[36]. Nyblade, L., Menken, J., Wawer, M., Sewankambo, N., Serwadda, D., Makumbi, F., Lutalo, T., & Gray, R., 2001, Population-based HIV testing and counselling in rural Uganda: Participation and risk characteristics. Journal of Acquired Immune Deficiency Syndromes, 28(5), 463–470. *
[37]. Wang, Y., Chen, Y., Li, Q., Mmbaga, E. J., Chang, J., Kahesa, C., Mbatia, G., & Wang, J., 2022, Factors associated with HIV testing among youth in Tanzania based on the 2016–2017 Tanzania HIV Impact Survey (THIS). BMC Public Health, 22, 2426. https://doi.org/10.1186/s12889-022-14691-3.
[38]. Licata, F., Angelillo, S., Nobile, C. G. A., Di Gennaro, G., Bianco, A., 2020, Understanding individual barriers to HIV testing among undergraduate university students: Results from a cross-sectional study in Italy. Front. Med. 9:882125. doi: 10.3389/fmed.2022.882125. [DOI] [PMC free article] [PubMed] [Google Scholar
[39]. Bekele, Y. A., Fekadu, G. A., 2020, Factors associated with HIV testing among young females; further analysis of the 2016 Ethiopian demographic and health survey data. PLoS ONE. 15(2):e0228783. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228783. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228783.%20Return%20to%20ref%204%20in%20article Article CAS PubMed PubMed Central Google Scholar
[40]. Yohana, B. S., Massito, J., & Moshi, A., 2025, Unpacking the drivers of HIV testing uptake among adolescents and adults in twelve sub‑Saharan African countries using Population HIV Impact Assessment data. Discover Public Health, 22, Article 776. https://doi.org/10.1186/s12982‑025‑01124‑1
Viewed PDF 130 5 -
Trends and Determinants of Postnatal Care Utilization in South-West Nigeria Using NDHS Data (2013-2024)Author: Adeyinka W. OdejimiDOI: 10.21522/TIJPH.2013.14.01.Art028
Trends and Determinants of Postnatal Care Utilization in South-West Nigeria Using NDHS Data (2013-2024)
Abstract:
Despite readily available information on national-level analyses of Postnatal care utilization, there is a paucity of studies on subnational evidence on postnatal care uptake. This study addresses this gap by examining trend PNC uptake across the South-West states in Nigeria using pooled NDHS data from 2013 to 2024. A secondary analysis of pooled data from the Nigeria Demographic and Health Surveys (NDHS) conducted in 2013, 2018, and 2024 with a final unweighted sample size of 5,514. The study outcome variable is the postnatal care utilization within seven days of delivery among women of reproductive age. Sampling weight was applied to estimates while multivariable multilevel logistic regression models were fitted to examine determinants of PNC uptake. Majority of the study respondent resided in urban area (72.1%), with secondary education being the highest maternal level of education (51.7%). The proportion of PNC uptake dropped drastically from 48.9% in 2013 to 23.9% in 2018 and 22.7% in 2024. Maternal level of education (Tertiary education: AOR=2.26; 95% CI=1.64-3.13) significantly increased the likelihood of PNC utilization among women of reproductive age. Findings revealed a disturbing downward slope in PNC utilization especially in 2024 which call for urgent response in programme design and implementation. Efforts should be reinforced in ensuring female education as a critical step to reduce neonatal and maternal mortality.
Trends and Determinants of Postnatal Care Utilization in South-West Nigeria Using NDHS Data (2013-2024)
References:
[1]. Tiruneh, G. T., Shiferaw, C. B., Worku, A., 2019, Effectiveness and cost-effectiveness of home-based postpartum care on neonatal mortality and exclusive breastfeeding practice in low- and middle-income countries: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 19(1), 507, https://doi.org/10.1186/s12884-019-2651-6
[2]. Ariff, S., Jiwani, U., Rizvi, A., Muhammad, S., Hussain, A., Ahmed, I., Hussain, M., Usman, M., Iqbal, J., Memon, Z., Soofi, S. B., Bhutta, Z. A., 2024, Effect of maternal and newborn care service package on perinatal and newborn mortality: a cluster randomized clinical trial. JAMA Netw Open, 7(2), e2356609, https://doi.org/10.1001/jamanetworkopen.2023.56609
[3]. Dol, J., Hughes, B., Bonet, M., Dorey, R., Dorling, J., Grant, A., Langlois, E. V., Monaghan, J., Ollivier, R., Parker, R., Roos, N., Scott, H., Shin, H. D., Curran, J., 2022, Timing of maternal mortality and severe morbidity during the postpartum period: a systematic review. JBI Evid Synth, 20(9), 2119–2194, https://doi.org/10.11124/JBIES-20-00578
[4]. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), 2024, Levels and trends in child mortality: report 2024. United Nations Children’s Fund, https://childmortality.org/
[5]. Baten, A., Biswas, R. K., Kendal, E., Bhowmik, J., 2025, Utilization of maternal healthcare services in low- and middle-income countries: a systematic review and meta-analysis. Syst Rev, 14(1), 88, https://doi.org/10.1186/s13643-025-02832-0
[6]. Morakinyo, O. M., Fagbamigbe, A. F., 2017, Neonatal, infant and under-five mortalities in Nigeria: an examination of trends and drivers (2003–2013). PLoS One, 12(8), e0182990, https://doi.org/10.1371/journal.pone.0182990
[7]. Adeyinka, D. A., Muhajarine, N., 2024, Geographic inequities in neonatal survival in Nigeria: a cross-sectional evidence from spatial and artificial neural network analyses. Journal of Biosocial Science, 56(5), 896–919, https://doi.org/10.1017/S0021932024000282
[8]. Agiri, U. A., Paul, O., Adjugah, J., Ndubuisi-Igwilo, O., 2023, Relationship between socio-demographic characteristics and the pattern of birth preparedness and complication readiness among pregnant women attending the antenatal clinic in UPTH. Nigerian Journal of Medicine, 32(5), 480–486, https://doi.org/10.4103/NJM.NJM_136_23
[9]. Ajayi, A. I., Akpan, W., 2017, Who benefits from free institutional delivery? Evidence from a cross-sectional survey of North Central and Southwestern Nigeria. BMC Health Serv Res, 17, 620, https://doi.org/10.1186/s12913-017-2560-1
[10]. Oyeneyin, L., van den Akker, T., Durojaiye, O., 2019, Confidential enquiries into maternal deaths in Ondo State, Nigeria – a comparative analysis. BMC Pregnancy Childbirth, 19, 514, https://doi.org/10.1186/s12884-019-2659-y
[11]. Ajayi, A. I., Akpan, W., 2020, Maternal health care services utilisation in the context of ‘Abiye’ (safe motherhood) programme in Ondo State, Nigeria. BMC Public Health, 20(1), 362, https://doi.org/10.1186/s12889-020-08512-z
[12]. Uzuegbu, C. N., Nnama-Okechukwu, C. U., Udeze, O. N., 2024, Access to maternal and child health care services in primary health care centers in Nigeria: perspectives from primary health care nurses. J Hum Rights Soc Work, 9, 606–614, https://doi.org/10.1007/s41134-024-00320-4
[13]. Dzinamarira, T., Moyo, E., Pierre, G., Mpabuka, E., Kahere, M., Tungwarara, N., Chitungo, I., Murewanhema, G., Musuka, G., 2023, Postnatal care services availability and utilization during the COVID-19 era in sub-Saharan Africa: a rapid review. Women Birth, 36(3), 295–299, https://doi.org/10.1016/j.wombi.2022.10.002
[14]. Akaba, G. O., Dirisu, O., Okunade, K. S., Adams, E., Ohioghame, J., Obikeze, O. O., Izuka, E., Sulieman, M., Edeh, M., 2022, Barriers and facilitators of access to maternal, newborn and child health services during the first wave of the COVID-19 pandemic in Nigeria: findings from a qualitative study. BMC Health Serv Res, 22, 611, https://doi.org/10.1186/s12913-022-07996-2
[15]. Aranda, Z., Binde, T., Tashman, K., Tadikonda, A., Mawindo, B., Maweu, D., Boley, E. J., Mphande, I., Dumbuya, I., Montaño, M., Clisbee, M., Mvula, M. G., Ndayizigiye, M., Casella, J. B., Varney, P. F., Anyango, S., Grépin, K. A., Law, M. R., Mugunga, J. C., Hedt-Gauthier, B., 2021, Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low- and middle-income countries. BMJ Glob Health, 7(1), e007247, https://doi.org/10.1136/bmjgh-2021-007247
[16]. Ahmed, T., Roberton, T., Vergeer, P., Hansen, P. M., Peters, M. A., Ofosu, A. A., Mwansambo, C., Nzelu, C., Wesseh, C. S., Smart, F., Alfred, J. P., Diabate, M., Baye, M., Yansane, M. L., Wendrad, N., Mohamud, N. A., Mbaka, P., Yuma, S., Ndiaye, Y., Sadat, H., Uddin, H., Kiarie, H., Tsihory, R., Mwinnyaa, G., de Dieu Rusatira, J., Amor Fernandez, P., Muhoza, P., Baral, P., Drouard, S., Hashemi, T., Friedman, J., Shapira, G., 2022, Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: an interrupted time-series analysis with mathematical modeling of administrative data. PLoS Med, 19(8), e1004070, https://doi.org/10.1371/journal.pmed.1004070
[17]. Adebowale, A. S., Fagbamigbe, A. F., Akinyemi, J. O., 2021, Regional differences in maternal healthcare utilization in Nigeria: a multilevel analysis. BMC Health Serv Res, 21, 111, https://doi.org/10.1186/s12913-020-05700-w
[18]. Amwonya, D., Kigosa, N., Kizza, J., 2022, Female education and maternal health care utilization: evidence from Uganda. Reprod Health, 19, 142, https://doi.org/10.1186/s12978-022-01432-8
[19]. Hassen, S. S., Lelisho, M. E., 2022, Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district. BMC Health Serv Res, 22, 1318, https://doi.org/10.1186/s12913-022-08710-y
[20]. Gesese, S. S., Mersha, E. A., Balcha, W. F., 2023, Knowledge of danger signs of pregnancy and health-seeking action among pregnant women: a health facility-based cross-sectional study. Ann Med Surg (Lond), 85, 1722–1730, https://doi.org/10.1097/MS9.0000000000000610
[21]. Ntoimo, L. F. C., Okonofua, F. E., Igboin, B., Ekwo, C., Imongan, W., Yaya, S., 2019, Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria. BMC Pregnancy Childbirth, 19, 277, https://doi.org/10.1186/s12884-019-2433-1
[22]. Solanke, B. L., Rahman, S. A., 2018, Multilevel analysis of factors associated with assistance during delivery in rural Nigeria: implications for reducing rural-urban inequity in skilled care at delivery. BMC Pregnancy Childbirth, 18, 438, https://doi.org/10.1186/s12884-018-2074-9
Viewed PDF 139 5 -
Family Functioning and its Association with Alcohol Use Disorder among Adolescents in Southwestern Uganda: A Cross-Sectional StudyAuthor: Novatus NyemaraDOI: 10.21522/TIJPH.2013.14.01.Art029
Family Functioning and its Association with Alcohol Use Disorder among Adolescents in Southwestern Uganda: A Cross-Sectional Study
Abstract:
This study investigates the association between family functioning and the severity of alcohol use disorders (AUD) among adolescents in Southwestern Uganda. Focusing on dimensions such as family cohesion, adaptability, communication, and satisfaction, the research explores how familial relationships and sociodemographic factors influence adolescent alcohol use. A cross-sectional study was conducted from September to December 2019 in Ibanda District, involving 308 adolescents aged 10 to 19 years. Participants were selected through multistage sampling, and data were collected using the Alcohol Use Disorders Identification Test (AUDIT) and the Family Adaptability and Cohesion Evaluation Scale IV (FACES IV). Ordered logistic regression was used to assess predictors of AUD severity. The findings revealed that 21.1% of participants were classified as hazardous drinkers, 9.1% as harmful drinkers, and 9.7% as dependent drinkers. Higher levels of family cohesion were associated with increased odds of more severe AUD classification (OR = 1.14, p<0.001), suggesting possible enabling or permissive dynamics in certain family contexts. In contrast, higher levels of adaptability (OR = 0.79, p<0.001) and satisfaction (OR = 0.82, p= 0.003) were protective against severe alcohol use. Additionally, lower household income, non-nuclear living arrangements, and unstable family structures were significantly associated with greater AUD severity. These findings underscore the critical role of family dynamics and socioeconomic conditions in shaping adolescent alcohol use behaviours. The study highlights the need for family-centred and context-sensitive interventions that strengthen adaptability and satisfaction within the family unit, while also addressing underlying structural vulnerabilities.
Family Functioning and its Association with Alcohol Use Disorder among Adolescents in Southwestern Uganda: A Cross-Sectional Study
References:
[1]. World Health Organization, 2023, Global Status Report on Alcohol and Health 2023. Geneva: WHO.
[2]. Nalugya, J. S., Nakasujja, N., Engebretsen, I. M., Abbo, C., Tumwine, J. K., Musisi, S., Babirye, J. N., Mpungu, E. N., and Ndeezi, G., 2024, Prevalence and psycho-social factors associated with alcohol use among primary school-going children aged 6 to 13 years in Mbale district, Uganda: a cross-sectional study. BMC pediatrics, 24(1), p.782. https://doi.org/10.1186/s12887-024-05260-6
[3]. Sjödin, L., Raninen, J., and Larm, P., 2024, Early drinking onset and subsequent alcohol use in late adolescence: A longitudinal study of drinking patterns. Journal of Adolescent Health, 74(6), pp.1225-1230. https://doi.org/10.1016/j.jadohealth.2024.02.014
[4]. Tackaberry-Giddens, L., Henderson, J., and Hawke, L. D., 2023, Early alcohol onset: clinical and demographic characteristics of service-seeking youth. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 32(3), p.150. https://pubmed.ncbi.nlm.nih.gov/37534111/
[5]. Sellers, C. M., McRoy, R. G., and O'Brien, K. H. M., 2019, Substance use and suicidal ideation among child welfare involved adolescents: A longitudinal examination. Addictive behaviors, 93, pp.39-45. https://doi.org/10.1016/j.addbeh.2019.01.021
[6]. Newton-Howes, G., Cook, S., Martin, G., Foulds, J. A., and Boden, J. M., 2019, Comparison of age of first drink and age of first intoxication as predictors of substance use and mental health problems in adulthood. Drug and alcohol dependence, 194, pp.238-243. https://doi.org/10.1016/j.drugalcdep.2018.10.012
[7]. DeWit, D. J., Adlaf, E. M., Offord, D. R., and Ogborne, A. C., 2000, Age at First Alcohol Use: A Risk Factor for the Development of Alcohol Disorders. American Journal of Psychiatry, 157(5):745–50. https://doi.org/10. 1176/appi.ajp.157.5.745 PMID:10784467
[8]. Grant, B. F., and Dawson, D. A., 1997, Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse, 9, 103–110.
[9]. Crone, E. A., and van Duijvenvoorde, A. C., 2021, Multiple pathways of risk taking in adolescence. Developmental Review, 62, 100996. https://doi.org/10.1016/j.dr.2021.100996
[10]. Uganda Bureau of Statistics (UBOS). 2022, Uganda National Adolescent Health Survey Report. Kampala: UBOS.
[11]. Umberson, D., and Thomeer, M. B., 2020, Family matters: Research on family ties and health, 2010 to 2020. Journal of Marriage and Family, 82(1), pp.404-419. https://doi.org/10.1111/jomf.12640
[12]. Katafiasz, H., 2019, Bowen Family Systems Therapy with Families. In Encyclopedia of Couple and Family Therapy (pp. 325-331). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319- 15877-8_1147-1.
[13]. Holtom-Viesel, A., and Allan, S., 2014, A systematic review of the literature on family functioning across all eating disorder diagnoses in comparison to control families. Clinical psychology review, 34(1), pp.29-43. https://doi.org/10.1016/j.cpr.2013.10.005.
[14]. Olson, D., 2011, FACES IV and the circumplex model: Validation study. Journal of marital and family therapy, 37(1), pp.64-80. https://doi.org/10.1111/j.1752-0606.2009.00175.x
[15]. Joh, J. Y., Kim, S., Park, J., and Kim, Y. P., 2013, Relationship between family adaptability, cohesion and adolescent problem behaviors: curvilinearity of circumplex model. Korean J Fam Med; 34(3):169–77. https://doi.org/10.4082/kjfm.2013.34.3.169.
[16]. Gikandi, A. W., Egunjobi, J. P. P., and Muriithi, J. K. P., 2021, Influence of Family Cohesion on Substance Use Disorders among the Youth in Selected Rehabilitation Centres in Nairobi County, Kenya. https://doi.org/10.47772/IJRISS.2021.5816
[17]. Rukundo, A., Ayebare, D. S., Kibanja, G., and Steffens, K., 2020, Family Factors Associated with Consumption of Spirits: A Comparative Gender‐Based Study of Ugandan Students in Public Secondary Schools. Education Research International, 2020(1), p.5432545. https://doi.org/10.1155/2020/5432545
[18]. Kivuva, S. N., and Muasa, W. P., 2023, Role of family functioning in substance addiction among emerging adults in Ongata Rongai Sub county in Kajiado county, Kenya. International Journal of Research and Innovation in Social Science, 7(9), pp.1941-1950. https://doi.org/10.47772/IJRISS.2023.71057
[19]. Cavanaugh, C. E., Andrade, F. C. D., George, S., and Wurth, M., 2020, Family functioning and substance use among African adolescents: A systematic review. Substance Use & Misuse, 55(4), 625–640. https://doi.org/10.1080/10826084.2019.1686043
[20]. Lander, L., Howsare, J., and Byrne, M., 2013, The impact of substance use disorders on families and children: From theory to practice. Social Work in Public Health, 28(3–4), 194–205. https://doi.org/10.1080/19371918.2013.759005
[21]. Puffer, E. S., Friis Healy, E., Green, E. P. M., Giusto, A. N., Kaiser, B., Patel, P., and Ayuku, D., 2020, Family functioning and mental health changes following a family therapy intervention in Kenya: A pilot trial. Journal of Child and Family Studies, 29(12), 3493-3508. https://doi.org/10.1007/s10826-020-01816-z
[22]. Opara, I., Lardier Jr, D. T., Reid, R. J., and Garcia-Reid, P., 2019, “It all starts with the parents”: A qualitative study on protective factors for drug-use prevention among Black and Hispanic girls. Affilia, 34(2), pp.199-218. https://doi.org/10.1177/0886109918822543
[23]. Wiggins, J. L., Mitchell, C., Hyde, L. W., and Monk, C. S., 2015, Identifying early pathways of risk and resilience: The codevelopment of internalizing and externalizing symptoms and the role of harsh parenting. Development and psychopathology, 27(4pt1), pp.1295-1312. https://doi.org/10.1017/S0954579414001412
[24]. Yap, M. B. H., Pilkington, P. D., Ryan, S. M., and Jorm, A. F., 2014, Parental factors associated with depression and anxiety in young people: A systematic review and meta-analysis. Journal of affective disorders, 156, pp.8-23. https://doi.org/10.1016/j.jad.2013.11.007
[25]. Skylstad, V., Nalugya, J. S., Skar, A. M. S., Opesen, C., Ndeezi, G., Okello, E. S., Moland, K. M., Engebretsen, I. M. S., and Tumwine, J. K., 2022, ‘As soon as they can hold a glass, they begin taking alcohol’: a qualitative study on early childhood substance use in Mbale District, Uganda. BMC public health, 22(1), p.812. https://doi.org/10.1186/s12889-022-13140-w.
[26]. Ali, T., and Worku, T., 2020, Current alcohol consumption and associated factors among school adolescents and youths in Ethiopia: a systematic review and meta-analysis. SAGE Open Medicine, 8, p.2050312120974154. https://doi.org/10.1177/2050312120974154
[27]. Biramo, Y. B., and Philipos, G., 2016, Peer pressure and alcohol use among undergraduate students of Wolaita Sodo University. International Journal of Sciences: Basic and Applied Research, 29(1), pp.212-223. https://doi.org/10.24085/jsaa.v12i2.4524
[28]. Romero-Rodríguez, E., Ortega, E., and Rivera, F., 2022, Family functionality and alcohol consumption among university students: A cross-sectional study using the Family APGAR questionnaire. International Journal of Environmental Research and Public Health, 19(4), 2321. https://doi.org/10.3390/ijerph19042321
[29]. Dorji, T., Tshering, T., and Wangdi, K., 2020, Factors associated with alcohol use and hazardous drinking among youth in Bhutan: A cross-sectional study. BMC Public Health, 20(1), 1441. https://doi.org/10.1186/s12889-020-09531-1
[30]. Demilew, D., Yeneabat, T., and Assefa, N., 2021, Assessment of alcohol use disorder and associated factors among people in Ethiopia: A community-based cross-sectional study. Substance Abuse Treatment, Prevention, and Policy, 16(1), 1-10. https://doi.org/10.1186/s13011-021-00381-7
[31]. Chege, A., and Kathungu, B., 2021, Does Family Structure Predispose Youth to Drug Use: The Case of Kajiado County, Kenya. African Journal of Alcohol and Drug Abuse (AJADA), pp.68-80.
[32]. Reisdorfer, E., Büchele, F., and Pasa, M. B., 2012, Prevalence and associated factors with alcohol use disorders among adults in a southern Brazilian city. Revista de Saúde Pública, 46(6), 1049–1056. https://doi.org/10.1590/S0034-89102012005000078
[33]. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., and Monteiro, M. G., 2001, The alcohol use disorders identification test.
[34]. Kemjika, O. G., and Ojiugo, A. B., 2015, Influence of family dysfunction on drug abuse of adolescent students of unity schools in south-south zone Nigeria. European Journal of Psychological Research Vol, 2(2) ISSN 2057-4794
[35]. Lin, C. Y., and Yi, C. C., 2019, Family functioning and adolescent problem behaviors: Moderating roles of birth order and gender. Journal of Family Issues, 40(5), 587–611, https://doi.org/10.1177/0192513X18810980
[36]. Gebremariam, K. T., and Sandhu, T., 2020, Family environment and substance use among university students. Internatıonal Journal of Scientific & Technology Research, 9(2), pp.1530-1535. https://doi.org/10.1186/s13011-018-0150-9
[37]. Wahab, S., Baharom, M. A., Abd Rahman, F. N., Wahab, K. A., Zulkifly, M. A., Azmi, A. D. and Ahmad, N., 2021, The relationship of lifetime substance-use disorder with family functioning, childhood victimisation, and depression, among juvenile offenders in Malaysia. Addictive behaviors reports, 14, p.100359. https://doi.org/10.1016/j.abrep.2021.100359
[38]. LaFreniere, L. S., Newman, M. G., and Graham, J. W., 2021, Parental support and monitoring influences on adolescent alcohol use: A peer selection mediation model. Mental health and addiction research, 6(2), pp.10-15761. https://doi.org/10.15761/mhar.1000202
[39]. Kelly, A. B., O'Flaherty, M., Toumbourou, J. W., Connor, J. P., Hemphill, S. A., and Catalano, R. F., 2011, Gender differences in the impact of families on alcohol use: A lagged longitudinal study of early adolescents. Addiction, 106(8), pp.1427-1436. https://doi.org/10.1111/j.1360-0443.2011.03435.x
Viewed PDF 116 2 -
Community Health Workers’ Integration Models and Health System Integration Effectiveness for Universal Health Coverage in Sub Saharan Africa: A Systematic ReviewAuthor: Sowo Anita LebbieDOI: 10.21522/TIJPH.2013.14.01.Art030
Community Health Workers’ Integration Models and Health System Integration Effectiveness for Universal Health Coverage in Sub Saharan Africa: A Systematic Review
Abstract:
In sub-Saharan Africa (SSA), evidence suggests that many low and middle-income countries face severe shortages and uneven distribution of health workers, medicines and infrastructure, resulting in poor quality services and serious gaps in coverage for essential health care. In addressing the human resources gaps of trained health professionals, Community Health Workers (CHWs) were recruited and integrated in the health system and they are increasingly regarded as central actors in achieving Universal Health Coverage (UHC) and strengthening primary health care (PHC) in SSA. Evidence from existing studies shows that community health workers have the greatest impact when they are well integrated across the main health system building blocks. Estimates of Community Health Worker (CHW) density vary widely across Sub-Saharan Africa, ranging from about 11.2 to 59.5 CHWs for every 10,000 people. These differences depend largely on how many hours CHWs work and the scope of services they provide. However, integration models differ widely across nations with mixed outcomes in service provision, equity, and sustainability. Three models of integration dominated: government-driven, hybrid, and Non-Governmental Organisation-driven (NGO). Government-driven models have 40% higher levels of sustainability than donor-based models and cost-effectiveness ratios of $1.20 per capita per annum, for example in Ethiopia and Ghana, among others. Successful CHW integration is context-dependent model selection, with no single model likely to be optimal for every situation; success depends on close adaptation to the local health system and community context.
Community Health Workers’ Integration Models and Health System Integration Effectiveness for Universal Health Coverage in Sub Saharan Africa: A Systematic Review
References:
[2]. World Health Organization, 2016, Global strategy on human resources for health: Workforce 2030. WHO. https://www.who.int/publications/i/item/9789241511131
[3]. Schneider, H., Okello, D., & Lehmann, U., 2016, The global pendulum swing towards community health workers in low- and middle-income countries: A scoping review of policies and programmes. Human Resources for Health, 14(Suppl 1), S65. https://doi.org/10.1186/s12960-016-0163-2
[4]. World Health Organization, 2018, WHO guideline on health policy and system support to optimize community health worker programmes. WHO. https://www.who.int/publications/i/item/9789241550369
[5]. Nkonki, L., et al., 2017, A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes. Human Resources for Health, 15(1), 17. https://doi.org/10.1186/s12960-017-0192-1
[6]. Perry, H. B., Zulliger, R., & Rogers, M. M., 2014, Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annual Review of Public Health, 35, 399–421. https://doi.org/10.1146/annurev-publhealth-032013-182354
[7]. Naimoli, J. F., Perry, H. B., Townsend, J. W., Frymus, D. E., & McCaffery, J. A., 2014, Strategic partnering to improve community health worker programming and performance: Features of a community health system integrated approach. Human Resources for Health, 12, Article 91. https://doi.org/10.1186/1478-4491-12-91
[8]. Scott, K., Beckham, S., Gross, M., Pariyo, G., Rao, K. D., Cometto, G., & Perry, H. B., 2018, Community-based health information systems: A systematic review. Journal of Global Health, 8(2), Article 020409. https://doi.org/10.7189/jogh.08.020409
[9]. McCollum, R., Gomez, W., Theobald, S., & Taegtmeyer, M., 2019, How health system factors influence CHW programmes: A qualitative comparison of policies and programmes in Tanzania, Uganda and Mozambique. Human Resources for Health, 17, Article 58. https://doi.org/10.1186/s12960-019-0382-8
[10]. Ballard, M., Bonds, M., Taylor, L., Dowler, E., Foth, J., Furth, R., & Johnson, A., 2018, Community health worker economic evaluation: Cost and cost-effectiveness. USAID Health Finance and Governance Project, Abt Associates. https://www.hfgproject.org/community-health-worker-economic-evaluation-cost-and-cost-effectiveness/
[11]. Kok, M. C., Dieleman, M., Taegtmeyer, M., Broerse, J. E. W., Kane, S. S., Ormel, H., Tijm, M. M., & de Koning, K. A. M., 2015, Which intervention design factors influence performance of community health workers? A systematic review. Health Policy and Planning, 30(9), 1207–1227. https://doi.org/10.1093/heapol/czu126
[12]. Rowe, A. K., Rowe, S. Y., Peters, D. H., Holloway, K. A., Chalker, J., & Ross-Degnan, D., 2018, Effectiveness of supportive supervision on quality of care: A systematic review. Tropical Medicine & International Health, 23(9), 1040–1056. https://doi.org/10.1111/tmi.13100
[13]. Agarwal, S., LeFevre, A. E., Lee, J., L'Engle, K., Mehl, G., Sinha, C., & Labrique, A., 2019, Digital tools for frontline health workers. BMJ Global Health, 4(Suppl. 1), Article e001146. https://doi.org/10.1136/bmjgh-2018-001146
[14]. Zachariah, R., Ford, N., Philips, M., Lynch, S., Massaquoi, M., Janssens, V., & Harries, A. D., 2011, Task shifting in HIV/AIDS: Supply chains and outcomes in community-based interventions. Transactions of the Royal Society of Tropical Medicine and Hygiene, 105(10), 598–606. https://doi.org/10.1016/j.trstmh.2011.07.019
[15]. WHO, 2022, WHO guidance on community health worker programmes: monitoring and evaluation and indicators, World Health Organization, Geneva. Available at: https://www.who.int/publications/i/item/9789240058989
[16]. Assefa, Y., Gelaw, Y. A., Hill, P. S., Taye, B. W. & Van Damme, W., 2019, Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare, BMJ Global Health, vol. 4, e001002. https://doi.org/10.1136/bmjgh-2018-001002
[17]. Condo, J., Mugeni, C., Naughton, B., Hall, K., Tuazon, M. A., Omwega, A., Nwaigwe, F., Drobac, P., Hyder, Z., Ngabo, F., Karema, C., Binagwaho, A. & Gaju, E., 2014, Rwanda’s evolving community health worker system: a qualitative assessment of client and provider perspectives, Human Resources for Health, vol. 12, 71. https://doi.org/10.1186/1478-4491-12-71
[18]. Khatri, R. B., et al., 2024, Enablers and barriers of community health programs for primary health care delivery in the context of universal health coverage: A scoping review. BMC Primary Care, 25(1), Article 366. https://pmc.ncbi.nlm.nih.gov/articles/PMC11520389/
[19]. Mlotshwa, L., et al., 2023, Community health worker programmes’ integration into national health systems: Scoping review. African Journal of Primary Health Care & Family Medicine, 15(1), Article 1925. https://phcfm.org/index.php/phcfm/article/view/3204
[20]. CHW Central, 2015, Investment case and financing recommendations for community health workers. https://chwcentral.org/wp-content/uploads/2015/09/CHW-Financing-FINAL-July-15-2015.pdf.
[21]. Ministry of Health (Kenya), 2014, Kenya Community Health Strategy 2014–2019: delivering primary health care for universal health coverage, Ministry of Health, Nairobi. Available at: https://www.health.go.ke (policy outlines CHS, CHV integration, roles, and mixed funding modalities)
[22]. Kalyango, J. N., Rutebemberwa, E., Alfven, T., Ssali, S., Peterson, S., & Karamagi, C., 2012, Performance of community health workers under integrated community case management of childhood illnesses in eastern Uganda, Malaria Journal, 11, 282. https://doi.org/10.1186/1475-2875-11-282
[23]. Gilroy, K. E., Callaghan-Koru, J. A., Cardemil, C. V., Nsona, H., Amouzou, A., Mtimuni, A., Daelmans, B., & Bryce, J., 2013, Quality of sick child care delivered by Health Surveillance Assistants in Malawi, The American Journal of Tropical Medicine and Hygiene, 89(1), pp. 144–153. https://doi.org/10.4269/ajtmh.12-0387
[24]. Procter, C. D., et al., 2023, The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania. PLOS Global Public Health, 3(9), e0002050. https://doi.org/10.1371/journal.pgph.0002050
[25]. Ministry of Health (Liberia), 2016, National Community Health Services Policy 2016–2021, Ministry of Health, Monrovia. Available at: https://moh.gov.lr
[26]. Ministry of Health and Sanitation (Sierra Leone), 2016, National Community Health Worker Policy 2016–2020, Ministry of Health and Sanitation, Freetown. Available at: https://mohs.gov.sl
[27]. Mirzoev, T., et al., 2016, Study protocol: Realist evaluation of effectiveness and sustainability of a community health workers programme in Nigeria. Implementation Science, 11, Article 79. https://doi.org/10.1186/s13012-016-0443-0
[28]. Awoonor Williams, J. K., Bawah, A. A., Nyonator, F. K., Asuru, R., Oduro, A., Ofosu, A., & Phillips, J. F., 2013, The Ghana Essential Health Interventions Program: A plausibility trial of the impact of health systems strengthening on maternal and child survival. BMC Health Services Research, 13(Suppl 2), S3.
[29]. Assefa, Y., Hill, P. S., Gilks, C. F., Van Damme, W., Haregu, T. N., Topp, S. M., Docrat, S., Reddy, T., Östlin, P., & Sanders, D., 2019, Primary health care contributions to universal health coverage, health security, and healthier populations: The South African case study. BMJ Global Health, 4(Suppl. 8), Article e001802. https://doi.org/10.1136/bmjgh-2019-001802
[30]. Kane, S., Scott, K., Nacarella, L., Diop, K., Sarr, B., Ndiaye, M., Sylla, M., Gueye, M., Somé, H., & Kok, M., 2016, Strengthening community health worker "Bajenu Gox" to improve maternal and newborn health in Senegal: A qualitative evaluation of program integration and effects on postpartum family planning. Global Health: Science and Practice, 4(3), 367–381. https://doi.org/10.9745/GHSP-D-16-00087
[31]. Idriss-Wheeler, D., Ormel, I., Assefa, M., Rab, F., Angelakis, C., Yaya, S., & et al., 2024, Engaging community health workers (CHWs) in Africa: Lessons from the Canadian Red Cross supported programs. PLOS Global Public Health, 4(1), Article e0002799. https://doi.org/10.1371/journal.pgph.0002799
[32]. Gebremeskel, A. T., Omonaiye, O., & Yaya, S., 2022, Multilevel determinants of community health workers for an effective maternal and child health programme in sub-Saharan Africa: A systematic review. BMJ Global Health, 7(4), Article e008162. https://doi.org/10.1136/bmjgh-2021-008162
[33]. UNICEF, USAID, MCHIP, & WHO, 2014, Community health worker program overviews: Systematic references to program implementation and integration. UNICEF/USAID/MCHIP. (Profiles CHW programs in Mozambique, Malawi, Uganda, and Tanzania, including many NGO led or NGO supported models and their integration challenges.)
[34]. Perry, H. B., et al., 2014, Developing and strengthening community health worker programs at scale for improved child health outcomes. USAID/MCHIP. https://socialserviceworkforce.org/wp-content/uploads/2024/03/MCHIP_CHW-Ref-Guide.pdf
[35]. Kumar, M., Nefdt, R., Ribaira, E., & Diallo, K., 2014, Access to healthcare through community health workers in East and Southern Africa. UNICEF. https://teampata.org/wp-content/uploads/2017/06/Access-to-healthcare-through-CHWs-in-ESA.pdf
[36]. Abanilla, P. K., Huang, K. Y., Shinners, D., Levy, A., Ayernor, K., Aikins, A. D., & Ogedegbe, O., 2011, Cardiovascular disease prevention in Ghana: Feasibility of a faith-based organizational approach. Bulletin of the World Health Organization, 89(9), 648–656. https://doi.org/10.2471/BLT.11.086777
[37]. Mayo, V., & Mendoza, J., 2024, The role of community health workers in universal health coverage.
[38]. Gilmore, B., & McAuliffe, E., 2013, Effectiveness of community health workers delivering preventive interventions for maternal and child health in developing countries: A systematic review. Health Policy and Planning, 28(7), 633–657. https://doi.org/10.1093/heapol/czs097
[39]. Asamani, J. A., Okoroafor, S. C., Mwinga, K., & et al., 2025, Community health worker requirements to accelerate universal health coverage in Africa. BMJ Global Health, 10(Suppl. 1), Article e013628. https://pmc.ncbi.nlm.nih.gov/articles/PMC11851756/
[40]. Mupara, L. M., et al., 2023, Community health worker programmes' integration into national health systems: Scoping review. African Journal of Primary Health Care & Family Medicine, 15(1), Article 1925. https://doi.org/10.4102/phcfm.v15i1.1925
Viewed PDF 135 4 -
The Role of a Father in Access to Maternal and Child Health Services in Ethiopia: A Neglected Key to SurvivalAuthor: David DakDOI: 10.21522/TIJPH.2013.14.01.Art031
The Role of a Father in Access to Maternal and Child Health Services in Ethiopia: A Neglected Key to Survival
Abstract:
Children's survival and health critically depend on supportive adults, particularly their parents. Sub-Saharan Africa and Central and Southern Asia bear the highest burden of maternal, stillbirth, and neonatal deaths. Ethiopia ranks 5th globally among countries accounting for 60% of these deaths. The major underlying causes are harmful gender norms, biases and inequalities. This study identifies factors affecting male involvement in Maternal and Child Health (MCH) care in Ethiopia and proposes strategies to enhance father's contributions to maternal and child survival. Methodologically, an extensive literature review and critical analysis of existing studies, health policies, and reports related to MCH, and father’s role was conducted. Despite Ethiopia's health system improvements that incorporate life-cycle services, significant inequalities persist by economic status, education, residence, and gender. Political commitment to reducing stillbirths remains insufficient. Key barriers to male involvement include health facility factors (inaccessibility, unwelcoming environments, disrespectful care), sociodemographic characteristics (age, education, occupation), low income, and deep-rooted cultural norms relegating MCH to women's domain. In conclusion, the crucial role of father’s in MCH care is widely acknowledged yet underexplored in the policy. Ethiopian men's hesitancy to engage in MCH significantly impacts survival outcomes. Implementing policies promoting male involvement – such as father-friendly clinics, targeted education campaigns, and couple-based antenatal care – can strengthen health systems and improve family well-being.
The Role of a Father in Access to Maternal and Child Health Services in Ethiopia: A Neglected Key to Survival
References:
[1]. McIntosh, C. A., and Finkle, J. L., 1995, The Cairo conference on population and development: A new paradigm? Population and Development Review, 21(2), pp.223-260.
[2]. Sternberg, P., and Hubley, J., 2004, Evaluating men's involvement as a strategy in sexual and reproductive health promotion. Health Promotion International, 19(3), pp.389-396. https://doi.org/10.1093/heapro/dah312
[3]. Okafor, I. P., Chukwudi, C. L., Igwilo, U. U., and Ogunnowo, B. E., 2022, “Men are the head of the family, the dominant head”: A mixed method study of male involvement in maternal and child health in a patriarchal setting, Western Nigeria. PLoS ONE, 17(10), e0276059. https://doi.org/10.1371/journal.pone.0276059
[4]. Messner, L., Smith, D., Tadesse, H. A., and Santillán, D., 2020, Engaging Men for Positive Maternal and Reproductive Health Outcomes in Ethiopia: Technical Brief. Rockville, MD: EnCompass LLC.
[5]. World Health Organization, 1997, Managing maternal and child health programmes: a practical guide. (WPRO Education in Action Series N° 10). WHO Regional Office for the Western Pacific, Manila. https://apps.who.int/iris/handle/10665/207028
[6]. World Health Organization, 2023, Improving maternal and newborn health and survival and reducing stillbirth: Progress Report 2023. Geneva.
[7]. World Health Organization, 2022. Improving maternal and newborn health and survival and reducing stillbirth: Progress Report 2022. Geneva.
[8]. Ministry of Health [Ethiopia], 2021, Ethiopian Health Sector Transformation Plan II (HSTP II): 2020/21 – 2024/25. Addis Ababa, Ethiopia.
[9]. EPHI and ICF, 2019, Ethiopia Mini Demographic and Health Survey 2019, Addis Ababa, Ethiopia, and Rockville, Maryland, USA.
[10]. Mengesha, E. W., Tessema, G. A., Assefa, Y., and Alene, G. D., 2023, Social capital and its role to improve maternal and child health services in Northwest Ethiopia: A qualitative study. PLoS ONE, 18(4), e0284592. https://doi.org/10.1371/journal.pone.0284592
[11]. Cardenas, A., Singh, S., Harpin, M., et al., 2023, Center for Reproductive Rights. "Accelerating Progress: Liberalization of Abortion Laws since ICPD." reproductiverights.org/sites/default/files/documents/WorldAbortion-Map-AcceleratingProgress.pdf (Accessed 26 May 2025).
[12]. United Nations Population Fund, 2024, Navigating Megatrends: The ICPD Programme of Action for a Sustainable Future ICPD30 Think Piece: The Future of Sexual and Reproductive Health and Rights. July 2024.
[13]. Melesse, D. Y., Tadele, A., Mulu, S., et al., 2024, Learning from Ethiopia’s success in reducing maternal and neonatal mortality through a health systems lens. BMJ Global Health, 9, e011911. http://dx.doi.org/10.1136/bmjgh-2023-011911.
[14]. World Bank, 2016, Ethiopia - Health Extension Program: An Institutionalized Community Approach for Universal Health Coverage. Washington, DC.
[15]. Ditekemena, J., Koole, O., Engmann, C., et al., 2012, Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review. Reprod Health, 9, 32. https://doi.org/10.1186/1742-4755-9-32
[16]. Byamugisha, R., Tumwine, J. K., Semiyaga, N., et al., 2010, Determinants of male involvement in the PMTCT of HIV programme in Eastern Uganda: a cross-sectional survey. Reprod Health, 7, 12. https://doi.org/10.1186/1742-4755-7-12
[17]. Hailemariam, S., Abayneh, M., Genetu, A., 2021, Individual, socio-cultural, and health facility factors affecting men's involvement in facility-based childbirth in Southwest, Ethiopia: A mixed method study. SAGE Open Med. 9:20503121211023367. https://doi:10.1177/20503121211023367
[18]. Baran, M. B., and Sawrikar, V., 2024, Service-level barriers and facilitators to father engagement in child and family services: A systematic review and thematic synthesis of qualitative studies. https://doi.org/10.1016/j.childyouth.2023.107295
[19]. Dumbaugh, M., Tawiah-Agyemang, C., Manu, A., et al., 2014, Perceptions of, attitudes towards and barriers to male involvement in newborn care in rural Ghana, West Africa: a qualitative analysis. BMC Pregnancy Childbirth, 14, 269. https://doi.org/10.1186/1471-2393-14-269
[20]. Ditekemena, J., Matendo, R., Koole, O., et al., 2011, Male partner voluntary counselling and testing associated with the antenatal services in Kinshasa, Democratic Republic of Congo: a randomized controlled trial. International Journal of STD & AIDS, 22(3), pp.165-170. Doi:10.1258/ijsa.2010.010379.
[21]. Cabrera, N., and Peters, H. E., 2014, Public policies and father involvement. In Fatherhood (pp. 295-314). Routledge.
[22]. Comrie-Thomson, L., Mavhu, W., Makungu, C., Nahar, Q., Khan, R., Davis, J., Hamdani S., Stillo E., and Luchters, S., 2015, Men matter: Engaging men for better MNCH outcomes in Bangladesh, Tanzania and Zimbabwe.
[23]. Kowalczyk, J., Jolly, P., Karita, E., Nibarere, J.A., Vyankandondera, J., and Salihu, H., 2002, Voluntary counselling and testing for HIV among pregnant women presenting in labor in Kigali, Rwanda. Journal of Acquired Immune Deficiency Syndromes, 31(4), pp.408-415. https://doi.org/10.1097/00126334-200212010-00007
[24]. Gorman, E. H., 1999, Bringing Home the Bacon: Marital Allocation of Income-Earning Responsibility, Job Shifts, and Wives’ Labor-Force Participation. Journal of Marriage and Family, 61(1), pp.110-122.
[25]. Worku, G., and Enquselassie, F., 2007, Factors determining acceptance of voluntary HIV counselling and testing among pregnant women attending antenatal clinic at army hospitals in Addis Ababa. Ethiopian Medical Journal, 45(1), pp.1-8.
[26]. Bougangue, B., and Ling, H., 2017, Male involvement in maternal healthcare through Community-based Health Planning and Services: the views of the men in rural Ghana. BMC Public Health, 17(1), 693. https://doi.org/10.1186/s12889-017-4680-2
[27]. Ganle, J., and Dery, I., 2015, ‘What men don’t know can hurt women’s health’: a qualitative study of the barriers to and opportunities for men’s involvement in maternal healthcare in Ghana. Reprod. Health, 12(1), 93. https://doi.org/10.1186/s12978-015-0083-y
[28]. Muthiru, A. W., and Bukachi, S. A., 2024, Male involvement in maternal and child nutrition in low-income informal settlements, Nairobi, Kenya. J Health Popul Nutr, 43, 47. https://doi.org/10.1186/s41043-023-00476-1
[29]. Aborigo, R. A., Reidpath, D. D., Oduro, A. R., et al., 2018, Male involvement in maternal health: perspectives of opinion leaders. BMC Pregnancy Childbirth, 18, 3. https://doi.org/10.1186/s12884-017-1641-9
[30]. Doyle, K., and Kato-Wallace, J., 2013, MenCare: A Global Fatherhood Campaign; Guide for MenCare Partners; Male Engagement in Maternal, Newborn and Child Health/Sexual Reproductive Health Rights. Promundo-US.
Viewed PDF 130 7 -
Understanding Socio-Demographic, Environmental, and Behavioral Factors Associated with Malaria Infection Among Children Under Five Years in Tanzania: A Rapid ReviewAuthor: Hamad NnimboDOI: 10.21522/TIJPH.2013.14.01.Art032
Understanding Socio-Demographic, Environmental, and Behavioral Factors Associated with Malaria Infection Among Children Under Five Years in Tanzania: A Rapid Review
Abstract:
Malaria is a global public health concern and remains one of the major causes of morbidity and mortality among children under five in sub-Saharan Africa, with Tanzania bearing a substantial share of the burden. Although multiple studies have examined risk factors, evidence on socio-demographic, environmental, and behavioral determinants remains fragmented. A comprehensive synthesis of this evidence is critical to guide context-specific interventions. This rapid review synthesised studies published between January 2021 and December 2025 to identify factors associated with malaria infection among children under five. Data on study characteristics and key findings were extracted systematically, verified, and synthesized narratively. The results were organised into socio-demographic, environmental, and behavioural determinant domains. Twenty-one studies met inclusion criteria. Cross-sectional designs predominated (n=8, 38%), followed by randomized trials (n=5, 24%). Most studies were community-based (n=19, 91%) and focused either exclusively on children under 5 (n=8, 38%) or on mixed-age groups (n=6, 29%). Malaria infection among children under five in Tanzania is consistently associated with child age, maternal education, and household socio-economic status. Environmental factors such as housing quality, sanitation, and proximity to mosquito breeding sites, along with behavioral factors including ITN use, care-seeking, and nighttime outdoor exposure, also influence risk. These determinants interact within ecological and socio-economic contexts, underscoring the need for integrated, context-specific interventions. Strengthening vector control, improving housing and environmental conditions, promoting protective behaviors, and addressing socio-economic inequities are key to reducing malaria. This review provides evidence to guide targeted interventions and future research for accelerating malaria control in Tanzania.
Understanding Socio-Demographic, Environmental, and Behavioral Factors Associated with Malaria Infection Among Children Under Five Years in Tanzania: A Rapid Review
References:
[1]. World Health Organization, 2025, Malaria, Available from: https://www.who.int/news-room/fact-sheets/detail/malaria.
[2]. Ranjha, R., Singh, K., Baharia, R. K., Mohan, M., Anvikar, A. R., Bharti, P. K., 2023, Age-specific malaria vulnerability and transmission reservoir among children, Global Pediatrics, 6, https://doi.org/10.1016/j.gpeds.2023.100085.
[3]. World Health Organization, 2021, Tanzania to ensure every malaria case is reported and investigated promptly., Available from: https://www.afro.who.int/news/tanzania-ensure-every-malaria-case-reported-and-investigated-promptly.
[4]. Ministry of Health, Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), ICF), 2022, Tanzania Demographic and Health Survey and Malaria Indicator Survey 2022: Key indicators report.
[5]. Ministry of Health, 2020, National Malaria Strategic Plan 2021–2025, https://www.nmcp.go.tz/storage/app/uploads/public/643/916/391/6439163912677679591851.pdf.
[6]. Akowe, E., Ahman, Q. O., Agbata, B. C., Joseph, S. O., Senewo, E. O., Danjuma, A. Y., Yahaya, D. J., 2025, A novel malaria mathematical model: integrating vector and non-vector transmission pathways, BMC Infectious Diseases, 25(1), https://doi.org/10.1186/s12879-025-10653-8.
[7]. Savi, M. K., 2022, An Overview of Malaria Transmission Mechanisms, Control, and Modeling, Medical Sciences, 11(1), https://doi.org/10.3390/medsci11010003.
[8]. Adam, J., Luoga, P., Nyamhanga, T., Makunenge, C., Ayubu, M., 2025, Prevalence and determinants of malaria among children aged 6–59 months in Tanzania: a nationwide cross-sectional study, Malaria Journal, 24(1), https://doi.org/10.1186/s12936-025-05409-3.
[9]. Mwaiswelo, R. O., Mmbando, B. P., Chacky, F., Molteni, F., Mohamed, A., Lazaro, S., Mkalla, S. F., Samuel, B., Ngasala, B., 2021, Malaria infection and anemia status in under-five children from Southern Tanzania where seasonal malaria chemoprevention is being implemented, PLOS ONE, 16(12), https://doi.org/10.1371/journal.pone.0260785.
[10]. Bofu, R. M., Santos, E. M., John, B., Kahamba, N., Swilla, J., Njalambaha, R., Kelly, A. H., Lezaun, J., Christofides, N., Okumu, F. O., Finda, M. F., 2023, The Needs and Opportunities for Housing Improvement as a Malaria Intervention in Southern Tanzania, https://doi.org/10.21203/rs.3.rs-2431993/v1, https://www.researchsquare.com/article/rs-2431993/v1.
[11]. Mmbando, A. S., Ngonzi, A. J., Mshamu, S., Bradley, J., Bøjstrup, T. C., Ngowo, H. S., Knudsen, J., Von Seidlein, L., Okumu, F. O., Lindsay, S. W., 2025, Effect of a novel house design (star home) on indoor malaria mosquito abundance in rural Tanzania: secondary outcomes of an open-label, household, randomised controlled trial, The Lancet Planetary Health, 9(4), https://doi.org/10.1016/S2542-5196(25)00046-4.
[12]. Mshamu, S., Mmbando, A., Meta, J., Bradley, J., Bøjstrup, T. C., Day, N. P. J., Mukaka, M., Okumu, F., Olotu, A., Pell, C., Deen, J., Knudsen, J., Lindsay, S. W., Von Seidlein, L., 2022, Assessing the impact of a novel house design on the incidence of malaria in children in rural Africa: study protocol for a household-cluster randomized controlled superiority trial, Trials, 23(1), https://doi.org/10.1186/s13063-022-06461-z.
[13]. Mshamu, S., Halifa, S., Meta, J., Mmbando, A., Lindsay, S. W., Okumu, F., Wood, H. S., Wood, O. S., Bøjstrup, T. C., Day, N. P. J., Knudsen, J., Deen, J., Pell, C., Von Seidlein, L., 2023, Studying the health benefits of improved housing in rural Tanzania: challenges and progress, Transactions of The Royal Society of Tropical Medicine and Hygiene, 117(10), https://doi.org/10.1093/trstmh/trad039.
[14]. Khatib, B., Mcha, J., Pandu, Z., Haji, M., Hassan, M., Ali, H., Mrisho, R., Abdallah, K., Ali, A., Ali, K., Said, T., Mohamed, S., Mkali, H., Mgata, S., Makwaruzi, S., Gulaka, M., Makenga, G., Mkude, S., Githu, V., Mero, V., Serbantez, N., Ballard, S.-B., Chan, A., Shija, S. J., Govella, N. J., 2025, Early evening outdoor biting by malaria-infected Anopheles arabiensis vectors threatens malaria elimination efforts in Zanzibar, Malaria Journal, 24(1), https://doi.org/10.1186/s12936-025-05333-6.
[15]. Kihwele, F., Gavana, T., Makungu, C., Msuya, H. M., Mlacha, Y. P., Govella, N. J., Chaki, P. P., Sunguya, B. F., 2023, Exploring activities and behaviours potentially increases school-age children’s vulnerability to malaria infections in south-eastern Tanzania, Malaria Journal, 22(1), https://doi.org/10.1186/s12936-023-04703-2.
[16]. Garritty, C., Hamel, C., Trivella, M., Gartlehner, G., Nussbaumer-Streit, B., Devane, D., Kamel, C., Griebler, U., King, V. J., 2024, Updated recommendations for the Cochrane rapid review methods guidance for rapid reviews of effectiveness, BMJ, 384, https://doi.org/10.1136/bmj-2023-076335.
[17]. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., Moher, D., 2021, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, BMJ, https://doi.org/10.1136/bmj.n71.
[18]. Ouzzani, M., Hammady, H., Fedorowicz, Z., Elmagarmid, A., 2016, Rayyan—a web and mobile app for systematic reviews, Systematic Reviews, 5(1), https://doi.org/10.1186/s13643-016-0384-4.
[19]. Animut, Y., Nigatu, S. G., Teklu, R. E., Abiy, S. A., 2025, Spatial distribution of malaria among under-five children and associated factors in Tanzania: a spatial and multilevel analysis, Malaria Journal, 24(1), https://doi.org/10.1186/s12936-025-05313-w.
[20]. Pauline, R. N., Kikwale, E. A., Migamba, J. D., 2025, Socio-economic and Environmental Factors Influencing Malaria Prevalence among Children Under Five in Tanzania, Rural Planning Journal, 27(2), https://doi.org/10.59557/rpj.25.2.2025.208.
[21]. Matovelo, D., Ndaki, P., Yohani, V., Laisser, R., Bakalemwa, R., Ndaboine, E., Masatu, Z., Mwaikambo, M., Brenner, J. L., Wilson, W. M., 2021, Why don’t illiterate women in rural, Northern Tanzania, access maternal healthcare? BMC Pregnancy and Childbirth, 21(1), https://doi.org/10.1186/s12884-021-03906-2.
[22]. Chacky, F., Hicks, J. T., Remiji, M. J., Rumisha, S. F., Walker, P. G. T., Chaki, P., Aaron, S., Nhiga, S. L., Reaves, E., Serbantez, N., Molteni, F., Ngasala, B., Kc, A., Mmbando, B. P., Snow, R. W., Van Geertruyden, J.-P., 2025, Trends in malaria prevalence among school-age children in Mainland Tanzania, 2015–2023: A multilevel survey analysis, PLOS Global Public Health, 5(4), https://doi.org/10.1371/journal.pgph.0004386.
[23]. Challe, D. P., Petro, D. A., Francis, F., Seth, M. D., Madebe, R. A., Mandai, S. S., Budodo, R., Kisambale, A. J., Chacha, G. A., Moshi, R., Mbwambo, R. B., Pereus, D., Bakari, C., Mbata, D., Lyimo, B., Kanyankole, G. K., Aaron, S., Mbwambo, D., Kajange, S., Lazaro, S., Kapologwe, N., Mandara, C. I., Makene, V. W., Ishengoma, D. S., 2025, Trends of malaria prevalence among individuals from rural communities in three regions with varying transmission intensities in Mainland Tanzania; Data from 2021 - 2023 community cross-sectional surveys, https://doi.org/10.1101/2025.02.13.25322171, https://www.medrxiv.org/content/10.1101/2025.02.13.25322171v1.
[24]. Mohammed, K., Dhillon, S., Pienaah, C. K. A., Luginaah, I., Knoll, E.-M., Campbell, G., Hambati, H., 2025, Where environment and malaria intersect: Exploring the spatio-temporal footprints of Plasmodium falciparum in Tanzania, PLOS One, 20(5), https://doi.org/10.1371/journal.pone.0321200.
[25]. Petro, D. A., Shaban, N., Aaron, S., Chacky, F., Lazaro, S., Boni, M. F., Ishengoma, D. S., 2024, Geospatial Analysis of Malaria Burden in Kagera Region, Northwestern Tanzania Using Health Facility and Community Survey Data, Open Forum Infectious Diseases, 11(11), https://doi.org/10.1093/ofid/ofae609.
[26]. Lutambi, A. M., Emidi, B., Mbuya, F. G., Ryoba, M., Sagamiko, T. D., Hugo, A. K., Mbalawata, I. S., 2025, Modelling the impact of climatic and environmental variables on malaria incidence in Tanzania: Implications for achieving the WHO’s 2030 Targets, PLOS Global Public Health, 5(8), https://doi.org/10.1371/journal.pgph.0005075.
[27]. Odufuwa, O. G., Moore, S. J., Mboma, Z. M., Mwanga, R., Matwewe, F., Hofer, L. M., Matanila, I., Abbasi, S., Rashid, M. A., Philipo, R., Kihwele, F., Moore, J., Nguyen, H., Bosselmann, R., Skovmand, O., Stevenson, J. C., Muganga, J. B., Bradley, J., 2025, A household randomized-control trial of insecticide-treated screening for malaria control in unimproved houses in Tanzania, Malaria Journal, 24(1), https://doi.org/10.1186/s12936-025-05434-2.
[28]. Lukole, E. A., Cook, J., Mosha, J. F., Matowo, N. S., Kulkarni, M. A., Mallya, E., Aziz, T., Martin, J., Rowland, M., Kleinschmidt, I., Manjurano, A., Mosha, F. W., Protopopoff, N., 2025, Community benefits of mass distribution of three types of dual-active-ingredient long-lasting insecticidal nets against malaria prevalence in Tanzania: evidence from a 3-year cluster-randomized controlled trial, BMC Public Health, 25(1), https://doi.org/10.1186/s12889-025-21586-x.
[29]. Liheluka, E. A., Massawe, I. S., Chiduo, M. G., Mandara, C. I., Chacky, F., Ndekuka, L., Temba, F. F., Mmbando, B. P., Seth, M. D., Challe, D. P., Makunde, W. H., Mhina, A. D., Baraka, V., Segeja, M. D., Derua, Y. A., Batengana, B. M., Hayuma, P. M., Madebe, R. A., Malimi, M. C., Mandike, R., Mkude, S., Molteni, F., Njau, R., Mohamed, A., Rumisha, S. F., Ishengoma, D. S., 2023, Community knowledge, attitude, practices and beliefs associated with persistence of malaria transmission in North-western and Southern regions of Tanzania, Malaria Journal, 22(1), https://doi.org/10.1186/s12936-023-04738-5.
[30]. Mwalimu, C. D., Lazaro, S. N., Kisinza, W. N., Magesa, S. M., Kiware, S. S., 2023, The impact of Indoor Residual Spraying (IRS) withdrawal in the Lake Zone Regions in Mainland Tanzania. Should Tanzania withdrawal its IRS program?, https://doi.org/10.21203/rs.3.rs-2888818/v1, https://www.researchsquare.com/article/rs-2888818/v1.
[31]. Amoroso, C. R., 2021, Integrating Concepts of Physiological and Behavioral Resistance to Parasites, Frontiers in Ecology and Evolution, 9, https://doi.org/10.3389/fevo.2021.635607.
[32]. Langat, E. C., Ward, P., Gesesew, H., Mwanri, L., 2025, Challenges and Opportunities of Universal Health Coverage in Africa: A Scoping Review, International Journal of Environmental Research and Public Health, 22(1), https://doi.org/10.3390/ijerph22010086.
[33]. Firdaus, M. H., Wan Puteh, S. E., Sutan, R., Abdul Manaf, M. R., 2025, Effectiveness of family health education in malaria elimination programmes: a scoping review, Malaria Journal, 24(1), https://doi.org/10.1186/s12936-025-05371-0.
[34]. Nketiah-Amponsah, E., Adjotor, F. N., 2025, The impact of Malaria-related expenditures on Malaria incidence and mortality rates in Sub-Saharan Africa (SSA), Development Studies Research, 12(1), https://doi.org/10.1080/21665095.2025.2481830.
[35]. Kaseya, J., Dereje, N., 2025, The resurgence of malaria in Africa is an avoidable crisis—here’s what we must do, BMJ, 390, https://doi.org/10.1136/bmj.r1874.
[36]. Onyinyechi, O. M., Mohd Nazan, A. I. N., Ismail, S., 2023, Effectiveness of health education interventions to improve malaria knowledge and insecticide-treated nets usage among populations of sub-Saharan Africa: systematic review and meta-analysis, Frontiers in Public Health, 11, https://doi.org/10.3389/fpubh.2023.1217052.
[37]. Beloconi, A., Nyawanda, B. O., Bigogo, G., Khagayi, S., Obor, D., Danquah, I., Kariuki, S., Munga, S., Vounatsou, P., 2023, Malaria, climate variability, and interventions: modelling transmission dynamics, Scientific Reports, 13(1), https://doi.org/10.1038/s41598-023-33868-8.
[38]. Mao, W., Cooke, R., Silimperi, D., Urli Hodges, E., Ortiz, E., Udayakumar, K., 2023, Scaling malaria interventions: bottlenecks to malaria elimination, BMJ global health, 8(11), https://doi.org/10.1136/bmjgh-2023-013378.
Viewed PDF 133 6 -
Barriers and Facilitators of Mental Health Well-Being Among Postnatal Mothers: A Systematic ReviewAuthor: Simone Roberts KentDOI: 10.21522/TIJPH.2013.14.01.Art033
Barriers and Facilitators of Mental Health Well-Being Among Postnatal Mothers: A Systematic Review
Abstract:
The postnatal mothers experience mental health challenges which include depression, anxiety, and stress. Although frequency is markedly higher in low- and middle-income countries (LMICs), systemic and cultural barriers often impede help-seeking and access to care, even as various facilitators promote resilience and recovery. This systematic review aims to assess the barriers and facilitators to mental health and well-being among postnatal mothers in St. Vincent and the Grenadines, synthesising findings from both qualitative and quantitative studies. A thorough, systematic search was conducted in electronic databases, including EBSCOhost, PubMed, PsycARTICLES, Google Scholar, and ScienceDirect, for studies published between January 2015 and April 2025. Studies included in this review are qualitative, quantitative, or mixed methods. The identified themes were categorized as individual, interpersonal, organizational, community and societal. The systematic review included eighteen studies. The main barriers were as follows: (1) Individual: low mental health literacy, stigma, and fear of judgment; (2) Interpersonal: lack of partner or family support; (3) Organizational: healthcare systems focused predominantly on infant physical health, poor provider communication, and fragmented referral pathways; (4) Community: cultural norms discouraging disclosure of emotional distress; and (5) Societal: financial constraints, geographical inaccessibility, and under resourced mental health services. The main facilitators included: strong social support networks, perceived self-efficacy, culturally sensitive and integrated care models, peer support programs, and technology-enabled interventions. By focusing on the unique culture within regions like the Caribbean, researchers can build a support system that ensures no mother has to struggle through the postnatal period alone.
Barriers and Facilitators of Mental Health Well-Being Among Postnatal Mothers: A Systematic Review
References:
[1]. Howard, L. M., Khalifeh, H., 2020, Perinatal mental health: A review of progress and challenges. World Psychiatry, 19(3), 313-327, https://doi.org/10.1002/wps.20769.
[2]. Shorey, S., Chee, C. Y. I., Ng, E. D., Chan, Y. H., Tam, W. W. S., Chong, Y. S., 2018, Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. Journal of Psychiatric Research, 104, 235-248, https://doi.org/10.1016/j.jpsychires.2018.08.001.
[3]. Fisher, J., Cabral de Mello, M., Patel, V., Rahman, A., Tran, T., Holton, S., et al., 2012, Prevalence and determinants of common perinatal mental disorders in low- and lower-middle-income countries: A systematic review. Bulletin of the World Health Organization, 90(2), 139-149, https://doi.org/10.2471/BLT.11.091850.
[4]. Gelaye, B., Rondon, M. B., Araya, R., Williams, M. A., 2016, Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry, 3(10), 973-982, https://doi.org/10.1016/S2215-0366(16)30284-X.
[5]. Letourneau, N. L., Dennis, C. L., Benzies, K., Duffett-Leger, L., Stewart, M., Tryphonopoulos, P. D., et al., 2012, Postpartum depression is a family affair: Addressing the impact on mothers, fathers, and children. Issues in Mental Health Nursing, 33(7), 445-457, https://doi.org/10.3109/01612840.2012.673054.
[6]. Byatt, N., Biebel, K., Friedman, L., Debordes-Jackson, G., Ziedonis, D., 2015, Strategies for improving perinatal depression care in obstetric settings. General Hospital Psychiatry, 37(5), 447-453, https://doi.org/10.3109/0167482X.2012.728649.
[7]. Leahy-Warren, P., McCarthy, G., Corcoran, P., 2012, First-time mothers: Social support, maternal parental self-efficacy and postnatal depression. Journal of Clinical Nursing, 21(3-4), 388-397, https://doi.org/10.1111/j.1365-2702.2011.03701.x.
[8]. Dennis, C.-L., Hodnett, E., Kenton, L., Weston, J., Zupancic, J., Stewart, D. E., et al., 2009, Effect of peer support on prevention of postnatal depression among high-risk women: Multisite randomized controlled trial. BMJ, 338, a3064, https://doi.org/10.1136/bmj.a3064.
[9]. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al., 2021, The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71, https://doi.org/10.1136/bmj.n71.
[10]. Adams, Y. J., Miller, M. L., Agbenyo, J. S., Ehla, E. E., Clinton, G. A., 2023, Postpartum care needs assessment: Women's understanding of postpartum care, practices, barriers, and educational needs. BMC Pregnancy and Childbirth, 23(1), 502, https://doi.org/10.1186/s12884-023-05813-0.
[11]. Ahmed, A., Bowen, A., Feng, C. X., 2017, Maternal depression in Syrian refugee women recently moved to Canada: A preliminary study. BMC Pregnancy and Childbirth, 17(1), 240, https://doi.org/10.1186/s12884-017-1433-2.
[12]. Ash, M. J., Woods-Jaeger, B., Udoetuk, S., Livingston, M. D., Sales, J. M., 2025, Barriers and facilitators to accessing mental health supports among black perinatal women: Application of the patient-centered access framework. Journal of Racial and Ethnic Health Disparities, 1-11, https://doi.org/10.1007/s40615-025-02428-3.
[13]. McLeish, J., Ayers, S., McCourt, C., 2023, Community-based perinatal mental health peer support: A realist review. BMC Pregnancy and Childbirth, 23(1), 570,
[14]. https://doi.org/10.1186/s12884-023-05843-8.
[15]. Al Nasr, R. S., Altharwi, K., Derbah, M. S., Gharibo, S. O., Fallatah, S. A., Alotaibi, S. G., et al., 2020, Prevalence and predictors of postpartum depression in Riyadh, Saudi Arabia: A cross-sectional study. PLoS ONE, 15(2), e0228666, https://doi.org/10.1371/journal.pone.0228666.
[16]. Place, J. M. S., Renbarger, K., Van De Griend, K., Guinn, M., Wheatley, C., Holmes, O., 2024, Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers. Frontiers in Global Women's Health, 5, 1335437, https://doi.org/10.3389/fgwh.2024.1335437.
[17]. Dimidjian, S., Goodman, S. H., Felder, J. N., Gallop, R., Brown, A. P., Beck, A., 2016, Staying well during pregnancy and the postpartum: A pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence. Journal of Consulting and Clinical Psychology, 84(2), 134-145, https://doi.org/10.1037/ccp0000068.
[18]. Gidey, S., Tefera, F., Ababiya, T., Fissehatsion, F., Teka, B., Zergaw, R., et al., 2025, Prevalence and associated factors of postpartum depression among postpartum mothers in Addis Ababa, Ethiopia. American Journal of Psychiatry and Neuroscience, 13(2), https://doi.org/10.11648/j.ajpn.20251302.12.
[19]. Grote, N. K., Katon, W. J., Russo, J. E., Lohr, M. J., Curran, M., Galvin, E., et al., 2015, Collaborative care for perinatal depression in socioeconomically disadvantaged women: A randomized trial. Depression and Anxiety, 32(11), 821-834, https://doi.org/10.1002/da.22405.
[20]. Uzobo, E., Ogeh, V. I., Teibowei, B. J., 2022, Prevalence and coping strategies of postnatal depression among women in Bayelsa State, Nigeria. Africa Journal of Nursing and Midwifery, 24(1), https://doi.org/10.25159/2520-5293/9457.
[21]. Milgrom, J., Danaher, B. G., Gemmill, A. W., Holt, C., Holt, C. J., Seeley, J. R., et al., 2016, Internet cognitive behavioral therapy for women with postnatal depression: A randomized controlled trial of MumMoodBooster. Journal of Medical Internet Research, 18(3), e4993, https://doi.org/10.2196/jmir.4993.
[22]. Oladeji, B. D., Gureje, O., Bello, T., 2025, "You just have to pray about it": Exploring mental health help-seeking barriers among young mothers in Belize. International Journal of Mental Health Systems, 19(1), 5, https://doi.org/10.26633/RPSP.2025.3.
[23]. Shorey, S., Ng, E. D., 2019, Evaluation of a technology-based peer-support intervention program for preventing postnatal depression (part 2): Qualitative study. Journal of Medical Internet Research, 21(8), e12915, https://doi.org/10.2196/12915.
[24]. Zhu, Z., Wang, H., Zhu, T., Wang, Z., Shen, Y., Xiong, C., et al., 2025, Mental health service utilization among pregnant and postpartum women: Status, determinants, and insights from a mixed-methods study. BMC Public Health, 25(1), 1942, https://doi.org/10.1186/s12889-025-23132-1.
[25]. Fonseca, A., Monteiro, F., Pacheco, A., Santos, L., 2015, Acceptability of e-mental health interventions among perinatal women: A mixed-methods study in Portugal. Journal of Affective Disorders, 188, 59-67, https://doi.org/10.1192/bja.2024.23.
[26]. Letourneau, N., Stewart, M., Dennis, C. L., Hegadoren, K., Duffett-Leger, L., Watson, B., 2011, Effect of home-based peer support on maternal-infant interactions among women with postpartum depression: A randomized, controlled trial. International Journal of Mental Health Nursing, 20(5), 345-357, https://doi.org/10.1111/j.1447-0349.2010.00736.x.
[27]. Meireles, L. G. V., Peñacoba, C., Écija, C., Gutiérrez, L., Arribas, C., Catalá, P., 2025, Perspectives on perinatal support and maternal mental health: A qualitative cross-cultural study in Spain and Brazil. Psychiatry International, 6(2), 70, https://doi.org/10.3390/psychiatryint6020070.
[28]. Webb, R., Uddin, N., Ford, E., Easter, A., Shakespeare, J., Roberts, N., et al., 2021, Barriers and facilitators to implementing perinatal mental health care in health and social care settings: A systematic review. The Lancet Psychiatry, 8(6), 521-534, https://doi.org/10.1016/S2215-0366(20)30467-3.
[29]. World Health Organization, 2013, WHO recommendations on postnatal care of the mother and newborn. Geneva: World Health Organization, https://pubmed.ncbi.nlm.nih.gov/24624481/.
[30]. Zlotnick, C., Johnson, S. L., Miller, I. W., Pearlstein, T., Howard, M., 2001, Postpartum depression in women receiving public assistance: Pilot study of an interpersonal-therapy-oriented group intervention. American Journal of Psychiatry, 158(4), 638-640, https://doi.org/10.1176/appi.ajp.158.4.638.
[31]. Le, H. N., Perry, D. F., Stuart, E. A., 2011, Randomized controlled trial of a preventive intervention for perinatal depression in high-risk Latinas. Journal of Consulting and Clinical Psychology, 79(2), 135-141, https://doi.org/10.1037/a0022492.
[32]. Khademi, K., Kaveh, M. H., 2024, Social support as a coping resource for psychosocial conditions in postpartum period: A systematic review and logic framework. BMC Psychology, 12(1), 301, https://doi.org/10.1186/s40359-024-01814-6.
Viewed PDF 177 13 -
Health System Maturity: A Narrative Review of Existing Maturity ModelsAuthor: Higenyi EmmanuelDOI: 10.21522/TIJPH.2013.14.01.Art034
Health System Maturity: A Narrative Review of Existing Maturity Models
Abstract:
Various health system maturity models have been elaborated in literature but none offers a unified and integrated perspective to facilitate comparison of maturity levels across different health systems. Such a unified and universal health system maturity model would enable various stakeholders-national governments, international agencies, scholars and researchers, and other interested parties to gain insight into maturity of individual health systems while also permitting quantitative and qualitative comparisons across systems. It would facilitate progress tracking and systematic improvement at global, national and sub-national levels. This article explored and examined the various models for health system maturity and proposes robust criteria and framework for health system maturity assessment. Basing on the purpose, functions and goal of the health system, ten (10) maturity dimensions were synthesized to form a benchmark for the critical review of the existing maturity models and constitute a bedrock for the unified and integrated maturity assessment framework. The dimensions are: Universal Health Coverage; Continuity of Care; Continuum of Care; Population Health Status; Quality Management; Responsiveness; Resilience; Partnerships and Collaborations; Global Participation and Integration; and Sustainability. A critical review of the existing maturity models indicated that none of the maturity models covers all the health system maturity dimensions thus confirming the need for the synthesis of a unified and integrated framework for health system maturity assessment. The information from the review was used to formulate metrics and performance indicators for each dimension, thereby giving rise to the proposed comprehensive assessment framework.
Health System Maturity: A Narrative Review of Existing Maturity Models
References:
[1]. Tetlay, A., & John, P., 2009, Determining the lines of system maturity, system readiness and capability readiness in the system development lifecycle.
[2]. ACRES-The Center for Rapid Evidence Synthesis, 2020, Forming partnerships between Health Management Organisations and public health service providers. https://deb.acres.or.ug/media/briefs/Forming_partnerships_between_Health_Management_Organisations_and_Public_Health_Se_xur4C8l.pdf
[3]. Aiwerioghene, E. M., Lewis, J., & Rea, D., 2024, Maturity models for hospital management: A literature review. International Journal of Healthcare Management, 1–14, https://doi.org/10.1080/20479700.2024.2367858),
[4]. De Silva, A., 2000, A framework for measuring responsiveness. GPE Discussion Paper series No 32. Geneva: World Health Organization, https://gh.bmj.com/content/bmjgh/2/4/e000486.full.pdf
[5]. Endeshaw, B., 2021, Healthcare service quality-measurement models: a review. Journal of Health Research, 35(2), 106-117.
[6]. Cresswell, K., Jahn, F., Silsand, L., Woods, L., Postema, T., Logan, M., Malkic, S., Ammenwerth, E., 2025, Assessing Digital Maturity of Hospitals: Viewpoint Comparing National Approaches in Five Countries. J. Med Internet Res, 2025;27:e57858, Doi: 10.2196/57858, PMID: 40053724, PMCID: 11926443.
[7]. Wilson, D., Sheikh, A., Görgens, M., Ward, K., & Bank, W., 2021, Technology and Universal Health Coverage: Examining the role of digital health. Journal of Global Health, 11, 16006. https://jogh.org/wp-content/uploads/2021/11/jogh-11-16006.pdf
[8]. Debie, A., Khatri, R. B., & Assefa, Y., 2022, Successes and challenges of health systems governance towards universal health coverage and global health security: a narrative review and synthesis of the literature. Health Res Policy Sys 20, 50. https://doi.org/10.1186/s12961-022-00858-7
[9]. Greg, D., 2013. The Four Levels of Supply Chain Maturity. Deploying the Right Capabilities to Strengthen Operational Performance and Resilience. https://www.supplychain247.com/article/the_four_levels_of_supply_chain_maturity
[10]. Emmanuel, H., 2025, Customer Service in Health care Presentation to Mengo Hospital Staff [Unpublished PowerPoint slides], Directorate of Technical Services, Joint Medical Store
[11]. Emmanuel, H., Freddy, K., & Samuel, K., 2023, Extent of integration of social determinants of health in clinical practice in hospitals in Uganda. Texila International Journal of Public Health, ISSN: 2520-3134, Doi: 10.21522/TIJPH.2013.11.01.Art017.
[12]. Jeffrey, G., Gwen, K., Jenna, M. S., Robert, A. C., Victor, B. A. M., Paola G. D. N., Sarah, S., Carl, L. H., Alisha, H. R., and Lelinneth, M. B. N., 2024, Do healthcare providers consider the social determinants of health? Results from a nationwide cross-sectional study in the United States. BMC Health Serv Res, 24, 271 (2024). https://doi.org/10.1186/s12913-024-10656-2
[13]. Kolukısa Tarhan, A., Garousi, V., Turetken, O., Söylemez, M., Garossi, S.,2020, Maturity assessment and maturity models in health care: A multivocal literature review. Digit Health. Doi: 10.1177/2055207620914772. PMID: 32426151; PMCID: PMC7216018.
[15]. Gulliford, M., Naithani, S., & Morgan, M., 2006, What is' continuity of care’? Journal of health services research & policy, 11(4), 248-250.
[16]. McKinsey & Company, 2024, What are Scope 1, 2, and 3 emissions? https://www.mckinsey.com/featured-insights/mckinsey-explainers/what-are-scope-1-2-and-3-emissions
[17]. MEASURE Evaluation, 2018, Global Digital Health Resources and Maturity Models: A Summary. https://www.measureevaluation.org/resources/publications/fs-18-305.html
[18]. National Academic of Sciences, 2019, Integrating Social Care into the Delivery of Healthcare: Moving Upstream to Improve the Nation’s Health
[19]. OECD, 2025, Health at a Glance 2025: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/8f9e3f98-en.
[20]. Rajapaksha, R. M. N. U., Khatri, R. B., Abeysena, C., Wijesinghe. M. S. D., Endalamaw, A., Thomas. T. K., Perera. N., Rambukwella. R., De Silva, G., Fernando, M., Alemu, Y. A., 2022, Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol. BMJ Open. 2022 Nov 21;12(11):e067829. Doi: 10.1136/bmjopen-2022-067829. PMID: 36410836; PMCID: PMC9680175.
[21]. Shari Blanch & Diana Anderson, 2026, Healthcare Sustainability. https://www.ache.org/blog/2021/designing-for-healthcare-sustainability-a-framework#:~:text=In%20a%20health%20setting%2C%20social
[22]. Robone, S., Rice, N., & Smith, P. C., 2011, Health Systems' Responsiveness and Its Characteristics: A Cross-Country Comparative Analysis. Health Services Research. Doi: 10.1111/j.1475-6773.2011.01291.x. https://pmc.ncbi.nlm.nih.gov/articles/PMC3393001/pdf/hesr0046-2079.pdf
[23]. Steinbeis, F., Gotham, D., von Philipsborn, P., Stratil, J. M., 2019, Quantifying changes in global health inequality: the Gini and Slope Inequality Indices applied to the Global Burden of Disease data, 1990-2017. BMJ Glob Health. 2019 Sep 24;4(5):e001500. Doi: 10.1136/bmjgh-2019-001500. PMID: 31637024; PMCID: PMC6768361.
[24]. Mirzoev, T., & Kane, S., 2017, What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework. BMJ Glob Health 2017;2:e000486. Doi:10. https://gh.bmj.com/content/bmjgh/2/4/e000486.full.pdf
[25]. UNICEF,2019, The UNICEF Supply Chain Maturity Model. https://www.unicef.org/supply/media/10496/file/maturity-model-concept-note.pdf
[26]. US Government Global Supply Chain Program, 2021, Bridging the Silos of Supply Chain Information Systems Through a Holistic Maturity Model. https://www.ghsupplychain.org/node/1483).
[27]. WHO, 2000, Measuring and reporting on the health of populations. https://apps.who.int/gb/ebwha/pdf_files/EB107/ee8.pdf
[28]. WHO, 2015, Operational framework for building climate resilient health systems.
[29]. World Health Organization, 2017, Environmentally sustainable health systems: a strategic document. World Health Organization. Regional Office for Europe. https://iris.who.int/handle/10665/340375
[30]. WHO, 2018, Technical Series on Primary Health Care. https://www.who.int/docs/default-source/primary-health-care-conference/linkages.pdf
[31]. WHO, 2021, Framework for countries to achieve an integrated continuum of long-term care. https://iris.who.int/server/api/core/bitstreams/7eea5d40-06e6-4702-b42d-6f89c7c70474/content
[32]. WHO, 2022, Health system performance analysis, a framework for policy analysis. 57 Health Policy Series. https://iris.who.int/server/api/core/bitstreams/266443fd-e3c2-4c02-ad69-a5e7d99b5e3d
[33]. WHO, 2024d, National health accounts: tracking health investments towards better health for all. https://www.who.int/westernpacific/newsroom/feature-stories/item/national-health-accounts--tracking-health-investments-towards-better-health-for-allhttps://iris.who.int/server/api/core/bitstreams/3f8594b3-4e8b-4ed1-9645-14e3bd00663c/content
[34]. WHO, 2024a, Building health system resilience to public health challenges Guidance for implementation in countries. https://iris.who.int/server/api/core/bitstreams/70b880e5-ccf1-4b59-a6cd-57d7ecfe017b/content
[35]. WHO, 2024b, WHO methods and data sources for global burden of disease estimates 2000-2021. https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2021_daly_methods.pdf.
[36]. World Economic Forum, 2023, How developing countries can empower themselves to navigate the challenges of global cooperation. https://www.weforum.org/stories/2023/09/how-developing-countries-empower-themselves-to-navigate-the-challenges-of-global-cooperation-sdim23/
[37]. WHO, 2024c, Framework for assessing maturity of health accounts institutionalization. https://www.who.int/publications/i/item/9789240079458#:~:text=Overview,makers%20and%20health%20accounts%20teams
[38]. WHO, 2026, One Health. Available at: https://www.who.int/health-topics/one-health#tab=tab_2. Accessed: 19 January 2026.
[39]. Workleap, 2022, Percentiles Demystified: How to Interpret Your Salary Benchmarking Survey. Available at: https://workleap.com/blog/percentiles-demystified-how-to-interpret-your-salary-benchmarking-survey. (Accessed: 19 January 2026)
[40]. Yasmyne, R., Arlen, M., Scott, J. K., 2023. Digital Health. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470260/. (Accessed 1 January 2026)
Viewed PDF 111 4 -
Donor Dependency and Health-Service Sustainability: A Meta-Analysis & Systematic Review of the Great Mundri, Western Equatoria State, South SudanAuthor: Zakaria Kenneth Kaunda KaidriDOI: 10.21522/TIJPH.2013.14.01.Art035
Donor Dependency and Health-Service Sustainability: A Meta-Analysis & Systematic Review of the Great Mundri, Western Equatoria State, South Sudan
Abstract:
South Sudan's health sector relies heavily on external support, yet the magnitude of donor dependency and its impact on service sustainability remains poorly quantified. This systematic review and meta-analysis examined donor dependency in Great Mundri County's health system and its effects on service coverage. A PRISMA-guided systematic search of MEDLINE, Embase, Web of Science, Scopus, and Google Scholar (2005-2024) yielded 1,243 records. After screening, 37 studies met inclusion criteria, with 12 containing extractable quantitative data for meta-analysis. Random-effects models generated pooled estimates and assessed heterogeneity. Donors financed 78% (95% CI 70-85; I² = 64%) of recurrent health-sector costs in Great Mundri. Donor withdrawal was associated with significant declines in skilled birth attendance (pooled decline: 23 percentage points, 95% CI 15-31), childhood immunization coverage (pooled decline: 19 percentage points, 95% CI 12-26), and essential drug availability (pooled decline: 34 percentage points, 95% CI 26-42). Community engagement initiatives showed protective effects, reducing the magnitude of service decline by 40-60%. Nearly four-fifths of health financing remains donor-derived, with abrupt funding transitions leading to substantial reductions in service coverage. Enhanced community engagement and gradual donor transition strategies may mitigate negative impacts on health service sustainability in fragile settings.
Donor Dependency and Health-Service Sustainability: A Meta-Analysis & Systematic Review of the Great Mundri, Western Equatoria State, South Sudan
References:
[1]. Jones, A., Howard, N., Legido-Quigley H., 2015, Feasibility of health systems strengthening in South Sudan: A qualitative study of international practitioner perspectives. BMJ Open, 5 (12): e009296. ScholarBank@NUS Repository. https://doi.org/10.1136/bmjopen-2015-009296
[2]. Valadez, J. J., Berendes, S., Odhiambo, J., Vargas, W., Devkota, B., Lako, R., & Jeffery, C., 2020, Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011–2015. BMJ Global Health, 5(4), e002093.
[3]. Widdig, H., Tromp, N., Lutwama, G. W., & Jacobs, E., 2022, The political economy of priority-setting for health in South Sudan: a case study of the Health Pooled Fund. BioMed Central, 21(1). https://doi.org/10.1186/s12939-022-01665-w
[4]. Daw, M. A., 2022, Armed conflicts; implications, dynamics and impacts on public health care services. Frontiers in Public Health, 10, 1008883.
[5]. Bernal, O., Garcia-Betancourt, T., León-Giraldo, S., Rodríguez, L. M., González-Uribe, C., 2024, Impact of the armed conflict in Colombia: consequences in the health system, response and challenges, 3(18):4. https://doi.org/10.1186/s13031-023-00561-6.
[6]. DerSimonian, R. and Laird, N., 1986, Meta-Analysis in Clinical Trials. Control Clinical Trials, 7, 177-188. https://doi.org/10.1016/0197-2456(86)90046-2
[7]. Ishak, K. J., Platt, R. W., Joseph, L., Hanley, J. A., 2008, Impact of approximating or ignoring within-study covariance’s in multivariate meta-analyses. Stat Med, 27: 670–686.
[8]. Lan, H. Y., Yu, X., Wang, Z., Wang, P., Sun, Y., Wang, Z., Su, R., et al., 2023. How about the evidence assessment tools used in education and management systematic reviews? Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1160289
[9]. Haar, R. J., Footer, K. H., Singh, S., 2014, Measurement of attacks and interferences with health care in conflict: a systematic review. PLoS One, 9(6): e89120.
[10]. Kruk, M. E., Myers, M., Varpilah, S. T., 2015, What is a resilient health system? Lessons from Ebola. The Lancet, 385(9980):1910-1912.
[11]. Mu, X., Wei, J., A, J., Li, Z., & Ou, Y., 2018, The short-term efficacy and safety of artificial total disc replacement for selected patients with lumbar degenerative disc disease compared with anterior lumbar interbody fusion: A systematic review and meta-analysis. PLoS One, 13(12), e0209660.
[12]. Jones, S., Tarp, F., 2016, Does foreign aid harm political institutions? Journal of Development Economics, 118:266-281.
[13]. Whiting, P., Savovic, J., Higgins, J. P. T., et al., 2016, ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol. 69:225–234. Doi: 10.1016/j.jclinepi.2015.06.005
[14]. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., 2009, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med, 151:264-9, W64. 10.7326/0003-4819-151-4-200908180-00135.
[15]. Hedges, L. V., & Vevea, J., L., 1998. Fixed-and random-effects models in meta-analysis. Psychological Methods, 3, 486-504.
[16]. Bertone, M. P., Lurton, G., Mutombo, P. B., 2016, Investigating the remuneration of health workers in the DR Congo: implications for the health workforce and the health system in a fragile setting. Health Policy and Planning, 31(9):1143-1151.
[17]. Bramer, W. M., Rethlefsen, M. L., Kleijnen, J., & Franco, O. H., 2017, Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study [Review of Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Systematic Reviews, 6(1). BioMed Central. https://doi.org/10.1186/s13643-017-0644-y
[18]. Lu, C., Schneider, M. T., Gubbins, P., 2010, Public financing of health in developing countries: a cross-national systematic analysis. The Lancet, 375(9723):1375-1387.
[19]. Newbrander, W., Waldman, R., Shepherd-Banigan, M., 2011, Rebuilding and strengthening health systems and providing basic health services in fragile states. Disasters, 35(4):639-660.
[20]. Die leman, J. L., Schneider, M. T., Haakenstad, A., 2016, Development assistance for health: past trends, associations, and the future of international financial flows for health. The Lancet, 387(10037):2536-2544.
Viewed PDF 130 5 -
Strengthening Anaemia Data Systems in Africa: Challenges, Innovations, and Policy OpportunitiesAuthor: Elodia Cheutou SiewoueDOI: 10.21522/TIJPH.2013.14.01.Art036
Strengthening Anaemia Data Systems in Africa: Challenges, Innovations, and Policy Opportunities
Abstract:
Anaemia is a major public-health challenge in Africa, affecting over one-third of women of reproductive age and nearly half of pregnant women (World Health Organization (WHO), 2025). Despite global and continental commitments to halve anaemia by 2030, progress has stalled, largely due to weak data systems that hinder timely, evidence-based action. This paper reviews anaemia data in Africa, examining how indicators are collected, integrated, and used within health-information systems. Drawing on the literature, policy frameworks, and country examples, it explores opportunities to strengthen surveillance through digital health innovations and governance reforms. Findings reveal persistent fragmentation between surveys, routine health systems, and laboratory data, leading to incomplete and delayed reporting. Emerging solutions such as the District Health Information System (DHIS2) nutrition modules, improved lab interoperability, mobile community reporting, and regional scorecards offer practical integration pathways. However, anaemia-specific indicators remain absent in several platforms, including the Economic Community of West African States (ECOWAS) Sexual, Reproductive, Maternal, Newborn, Child, and Adolescent Health (SRMNCAH) scorecard. Updating these tools to align with WHO’s Comprehensive Framework and the African Union’s Anaemia Reduction Framework (2023–2030) is critical. Strengthening anaemia data systems requires investment in governance, interoperability, and analytical capacity rather than creating parallel mechanisms. Embedding anaemia indicators within existing digital-health infrastructures can transform fragmented data into actionable intelligence, enabling governments to monitor progress, address inequities, and accelerate reductions by 2030, contributing to the global target of reducing anaemia among women of reproductive age by 50% from the 2012 baseline.
Strengthening Anaemia Data Systems in Africa: Challenges, Innovations, and Policy Opportunities
References:
[1]. World Health Organization, 2025, https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children
[2]. African Union Commission, Framework for Accelerating Anaemia Reduction in Africa 2023–2030, 2023, AUC, Addis Ababa.
[3]. Dzando, G., Ward, P. R., Mwanri, L., Moussa, R. K., & Ambagtsheer, R. C., 2025, Association between frailty and quality of life, and the moderating effect of mobile, broadcast and digital media in sub-Saharan Africa: Evidence from Kenya, BMC Geriatrics, 25(1), p. 521.
[4]. Stevens, G. A., Paciorek, C. J., Flores-Urrutia, M. C., Borghi, E., Namaste, S., Wirth, J. P., Suchdev, P. S., Ezzati, M., Rohner, F., Flaxman, S. R., & Rogers, L. M., 2022, National, regional, and global estimates of anaemia by severity in women and children for 2000–19: a pooled analysis of population-representative data, The Lancet Global Health, 10(5), pp. 627-639.
[5]. Suprapti, E., Hadju, V., Ibrahim, E., Indriasari, R., Erika, K. A., & Balqis, B., 2025, Anemia: Etiology, Pathophysiology, Impact, and Prevention: A Review, Iranian Journal of Public Health, 54(3), pp. 509-520.
[6]. Rumisha, S. F., Lyimo, E. P., Mremi, I. R. et al., 2020, Data quality of the routine health management information system at the primary healthcare facility and district levels in Tanzania, BMC Medical Informatics and Decision Making, 20(340).
[7]. Uganda Bureau of Statistics (UBOS) & ICF., 2018, Uganda Demographic and Health Survey 2016, Kampala and Rockville.
[8]. World Health Organization, 2023, Comprehensive Framework for the Prevention and Management of Anaemia in Women of Reproductive Age, WHO, Geneva.
[9]. Nankinga, O., Aguta, D., 2019, Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys, BMC Public Health, vol. 19, no. 1757.
[10]. Rendell, N., Lokuge, K., Rosewell, A., & Field, E., 2020, Factors that influence data use to improve health service delivery in low- and middle-income countries, Global Health: Science and Practice, 8(3), pp. 566-581.
[11]. Nutley, T., & Reynolds, H. W., 2013, Improving the use of health data for health system strengthening, Global Health Action, 6(1), p. 20001.
[12]. Ara, G., Hassan, R., Haque, M. A., Boitchi, A. B., Ali, S. D., Kabir, K. S., Mahmud, R. I., Islam, K. A., Rahman, H., & Islam, Z., 2024, Anaemia among adolescent girls, pregnant and lactating women in the southern rural region of Bangladesh: Prevalence and risk factors, PLOS ONE, 19(7).
[13]. Arizmendi, L. F., De la Torre-Domingo, C., & Rengifo, E. W., 2024, Anemia, weight, and height among children under five in Peru from 2007 to 2022: A panel analysis, PLOS ONE, 19(7).
[14]. Nguyen, M. N., Tran, N. H., Tun, Y. K., Han, Z., & Hong, C. S., 2021, Toward multiple federated learning services resource sharing in mobile edge networks, Transactions on Mobile Computing, 22(1), pp. 541-555.
[15]. ITAD, 2021, Evaluation of the global partnership for sustainable development data.
[16]. AbouZahr, C., & Boerma, T., 2005, Health information systems: the foundations of public health, Bulletin of the World Health Organization, 83(8), pp. 578-583.
[17]. Health Information Systems Programme Centre, 2024, HISP Centre 2024 Annual Report, University of Oslo, Oslo.
[18]. D. Square, PATH, 2025, https://www.digitalsquare.org
[19]. West Africa Health Organization &. World Health Organization, 2022, ECOWAS Regional SRMNCAH Scorecard, Abidjan.
Viewed PDF 208 10 -
Assessment of Emergency Preparedness and Response Using One Health Approach in Juba, South SudanAuthor: Angelo Goup Thon KouchDOI: 10.21522/TIJPH.2013.14.01.Art037
Assessment of Emergency Preparedness and Response Using One Health Approach in Juba, South Sudan
Abstract:
Emerging and re-emerging public health threats such as zoonotic diseases, outbreaks, and environmental hazards continue to challenge South Sudan’s fragile health system. This study, titled “Assessment of Emergency Preparedness and Response Using One Health Approach in Juba, South Sudan,” evaluates the extent to which the One Health (OH) framework integrating human, animal, and environmental health, has been applied to strengthen emergency preparedness and response (EPR) capacities in Juba, Republic of South Sudan. A mixed-methods approach was employed, combining quantitative data from structured questionnaires administered to 378 respondents across key sectors (human health, animal health, and environment) with qualitative data from 20 key informant interviews and document reviews of national preparedness plans. Results revealed that while awareness of the OH approach was moderate (67%), its operationalization within emergency preparedness structures remained limited due to fragmented coordination, inadequate funding, and weak intersectoral collaboration. Surveillance and laboratory capacities improved, yet joint outbreak investigations and data sharing remained inconsistent. However, the study found positive trends in multisectoral training initiatives and policy alignment efforts supported by international partners. The study concludes that adopting a fully functional One Health model could significantly enhance South Sudan’s emergency preparedness and response (EPR) systems. Strengthening institutional coordination, capacity building, and resource mobilization across sectors is critical for building resilience against health emergencies in Juba and beyond.
Assessment of Emergency Preparedness and Response Using One Health Approach in Juba, South Sudan
References:
[1]. Avis., W., 2020, Coping mechanisms in South Sudan in relation to different types of shock.
[2]. Behnke, R. H., and Osman, H. M., 2012, The contribution of livestock to the Sudanese economy.
[3]. Cheung, J. M., Basiaga, M., and Olympia, R. P., 2014, Compliance of colleges and universities in the United States with nationally published guidelines for emergency and disaster preparedness. Pediatric emergency care, 30(5), pp.319-326.
[4]. Cox, A., 2022, The assessment of emergency preparedness among university students. Minnesota State University, Mankato.
[5]. Downs, B., Kettner, A. J., Chapman, B. D., Brakenridge, G. R., O’Brien, A. J., and Zuffada, C., 2023, Assessing the relative performance of GNSS-R flood extent observations: Case study in South Sudan. IEEE Transactions on Geoscience and Remote Sensing, 61, pp.1-13.
[6]. Drennan, L. T., McConnell, A., Stark, A., and Drennan, L. T., 2014. Risk and crisis management in the public sector, Routledge.
[7]. George, J., 2022, Mechanisms and contextual factors affecting the implementation of animal health Surveillance in Tanzania: a process evaluation, Front. Veterin. Sci, https://doi.org/10.3389/fvets.2021.790035
[8]. Gadberry, M., 2018, Emergency Preparedness Among College Students at the University of Arkansas.
[9]. Getu, D. K., 2011, Factors Related to Male Participation in Prevention of Motherto-Child Transmission of Human Immunodeficiency Virus in Three Public Hospitals in Addis Ababa, Ethiopia (Master's thesis, University of South Africa (South Africa)).
[10]. Hill, S., Yusuf, J. E., and Jordan, M. M., 2024, College Students and Hurricane Preparedness: Cluster Analysis of Factors Affecting Vulnerability and Coping Capacity, In Advances in Hurricane Risk in a Changing Climate, (pp. 187-208). Cham: Springer Nature Switzerland.
[11]. Khabbaz, R., Bell, B. P., Schuchat, A., Ostroff, S. M., Moseley, R., Levitt, A., and Hughes, J. M., 2014. Emerging and reemerging infectious disease threats. Mandell, Douglas, and Bennett's principles and practice of infectious diseases, p.158.
[12]. Landesman, L.Y., 2005, Public health management of disasters, The practice guide. American public health association.
[13]. Mann, S., 2012, Building sustainable cities in a post-Katrina nation: HR’s role in mitigation and planning. Public Works Management & Policy, 17(1), pp.30-51.
[14]. Mokaba, S. A., 2013, Perceptions of Adolescent High School Learners of HIV Counselling and Testing in Madibeng Sub-district, North West Province. University of South Africa (South Africa).
[15]. Molefi, Z. M., 2014, Exploring the understanding of routinely collected data by the health practitioners in a primary health care setting., University of South Africa (South Africa).
[16]. Mulei, L., 2017, Mapping livestock value chains in the IGAD region.
[17]. Murphy, B. L., McBean, G., Dolan, H., Falkiner, L., and Kovacs, P., 2005. Enhancing local level emergency management: the influence of disaster experience and the role of households and neighborhoods. Toronto: Institute for Catastrophic Loss Reduction.
[18]. Nkala, G. C., 2017., Nursing Student's Perspectives on Spiritual Care in Clinical Nursing Practice in a Selected School of Nursing at Umkhanyakude District in KZN Province. University of South Africa (South Africa).
[19]. Odhiambo, J., Jeffery, C., Lako, R., Devkota, B., and Valadez, J. J., 2020. Measuring health system resilience in a highly fragile nation during protracted conflict: South Sudan 2011–15. Health policy and planning, 35(3), pp.313-322.
[20]. OpenAI (2025) ChatGPT (GPT-5.2), large language model. Available at: https://chat.openai.com (Accessed: 14 December 2025).
[21]. Otim, M. E., Demaya, D. K., Al Marzouqi, A., and Mukasa, J., 2021, Are antibiotics prescribed to inpatients according to recommended standard guidelines in South Sudan? A retrospective cross-sectional study in Juba Teaching Hospital. Journal of Multidisciplinary Healthcare, pp.2871-2879.
[22]. Perry, R.W., and Lindell, M. K., 2003, Preparedness for emergency response: guidelines for the emergency planning process. Disasters, 27(4), pp.336-350.
[23]. Refisch, J., MacMillan, S., Wright, C. Y., Bett, B., Robinson, D., Wernecke, B., Lee, H., Karesh, W. B., Machalaba, C., Fraenkel, A., and Barbieri, M., 2020, Preventing the next pandemic, Zoonotic diseases and how to break the chain of transmission. The United Nations Environment Program.
[24]. Saba, N., and Balwan, W. K., 2021, Potential threat of emerging and re-emerging zoonotic diseases. Annals of the Romanian Society for Cell Biology, 25(5), pp.29-36.
[25]. Seeger, M. W., Islam, K., and Seeger, H. S., 2021, Emergency preparedness, response, and strategic communication for natural disasters, the Handbook of strategic communication, pp.208-221.
[26]. Soujaa, I., Nukpezah, J. A., and Dimitrijevska‐Markoski, T., 2024, A balanced scorecard approach to the homeland security evaluation and exercise program, risk, Hazards & Crisis in Public Policy, 15(3), pp.393-407.
[27]. Sulieman, H. M., 2018, Exploring drivers of forest degradation and fragmentation in Sudan: The case of Erawashda forest and its surrounding community. Science of the total environment, 621, pp.895-904.
[28]. Traore, T., Shanks, S., Haider, N., Ahmed, K., Jain, V., Rüegg, S.R., Razavi, A., Kock, R., Erondu, N., Rahman-Shepherd, A. and Yavlinsky, A., 2023, How prepared is the world? Identifying weaknesses in existing assessment frameworks for global health security through a One Health approach. The Lancet, 401(10377), pp.673-687.
[29]. Unango, K., 2024, South Sudan’s bold climate change commitment: A Journey from vision to action. South Sudan Mining Journal, 3(1), pp.22-23.
[30]. World Health Organization, 2017, Weekly Bulletin on Outbreaks and other Emergencies: Week 16: 15-21 April 2017. Weekly Bulletin on Outbreaks and other Emergencies, pp.1-11.
[31]. World Health Organization, Regional Office for Europe. One Health. https://www. euro.who.int/en/health-topics/health-policy/one-health (Accessed December 10, 2021). https://www.mef.gov.it/en/focus/People-planet-prosperity-The-Italian-G20-Fina nce-track-00001/ (Accessed February 25, 2022). https://www.ispionline.it/it/think-t20-italy (Accessed February 25, 2022).
[32]. World Health Organization, 2019, Taking a Multisectoral, One Health Approach. A Tripartite Guide to Addressing Zoonotic Diseases in Countries.
[33]. Zinsstag, J., Schelling, E., Waltner-Toews, D., Whittaker, M., and Tanner, M., 2015, One Health: The Theory and Practice of Integrated Health Approaches. CABI, Wallingford, United Kingdom.
[34]. Krejcie, R. V., & Morgan, D. W., 1970, Determining sample size for research activities. Educational and Psychological Measurement, 30, 607–610.
Viewed PDF 124 5
